Placenta increta presenting as delayed postabortal hemorrhage.
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Abortion, Spontaneous↗
Biomedical subjects
M D Patel
Publications and source records attributed to M D Patel.
Endometriomas: diagnostic performance of US.
PURPOSE: To determine the diagnostic performance of specific ultrasonographic (US) features in discriminating endometriomas from other adnexal masses. MATERIALS AND METHODS: Two sonologists independently reviewed the sonograms of 252 adnexal masses in 226 women and recorded US features by using a standardized checklist. The diagnostic performance of specific US features and overall reviewer impression in discriminating endometriomas from other adnexal masses were evaluated. RESULTS: There were 40 endometriomas. Diffuse low-level internal echoes were present in 38 (95%) endometriomas and 40 (19%) nonendometriomas (positive likelihood ratio, 5). The positive likelihood ratio for the diagnosis of endometrioma increased to 8 if masses with neoplastic features at gray-scale US were excluded, allowing identification of 30 endometriomas (75%). The presence of multilocularity or hyperechoic wall foci further increased the positive likelihood ratio to 48, allowing the identification of 18 endometriomas (45%). CONCLUSION: An adnexal mass with diffuse low-level internal echoes and absence of particular neoplastic features is highly likely to be an endometrioma if multilocularity or hyperechoic wall foci are present. A patient with a mass with diffuse low-level internal echoes and other US features may benefit from additional imaging.
Adnexal Diseases↗
Development and evaluation of the Osteoporosis Self-Efficacy Scale.
The Osteoporosis Self-Efficacy Scale was developed as a measure of self-efficacy, or confidence, for behaviors related to physical activity and calcium intake. An item pool of 21 statements, responded to on a visual analog self-report format, was reviewed by a panel of expert judges. The revised item stems were tested with a sample of 201 women, ages 35 to 95. Concurrent data on sport, leisure, and exercise activity and calcium in diet and dietary supplements were collected from the respondents. Factor analysis of responses to the self-efficacy items revealed a logical, theoretically meaningful two-factor structure, one for physical activity and one for calcium intake. Internal consistency estimates for each of the two factors were in the .90s. Convergent and discriminant validity analyses as well as hierarchical regression analyses to explain self-reports of physical activity and calcium intake were supportive. The final version of the brief, psychometrically sound scale contains items reflecting initiation, maintenance, and persistence at osteoporosis preventive behaviors; thus, the Osteoporosis Self-Efficacy Scale is a potentially beneficial research instrument.
Activities of Daily Living↗
Cystic teratomas of the ovary: diagnostic value of sonography.
OBJECTIVE: This study was undertaken to determine if the diagnosis of cystic teratomas of the ovary can be made by experienced sonologists using only specific associated sonographic features. MATERIALS AND METHODS: Two sonologists independently reviewed the sonograms of 252 adnexal masses. For each mass, each sonologist recorded sonographic features using a standardized checklist, which included four descriptions associated with cystic teratomas. From a list of diagnostic possibilities, each reviewer chose one specific conclusion, with emphasis on achieving the highest combination of sensitivity and positive predictive value for any particular diagnosis. The sensitivity, positive predictive value, and positive likelihood ratio for the diagnosis of cystic teratoma were evaluated for each sonographic finding and for each sonologist's interpretation. RESULTS: Of the 252 masses, 74 cystic teratomas were found, 55 of which showed two or more associated sonographic features. Each reviewer had a 98% positive predictive value with 85% sensitivity for the diagnosis and identification of cystic teratomas (positive likelihood ratio = 152). The positive predictive value was 100% when an adnexal mass had two or more sonographic features associated with dermoid masses. The positive predictive value for individual sonographic features associated with dermoid masses was 80% for a shadowing echodensity, 75% for regionally bright echoes, 50% for hyperechoic lines and dots, and 20% for a fluid-fluid level. CONCLUSION: An adnexal mass showing two or more of the sonographic features associated with cystic teratomas can be confidently diagnosed as a cystic teratoma.
Adult↗
Recombinant human monoclonal antibody IgG1b12 neutralizes diverse human immunodeficiency virus type 1 primary isolates.
