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Biomedical subjects

H L Neiman

Publications and source records attributed to H L Neiman.

At least 19 recordsLinked to original sources
PubMed2000

Power Doppler imaging: initial evaluation as a screening examination for carotid artery stenosis.

PURPOSE: To evaluate power Doppler imaging as a possible screening examination for carotid artery stenosis. MATERIALS AND METHODS: In the principal pilot study, a prospective, blinded comparison of power Doppler imaging with duplex Doppler imaging, the reference-standard method, was conducted in 100 consecutive patients routinely referred for carotid artery imaging at a large, private multispecialty clinic. In the validation pilot study, a prospective, blinded comparison of power Doppler imaging with digital subtraction angiography, the reference-standard method, was conducted in 20 consecutive patients routinely referred at a teaching hospital. Using conservative assumptions, the authors performed cost-effectiveness analysis. RESULTS: Power Doppler imaging produced diagnostic-quality images in 89% of patients. When the images of the patients with nondiagnostic examinations were regarded as positive, power Doppler imaging had an area under the receiver operating characteristic curve, A(z), of 0.87, sensitivity of 70%, and specificity of 91%. The validation study results were very similar. The cost-effectiveness of screening and, as indicated, duplex Doppler imaging as the definitive diagnostic examination and endarterectomy was $47,000 per quality-adjusted life-year. CONCLUSION: The A(z) value for power Doppler imaging compares well with that for mammography, a generally accepted screening examination, and with most other imaging examinations. Power Doppler imaging is likely to be a reasonably accurate and cost-effective screening examination for carotid artery stenosis in asymptomatic populations.

Adult↗
PubMed1997

Implementation of a radiology electronic imaging network: the community teaching hospital experience.

Because of their typically small in-house computer and network staff, non-university hospitals often hesitate to consider picture archiving and communication system (PACS) as a solution to the very demanding financial, clinical, and technological needs of today's Radiology Department. This article presents the experiences of the 3-year process for the design and implementation of the Radiology Electronic Imaging Network (REIN) in the Department of Radiology at The Western Pennsylvania Hospital (WPH). WPH embarked on this project in late 1994 to find a solution to the very pressing demands to reduce operating costs and improve service to primary care clinicians, both on-site and at WPH-affiliated clinics. A five-member committee consisting of in-house medical, administrative, information services, and medical physics staff was formed to design a network that would satisfy specific needs of WPH by using a phased mini-PACS approach and to select the various vendors to implement it. Suppliers for individual mini-PACS were selected to provide modality-specific solutions. For the backbone network, vendors were evaluated based on their technological progress, competence and resources, the commitment of the company to the imaging network business, and their willingness to embark on a mid-sized PACS project such as this. Based on patient volume, workflow patterns, and image quality requirements, the committee produced proposals detailing number and location of workstations, short- and long-term memory requirements, and so on. Computed tomography/magnetic resonance imaging, computer radiography, ultrasound, nuclear medicine, digital fluoroscopy, and angiography mini-PACS have been implemented over the past 2 years, and most of these are already integrated into the main REIN. This article presents detailed information concerning the design, selection and implementation processes, including storage requirement calculations. This indicates that PACS implementation is achievable for community hospitals with small computer, networking, and physics departments. Also presented are recommendations concerning design and vendor selection, that may be helpful for similar institutions.

Computer Communication Networks↗
PubMed1988

Gynecologic imaging: comparison of transabdominal and transvaginal sonography.

The sonographic findings in 200 patients who underwent concurrent transabdominal and transvaginal pelvic ultrasound were reviewed. The sonographic techniques were compared for image quality, completeness of anatomic detail depicted, and unique diagnostic information. Transvaginal image quality was better in 79%-87% of scans; transabdominal image quality was better in 3%-5% of scans; images of both techniques were equally good in 10%-18% of scans. The techniques provided equivalent diagnostic information in 60%-84% of cases. Transvaginal sonography was particularly helpful when exclusion of ectopic pregnancy was the clinical concern. Individual organs and fine structures were better seen transvaginally, but the regional survey offered by the transabdominal full-bladder approach remains necessary to provide anatomic orientation, particularly when the patient has not been studied previously.

Adolescent↗
PubMed1988

Endometrial abnormalities: evaluation with transvaginal sonography.

The value of transvaginal sonography in detecting gynecologic disease currently is being defined. To evaluate transvaginal depiction of the endometrium, transvaginal sonograms were compared with conventional transabdominal scans in 29 patients whose sonograms revealed endometrial abnormalities. The two techniques were compared for image quality and ability to provide unique diagnostic information. Sonographic findings included fluid collections (16), thickened and/or echogenic endometria (10), endometrial irregularities (two), and echogenic foci (two). Clinical diagnoses included early intrauterine pregnancies (five), pseudogestational sacs of ectopic pregnancy (one), intrauterine contraceptive devices (two), endometrial carcinoma (one), and intrauterine synechiae with amenorrhea (Asherman syndrome) (two). In most cases (77%), diagnostic information was obtainable by either transabdominal or transvaginal sonograms, although in 23% transvaginal scanning provided unique diagnostic information not available with the transabdominal technique. In no case did transabdominal sonography contribute diagnostic information not provided transvaginally. The quality of the transvaginal image was judged to be better than that of the transabdominal image in 63% of cases; image quality was the same in 33% of cases and worse in 3% of cases. The results show that transvaginal sonography is often superior to transabdominal scanning in the evaluation of endometrial abnormalities. Transvaginal sonography may be the preferred technique in these cases.

Adolescent↗
PubMed1987

Ergotism presenting as restenosis following angioplasty.

