Biomedical subjects
Publications and source records attributed to G A Gooding.
A case is reported of an adenomatoid tumor of the epididymis. A discussion of the appropriate differential of mass of the epididymis as well as a review of adenomatoid tumors per se and their occurrence in the scrotum are presented.
To determine whether the use of color Doppler imaging in conjunction with standard high-resolution 10-MHz ultrasound could increase the screening sensitivity in distinguishing between thyroid and parathyroid lesions in the detection of parathyroid disease, we studied 32 patients with hyperparathyroidism with both modalities who were subsequently treated surgically. Among these 32 patients, parathyroid lesions were predominantly avascular (n = 21, average size 0.9 x 0.6 cm) but with increased size demonstrated some vascularity (n = 9, average size 2.1 x 1 cm, 32%). Of these 32 patients, 46.6% had thyroid lesions as well. Thyroid lesions were avascular when small (n = 26 lesions, average size 0.5 x 0.5 cm) but tended to demonstrate vascularity (n = 14, 35%) at about 1 cm in size or greater. Although the addition of color Doppler imaging enabled the differentiation of vessel from soft-tissue abnormalities and some distinction between parathyroid and thyroid lesions, it had no effect on overall sensitivity (65%) in the detection of parathyroid disease.
Postoperative deep venous thrombosis and pulmonary embolus remain a major source of morbidity and mortality for the urological surgery patient. We report the results of the first 100 patients in a prospective, randomized trial of low dose warfarin and intermittent pneumatic leg compression for deep venous thrombosis prophylaxis. All patients underwent preoperative and postoperative real-time ultrasound imaging and Doppler flow studies of the popliteal, femoral and iliac veins for the evaluation of deep venous thrombosis. Our results indicate that low dose warfarin is as effective as intermittent pneumatic leg compression for prophylaxis of deep venous thrombosis. Low dose warfarin can be used effectively without any significant bleeding complications. We recommend the use of low dose warfarin as an alternative to intermittent pneumatic leg compression for deep venous thrombosis prophylaxis of the urological patient undergoing a major urological operation.
To assess the feasibility of using magnetic resonance (MR) angiography and velocity-encoded cine MR imaging to evaluate morphology and function in the popliteal and tibioperoneal arteries, the profiles of blood flow velocity measured with velocity-encoded cine MR were compared with those measured with color-coded sonography. Two-dimensional time-of-flight MR angiography was performed in the popliteal and tibioperoneal arteries of 10 healthy subjects; velocity-encoded cine MR and color-coded sonography were performed above and below the trifurcation. The velocity waveforms acquired with velocity-encoded cine MR and color-coded sonography correlated well and showed a typical triphasic pattern. At peak systole in the popliteal artery, spatial maximum and spatial mean velocities measured with velocity-encoded cine MR were 42.29 cm/sec +/- 9.55 (standard deviation) and 27.7 cm/sec +/- 5.8, respectively; the peak velocity measured with color-coded sonography was 44.2 cm/sec +/- 12.3. It is concluded that use of both MR angiography and velocity-encoded cine MR should be considered for identification of arterial stenoses and assessment of the hemodynamic importance of peripheral vascular stenoses.
Bilateral cystic parotid glands occur in some cases of human immunodeficiency virus (HIV) infection. This abnormality, which is associated with cervical adenopathy, can be defined by sonography in the superficial gland, as noted in three men. In retrospect, this parotid disease has similarity to the sonographic finding of Sjögren's syndrome, except for the finding of cervical adenopathy, an observation not previously appreciated.
Refinements in the sonographic diagnosis of cerebrovascular disease and transcranial applications, which continue to expand, are detailed. Peripheral arterial and cervical indications for ultrasound are also included.
Eighty-five men with 92 vascular grafts placed for peripheral vascular disease of the lower extremity underwent a total of 264 examinations with duplex Doppler over a 2.5-year period. In 64 patients who underwent more than one examination, the total follow-up encompassed 740 months. In 220 native femoral arteries (96.0%) the peak systolic velocity (PSV) was higher than that in the graft. Arteriovenous shunting was associated with a normal PSV and a markedly elevated diastolic component at spectral analysis. Focal fluid collections were common initially near the graft and usually disappeared uneventfully. An average PSV of 32 cm/sec or less was always associated with impending occlusion. The sensitivity of an average PSV of 40 cm/sec or less to indicate impending graft occlusion by the next visit was only 33%; the specificity, 94%. At initial examination, stenoses were associated with high PSV focally in the graft or low PSV with absent diastolic flow.
The presence of mirror artifacts in color Doppler has been noted by others. In that report, the artifact arose from scattering at the smooth vessel wall and appeared as signal outside the lumen of the vessel, but with no change in flow direction. As experience increases, recognition of the artifacts of color Doppler will lead to a better understanding and more precise evaluation. This case shows that a band of metal around the carotid artery causes registration errors in color-coded Doppler, and perhaps other metal foreign bodies in the soft tissues have similar potential. The specific appearance of the artifact will depend sensitively on the geometrical configuration of the metal body itself and on its orientation relative to the surrounding anatomy and the ultrasound probe. Appropriate placement of the transducer will reduce such artifact.
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To assess the reliability of sonography in the detection of absence of invasion of the carotid artery by tumor, high-resolution ultrasound, surgical, and pathologic findings were prospectively evaluated in 24 patients with disease metastatic to the neck. Sonography performed with 5- and 10-MHz transducers had a sensitivity of 100% for the demonstration of absence of carotid invasion. Stringent criteria were used to eliminate false-negative studies. There were only five false-positive studies, for a positive predictive rate of 44.4%. Specific criteria for diagnosis of carotid invasion included visualization of an obvious break in the carotid wall with an offset in two planes and sonographic demonstration of gross tumor within the lumen. False-positive interpretations are more likely if there is inability to image the vessel at a perpendicular interface, if the abnormality cannot be seen in two planes, or if the neoplastic mass adjacent to the carotid considerably attenuates the acoustic beam.
