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Biomedical subjects

B B Goldberg

Publications and source records attributed to B B Goldberg.

At least 19 recordsLinked to original sources
PubMed1992

Transnasal US of the esophagus: preliminary morphologic and function studies.

High-frequency catheter-based ultrasound (US) transducers can be inserted into the esophagus transnasally to evaluate esophageal wall structures. Studies were performed in two sheep esophagus specimens in vitro, in 17 healthy human subjects, and in 16 patients with esophageal abnormalities (eight with achalasia, four with scleroderma, three with esophageal carcinoma, and one with esophagitis). In the sheep specimens, endoluminal US delineated seven layers of the esophageal wall; these results correlated closely with histologic findings. Real-time US of the normal esophageal wall was performed during resting and swallowing. Muscles at the lower esophageal sphincter (LES) were shown to be thicker than muscles in the body of the esophagus. Thickening of the muscular layers at the LES in achalasia, dilated blood vessels within the submucosa in esophagitis, and fibrotic changes within the muscular layers in scleroderma were demonstrated. Extramural structures adjacent to the esophagus were also seen. These preliminary results suggest that transnasal esophageal US may become an important diagnostic tool in evaluation of the esophagus.

Adult↗
PubMed1992

Can detection of the yolk sac in the first trimester be used to predict the outcome of pregnancy? A prospective sonographic study.

Recent reports have indicated that identification of the yolk sac should precede the detection of the embryo in a normal first-trimester sonographic examination and that failure to visualize a yolk sac strongly suggests an abnormal intrauterine pregnancy. A first-trimester prospective study was performed in 163 normal and 49 abnormal consecutive singleton gestations. All women were examined both abdominally and transvaginally, with pregnancy outcome determined by delivery of a normal infant or a spontaneous abortion. The yolk sac was analyzed in all patients in whom an embryo was not identified (n = 76). When the yolk sac was identified, the following was found: by the abdominal approach with the mean sac diameter (MSD) less than 27 mm (n = 15), nine gestations were normal and six were abnormal, and by the transvaginal approach with the MSD less than 18 mm (n = 13), seven gestations were normal and six were abnormal. The presence of a yolk sac was not consistently predictive of a normal early pregnancy. When the yolk sac was also not identified, the following was found: abdominally with the MSD less than 27 mm (n = 41), 19 gestations were normal and 22 were abnormal, and transvaginally with the MSD less than 18 mm (n = 11), six gestations were normal and five were abnormal. Absence of the yolk sac was not consistently predictive of a spontaneous abortion. When using the MSD range (20-27 mm abdominally and 7-16 mm transvaginally), over which the yolk sac but not the embryo should be identified sonographically, the yolk sac was again not consistently visualized. On abdominal sonograms, the yolk sac was present and absent in three and 10 patients, respectively, for both normal and abnormal pregnancies. On transvaginal sonograms, the yolk sac was present and absent in seven and five normal gestations and in six and four abnormal gestations, respectively. The results of this study suggest that detection of the yolk sac in the first trimester is not an early predictor of pregnancy outcome.

Female↗
PubMed1991

Color Doppler imaging of the eye and orbit. Technique and normal vascular anatomy.

Color Doppler imaging is a recent advance in ultrasonography that allows simultaneous two-dimensional imaging of structure and blood flow to be performed. Doppler information is superimposed in color over a conventional gray-scale ultrasound image. Using this technique, we examined 40 normal eyes. The central retinal artery, posterior ciliary arteries, ophthalmic artery, and central retinal vein could be located in all patients. Using the color image as a guide, Doppler spectral analysis allows quantitative assessment of blood flow velocity in these vessels. Color Doppler imaging is a new modality for the study of ocular and orbital hemodynamics.

Adult↗
PubMed1991

Successful shock-wave lithotripsy of bile duct stones using ultrasound guidance.

Eighteen patients with 41 gallstones in the common bile duct, common hepatic, cystic, and intrahepatic ducts underwent shock-wave lithotripsy using the electrohydraulic Sonolith 3000 lithotripter. Lithotripsy was performed using ultrasound guidance alone under intravenous analgesia/sedation. All patients previously had failed stone extraction via retrograde endoscopy, T-tube, or cholecystostomy. Lithotripsy was performed according to an FDA-approved protocol allowing a maximum of two 2500 shock-wave treatments at a 48 hr interval. Following the final lithotripsy or cholangiographic evidence of stone fragmentation, residual fragments were removed via endoscopic or percutaneous route within 24-72 hr. Ultrasound localization of gallstones was aided by continuous infusion of the common bile duct with saline solution. In 15 of the 18 patients, complete fragmentation of the stones was accomplished, two had minimal fragmentation, and one with an encysted stone had no fracturing. No serious complications were encountered. Overall nonsurgical stone-free success rate was 17 of 18 patients, indicating biliary duct stones can be successfully treated using an ultrasound-guided lithotripter and intravenous sedation alone.

Aged↗
PubMed1991

Endoluminal sonography of the urinary tract: preliminary observations.

