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Biomedical subjects

R Kedar

Publications and source records attributed to R Kedar.

11 recordsLinked to original sources
PubMed2003

Vaginal evisceration long after vaginal hysterectomy.

BACKGROUND: Vaginal evisceration can take place many years after vaginal surgery. CASE: An 87-year-old woman presented with evisceration of small bowel through the vagina, 15 years after she underwent a vaginal hysterectomy. On physical examination, her vital signs were normal. Forty centimeters of small bowel was visible emerging from the vagina, appearing viable and nonedematous. Because of the high surgical risk, the bowel was replaced and the defect in the vaginal wall was repaired transvaginally. CONCLUSION: Vaginal evisceration can be treated by a transvaginal surgical approach. Factors such as the medical condition of the patient and the viability of the herniated viscus should dictate the optimal approach in each case.

Aged↗
PubMed1999

Periodic, profound peripheral vasoconstriction--a new marker of obstructive sleep apnea.

We report a novel approach to the determination of sleep apnea based on measuring the peripheral circulatory responses in a primary condition of disordered breathing. The apparatus is a finger plethysmograph coupled to a constant volume, variable pressure, pneumatic system. The plethysmograph's tip (measurement site) is composed of two parallel opposing longitudinal half thimbles, which is attached to a contiguous annular cuff. Each compartment consists of an internal membrane surrounded by an outer rigid wall. These provide a uniform pressure field and impart a two-point locking action preventing axial and longitudinal motion of the finger. Subdiastolic pressure is applied to prevent venous pooling, engorgement, and stasis, to inhibit retrograde venous shock wave propagation and partially unload arterial wall tension. The annular cuff extends the effective boundary of the pressure field beyond the measuring site. In 42 patients with Obstructive Sleep Apnea Syndrome (OSAS) profound, transient vasoconstriction and tachycardia usually of a periodic nature, were clearly seen with each apneic event, possibly related to transient arousal. Good agreement was found between standard total apnea-hypopnea scoring, 129.5+/-22.4 (Mean +/- SEM), and transient vasoconstriction and tachycardia events, 121.2+/-19.4 (R = .92, p<.0001). We conclude that the finger tip exemplifies the scope of peripheral vascular responsiveness due to its high density of alpha sympathetic innervation, and its high degree of blood flow rate lability. Given that elevated peripheral resistance and tightly linked transient heart rate elevation is a consistent part of the hemodynamic response to arousal and OSAS, we believe that pulsatile finger blood flow patterns can be clearly diagnostic of OSAS and other sleep-disordered breathing conditions.

Constriction, Pathologic↗
PubMed1996

Color doppler in the diagnosis of the gastroesophageal reflux in children: comparison with pH measurements and B-mode ultrasound.

Eighty-four high risk children were examined for suspected gastroesophageal reflux comparing 24-h esophageal pH measurements with ultrasound (US) scans with and without the use of color Doppler (CD). In 83.3 % of the patients there was unequivocal agreement (reflux or no reflux) among all three techniques; 60.7 % of the children showed reflux by pH-metry as compared to 51.2 % by B-mode US and 59.5 % by CD US. In 87 % of patients there was agreement between pH-metry and B-mode US as compared to 94 % between pH-metry and CD US. The sensitivity of reflux detection increased from 84.4 % to 98 % when CD was added to B-mode US. This improvement was thought to be due to the higher sensitivity of CD for rapid and small quantities of reflux. The small number of discrepancies between pH-metry and CD US is probably due to the inability of the former to detect neutral reflux of contents or short duration (< 30 s), while CD US may miss some cases of acid reflux due to the short time of the examination (10 min). The addition of CD increases the sensitivity of US for detecting reflux. This rapid, easy and reliable method can be used to screen high risk populations when reflux is thought to be the cause of respiratory symptoms.

Child↗
PubMed1995

Detection of increased blood flow to the affected arm in repetitive strain injury with radionuclide and Doppler ultrasound studies. A case report.

