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P Arger

Publications and source records attributed to P Arger.

At least 19 recordsLinked to original sources
PubMed1999

The effect of androgen deprivation on the early changes in prostate volume following transperineal ultrasound guided interstitial therapy for localized carcinoma of the prostate.

PURPOSE: To determine the change in volume of the prostate as a result of neoadjuvant androgen deprivation prior to prostate implant and in the early postimplant period following transperineal ultrasound guided palladium-103 brachytherapy for early-stage prostate cancer. METHODS AND MATERIALS: Sixty-nine men received 3 to 6 months of androgen deprivation therapy followed by treatment planning ultrasound followed 4 to 8 weeks later by palladium-103 implant of the prostate. All patients had clinical and radiographic stage T1c-T2b adenocarcinoma of the prostate. A second ultrasound study was carried out 11 to 13 days following the implant to determine the change in volume of the prostate as a result of the implant. The prehormonal and preimplant volumes were compared to the postimplant volume to determine the effect of hormones and brachytherapy on prostate volume. RESULTS: The median decrease in prostate volume as a result of androgen deprivation was 33% among the 54 patients with prostate volume determinations prior to hormonal therapy. The reduction in volume was greatest in the quartile of men with the largest initial gland volume (59%) and least in the quartile of men with smallest glands (10%). The median reduction in prostate volume between the treatment planning ultrasound and the follow-up study after implant was 3%, but 23 (33%) patients had an increase in prostate volume, including 16 (23%) who had an increase in volume >20%; 11 of these patients (16%) had an increase in volume >30%. The time course of development and resolution of this edema is not known. The severity of the edema was not related to initial or preimplant prostate volume or duration of hormonal therapy. CONCLUSIONS: Prostate edema may significantly affect the dose delivered to the prostate following transperineal ultrasound guided brachytherapy. The effect on the actual delivered dose will be greater when shorter lived isotopes are used. It remains to be observed whether this edema will affect outcome.

Adenocarcinoma↗
PubMed1997

Prostate imaging may not be necessary in nonpalpable carcinoma of the prostate.

OBJECTIVES: Stage T1c carcinoma of the prostate is defined as a nonpalpable carcinoma (NPC-P) that is not visible by imaging and is identified by needle biopsy performed because of elevated prostate-specific antigen (PSA) concentrations. The purpose of this study was to define the incidence of normal findings on transrectal ultrasound (TRUS) and/or endorectal coil magnetic resonance imaging (EMRI) among patients with NPC-P, as well as to investigate the value of differentiating patients with Stage T1c disease from all other patients with NPC-P. METHODS: The records of 2211 patients diagnosed with prostate carcinoma between 1988 and 1995 were reviewed to identify 291 men with NPC-P. TRUS and EMRI reports were analyzed with regard to the presence and laterality of hypoechoic nodules or low-signal areas reported on T2-weighted images, respectively. Ninety percent of patients (n = 262) had at least six prostate biopsies, 185 patients (64%) underwent both TRUS and EMRI, 224 (77%) had TRUS, and 251 (86%) had an EMRI study. RESULTS: Results were considered normal in 101 (47%) of 214 patients undergoing TRUS, in 58 (23%) of 249 undergoing EMRI, and in 22 (12%) of 185 undergoing both TRUS and EMRI. For the side of the prostate with positive biopsy results, correlation with imaging abnormalities was better for EMRI than for TRUS (39% versus 24%). There was no significant difference in mean PSA value, distribution of Gleason score, or unilateral versus bilateral positive biopsy results among patients with normal versus abnormal findings on both TRUS and EMRI. CONCLUSIONS: (1) Only 12% of men with NPC-P have no TRUS or EMRI abnormalities, fulfilling the criteria for Stage T1c prostate carcinoma. (2) Those patients with Stage T1c disease do not differ from patients with NPC-P up-staged by TRUS or EMRI, with regard to pretreatment PSA levels, Gleason scores, and the probability of having bilateral rather than unilateral positive biopsy results. (3) The value of classifying patients with NPC-P into Stage T1c versus higher stages of prostate carcinoma on the basis of imaging should be questioned.

Adenocarcinoma↗
PubMed1991

Measurement of systolic-diastolic ratio in the umbilical artery by continuous-wave and pulsed-wave Doppler ultrasound: comparison at different sites.

Analysis of umbilical artery flow velocity waveforms, especially systolic-diastolic (S-D) ratio, can predict some pregnancy abnormalities. Most of the earlier studies did not specify the exact segment of umbilical artery sampled. We studied 53 normal singleton pregnancies between 18-41 weeks' gestation to compare S-D ratio measurements of the umbilical artery at different sites: 1) abdominal insertion site, 2) placental insertion site, 3) mid-cord, and 4) an undetermined site. The mean S-D ratio was significantly different (P less than .01) at various segments of the umbilical artery--higher near the abdominal insertion site when compared with the mid-cord, near-placental, and undetermined sites. The S-D ratio at mid-cord was higher than at the undetermined site and the placental insertion site. The near-placental-site S-D ratio was not different from the undetermined site. A lower S-D ratio at the undetermined site may not adequately reflect the true physiologic status of the fetus. Specifying the site of measurement should be an integral part of any report, in order to describe accurately the pathophysiology of fetoplacental circulatory diseases.

