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Biomedical subjects

D M Warshauer

Publications and source records attributed to D M Warshauer.

At least 37 records · Page 2Linked to original sources
PubMed1991

Diverticula of the female urethra: diagnosis by endovaginal and transperineal sonography.

Diverticula of the female urethra can be difficult to diagnose. Invasive contrast studies (voiding cystourethrography or double-balloon urethrography) or urethroscopy are frequently required for definitive diagnosis. Although transabdominal sonography has been able to visualize large diverticula, this technique has not proved useful in routine screening. In this study, we examined the use of higher frequency (5 MHz) near-focus endovaginal or transperineal sonography for the diagnosis of urethral diverticula. Five patients with radiographically proved (three with double-balloon urethrography and two with voiding cystourethrography) urethral diverticula were examined with endovaginal (two cases) or transperineal (four cases) sonography. In all five cases, sonography showed the diverticula previously demonstrated on the contrast study. The spatial relationship of the diverticula to the urethra, an important consideration at surgery, was shown more clearly by sonography than by contrast radiography. These findings suggest that sonography may be useful as a noninvasive screening technique for urethral diverticula.

Adult↗
PubMed1990

Esophageal obstruction with a dietary fiber product designed for weight reduction.

Supplements consisting primarily of dietary fibers are marketed as aids to weight reduction. Of uncertain efficacy, they have generally been regarded as safe when used according to directions. We report two cases of acute esophageal obstruction by a guar gum product in patients with preexisting esophageal abnormalities and review similar reports from other centers.

Adult↗
PubMed1989

Rhinovirus infections in an isolated antarctic station. Transmission of the viruses and susceptibility of the population.

It is commonly believed that living in polar isolation causes high susceptibility to respiratory illness. At McMurdo Station, a US research base in Antarctica, we tested this belief by comparing, over 36 days (August 31-October 5, 1976), the incidence and severity of respiratory illness in 64 men finishing six months isolation and in 136 men just arrived from the United States. The colds in the two intermingled populations were essentially equivalent. Forty-three per cent of the newcomers and 39% of the wintering group reported colds; symptoms and duration were nearly identical between the two populations. Movement of the colds was slow. The newcomers brought in 31 colds; subsequently, only 52 evenly spaced illnesses arose. Incidence of respiratory illness was twice higher in the smaller living units than in the spacious main dormitory. Two nontypable rhinoviruses, McMurdo 4 and McMurdo 88, were brought in by the new population and were the only viruses isolated. Only McMurdo 88 spread, although more than 65% of the men were antibody-free (less than 1:3) to either agent. McMurdo 88 caused an estimated 60% of antarctic-contracted colds. In brief, this isolated polar group was not especially susceptible to respiratory illness, and virus movement through the group was deliberate.

Adolescent↗
PubMed1988

Detection of renal masses: sensitivities and specificities of excretory urography/linear tomography, US, and CT.

A prospective blinded study of 201 patients was performed to determine the relative sensitivities and specificities of excretory urography/linear tomography (EU/LT) and ultrasound (US) for the diagnosis of renal parenchymal masses. Computed tomography (CT) was used as a standard. EU/LT permitted detection of 10% of CT-confirmed masses (cystic or solid) less than 1 cm, 21% of lesions greater than or equal to 1 cm but less than 2 cm, 52% of lesions greater than or equal to 2 cm but less than 3 cm, and 85% of lesions 3 cm or more in diameter. US permitted detection of 26% of CT-confirmed lesions less than 1 cm, 60% of lesions greater than or equal to 1 cm but less than 2 cm, 82% of lesions greater than or equal to 2 cm but less than 3 cm, and 85% of lesions 3 cm or more in size. The results confirm the relative insensitivity of EU/LT for masses less than 3 cm in diameter and of US for masses less than 2 cm. Further, they suggest that CT may have a role not only in evaluation of cases in which the urographic or sonographic results are questionable or positive, but also in confirmation of apparently negative urographic findings when clinical suspicion of a lesion is high.

Carcinoma, Renal Cell↗
PubMed1988

Unusual causes of increased vascular impedance in renal transplants: duplex Doppler evaluation.