A case of clinically diagnosed repetitive strain injury was referred for investigation to rule out the possibility of an occult bone disease. The patient was a female keyboard operator who had pain and tenderness over the flexor muscles of the right hand and arm. The pain was severe and almost constant. The authors observed an increase in Tc-99m MDP delivery to the affected forearm during the dynamic sequence of a three-phase bone scintigram, indicating increased blood flow compared to the contralateral side. The same result was achieved using quantitative blood flow measurements with the Doppler technique and Tc-99m HMPAO perfusion imaging. These findings agree with recent studies that suggest increased total arm blood flow in repetitive strain injury and may provide an easy screening method.

Adult↗
PubMed1995

Adaptive speckle reduction for improving the differential diagnosis of breast lesions.

Adaptive speckle reduction could mask diagnostic features and adversely affect diagnosis of focal breast lesions. Four radiologists assessed focal breast lesions (29 malignant and 31 benign) by blind review of representative static B-mode scans before and after adaptive speckle reduction processing, scoring 14 diagnostic features for breast cancer and recording their opinions on the diagnosis and on how adaptive speckle reduction affected interpretation of each feature. No adverse affect on diagnosis of malignant (P = 0.756) or benign (P = 1.000) breast lesions was found, despite some differences in scoring of the diagnostic features after adaptive speckle reduction. Observer recognition of most diagnostic features was easier after adaptive speckle reduction (e.g., edge definition [50% of cases], edge regularity [40%], lesion texture [44%], and lesion echogenicity [35%]).

Adult↗
PubMed1993

Cellular versus vascular rejection in transplant kidneys. Correlation of radionuclide and Doppler studies with histology.

The presence of two distinct subtypes of renal allograft rejection are well documented by histological studies. The differentiation between vascular rejection (VR) and cellular rejection (CR) is essential for proper management by avoiding the need for unnecessary and potentially harmful immunosuppressive treatment of VR. A histological pattern with features that are similar and confusable with some cases of rejection may be seen in cyclosporin A toxicity (CyT). To evaluate the efficiency of Guy's perfusion index (GPI) and the Doppler pulsatility index (DPI) in differentiating these two histological subtypes, a prospective study was designed in which a total of 140 radionuclide tests and 133 ultrasounds scans performed on the same day on 58 patients during the first 3 months post-transplant were analysed, and the results correlated with the histological findings of 84 renal biopsies. Results show that the GPI had a sensitivity of 86.5% and a specificity of 94% in differentiating VR and CyT from CR, while the DPI had values of 83% and 69%, respectively. Chi-squared analysis showed a higher significant association between the GPI and histology (P < 0.0001) compared to that of the DPI and histology (P < 0.005), while Youden's index (J) showed a significant difference (P < 0.05) between GPI and DPI. It is concluded that GPI is more sensitive and specific than DPI in differentiating transplants that are well perfused from those with poor perfusion (VR and CyT).

Adult↗
PubMedDate not supplied

[Color coded Doppler ultrasound in diagnosis of gastroesophageal reflux].

We report the possibility to detect small gastro-oesophageal refluxes by means of colour coded Doppler(CD)ultrasonography. The choice of an adequate pulse repetition frequency, which coded velocities up to 30 cm/s into colour without aliasing phenomenon, is an important premise for a colour coded proof of reflux. The sensitivity has been increased from 87% to 94% in sonographically detection of reflux, if the results are compared with the pH metry, measured about 24 hours. It is shown by comparison of the three methods (B-mode-, CD-ultrasonography and 24 hours pH-monitoring), that there are in each case equal false negative and false positive results. So the over all agreement was just 83% of all three methods. In our opinion it should be performed an additional ultrasonography in completion to the customary pH metry, which can detect even short term and pH neutral refluxes. If it is used supplementary, the colour coded Doppler ultrasonography improves the diagnostic sensitivity especially in trifle refluxes.

Child↗