Blood Flow Velocity↗
PubMed1991

Weight loss and body fat distribution: a feasibility study using computed tomography.

Computerized tomography (CT) was used to assess the effect of a loss of body weight (18.8 kg) on the size of five fat depots in 11 obese postmenopausal women: the abdominal subcutaneous and visceral depots, the pelvic subcutaneous and intrapelvic depots, and the thigh subcutaneous depot. The mean decrease in total body fat was 34 percent, with comparable decreases in total abdominal fat (33 percent) and total pelvic fat (32 percent). In the abdomen, visceral fat was reduced by 35 percent and subcutaneous fat by 33 percent. In the pelvic region, intrapelvic fat decreased by 51 percent and subcutaneous fat by 25 percent. The decrease in the size of the abdominal visceral fat depot was highly correlated with fat loss during treatment (r = 0.68). By contrast, the decrease in the size of the subcutaneous abdominal fat depot correlated less highly with fat loss. These preliminary findings suggest that obese postmenopausal women with large visceral fat depots will decrease the size of their visceral fat depots by weight reduction. This is good news since the adverse health effects of obesity are believed to be associated with visceral fat.

Adipose Tissue↗
PubMed1991

Clinical and pathologic correlation of endometrial cavity fluid detected by ultrasound in the postmenopausal patient.

A registry of ultrasound procedures spanning nearly 5 years was searched retrospectively to discover cases of endometrial cavity fluid collections in postmenopausal women. Twenty cases were identified; all medical records were available for review. One patient was lost to follow-up. Seventeen patients had surgical procedures: 11 had only a D&C, and six had a primary evaluation of laparotomy with removal of the uterus and adnexa. Five women had cancer (two ovarian, one tubal, one endometrial, and one cervical); eight women had benign gynecologic conditions, including uterine fibroids (five), ovarian serous cystadenoma (two), and cervical dysplasia (one). There were two cases of apparent subclinical pyometra. Five women had endometrial pathology consistent with prescribed hormone therapy for breast cancer (four) or endometrial hyperplasia (one).

Aged↗
PubMed1990

Nonvisualized gallbladder on oral cholecystography: implications for lithotripsy.

Currently, most protocols evaluating the efficacy of gallstone lithotripsy require a visualized gallbladder on oral cholecystography (OCG). The primary purpose of the OCG is to establish that the cystic duct is patent. When the gallbladder is visualized on OCG, it can also be used to number and size gallstones accurately. Patients with non-visualization of the gallbladder on OCG are excluded from consideration for lithotripsy. The purpose of this study was to evaluate retrospectively the ultrasonographic findings (i.e., number and sizes of stones in 32 patients with nonvisualization on the OCG). In 11 patients (34%) ultrasound (US) did not detect any stone, and it is presumed that the gallbladder failed to visualize for other reasons. Six patients (19%) had one or two stones and 15 (47%) patients had more than three stones. This suggests that 20% of patients with nonvisualization of the gallbladder on OCG would otherwise be eligible for lithotripsy provided that patency of the cystic duct can be demonstrated by other means, such as computed tomographic (CT) examination with oral biliary contrast or cholescintigraphy.

Cholecystography↗
PubMed1990

Intact stones or fragments? Potential pitfalls in the imaging of patients after biliary extracorporeal shock wave lithotripsy.

Ultrasound is used after extracorporeal shock wave lithotripsy of gallbladder stones to assess fragmentation. In many patients with apparently successful fragmentation, the posttreatment studies show an intraluminal, echogenic focus within the gallbladder, with posterior acoustic shadowing characteristic of an intact stone. Cholesterol gallstones were fragmented in vitro by means of lithotripsy, and the sonographic appearance of the fragmented stones was followed up over time to study factors that might affect the process. After lithotripsy, fragments settled and produced an echogenic focus with posterior shadowing indistinguishable from the appearance of an intact stone. These experimental observations led to the development of a clinical maneuver to overcome the diagnostic pitfalls posed by the reaggregation of stone fragments in situ. This rollover maneuver helps distinguish between intact stones and fragments, and prevents both diagnostic errors in follow-up and unnecessary retreatment.

Cholelithiasis↗
PubMed1987

Assessment of adrenal gland volume by computed tomography in depressed patients and healthy volunteers: a pilot study.

