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Biomedical subjects

T J Barloon

Publications and source records attributed to T J Barloon.

At least 19 recordsLinked to original sources
PubMed1998

Teaching physical examination of the adult liver with use of real-time sonography.

RATIONALE AND OBJECTIVES: The authors developed and evaluated an approach to teaching examination of the liver that incorporates real-time ultrasound (US) imaging as immediate feedback to improve diagnostic accuracy. MATERIALS AND METHODS: Second-year medical students participating in a course in physical examination were assigned to receive instruction in measuring liver span without (group 1) or with (group 2) real-time sonography. Students from each group attended a practice session given by one of two physicians who were board certified in radiology and internal medicine with special expertise in US. During the practice session for group 2, students were shown the boundaries of the liver of the practice patient with real-time US. Both groups of students then made three measurements each of the liver span of a healthy practice patient and a single healthy test patient without US. The vertical liver span reference standard was determined by one of the authors. RESULTS: Students in group 2 showed greater accuracy in measuring liver span during both the practice and the test sessions than did students in group 1. The differences were significant for the third practice measurement and all three test measurements (P < .05). CONCLUSION: The use of real-time US as an aid in teaching physical examination improves students' accuracy in measuring liver size.

Adult↗
PubMed1997

Diagnostic imaging of lower limb deep venous thrombosis.

Lower limb deep venous thrombosis is a common clinical disorder that can lead to fatal pulmonary emboli and postphlebitic syndrome. The clinical evaluation for deep venous thrombosis has been found to be useful in nonhospitalized patients, but a low-cost, easily available technique to confirm the presence of lower limp thrombi is still needed. Doppler ultrasound examination with compression has emerged as the diagnostic imaging study of choice for most patients. Contrast venography, magnetic resonance imaging or radionuclide scintigraphy may be useful in selected patients.

Algorithms↗
PubMed1997

Charles Darwin and panic disorder.

Charles Darwin (1809-1882) suffered from a chronic illness that, throughout much of his adult life, impaired his functioning and severely limited his activities. The writings of this famous scientist as well as biographical materials indicate that he probably suffered from an anxiety disorder. His symptoms, when considered individually, suggest a variety of conditions, but taken together they point toward panic disorder with agoraphobia. This diagnosis brings coherence to Darwin's activities and explains his secluded lifestyle, including difficulty in speaking before groups and meeting with colleagues.

Agoraphobia↗
PubMed1997

Normal lower limb venous Doppler flow phasicity: is it cardiac or respiratory?

OBJECTIVE: The purposes of this study were to determine the origin and nature of normal lower limb venous Doppler flow phasicity and to assess normal and respiratory variations. SUBJECTS AND METHODS: The common femoral veins of 12 healthy volunteers (three men and nine women; age range, 21-50 years; mean, 29 years) were evaluated by detailed spectral Doppler examinations with simultaneous ECG and respirometric tracings. The examinations were performed using a 5- or 7-MHz linear-array transducer with breath held in mid respiration, at the end of deep expiration, at the end of deep inspiration, during Valsalva's maneuver, and during quiet and deep breathing. The tracing obtained during breath-hold in mid respiration was considered the baseline. Tracings obtained during the other respiratory phases were analyzed for changes from the baseline. Doppler tracings were analyzed for phasicity, waveform frequency, components, velocities, velocity ratios, and presence of retrograde flow, all in correlation with simultaneous ECG and respirometric tracings. Tracings were analyzed independently by two observers to assess interobserver variability. RESULTS: With breath-hold in mid respiration, the common femoral vein Doppler tracings consisted of multiphasic waveforms that had a frequency similar to that of the heart rate. Each waveform consisted of systolic, v, diastolic, and a waves. The systolic wave occurred 0.4 sec later than the QRS complex of the ECG and was always antegrade. The v wave was always retrograde without flow reversal. The diastolic wave was always antegrade. The a wave was always retrograde but showed flow reversal in nine of 12 subjects. The systolic:diastolic velocity ratio ranged from 0.9 to 1.5 (mean, 1.1). The minimum:maximum velocity ratio ranged from -0.4 to 0.2 (mean, -0.15). With breath-hold at the end of expiration, the waveforms became slightly damped, becoming biphasic in five subjects and remaining multiphasic in seven. With breath-hold at the end of inspiration, the waveforms became nonphasic or biphasic in nine and decreased in velocity in 12. With Valsalva's maneuver, flow stopped. With normal respiration, cardiac waveforms were modulated by higher amplitude and less frequent biphasic respiratory waves. The plasticity was equal in two, dominantly cardiac in six, and dominantly respiratory in four. Flow velocity increased with expiration and decreased with inspiration. With deep breathing, the respiratory waves further increased, while the cardiac ones decreased in amplitude. The latter continued to modulate the respiratory phasicity in 10 subjects. CONCLUSION: During quiet respiration, lower limb venous Doppler tracings consisted of both cardiac and respiratory waveforms. Although respiratory waveforms disappeared when patients held their breath, Doppler tracings continued to be multiphasic and cardiac. Therefore, cardiac phasicity in lower limb venous Doppler tracings does not necessarily indicate cardiac disease. Other respiratory phases can modulate this basic cardiac pattern. Decrease in or loss of phasicity in these waveforms does not always mean proximal obstruction, because it can be caused by respiratory factors. Finally, the presence of minimal cyclic retrograde flow that is 5 cm/sec or less does not necessarily indicate cardiac disease.