The CD4-binding domain of human immunodeficiency virus type 1 (HIV-1) gp120 elicits antibodies that are present in infected human sera. Monoclonal antibodies that recognize the HIV-1 gp120 CD4-binding domain have been isolated. Some of these antibodies can neutralize laboratory-adapted strains of HIV-1 and probably mediate neutralization by interfering with virus binding to its cellular CD4 receptor. However, most anti-CD4 binding domain antibodies do not neutralize primary HIV-1 isolates. We used primary HIV-1 isolates in an infectivity reduction assay to test the uniquely derived anti-CD4 binding domain recombinant human monoclonal antibody, IgG1b12. All of the tested HIV-1 isolates were neutralized by this antibody. Additional studies indicated that neutralization of a primary isolate with MAb IgG1b12 did not require continuous exposure of human peripheral blood mononuclear cell cultures to the antibody. Finally, a complete IgG1 molecule of an in vitro-selected b12 FAb mutant with a > 400-fold increase in affinity was assembled, expressed in mammalian cells, and evaluated in the infectivity reduction assay in comparative studies with the parent IgG1b12 antibody. The mutant did not retain the level of primary isolate neutralization potency that was a property of the parent molecule. Thus, we confirm that recombinant IgG1b12 has a unique specificity, and that it can neutralize all primary isolates tested in human PBMC cultures in vitro.
Antibodies, Monoclonal↗
Transjugular intrahepatic portosystemic shunts: accuracy of Doppler US in determination of patency and detection of stenoses.
PURPOSE: To evaluate the accuracy of Doppler ultrasonography (US) in determination of patency and detection of stenosis in transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: Retrospective review was performed of 251 Doppler sonograms obtained in 79 patients who underwent TIPS placement. Sonograms were evaluated for (a) the presence of a spectral waveform or color flow signal within the shunt, (b) the maximum peak flow velocity (Vmax) measured at the midportion of the TIPS, and (c) the direction of intraparenchymal portal venous flow. Independent review was performed of 116 transjugular portal venograms obtained after TIPS placement. RESULTS: Doppler US showed TIPS occlusion in 25 of 26 (96%) cases and confirmed patency in 192 of 193 (99%) cases. Low Vmax within the TIPS (< 50 cm/sec) correlated to a diameter stenosis of 50% or greater at angiography in 25 of 32 (78%) stenotic cases and was not present in 71 of 72 (99%) cases in which no hemodynamically significant stenosis was seen. An interval change in direction of intraparenchymal portal venous flow from hepatofugal to hepatopetal was seen in association with TIPS stenoses in all stenotic cases and was not found in 24 of 26 (92%) cases in which stenosis was not seen. CONCLUSION: Doppler US allows accurate determination of TIPS patency. A Vmax of 50 cm/sec or less within the shunt and interval change from hepatofugal to hepatopetal intraparenchymal portal venous flow are reliable indicators of stenosis.
Evaluation Studies as Topic↗
Evaluation of a sonographic PACS in clinical practice: analysis of technical and analytical time savings.
The aim of this study was to generate quantitative data regarding technical and analytical time savings obtained by use of an ultrasonographic PACS. Data/time cards were recorded for each patient encountered in an outpatient diagnostic ultrasound facility for a 4 week period immediately before and a 1 year period after installation of a PACS environment. Use of a sonographic PACS resulted in a per case time savings of 293 s in the technical component and 51 to 63 s in the analytical component of an average ultrasonographic examination. We conclude that use of a PACS workstation has the potential to increase productivity for both the sonographer and the radiologist.
Ambulatory Care Facilities↗
Fetal cerebral ventricular atrium: difference in size according to sex.