Candida albicans infections are opportunistic and range from asymptomatic infections to life-threatening ones. Noted on sonography in three proven cases, Candida albicans cystitis produced a mildly thickened bladder wall and a discrete, well-defined, dense fluid-fluid interface within the bladder, debris that contained the long threadlike pseudomycelia of the fungus. This fluid-fluid interface shifted with changes in position. The sonographic appearance, although not pathognomonic, was similar in all three cases. Sonography was used to monitor the progress of therapy. In all three cases, conservative treatment successfully cleared the vesical debris without significant sequelae or the formation of concretions analogous to bezoars and the bladder returned to normal except for minimal residual wall thickening.
High-resolution sonography was used to study eight patients with suspected plantarflexed metatarsals and associated painful pedal callousities to determine metatarsal head position as the etiology of the pressure keratosis. Ultrasonography demonstrated a plantarflexed metatarsal head in all eight patients. Using both 5 and 10 MHz transducers, the plantarflexed metatarsal position could be accurately assessed and thus could aid in determining the degree of surgical correction necessary to properly realign the depressed metatarsal. Ultrasonography also allowed a noninvasive and accurate assessment of the surgical correction postoperatively in five of the eight patients. This preliminary study suggests that high-resolution sonography has applicability in accurately assessing metatarsal position. In addition, this new technique is noninvasive and presents insights concerning the amount of surgical correction necessary for realignment without increased risk or pain to the patient.
To determine the value of sonography of the parotid gland in patients with Sjögren syndrome, six consecutive cases were retrospectively reviewed in which clinical findings indicated Sjögren syndrome. All patients were women. Two patients were found at sonography to have normal parotid glands. Four patients had multiple cystic changes in the parotid glands bilaterally. Each of these four patients had a clinical diagnosis of Sjögren syndrome. One of the four underwent sialography, which demonstrated characteristic sialectasia. Pathologic examination of an excised gland in one of the patients with Sjögren syndrome demonstrated typical benign lymphoepithelial aggregates, which cause obstruction and progressive ductal dilatation. While parotid enlargement in these patients may be due to salivary tumor, lymphoma, or sarcoidosis--all of which appear as solid lesions at sonography--this study suggests that bilateral cystic changes may be the rule in uncomplicated cases of Sjögren syndrome.
The radial artery as a superficial structure at the wrist is susceptible both to direct penetrating injury and to blunt trauma, with the potential development of both false and true aneurysms. This report summarizes the sonographic features of seven consecutive patients who were referred for evaluation of the radial artery. The diagnoses include two cases of radial artery aneurysm, one tortuous nonaneurysmal artery, two cases of arteriovenous fistulae (one surrounded by fluid and one aneurysmal), a ganglion, and an inflammatory mass of the wrist. Although radial aneurysms are unusual and angiography may be required to define the nature and extent of distal embolization to the hand, the nature of a palpable aneurysm in this region, vascular vs avascular, is easily and quickly assessed with high-resolution sonography.
Several reports have indicated good results with MR imaging of hyperparathyroidism. However, its use in recurrent hyperparathyroidism has not been assessed separately. Thirty patients with recurrent hyperparathyroidism were evaluated by MR with both T1- and T2-weighted images. Twenty-six and 23 of these patients, respectively, also had thallium-201 scintigraphy and high-resolution sonography. For the 28 patients who eventually had surgical exploration and histologic evidence of adenoma (21 cases) or hypoplasia (seven cases), MR accurately located abnormal parathyroid glands in 75% evaluated prospectively and 89% evaluated retrospectively. Scintigraphy located 68% prospectively and 76% retrospectively. Sonography detected 57% prospectively and 67% retrospectively. For patients undergoing three studies, the prospective and retrospective detection rate was significantly better (p less than .05) for MR compared with sonography but was not significantly different for MR and scintigraphy. MR detected three of four mediastinal adenomas evaluated prospectively and retrospectively. One false-positive case was seen with MR, one with scintigraphy, and one with sonography. Thus, MR can be used to locate abnormal parathyroid tissue at a rate equal to or better than scintigraphy or sonography.
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Carcinoids occur in association with MEN types 1 and 2. To determine the relationship between carcinoids and MEN, we reviewed nine patients with carcinoids and other endocrine tumors. Analyzing these 9 patients and 56 other patients previously described in the literature, we found several clinically important relationships. In contrast to the usual midgut and hindgut origin, most carcinoids associated with MEN (69 percent) are of foregut origin (thymus 24 percent, bronchus 27 percent, stomach 3 percent, and duodenum 14 percent). Carcinoids are more commonly associated with MEN type 1 than MEN type 2 (59 patients and 6 patients, respectively). Thymic carcinoids associated with MEN are more common in men (15 versus 2), and most (82 percent) are malignant. Bronchial carcinoids associated with MEN are more common in women (15 versus 4), and most (74 percent) are benign. There is a strong association between thymic carcinoids and parathyroid tumors and between bronchial carcinoids and pituitary tumors. Most patients with carcinoids and hyperparathyroidism (82 percent) have had parathyroid hyperplasia or multiple parathyroid adenomas. Thus, carcinoids may occur in association with both MEN type I and MEN type II. MEN should be suspected in patients with foregut carcinoids. Patients with MEN and ectopic ACTH production should be considered to have bronchial carcinoids if they are female and thymic carcinoid if they are male. The thymus should be routinely removed in patients with MEN type I because of the possible presence of an ectopic parathyroid gland in this tissue and to prevent subsequent development of a carcinoid tumor.