Ergotism may cause isolated lower-extremity arterial stenoses that appear amenable to angioplasty but that will recur if the causative agent is not withdrawn. A case of femoral-popliteal stenosis caused by surreptitious ergot ingestion is presented. The lesion initially responded to angioplasty but quickly recurred, whereupon discovery of ergot use and withdrawal of the compound led to the disappearance of symptoms.

Angioplasty, Balloon↗
PubMed1986

Primary sclerosing cholangitis in the presence of a lupus anticoagulant.

Lupus anticoagulant, an immunoglobulin that prolongs the partial thromboplastin time, has been associated with thrombotic events, including deep venous thrombosis, pulmonary emboli, and Budd-Chiari syndrome. In this report, primary sclerosing cholangitis was diagnosed in a man with a 10-year history of multiple thrombotic events related to a circulating lupus anticoagulant. Progressive jaundice and pruritus developed, and sclerosing cholangitis was confirmed by direct cholangiography. Sclerosing cholangitis is the second hepatobiliary disease reported in association with a lupus anticoagulant.

Adult↗
PubMed1985

Value of computed tomography in the detection of complications of Crohn's disease.

Abdominal and pelvic computed tomography (CT) scans were performed on 17 patients with suspected complications of Crohn's disease. CT was superior to conventional barium studies and colonoscopy in demonstrating mural, serosal, and mesenteric pathology such as bowel wall thickening (100%), abscess (59%) and phlegmon (6%) formation, and fibro-fatty proliferation of the mesentery (41%). While not advocated as the primary means of evaluating Crohn's disease, CT can provide information vital to the management of complications of this disease.

Abscess↗
PubMed1985

Brain edema: ultrasound examination.

Sonographic examination of the brain in 10 patients who had cortical mass lesions was performed. Results were compared with findings of CT. In each case, brain edema surrounded the lesion, and the adjacent white matter had a diffusely echo-genic appearance that corresponded to the area of brain edema seen on CT.

Adult↗
PubMed1985

Endometriosis detection by US with laparoscopic correlation.

Endometriosis is a common cause of female infertility. It may affect as many as 40% of infertile women and may be the sole contributing factor to infertility in 15%. A study was undertaken to determine the usefulness of the routine pelvic ultrasound (US) examination in the detection of endometriosis by correlating pelvic US findings with laparoscopic findings in 85 patients who underwent both examinations. Forty-eight patients (56.5%) had no laparoscopic evidence of endometriosis, and 37 patients (43.6%) had endometriosis. Eight of the patients had abnormal sonograms; of these patients, only four had sonographic abnormalities that corresponded to laparoscopically identified endometriosis. Thus, US was successful in detecting endometriosis in only four (10.8%) of 37 patients. US is neither sensitive nor specific in diagnosing endometriosis. Furthermore, we believe that US does not have a significant role in the diagnosis or management of endometriosis in patients in whom a pelvic mass or other obvious pelvic abnormality is not suspected.

Adnexal Diseases↗
PubMed1985

The role of imaging in infertility management.

In a retrospective review of 211 female infertility patients receiving ovulation induction agents, the role of sonography in infertility management is defined. Sonography is used to determine imminence of ovulation for timing of insemination and in vitro fertilization. It is also used to diagnose ovarian hyperstimulation syndrome. To identify characteristics of the ovarian follicles of women able to conceive that might differentiate them from those unable to become pregnant, patients were assigned to "pregnant" (30.8%) or "nonpregnant" subgroups. In 259 sonographically monitored cycles reviewed, follicular size and configuration were not different for the two groups. The cumulus oophorus was seen in 28% of pregnant patients (8/28) and in only two nonpregnant patients. Low-level echoes were seen in the mature follicles of 11 patients but not in the large follicles of nonpregnant patients. Low-level intrafollicular echogenicity may be a prognostic indicator of fertility and may represent a periovulatory state, optimal, in the appropriate clinical setting, for artificial insemination or in vitro fertilization.

Adult↗
PubMed1985

Intraoperative sonography of the pancreas.

Intraoperative sonography (IOS) of the pancreas was performed in 12 patients, eight with known or suspected inflammatory disease and four with known or suspected malignancy, in order to assess its utility in aiding pancreatic surgery. In all eight patients with inflammatory disease, IOS provided additional information, aided in resection or biopsy, or identified structures that could not be evaluated by surgical dissection. IOS was particularly useful in these patients in determining the size and appearance of the pancreatic duct before dissection or ductography, thus allowing planning of appropriate pancreatic decompression or resection. It also was extremely helpful in locating and characterizing pseudocysts, including measurement of cyst wall thickness, and in directing needle aspiration of cyst contents. Adequate drainage of all cysts in multiple cystic masses was easily monitored. Finally, impalpable peripancreatic fluid collections and abscesses were often localized. In the four patients with probable malignancy, IOS was somewhat helpful in two, allowing exclusion of tumor in one and guiding biopsy in another. In the other two patients, IOS provided no information due to obvious local invasion and nonresectability. Results indicate a significant adjunctive role for IOS in surgery for inflammatory disease of the pancreas. It seems to be less helpful in patients with malignancy, probably because of the advanced stage of pancreatic carcinoma at the time of surgery.

Adult↗
PubMed1985

Inferior vena cava CT pseudothrombus produced by rapid arm-vein contrast infusion.

Laminar flow within the inferior vena cava can cause artifacts that may simulate thrombus if a foot-vein infusion is used. A "pseudothrombus" artifact within the suprarenal inferior vena cava produced by rapid infusion of contrast material through an arm vein is reported. This artifact was noted in 25 patients in a 6 month period and was believed to be from laminar flow of renal venous effluent of increased opacity around less opacified infrarenal caval contents. Differentiation from true thrombus can be made by the use of delayed scans as well as the increased density and relatively poor margination of the artifact.

Humans↗