PURPOSE: To determine whether the diameter of the fetal lateral ventricular atrium is larger in male than in female fetuses. MATERIALS AND METHODS: The atrial diameter in 219 fetuses retrospectively identified from a consecutive group of healthy newborns was measured without knowledge of the subject's sex. RESULTS: Atrial size demonstrated a near-normal distribution, with mean size for all subjects 6.1 mm +/- 1.3 (standard deviation). When separated by sex, the mean atrial diameter of 122 female fetuses was 5.8 mm +/- 1.3, and the mean atrial diameter of 97 male fetuses was 6.4 mm +/- 1.3. The difference in mean size is statistically significant (P < .005). CONCLUSION: Male fetuses have a slightly larger atrial size than female fetuses. This discovery has implications for defining the upper limit of normal for fetal ventricular atrial size.
Cerebral Ventricles↗
Homozygous achondroplasia: US distinction between homozygous, heterozygous, and unaffected fetuses in the second trimester.
PURPOSE: To determine if and at what gestational age prenatal ultrasonography (US) enables distinction between homozygous, heterozygous, and unaffected fetuses when both parents have heterozygous achondroplasia. MATERIALS AND METHODS: Serial US scans of 15 fetuses at 25% risk of homozygous achondroplasia were reviewed retrospectively. Femoral growth curves were established and compared with published standards to determine the gestational age, calculated according to biparietal diameter (BPD), at which femoral length crossed below the 3rd percentile. The presence and severity of achondroplasia were determined clinically after birth. RESULTS: Femoral length crossed the 3rd percentile at 14.0-16.5 weeks BPD age (mean, 15.6 weeks) in the four homozygous fetuses and at 18.2-26.2 weeks BPD age (mean, 21.5 weeks) in the eight heterozygous fetuses. In the three unaffected fetuses, femoral length did not cross percentiles as gestational age increased. CONCLUSION: Establishment of a femoral growth curve in the second trimester with serial US scans enables prenatal distinction between homozygous, heterozygous, and unaffected fetuses when both parents have heterozygous achondroplasia.
Achondroplasia↗
Microabscesses of the liver and spleen in AIDS: detection with 5-MHz sonography.
PURPOSE: To determine whether sonograms of the liver and spleen, obtained with 5-MHz linear-array transducers, aid in detection of hepatosplenic microabscesses in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Abdominal sonographic examinations (n = 111) were performed in 102 consecutive patients with AIDS. A 3.5-MHz sector transducer was used in each study, with additional images of the hepatic and splenic parenchyma obtained with a 5-MHz linear-array transducer. Each study was reviewed without benefit of the 5-MHz images, and categories of the hepatic and splenic parenchyma were as follows: 1, lesions definitely present; 2, lesions possibly present; and 3, lesions absent. The 5-MHz images were subsequently reviewed, and studies were recategorized. Findings were correlated with results of pathologic examination. RESULTS: The 5-MHz scans enabled identification of focal hepatic or splenic lesions in 14 of 96 studies placed in category 2 or 3 on the basis of the 3.5-MHz sector scans. CONCLUSION: In patients with AIDS, 5-MHz sonograms of the liver and spleen enable detection of microabscesses not confidently identified on 3.5-MHz scans.
AIDS-Related Opportunistic Infections↗
Lateral ventricular effacement as an isolated sonographic finding in premature infants: prevalence and significance.
OBJECTIVE: The sonographic finding of effaced lateral ventricles in premature infants, defined as the absence of visible CSF within the lateral ventricles on both coronal and sagittal sonograms, may be cause to suspect diffuse cerebral edema, especially as published reference standards do not address this phenomenon. This investigation was undertaken to determine the prevalence and significance of effaced lateral ventricles without associated parenchymal abnormality (isolated lateral ventricular effacement, or ILVE) in premature infants. MATERIALS AND METHODS: Sonographic records of 398 consecutive newborns examined from January 1 to December 31, 1993, were reviewed retrospectively to identify those premature infants (< 36 weeks of gestational age) whose initial sonograms showed no evidence of intracranial hemorrhage, ventriculomegaly, structural abnormality, or abnormal parenchymal echogenicity. We identified 142 neonates who met these criteria. Patients were separated into two groups on the basis of whether they had at least one sonographic study in which CSF was not visible within both lateral ventricles on coronal and sagittal images. Medical records were reviewed to assess neurologic outcome. RESULTS: Forty patients (28%) had at least one sonogram demonstrating ILVE, with neurologic follow-up in 33 (representing group A). One hundred two patients (72%) never demonstrated ILVE, with neurologic follow-up established in 86 (representing group B). A comparison of the two groups showed no significant difference in the development of ischemic injury (one patient in each group). ILVE was first detected on the initial sonogram obtained (mean, 4 days) in 30 of the 33 neonates in group A. ILVE was demonstrated beyond the seventh day of life in 30%. Of the 89 patients whose initial sonograms showed CSF in the lateral ventricles (86 in group B and three in group A), three (3%) subsequently had sonograms that showed ILVE; all three were normal at follow-up. CONCLUSION: ILVE in premature infants is common and not associated with neurologic deficits indicative of hypoxic-ischemic encephalopathy. By itself, ILVE is not a significant finding.