Endoluminal sonography of the urinary tract was performed by using endoluminal ultrasound transducers contained within 2-mm-diameter catheters. The catheters were inserted into the urinary bladder via the urethra and advanced into the ureters and renal pelvis under cystoscopic control; then, cross-sectional images of the bladder, ureters, and renal pelvis were obtained. Two dogs and seven human patients were studied. In one dog, a 4.5-mm pseudopolyp, which was surgically created in the bladder wall, was successfully imaged; in the other, stones 2 mm or larger inserted into the bladder were identified. Of the seven patients, sonography showed stones embedded in the renal parenchyma (one patient) and the mucosa of the distal ureter (one patient). These were ultimately confirmed by their eventual removal. In a third, sonography showed a tumor of the distal ureter and identified the depth of the tumor. This was confirmed by biopsy. In a fourth, sonography clearly showed a crossing vessel as the cause for narrowing of the proximal ureter. In a fifth, sonography showed that the cause of a ureteral stricture was idiopathic. In the last two cases, sonography did not reveal a cause for hematuria. In these last three cases, negative sonographic results were confirmed by direct ureteroscopic examinations and follow-up studies. Our observations based on this limited study suggest that endoluminal sonography is a useful procedure for diagnosing diseases of the urinary tract. Further study is warranted.

Adult↗
PubMed1991

Endoluminal gynecologic ultrasound: preliminary results.

Specially developed high-resolution real-time ultrasound transducers (12.5 and 20 MHz) on the tip of endoluminal catheters were inserted into the endometrial canal to evaluate the usefulness of this approach. Uterine abnormalities, most confirmed by biopsy, surgery, or both, were detected in 12 patients, including submucosal myomas, nabothian cysts, endometrial polyps, synechiae, and endometrial and cervical carcinoma. In one case the catheter was directed under hysteroscopic guidance into a fallopian tube, demonstrating its potential usefulness in this region. In 4 of the 12 cases in which a hysterectomy was performed, an in vitro ultrasound examination of the organ was performed, which confirmed the initial in vivo ultrasound impressions. Anatomic cross-sectional slices of the uterus resulted in excellent correlation with the ultrasound findings. These preliminary results suggest that this new sonographic procedure will become an important diagnostic tool, supplementing abdominal and endovaginal ultrasound approaches.

Adult↗
PubMed1991

Prospective comparison of vaginal and abdominal sonography in normal early pregnancy.

Vaginal and abdominal sonography were prospectively compared in 309 consecutive pregnancies of which 175 were normal. Two sonographic criteria of normal were analyzed: (1) the presence of an embryo compared with average gestational sac size and (2) the presence of embryonic cardiac activity compared with crown-rump length. Vaginally, 100% (160/160) of embryos were visualized when the average sac diameter was greater than or equal to 12 mm. Abdominally, an embryo was noted in 99.2% (123/124) of gestational sacs greater than or equal to 27 mm. Vaginal sonography revealed cardiac motion in all embryos of greater than or equal to 5 mm (149/149 cases); abdominal sonography revealed cardiac activity in 100% (132/132) of embryos with a crown-rump length of greater than or equal to 9 mm. One-third of normal embryos less than 5 mm crown-rump length did not demonstrate cardiac activity. The study demonstrates through objective comparison that vaginal sonography is superior to abdominal sonography for detection of an intrauterine embryo and its cardiac activity before 8 menstrual weeks. The diagnosis of embryonic demise should not be made by vaginal sonography in embryos measuring less than 5 mm crown-rump length without a heartbeat, and an empty gestational sac of less than 12 mm average diameter should not be diagnosed as blighted ovum by vaginal scans. In these cases follow-up vaginal sonography is suggested.

Abdomen↗
PubMed1991

Detection of retained products of conception following spontaneous abortion in the first trimester.

A retrospective analysis was performed to determine whether ultrasound could reliably rule in or out retained products of conception (POC) in women after first-trimester spontaneous abortions (miscarriages). Ninety-seven first-trimester pregnancies with pathologically proven results from dilatation and curettage (D&C) were studied within 7 days of ultrasound examination (60% within 2 days), either by the abdominal or a combination of abdominal and vaginal approaches. Cases were eliminated if there was clinical evidence of a spontaneous evacuation of POC during the interval between the ultrasound and the D&C. POC were diagnosed only if chorionic villi were evident pathologically. The pertinent ultrasound findings were related to the endometrium (thickness, echogenicity, a gestational saclike structure or a space-occupying collection). The results indicated that ultrasound could correctly diagnose POC in all of the cases by detecting a gestational sac or collection (77 cases), or a thickened endometrium of greater than 5 mm (6 cases). Ultrasound was less reliable in ruling out retained POC. When only a thin endometrial stripe of less than 2 mm was present, there was little likelihood of having POC (1 of 7 cases) with a moderately thick endometrium of 2 to 5 mm not diagnostic. Vaginal ultrasound added little new information and failed to change the ultrasound interpretation.

Abortion, Incomplete↗
PubMed1991

Endoluminal urologic ultrasound.

