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Biomedical subjects

L R Goodman

Publications and source records attributed to L R Goodman.

At least 19 recordsLinked to original sources
PubMed1998

Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group.

OBJECTIVE: To determine the utility of CT-determined main pulmonary artery diameter (MPAD) for predicting pulmonary hypertension (PH) in patients with parenchymal lung disease. DESIGN: Retrospective review of right-heart hemodynamic data and chest CT scans in 45 patients. SETTING: Tertiary-referral teaching hospital and VA hospital. PATIENTS: Between October 1990 and December 1995, 36 patients referred for evaluation of parenchymal lung disease or possible pulmonary vascular disease were found to have PH, as defined by mean pulmonary artery pressure (mPAP) > or =20 mm Hg. Nine control patients (mPAP <20 mm Hg) were also identified (4 from hospital records search, 5 after evaluation for possible PH). RESULTS: CT-determined MPAD was 35+/-6 mm in patients with PH and 27+/-2 mm in control subjects. In our group of patients, MPAD > or =29 mm had a sensitivity of 87%, specificity of 89%, positive predictive value (PPV) of 0.97, and positive likelihood ratio (LR) of 7.91 for predicting PH; in the subgroup of patients with parenchymal lung disease (n=28, PH and control subjects), MPAD > or =29 mm had a sensitivity of 84%, specificity of 75%, PPV of 0.95, and positive LR of 3.36 for predicting PH. The most specific findings for the presence of PH were both MPAD > or =29 mm and segmental artery-to-bronchus ratio > 1:1 in three or four lobes (specificity, 100%). There was no linear correlation between the degree of PH and MPAD (r=0.124). CONCLUSIONS: CT-determined MPAD has excellent diagnostic value for detection of PH in patients with advanced lung disease. Therefore, standard chest CT scans can be used to screen for PH as a cause of exertional limitation in patients with parenchymal lung disease. Because CT is commonly used to evaluate parenchymal lung disease, this information is readily available.

Adult↗
PubMed1997

Fast gradient echo magnetic resonance imaging of the normal diaphragm.

To determine the ability of fast gradient-recalled echo (GRE), breath-hold magnetic resonance imaging (MRI) to depict all regions of the diaphragm, 13 volunteers were scanned in coronal and sagittal planes. The central to anterior left hemidiaphragm and the posterior lumbar portions were each demonstrated in 12 subjects (92%). The crura were visible crossing anterior to the aorta in the sagittal plane in eight subjects (62%) and in the coronal plane in six subjects (46%). In the sagittal plane, the right crus was evident in eight subjects (62%). Muscular portions of the diaphragm in contact with the liver or body wall were less frequently discernible, and the central tendon could not be confidently resolved. Several artifacts occurred that interfered with visualization of the diaphragm. These observations indicate that many regions of the diaphragm can be seen with fast GRE, breath-hold MRI, but there are some limitations in depicting the diaphragm in its entirety.

Adult↗
PubMed1996

Blastomycosis.

Blastomycosis is a relatively uncommon disease, even in its endemic region. The clinical course and symptoms are highly variable; patients may be asymptomatic or present with severe, fulminant disease. Antifungal agents are effective against pulmonary and disseminated disease, but relapses and reactivation can occur. The radiographic findings are nonspecific, and patients are often assumed to have bacterial pneumonia, malignancy, tuberculosis, or sarcoidosis before the correct diagnosis is made.

Adult↗
PubMed1996

An acute/critical care nurse practitioner program.

To meet the demands for quality care, nursing education and nursing practice must collaborate and integrate services to educate Advanced Practice Nurses (APNs). One teaching hospital's successful APN curriculum is described. Topics addressed include structural reengineering, continuous quality improvement (CQI) and curriculum redesign.

Acute Disease↗
PubMed1995

Diaphragmatic motion: fast gradient-recalled-echo MR imaging in healthy subjects.

PURPOSE: To investigate the feasibility of imaging diaphragmatic motion with a fast gradient-recalled-echo (GRE) magnetic resonance (MR) pulse sequence. MATERIALS AND METHODS: Fast GRE pulse sequences in sagittal and coronal planes were used to acquire repeated, single-level, 1.2-second scans in 10 healthy volunteers during deliberately slowed, approximate-vital-capacity breathing. Motion was analyzed subjectively by viewing the image sequences as cine loops and quantitatively by measuring the displacement of different points on the diaphragm at a workstation. RESULTS: Temporal and spatial resolutions were adequate in all subjects. Absolute excursion of the domes was 4.4 cm on the right and 4.2 cm on the left. Analysis of diaphragmatic displacement at different locations revealed a gradient of excursion that increased from anterior to middle to posterior (P < .05-.001; paired t test). Excursion of the lateral aspects was greater than that of the medial aspect (P < .001). CONCLUSION: Fast GRE MR imaging can be reliably used to demonstrate diaphragmatic motion and may prove useful in the investigation of normal and abnormal respiratory mechanics.

Adult↗
PubMed1995

Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT versus angiography.