Excessive adrenocortical activation in depression has been postulated to be the result of overactivity of limbic system-hypothalamic function. In contrast, several studies have suggested the possibility that excessive secretion of cortisol might also result, in part, from a heightened adrenocortical responsiveness to adrenocorticotropic hormone (ACTH), or even a mild adrenal hyperplasia. Because computed tomography (CT) may provide a method for assessing an increase in adrenal size, we performed CT scans of the adrenal glands in depressed patients and healthy volunteers, who also received the dexamethasone suppression test. Eight out of 16 patients (50%) had adrenal volumes in excess of the 95th percentile value of the control distribution for adrenal volume. These observations suggest that there may be demonstrable adrenal hypertrophy during depressive illness.

Adrenal Glands↗
PubMed1986

Sonographic assessment of the endometrium in patients undergoing in vitro fertilization.

Sonography has an important role in the care of infertile patients undergoing in vitro fertilization. Unlike the ovarian follicle, sonographic changes in the endometrium during induction have not been extensively investigated. To determine whether changes in endometrial thickness or changes in endometrial texture would predict subsequent pregnancy, a randomized, double-blind review of 320 studies was performed. None of the endometrial patterns nor any particular change from one pattern to another during induction was predictive of subsequent pregnancy. Although differences in endometrial thickness between non-pregnant and subsequently pregnant patients were noted, on an individual basis, endometrial thickness was not a useful predictor.

Double-Blind Method↗
PubMed1985

Localization and protection of kidneys in radiation treatment planning using computed tomography.

Irradiation treatment portals of the upper abdomen must limit the dose to the kidneys. Sparing one-third of the parenchyma of each kidney will prevent late clinical sequelae. One hundred CT scans of the abdomen were studied to evaluate using the vertebrae as landmark for treatment planning. In lateral fields, using the anterior border of the vertebral column as a landmark for the posterior high isodose line will limit treatment to less than 60% (mean 22%) of a single kidney. Placing the edge of an anterior/posterior field 2 cm lateral to the vertebral column will limit the dose to less than 44% of a single kidney (mean 11%).

Adult↗
PubMed1985

Simultaneous ectopic pregnancy with intrauterine twin gestations after in vitro fertilization and embryo transfer.

A simultaneous ectopic tubal pregnancy with viable intrauterine twin gestations after IVF-ET of five fertilized eggs is presented. Pelvic ultrasound and serial quantitative hCG levels were not helpful in the diagnosis of the tubal pregnancy. The risk of multiple pregnancies and of concomitant intrauterine and extrauterine gestations increases with transfer of a greater number of embryos. Karyotype of the tubal pregnancy was normal (46,XX).

Adult↗
PubMed1985

CT in pelvic trauma.

The use of computed tomography is extremely important in the care of patients with pelvic trauma. We believe that it should be performed on all patients with severe pelvic injury. It depicts the pelvic anatomy in exquisite detail, enabling one to plan therapy on the basis of pathologic anatomy rather than the presumed mechanism of injury. CT is more expensive than tomography but gives considerably more information at a lower radiation dose. It is also of considerable value in postoperative follow-up for determination of the adequacy of reduction and fracture healing.

Acetabulum↗
PubMed1984

CT imaging of the unusually shaped bladder.

In the CT evaluation of a cystic pelvic mass it is important to identify the urinary bladder and assess its relationship to the mass. Although this is generally an easy task, we have encountered cases where delayed opacification of the bladder created diagnostic difficulties. Following intravenous contrast medium infusion, patients with normal renal function may have unopacified bladders due to (a) delayed transit from kidney to bladder and (b) rapid CT imaging of the bladder before opacification can occur. If one is aware of these problems, diagnostic dilemmas may be reduced by obtaining delayed scans of the pelvis or by obtaining postvoid films. Two cases are presented to illustrate these points.

Aged↗
PubMed1983

NMR imaging of the abdomen at 0.12 T: initial clinical experience with a resistive magnet.

Forty-five patients with a variety of abdominal abnormalities and five normal volunteers were imaged on a 0.12 T resistive nuclear magnetic resonance system. Scans were obtained with saturation-recovery technique and short repetition times. The images reflected both proton density and T1 information. A variety of neoplastic and nonneoplastic disease processes involving the abdomen were imaged. Results suggest that clinically useful images clearly may be obtained at 0.12 T. In addition, saturation-recovery imaging with short repetition rates can detect a wide range of abdominal abnormalities.

Abdomen↗
PubMed1980

Evaluation and therapy of mediastinal thymic cyst.

Two cases of mediastinal thymic cyst are presented. The clinical features of this entity are presented, as well as the case history of the 48-year-old man with an asymptomatic, calcified, cystic anterior mediastinal mass who was followed for four years without significant changes in the mediastinal lesion. Thymic cyst is an identifiable anterior mediastinal mass, in which recurrence following excision or malignant degeneration has never been reported. The risk of mediastinal exploration in a well-demarcated, anterior mediastinal cyst with calcific rim approximates or exceeds the risk of malignancy.

Adult↗