Adult↗
PubMed1997

Diagnostic imaging in the evaluation of constipation in adults.

Acute and chronic constipation are common conditions. In most instances, a thorough history and digital rectal examination provide sufficient information to begin treatment. Occasionally, imaging studies can be useful to confirm the presence of a suspected abnormality. The acute onset of constipation suggests colonic obstruction. Plain abdominal radiographs may be sufficient to determine the level and cause of the obstruction, such as sigmoid or cecal volvulus. Barium enema radiographic examination or colonoscopy may also be useful to detect the cause of obstruction. In patients with chronic constipation, plain abdominal radiographs can be used to show the extent of fecal impaction. Colonic transit time can be assessed on serial abdominal radiographs after the patient has ingested radiopaque markers. Evacuation proctography can be used to diagnose a variety of functional disorders of the rectum and anus, such as rectocele, intussusception and abnormal perineum floor descent.

Acute Disease↗
PubMed1996

The role of diagnostic imaging in women with breast implants.

Women who have undergone augmentation mammoplasty with silicone gel implants may present for routine breast cancer screening or with palpable breast lumps. Conventional mammography supplemented by additional displaced or Eklund view is usually sufficient to detect most abnormalities. Ultrasonographic evaluation may be performed as an ancillary technique to characterize palpable lumps or nonpalpable lesions detected on mammography. In patients suspected of having implant rupture, conventional mammography and displaced views are performed. If clinical findings warrant, magnetic resonance imaging may be performed to detect intracapsular and extracapsular rupture and migration of silicone globules to the axilla, branchial plexus and adjacent structures.

Breast↗
PubMed1996

Transvaginal ultrasonography in nonpregnant and postmenopausal women.

Compared with transabdominal pelvic ultrasonography, transvaginal ultrasonography provides improved resolution for visualization of female pelvic organs, with less artifact. Transvaginal ultrasonography has superseded the transabdominal approach in many situations. Identification of uterine and adnexal masses can be facilitated with use of transvaginal ultrasonography. Transvaginal ultrasonography is also useful in the evaluation of pelvic pain and suspected pelvic inflammatory disease. Postmenopausal patients with vaginal bleeding or a palpable ovary can be triaged on the basis of transvaginal ultrasonographic findings, avoiding invasive diagnostic procedures in selected patients. Screening average-risk patients for ovarian cancer is not an accepted indication for transvaginal ultrasonography at this time.

Diagnosis, Differential↗
PubMed1996

Diagnostic imaging in the evaluation of dysphagia.