Brain Edema↗
Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome.
PURPOSE: To assess the outcome of fetuses with isolated mild ventriculomegaly (IMVM). MATERIALS AND METHODS: The clinical course of 44 fetuses with IMVM was investigated. Cognitive and motor development was classified as normal or delayed. RESULTS: Clinical data were available for 37 subjects. Three (8%) neonates died. Of the 34 living children, follow-up was limited (< 9 months) in six and the clinical course beyond the 1st year of life was established in 28. Twenty-two (79%) of the 28 children are developing normally, whereas six (21%) are developmentally delayed. More than 90% of fetuses with ventricular atrial diameter of 10-11 mm are normal. Seventy-five percent of fetuses with IMVM were male. With exclusion of the six children with limited follow-up, 78% of boys older than 1 year are developmentally normal compared with only 50% of girls. CONCLUSION: The majority of living children with prenatally detected IMVM are developmentally normal, especially those with borderline ventriculomegaly. Gender differences in prevalence and outcome deserve further investigation.
Cerebral Ventricles↗
Anatomic and sonographic features of the fetal skull.
This article reviews developmental skull anatomy, especially as it relates to the formation of cranial sutures and fontanelles, and demonstrates the appearance of these structures on prenatal sonograms, illustrating the framework these structures provide to enable one to accurately identify components of the fetal skull. Examples are provided to illustrate the utility of this knowledge. An understanding of fetal skull development and appearance enables the sonographer to better characterize fetal cranial abnormalities. More importantly, recognition of the location of cranial sutures and fontanelles and their ability to serve as acoustic windows assists the sonographer in evaluation of the fetal brain.
Brain↗
Sonographically detected testicular microlithiasis and testicular carcinoma.
Testicular microlithiasis is an uncommon abnormality that produces the characteristic sonographic appearance of diffuse, punctate, hyperechoic foci throughout the testicular parenchyma. We have detected this distinctive sonographic pattern in 4 patients during a seven-year period. Three of the patients had proven concurrent testicular carcinoma. We describe our experience and review previous reports of testicular microlithiasis. We conclude that testicular microlithiasis may be associated with testicular neoplasia, and advocate particularly careful evaluation and follow-up of the testes when this abnormality is detected.
Adult↗
The direct effect of graft compliance mismatch per se on development of host arterial intimal hyperplasia at the anastomotic interface.
To study the direct and sole effect of compliance mismatch on anastomotic intimal hyperplasia of the host arterial wall and to minimize possible confounding factors, dogs with a low thrombotic potential were selected as experimental subjects. Externally supported 6 cm x 5 mm Dacron grafts with a compliance value of approximately 1/300 of the host artery were implanted into the carotid arteries with end-to-end anastomoses on one side and end-to-side anastomoses on the other. The control graft was an autogenous carotid artery segment 4 cm in length transplanted into the femoral artery. Eight cases (24 grafts) were studied for 1 year and three (nine grafts) for 6 months. All were patent throughout the study period except for two noncompliant grafts with end-to-end anastomoses; thrombosis was the documented cause of occlusion. For the patent grafts, follow-up arteriograms showed no progressive narrowing of noncompliant anastomoses. Whether compliant or noncompliant, light microscopy studies showed slight intimal thickening within 1 to 2 mm of the anastomotic line, possibly the result of the normal healing response to stitch and surgical trauma. Quantitatively, 22 measurements representing longitudinal and circumferential thickness of the neointima were taken at each of the 40 patent noncompliant and 22 patent compliant control anastomoses. There was no statistically significant difference in anastomotic neointimal thickness in compliant and noncompliant grafts or for the different implantation periods. These data suggest that graft/host artery compliance mismatch does not cause arterial intimal hyperplasia at the anastomotic interface.