Duplex Doppler ultrasound (US) examination of the renal vasculature has proved valuable in assessing the kidney transplant. The normal renal allograft exhibits low-impedance arterial inflow similar to that seen in the normotopic kidney. The authors and others previously reported that a high vascular impedance, defined as either a pulsatility index (PI) greater than 1.8 or a resistive index greater than 0.9, indicates acute vascular rejection (AVR). Although AVR remains the most common cause of increased PI, the authors noted ten episodes among 180 serially followed-up transplants in which abnormal waveforms were clearly not due to rejection. Four other causes of increased vascular impedance are reported, including renal vein obstruction, severe acute tubular necrosis, pyelonephritis, and extrarenal compression of the graft. These new causes only slightly decrease the specificity of high vascular impedance for rejection. Furthermore, the cause can usually be recognized from the clinical history or other US findings.

Acute Kidney Injury↗
PubMed1984

Scurvy: a clinical mimic of vasculitis.

A 54-year-old woman was admitted for evaluation of palpable purpura, arthralgias, and myalgias. An unusual dietary history was noted. This finding, along with follicular hyperkeratoses and corkscrew hairs, suggested scurvy, which was confirmed by results of laboratory evaluation, examination of biopsy specimens, and response to therapy. Scurvy, though unusual in developed countries, should be considered in the differential diagnosis of palpable purpura.

Diagnosis, Differential↗
PubMed1983

Sunlight and protection of the skin.

Sunburn, wrinkling and malignancies are the frequent results of excessive sun exposure. Photosensitivity and photoallergic or phototoxic reactions are less commonly observed. Sunscreens containing para-aminobenzoic acid (PABA), PABA esters and benzophenones offer substantial protection, allowing even fair-skinned persons to participate freely in outdoor activities. These products are now rated and assigned a sun protection factor (SPF). Their routine use should be encouraged.

Humans↗
PubMed1979

Impairment of isoproterenol, H2 histamine, and prostaglandin E1 response of human granulocytes after incubation in vitro with live influenza vaccines.

The release of the lysosomal enzyme beta-glucuronidase from granulocytes follows incubation in vitro with complement-activated zymosan particles. Release of beta-glucuronidase is inhibited by isoproterenol, histamine, and prostaglandin E1. This in vitro model was used to study the effect of incubating a live, bivalent (A + B) influenza vaccine on the granulocyte response to the agonists described. After incubation in vitro with the live, bivalent influenza vaccine, there was a significantly impaired granulocyte reponse to all 3 agonists. The change in the response of polymorphonuclear leukocytes to isoproterenol was similar to an impairment in beta-adrenergic response found during respiratory infections in vivo. The viral-induced changes in the granulocyte response to isoproterenol may reflect similar alteration in other tissues, such as variable control of the airways and provide one explanation for the occurrence of airway dysfunction during respiratory infections.

Adult↗
PubMed1976

Use of an inhibitor-resistant live attenuated influenza vaccine in normal and asthmatic adults.

The efficacy of a monovalent live attenuated influenza A (H3N2) vaccine (an inhibitor-resistant recombinant strain named "Alice") and of a bivalent vaccine composed of "Alice" and influenza B strain R75 (also inhibitor-resistant), was tested in healthy and asthmatic adults. Two intranasal doses of the monovalent "Alice" vaccine were given to 95 healthy adults in the winter of 1973-74. Ninety-three % of 68 subjects with initial serum hemagglutination (HI) titers of less than or equal to 1:40 had a significant (4-fold or greater) antibody increase in post-vaccination sera. Overall, 77% of the vaccinees had significant antibody rises. Two doses of the bivalent (A/B) vaccine were given to 53 healthy adults in the winter of 1974-75. Eighty-two % of 34 subjects with initial HI titers of less than or equal to 1:40 had 4-fold or greater antibody rises to influenza A, and overall 57% of the vaccinees responded. The B component of the bivalent vaccine was less effective; only 56% of persons with initial HI titers of less than or equal to 1:40, and 28% of all vaccinees had significant antibody rises. Both tf asthmatics who received "Alice" and one of 10 (10%) who received the bivalent vaccine had serologic responses to influenza A. None of the asthmatics responded to the B component of the bivalent vaccine. Analysis of the incidence of febrile respiratory illness during an influenza outbreak in the winter of 1974-75 revealed no differences in the attack rates of placebos and vaccines. In conclusion, both the "Alice" and bivalnet (A/B) vaccines were effective in eliciting serologic responses to influenza A in healthy persons. They were less effective in asthmatics. The lack of protection observed may have been due to the onset of influenza before the vaccine could take effect or to the failure of the vaccine itself.

Administration, Intranasal↗
PubMed1974

Entry of four tetracyclines into saliva and tears.