Evaluation of dysphagia is a challenge commonly encountered by family physicians. Dysphagia may be classified as either the oropharngeal type or the esophageal type and may have a variety of etiologies. Possible causes of oropharyngeal dysphagia include Zenker's diverticulum, pharyngeal carcinoma, pharyngeal webs and strictures, lateral pharyngeal pouches and neuromuscular diseases. Esophageal dysphagia can be caused by esophageal carcinoma, esophageal stricture and webs, achalasia, diffuse esophageal spasm and scleroderma, caustic esophagitis and infectious esophagitis. Studies using different textures of barium allow evaluation of the swallowing mechanism. Static images are obtained to evaluate the integrity of the mucosa.

Algorithms↗
PubMed1996

Pulsatile lower limb venous Doppler flow: prevalence and value in cardiac disease diagnosis.

The purpose of this study was to assess the frequency and significance of pulsatile Doppler waveforms in lower limb veins. We used Doppler sonographic data from the common femoral vein. In the first of two groups, the findings in 250 patients were correlated with the presence of cardiac decompensation on concurrent chest radiographs. In the second group, the findings in 81 patients were correlated with the presence of tricuspid regurgitation on Doppler echocardiograms. A venous Doppler sonographic examination was considered normal if spontaneous anterograde phasic flow was present and pulsatile if flow had a cyclic retrograde component. In group 1, 21% had pulsatile waveforms whereas 24% had cardiac decompensation. In group 2, 36% had pulsatile waveforms and 43% had tricuspid regurgitation. A statistically significant correlation was found between the presence of these abnormal waveforms and cardiac decompensation or tricuspid regurgitation, with sensitivities of 57% and 54%, specificities of 91% and 78%, positive predictive values of 66% and 66%, negative predictive values of 87% and 69%, and accuracies of 82% and 68%, respectively. In a subgroup of 55 patients who had both tests for correlation and in whom both were in agreement, the sensitivity of venous Doppler sonographic examination for detecting pathologic cardiac conditions was 79%, specificity was 87%, positive predictive value was 83%, negative predictive value was 84%, and accuracy was 84%. In 77 patients with pulsatile waveforms, including 24 without concurrent chest radiographs or echocardiograms, 63 (82%) had no prior history of cardiac disease. When correlated separately with chest radiograph or Doppler echocardiography, the test is not very sensitive in the diagnosis of cardiac disease; however, when both correlating tests are performed and are in agreement, all diagnostic parameters of the venous Doppler sonographic test, including sensitivity, become fairly high. The presence of pulsatile lower limb venous Doppler flow should alert the sonologist that a pathologic cardiac condition may be the culprit, especially in patients who have no such prior diagnosis.

Adolescent↗
PubMed1996

Diagnostic imaging of patients with acute scrotal pain.

Common causes of acute scrotal pain include testicular torsion, epididymo-orchitis and trauma. Epididymitis in adult men is typically associated with a history of urinary tract infection or prostatitis. Testicular torsion typically presents in young adults with a sudden onset of severe scrotal pain and, frequently, a history of recurrent episodes that have spontaneously resolved. With scrotal trauma, ultrasound may demonstrate testicular fracture, hematoceles and areas of hemorrhage or testicular infarction. Since both epididymitis and testicular torsion present with scrotal pain and swelling, and may be accompanied by fever and pyuria, Doppler ultrasound or radionuclide imaging may be necessary to make the diagnosis. In acute testicular torsion, color Doppler ultrasound shows absent flow to the epididymis and testis, while nuclear imaging shows central photon-deficient areas in the ischemic hemiscrotum. In epididymo-orchitis, color Doppler ultrasound shows increased flow to the epididymis and testis, while nuclear imaging shows increased perfusion of the affected testis and hemiscrotum.

Acute Disease↗
PubMed1996

Diagnostic imaging in the evaluation of blunt abdominal trauma.

Blunt abdominal trauma is a common cause of death and nonfatal injury. Diagnostic imaging may provide useful information in hemodynamically stable patients. In addition, patients who are comatose may benefit from imaging when intra-abdominal findings would change the course of clinical management. Computed tomographic scanning of the abdomen usually provides accurate information and may allow the physician to determine whether observation or surgery is warranted.