Anastomosis, Surgical↗
Motion of the patella during walking: a video digital-fluoroscopic study in healthy volunteers.
OBJECTIVE: The alignment of the quadriceps muscle and patella suggests that the patella should deviate laterally out of the patellar groove as the quadriceps muscle contracts during walking. The surgical treatment of patellar subluxation has been based on this presumption. The purpose of this study was to determine the movements of the patella in relation to the other bones of the knee joint during normal walking. This is the first study we know of that uses radiographs to show these movements. SUBJECTS AND METHODS: Eight healthy adult volunteers with no previous complaints referable to the knee walked on a slowly moving treadmill while their patellae were imaged fluoroscopically in the anteroposterior plane with a Toshiba C-arm. Images were retrieved, transferred to radiographic film, and randomized to prevent the observers from knowing the order of images. The position of the patella was measured and plotted in relation to fixed points of the knee. RESULTS: In each of the subjects at every gait cycle, the patella was observed to move vertically first, followed by a sudden shift to the medial side before returning to its original position. CONCLUSION: Contrary to conventional understanding, our results show that the patella deviates medially rather than laterally during walking. This occurs because of differential contraction of the components of the quadriceps muscle during walking. The management of painful and subluxated patellae must be reevaluated in light of this finding.
Adult↗
Implant site: a determinant of completeness of arterial prosthesis healing in the dog and possibly in humans.
This paper compares the healing of supported knitted Dacron prostheses implanted in the descending thoracic aorta and in the subcutaneous carotid-femoral positions in each of 10 dogs. The descending thoracic aorta prostheses were 6 cm long and the carotid-femoral prostheses averaged 76 cm in length. The healing of four porous clinical axillofemoral grafts is compared to that of the experimental carotid-femoral grafts. There was little similarity between the healing observed in the descending thoracic aortic and subcutaneous positions; the descending thoracic aorta grafts healed rapidly and completely by eight weeks, with thrombus-free flow surfaces covered with confluent endothelial cells. However, the inner wall of the carotid-femoral grafts remained largely unhealed at one year, with endothelialization largely confined to a limited pannus ingrowth across the anastomoses. This indicates that the implant site in the dog is a primary determinant of the rapidity and completeness of healing. The clinical axillofemoral grafts explanted after 20 months to six and one-half years exhibited healing characteristics that were similar to those seen in the carotid-femoral position in the dog. These findings suggest that valid comparisons of interspecies healing require data obtained from similar implant locations. They present a challenge to the previously held concepts of major interspecies differences in speed and extent of tissue ingrowth based on data obtained from noncomparable implant sites.
Animals↗
Spatial regulation of homeobox gene fusions in the embryonic central nervous system of transgenic mice.
The spatially restricted expression of mammalian homeobox genes in teh embryonic central nervous system (CNS) provides an opportunity to study the basis of spatial gene regulation in mammalian development. Here, we define a regulatory region of the murine Hox 1.3 gene that mediates such a region-specific expression pattern. The Hox 1.3 gene contains two exons, encodes a putative protein of 270 amino acids, and is expressed preferentially in the spinal cord at midgestation. We have analyzed transgenic mice containing various Hox 1.3 DNA fragments fused to reporter sequences, such as a human growth hormone gene fragment or the E. coli lacZ structural gene. As shown by RNAase protection assays or by in situ analyses of beta-galactosidase activity, several hybrid genes are expressed in the embryonic central nervous system in a spatially restricted manner, along both the rostrocaudal and dorsoventral axes. A 912 nucleotide sequence located immediately upstream of the Hox 1.3 coding sequence is sufficient to direct expression to the dorsolateral cells of the brachial spinal cord.
Amino Acid Sequence↗