OBJECTIVE: This study was designed to prospectively compare helical CT with pulmonary angiography in the detection of pulmonary embolism in patients with an unresolved clinical and scintigraphic diagnosis. SUBJECTS AND METHODS: Twenty patients with an unresolved suspicion of pulmonary embolism were evaluated with contrast-enhanced helical CT and with selective pulmonary angiography. An average of 11 hr separated the two studies. The CT scans were obtained during one 24-sec or two 12-sec breath-holds. CT scans were interpreted without knowledge of the results of scintigraphy or angiography. Selective pulmonary angiograms were obtained with knowledge of the findings on the ventilation/perfusion scan only. The sensitivity and specificity of CT were compared with those of angiography for central vessels (segmental and larger) only and for all vessels. RESULTS: Eleven of the 20 patients had proved pulmonary embolism (seven in central vessels and four in subsegmental vessels only). When only central vessels were analyzed, CT sensitivity was 86%, specificity was 92%, and the likelihood ratio was 10.7. However, when subsegmental vessels were included, CT results were 63%, 89%, and 5.7, respectively. CONCLUSION: In our subset of patients, helical CT was only 63% sensitive. Subsegmental emboli are difficult to diagnose. Pulmonary angiography remains the study of choice. CT has a limited role in the evaluation of acute pulmonary embolism.

Acute Disease↗
PubMed1994

Thoracostomy tubes after acute chest injury: relationship between location in a pleural fissure and function.

OBJECTIVE: The purpose of this study was to determine how often chest tubes placed for acute trauma lie within a pleural fissure and to determine whether an intrapleural location influences outcome. SUBJECTS AND METHODS: Fifty-eight consecutive thoracostomy patients who had 66 chest tubes were studied prospectively. Tube location was determined from frontal and lateral chest radiographs. Outcome measures recorded included the following: duration of thoracostomy drainage, quantity of pleural fluid drained, need for further tubes, length of hospital stay, appearance on last chest radiograph before discharge, and need for surgical intervention. RESULTS: Thirty-eight (58%) of the tubes were placed within a pulmonary fissure, 15 (23%) were posterior, nine (13%) were anterior, and four (6%) were in other locations. We found no significant difference in any of the outcome measures between tubes located in the fissure and other tubes. CONCLUSION: A large percentage of tubes placed for acute chest trauma lie within a pleural fissure. These tubes, however, appear to function as effectively as those located elsewhere in the pleural space.

Acute Disease↗
PubMed1993

Pneumothorax: detection with upright versus decubitus radiography.

To evaluate the value of decubitus chest radiography in the clinical assessment of pneumothorax, the authors compared the detectability of pneumothorax on expiratory, upright chest radiographs with that on expiratory, lateral decubitus radiographs obtained with the suspected side up. Five radiologists reviewed 19 sets of radiographs with pneumothoraces and 20 sets of radiographs without pneumothoraces. All five radiologists were more accurate and had greater confidence in the evaluation of the upright studies. A pneumothorax was detected 21% (77 versus 57 of 95) more often on the erect radiographs. In three cases, however, decubitus positioning was more definitive. These results suggest that when clinically feasible, the expiratory, upright chest radiograph is the procedure of choice for the evaluation of small pneumothoraces.

Confidence Intervals↗
PubMed1993

Computed equalization radiography: preliminary clinical evaluation.

Computed Equalization Radiography (CER) was designed to increase visualization of mediastinal structures without affecting lung contrast. CER optimizes the image by obtaining two 1-second fan beam scans. The initial low-dose prescan determines the location of the lungs by means of a stationary krypton gas detector. During the equalization scan, this information is used to position 35 beam attenuators in real time so as to increase exposure of the mediastinum while maintaining ideal optical density over the lungs. Eight observers analyzed 20 pairs of posteroanterior (PA) and lateral radiographs obtained on conventional and CER units. On the PA images, three of four mediastinal areas analyzed were visualized better in CER images, while there was no difference in lung detail. There were no appreciable differences in the lateral projection between the CER and conventional images. Contrast on the PA radiograph was preferred on the CER image. CER provided modest improvement in visualization of mediastinal structures and maintained lung contrast without degrading lung detail on the PA image. CER had no major effect on visualization in the lateral images.

Diagnosis, Computer-Assisted↗
PubMed1993

CT after reconstructive repair of the sternum and chest wall.

Acute mediastinitis and sternal infection after sternotomy are potentially devastating complications, but considerable advances in treatment have been made during the past decade. Sternectomy followed by reconstruction with use of either an omental transposition or a muscle flap has markedly decreased mortality and morbidity. After extensive rib resection, various reconstructive repairs, including the use of polytetrafluoroethylene mesh, have proved successful. The authors retrospectively reviewed 27 postoperative computed tomographic (CT) scans obtained in 19 patients. Twelve of these patients had sternal wounds repaired with either omental or muscle flap procedures. Seven patients had chest wall reconstructions with polytetrafluoroethylene patches, muscle transpositions, or both. The authors found no cases of unexpected or unexplained fluid collections on CT scans obtained beyond the 1st month. Any persistent or recurrent collection is suggestive of infection. If clinical and imaging findings are at odds, imaging-directed needle aspiration can help determine whether a fluid collection is infected and in need of further treatment.

Adult↗
PubMed1993

[Aortic traumatic lesion. Has tomodensitometry a role?].

The low positive yield from aortography in patients with suspected traumatic aortic rupture has prompted research into CT of the mediastinum as a screening investigation which could significantly reduce the number of negative angiograms performed. Much of the data published to date suggest a promising role for CT, but false negative scans have been reported and the precise false negative rate has yet to be determined. We propose an algorithm for the use of CT in suspected traumatic rupture but emphasise that continuous monitoring of outcomes and further large studies are required before CT can become an established screening technique.

Aorta↗