Abdominal Injuries↗
PubMed1996

Diagnostic imaging to identify the cause of jaundice.

Imaging studies can be helpful in identifying the etiology of conjugated (direct) hyper-bilirubinemia. An elevated direct bilirubin level suggests obstructive jaundice, and ultrasound or computed tomographic (CT) imaging may identify the responsible structural lesion. Imaging can also be used to guide percutaneous biopsy. A cost-effective strategy for determining the cause of direct hyperbilirubinemia rests on ultrasound as the primary modality. Endoscopic retrograde cholangiopancreatography and CT are performed as follow-up studies only when necessary. Magnetic resonance imaging is rarely useful.

Adult↗
PubMed1995

Medical malpractice involving radiologic colon examinations: a review of 38 recent cases.

OBJECTIVE: Our purposes were to determine the causes of malpractice claims against radiologists performing contrast examinations of the colon and to design strategies to reduce litigation and diminish patient morbidity. MATERIALS AND METHODS: Reports of malpractice claims were collected from legal journals and databases between 1985 and 1994. For this period, 38 plaintiffs raised 52 allegations of malpractice that involved radiologists performing barium or Hypaque (meglumine diatrizoate; Winthrop Pharmaceuticals, New York, NY) colon examinations. For the 38 cases, 18 plaintiffs for decedents alleged that failure to diagnose colorectal cancer by barium enema examination caused delay in treatment and the patient's death. Eighteen plaintiffs alleged that improper performance of barium (17 cases) or meglumine diatrizoate (one case) colon examinations caused perforation of the colon, resulting in significant morbidity (15 cases) or death (three cases). Miscellaneous causes for malpractice claims were recorded in two cases. RESULTS: In 18 cases of failure to diagnose colorectal cancer, the initial radiographs were interpreted as follows: normal findings in 14 cases, diverticulosis in one case, and spastic bowel in two cases; in the remaining case, colon cancer was missed because of nonopacification of the cecum. In retrospect, 17 of 18 colorectal cancers were visualized. The delay in the diagnosis of colorectal cancer ranged from 5 to 72 months. Missed colorectal cancers occurred in the cecum (two cases), transverse colon (two cases), rectosigmoid area (nine cases), or unspecified area (five cases). In 18 cases of colon perforation, the site was the cecum (one case), transverse colon (one case), extraperitoneal rectum (seven cases), rectosigmoid area (one case), colostomy stoma (two cases), or unspecified area (six cases). One patient experienced anaphylactic shock that required hospitalization. One underwent unnecessary surgery because barium enema films showing colon cancer were mislabeled with her name. CONCLUSION: On the basis of our analyses of malpractice claims, we suggest strategies to prevent medicolegal litigation. Strategies include communicating with the patient about the type and indications of the barium enema examination, performing digital rectal examinations on all patients to detect distal rectal lesions or strictures, recognizing colon perforation, and obtaining immediate surgical consultation if colon perforation occurs. The number of missed colon cancers may be reduced by reading twice or reviewing at a later time all barium enema examinations.

Adult↗
PubMed1994

Predictive value of normal endovaginal sonography in excluding disease of the female genital organs and adnexa.

Endovaginal sonograms of all patients that were interpreted normal during 1990 (12 months) were reviewed. Fifty-nine patients with normal EVS (age range, 18 to 63 years; average, 35 years) were followed either clinically for at least 12 months (average, 23 months) (N = 33) or until a definite diagnosis was established by a definitive procedure (N = 26). Of the 33 patients followed clinically, a definite diagnosis was established in nine, whereas in the remaining patients the symptoms resolved without further evaluation. Of the 26 undergoing definitive procedures, a diagnosis was established (six patients) or the procedure revealed normal pelvic organs (20 patients). A missed diagnosis on EVS was defined as failure to see pathologic lesions in the female pelvic genital organs or adnexa. According to our definition, five lesions were missed by EVS. The negative predictive value from a normal EVS was 92%, using patient outcome as the reference standard.

Adnexal Diseases↗