Although meningococci are susceptible to the tetracyclines by testing in vitro, oxytetracycline (OC) and doxycycline (DC) have failed to eliminate carriage, whereas minocycline (MC) has been effective. Because these congeners differ in lipophilicity, they and tetracycline (TC) were studied in volunteers by assay of serum, saliva, and tears obtained after 5 days of treatment. OC and TC were undetectable or attained concentrations subinhibitory for meningococci in saliva and tears. The concentrations of MC in saliva and tears were equal to or greater than the average minimal inhibitory concentration as long as 12 h post-dose. Near inhibitory concentrations resulted with DC at 100 mg/day; yet, doubling the dose to 100 mg/12 h did not yield concentrations that exceeded the average minimal inhibitory concentration for meningococci. The previous reports of failure or meager entry of DC and MC into saliva probably reflected extraction of these drugs in the paraffin chewed by subjects to stimulate salivary flow. The efficiency of entry of the tetracyclines into the secretions of the noninflamed upper respiratory tract correlates with lipophilicity at physiological pH, enabling prediction of meningococcal chemoprophylactic efficacy.

Doxycycline↗
PubMedDate not supplied

Nodular sarcoidosis of the liver and spleen: appearance on MR images.

Small nodular lesions in the liver and spleen have been reported as an infrequent manifestation of sarcoidosis. Five patients with this appearance on either dynamic contrast material-enhanced computed tomographic (CT) or ultrasound scans underwent magnetic resonance (MR) imaging with and without dynamic gadolinium enhancement. The lesions were relatively uniform in size, ranging from 0.5 to 1.5 cm. On CT scans, they were hypoattenuating relative to surrounding parenchyma. On MR images, the lesions were hypointense relative to background parenchyma with all sequences. No substantial enhancement was observed in the lesions, although lesion conspicuity decreased over time on serial postcontrast images. Lesion conspicuity was greatest on either T2-weighted fat-suppressed (T2FS) images or early-phase dynamic contrast-enhanced images. Abdominal adenopathy was seen in three of the five patients and was hyperintense relative to liver on T2FS images in two and intermediate in intensity in one patient.

Adult↗
PubMedDate not supplied

Inflammatory pseudotumor of the liver: appearance on contrast enhanced helical CT and dynamic MR images.

The dynamic pre- and post-contrast MRI and helical CT imaging findings in a patient with inflammatory pseudotumor of the liver are described. On immediate post gadolinium spoiled gradient echo images multiple, ill defined, irregular, and intensely enhancing lesions were seen. Rapid washout of contrast was noted. Periportal involvement was also shown on T2-weighted fat suppressed images. Lesions showed greater conspicuity on MRI than CT. MRI findings in this rare entity led to performance of a diagnostic open surgical biopsy.

Adolescent↗
PubMedDate not supplied

Immediate postgadolinium spoiled gradient-echo MRI for evaluating the abdominal aorta in the setting of abdominal MR examination.

To assess the reproducibility and image quality of immediate postgadolinium chelate spoiled gradient-echo MRI in demonstrating disease of the abdominal aorta. All patients (27 patients: 21 men, 6 women) with substantial disease of the abdominal aorta, who underwent abdominal MR examinations at 1.5 T between 1991 and 1995, were entered in the study. Patients were referred for evaluation of suspected aortic disease (14 patients) or other abdominal diseases (13 patients). Three experienced investigators manually measured luminal and external aortic wall diameters and rated image quality, definition of inner and outer walls, extent of disease, and presence of other abdominal abnormalities, in an independent fashion. A cardiovascular surgeon then rated all studies to determine whether clinical management could be based on the MR findings alone. There was 98 to 99% agreement in measurements of luminal and external wall diameter between the three investigators. Overall image quality was rated as good in 77.8 to 88.9% of patients. A total of 31 additional nonaortic abdominal abnormalities were detected by all observers. The cardiovascular surgeon rated 25 of 27 studies as adequate to determine clinical management based on MR findings alone. Immediate postgadolinium spoiled gradient-echo MRI is a reproducible technique for the demonstration of abdominal aortic disease and possesses good image quality. Advantages of this technique include simultaneous evaluation of other nonvascular diseases of the abdomen, short examination time, and easy implementation as part of routine abdominal MRI scanning protocol.

Aged↗
PubMedDate not supplied

Infarcted appendiceal carcinoid. CT appearance mimicking appendiceal abscess.

A unique case of an infarcted carcinoid of the appendix is presented in which the computed tomography (CT) and clinical findings mimicked an appendiceal abscess. Though unusual, this possibility and appearance should be familiar to the radiologist particularly if percutaneous drainage is considered.

Abscess↗