Miniature transducer-containing catheters (6 French 20 MHz and 9 French 12.5 MHz) have been inserted into the urethra, urinary bladder, ureter and renal pelvis. Real-time 360 degrees cross sectional ultrasound images were obtained delineating a variety of normal and abnormal structures in both animal models and humans. With this approach it was possible to measure wall thickness as well as adjacent external structures such as blood vessels, lymph nodes and muscle. It was possible to diagnose a variety of abnormalities including embedded stones in the ureter and renal pelvis, crossing blood vessels producing compression of the ureter and tumors within the urinary bladder and ureter. In addition, these transducer-containing catheters show promise in assisting in tumor staging and biopsy guidance. These specially developed transducer-containing catheters, intended originally for placement in blood vessels, show great promise in becoming important new tools in a wide variety of non-vascular lumina and surgically created openings in many areas of the body. From our initial results we can already predict that non-vascular endoluminal ultrasound will assume an important role in the evaluation of a variety of urologic abnormalities.

Animals↗
PubMed1990

Color Doppler imaging in the management of intraocular tumors.

Forty-four intraocular mass lesions were studied using a new, non-invasive ultrasound technique known as color Doppler imaging (CDI). This technique displays color-encoded Doppler flow information throughout a two-dimensional gray scale image thus providing selective analysis of Doppler spectra in small vessels using pulsed Doppler. Abnormal Doppler shifts were demonstrated within 39 neoplastic lesions studied, but Doppler shifts could not be detected in three tumor-simulating lesions. In a group of 12 choroidal melanomas studied after radiation therapy, lower Doppler shifts were seen compared with a group of 28 tumors before therapy. This change in Doppler shift may reflect the decreased vascular supply of the tumor. Color Doppler imaging may be of value as an additional useful tool in the diagnosis and management of intraocular tumors.

Adolescent↗
PubMed1990

Colour Doppler imaging in the demonstration of an orbital varix.

Colour Doppler imaging (CDI) is a recent development in ultrasonography. It allows simultaneous two-dimensional structural imaging and Doppler evaluation of blood flow. Quantitative information on flow velocity is obtained by pulsed Doppler spectral analysis, the colour information being used to choose the vessel of interest. Using this technique the authors examined a patient with an orbital varix previously diagnosed by clinical findings and computed tomography. Dynamic evaluation with real-time direct imaging of flow facilitated the diagnosis of this orbital disorder without the need for any contrast material. This technique may prove to be a useful adjunct to computed tomography for the evaluation of suspected vascular lesions of the orbit.

Adult↗
PubMed1990

Color Doppler imaging of the iliofemoral region.

Color Doppler imaging has been used to evaluate a variety of abnormalities in the iliofemoral region. This pictorial essay demonstrates how use of color Doppler techniques aids in the diagnoses of iliofemoral pseudoaneurysms, fluid collections, aneurysms, arteriovenous fistulas and malformations, venous thrombosis, vascular grafts, and soft-tissue masses including tumors and benign lymphadenopathy.

Color↗
PubMed1990

Endoluminal US: experiments with nonvascular uses in animals.

Catheters containing miniature ultrasound (US) transducers, originally developed for intravascular evaluation of plaque, were used in a series of in vivo and in vitro animal experiments to image a variety of nonvascular lumina. Measurements of the wall thickness and echotexture of the urethra, urinary bladder, ureter, renal pelvis, bile ducts, small bowel, fallopian tubes, and uterus were carried out. Close correlation between the US images and actual anatomic specimens was obtained. Structures outside of the lumen were identified and confirmed with both direct visualization and radiographic localization. Two small stones artificially inserted into the renal pelvis and a polyp-like projection artificially created within the fallopian tube were clearly identified by using the US probe. These initial US studies demonstrate the potential feasibility of these miniature transducers contained within catheters for intraluminal analysis in humans.

Animals↗
PubMed1990

Hepatic tumors: signal enhancement at Doppler US after intravenous injection of a contrast agent.

Experiments were carried out to detect and establish the origin of Doppler and echo signal enhancement in small vessels of the systemic circulation and of tumors after intravenous injection of a contrast agent. Eight woodchucks (Marmota monax) were studied; each woodchuck had naturally occurring hepatocellular carcinoma. Injections of 0.1-4.0 mL of air-filled human serum albumin microspheres were administered into a hind limb or jugular vein. Ultrasound (US) examination included transabdominal duplex scanning, color Doppler imaging, placement of a Doppler transducer on the exposed tumor, and surgical implantation of pulsed Doppler cuffs. Doppler signals were assessed by recording color Doppler images and results of spectral analysis. While subjective echo level was unaffected within the tumors, dramatic Doppler signal enhancement was recorded in both normal and tumor vessels. At optimum dose levels, a signal gain of approximately 10 dB was recorded from the tumor. Analysis showed that the echo enhancement was due to the presence of the contrast agent in branches of the hepatic artery. These results suggest that tumor detection may be enhanced by intravenous administration of a US contrast agent.

Animals↗