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Biomedical subjects

T K Pilgram

Publications and source records attributed to T K Pilgram.

At least 55 records · Page 3Linked to original sources
PubMed1997

Perception of postpalatoplasty speech differences in school-age children by parents, teachers, and professional speech pathologists.

The aims of this study were twofold: (1) to test the ability of parents and teachers to discriminate the speech of children with repaired cleft palate from that of their unaffected peers and (2) to compare these lay assessments of speech acceptability with the critical perceptual assessments of expert clinicians. The subjects for this study were 20 children of school age (age range, 8 to 12 years) who were drawn from a large population (n = 1282) of patients. All subjects had been referred for palatoplasty to the same tertiary cleft center between 1978 and 1991. There were 16 matched controls. The listening team included parents of subjects (n = 32) and teachers of age-matched school children (n = 12). Randomized master audiotape recordings of the study group were presented in blinded fashion to both groups of the adult raters, who were inexperienced in the evaluation of patients with speech dysfunction. An experienced panel of three extramural speech pathologists evaluated the same recordings. In all parameters rated, both parents and teachers showed a consistent tendency to give the subject children more negative ratings than the control children. Expert raters were sensitive to differences in resonance and intelligibility in the control and cleft palate groups. Results of this study differ from similar previous research, indicating that naive peer raters (similar-age children) were insensitive to speech differences in the cleft palate and control groups.

Adult↗
PubMed1997

Attachment loss with postmenopausal age and smoking.

To determine whether postmenopausal bone loss and factors associated with osteoporosis affect tooth retention, we examined vertebral and proximal femoral (postcranial) bone mineral density in relation to tooth loss and attachment loss in a cross-sectional study of 135 postmenopausal women (age range 41-70 yr). Women had at least 10 teeth and no evidence of moderate or severe periodontal disease. Full-mouth attachment loss measurements were made using a pressure-sensitive probe, and bone density was determined by dual-energy X-ray absorptiometry. Attachment loss was correlated with tooth loss (number of remaining teeth, radiologically determined), but not with vertebral or proximal femur bone density. Multivariate analysis showed current smoking (p = 0.01), years since menopause (p = 0.02) and the interaction of age and current smoking (p < 0.01), to be statistically significant predictors of attachment loss in our study population.

Absorptiometry, Photon↗
PubMed1997

Chest radiography: depiction of normal anatomy and pathologic structures with selenium-based digital radiography versus conventional screen-film radiography.

PURPOSE: To compare the subjective visibility of normal anatomy and pathologic structures in the chest on conventional screen-film radiographs versus selenium-based digital radiographs. MATERIALS AND METHODS: Screen-film and digital standard posteroanterior (PA) and lateral chest radiographs were obtained in 49 patients (32 men, 17 women; mean age, 60 years; range, 24-91 years) undergoing chest computed tomography (CT). Conventional images were phototimed at 115 kVp with use of a wide-latitude screen-film system and an antiscatter grid. Digital images were obtained at 150 kVp with use of a commercial system with a selenium detector and an air gap alone for scatter reduction. The image sets were independently compared by four radiologists, and the relative visibility of anatomic and pathologic features (proved at CT) was graded. Statistical significance (P < .0028) was evaluated with a one-tailed t test. RESULTS: Visibility with the digital images was statistically significantly increased for 11 of 13 normal anatomic features and for pathologic structures in the lung, soft tissue, and bone. CONCLUSION: Subjective visibility of pathologic structures and most normal anatomic features in the thorax was statistically significantly improved with selenium-based digital chest radiography compared with conventional screen-film chest radiography.

Adult↗
PubMed1997

Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents.

PURPOSE: To determine the effectiveness of using Wallstents to treat subclavian or brachiocephalic venous obstruction after unsuccessful angioplasty, in patients undergoing hemodialysis. MATERIALS AND METHODS: Dialysis records, radiology reports, and procedural images of 20 hemodialysis patients who underwent Wallstent insertion into a subclavian (n = 11) or brachiocephalic (n = 9) vein were reviewed. Technical success and primary, assisted primary, and cumulative patency rates were calculated. RESULTS: Twenty-three Wallstents were inserted for stenosis (n = 18) or occlusion (n = 2). Technical success was 100%. Eight patients underwent 11 reinterventions to maintain patency of the Wallstent during the follow-up period. Patency rates of the Wallstent were (a) primary at 1 month, 3 months, 6 months, and 1 year: 90%, 67%, 42%, and 25%; (b) assisted primary at 3 months, 6 months, and 1 year: 88%, 62%, and 47%; and (c) cumulative at 3 months, 6 months, 1 year, and 2 years: 89%, 64%, 56%, and 22%. Considerable shortening of the stent occurred in five patients. One occurred immediately during the deployment procedure, but four were discovered weeks to months later. No other complications occurred. CONCLUSION: After suboptimal angioplasty, treatment of subclavian and brachiocephalic vein stenoses with a Wallstent can provide continued use of a hemodialysis access. Close clinical surveillance and multiple reinterventions are necessary to maintain Wallstent patency.

Angioplasty↗
PubMed1997

Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome.

PURPOSE: To examine the relationship between preoperative radiologic findings and clinical outcome after lung volume reduction surgery. MATERIALS AND METHODS: In 50 consecutive patients, preoperative chest radiographs and computed tomographic (CT) scans were scored by four radiologists for features related to the severity and distribution of emphysema and compared with clinical improvement in forced expiratory volume in 1 second (FEV1), arterial partial pressure of oxygen, and exercise tolerance 6 months after surgery. RESULTS: In the 47 surviving patients, follow-up data showed greater postoperative improvement in function in patients with a global pattern of predominantly upper-lobe emphysema (P < .05) and in patients with a more heterogeneous distribution of emphysema, compressed lung, and a larger percentage of normal and mildly emphysematous lung (P < .05 for improvement in FEV1). Radiographic scores for individual features were more strongly correlated with outcome than CT scores. The combination of upper-lobe severity and percentage of normal and mildly emphysematous lung at CT were the strongest predictors of improvement in FEV1 (r2 = .49). The three patients who died were older (P = .05) and had more severe, diffuse emphysema compared with other patients. CONCLUSION: Imaging studies may help predict the degree of improvement and therefore should be considered an integral part of an objective patient selection process. Radiography alone may be adequate for initial screening.

Adult↗
PubMed1997

Acute cervical spine trauma: diagnostic performance of single-view versus three-view radiographic screening.

PURPOSE: To compare the diagnostic accuracy of single-view and three-view cervical spine radiographs in acute trauma. MATERIALS AND METHODS: Radiographs of 97 patients with acute cervical spine fractures were matched with those of 92 proved normal cases. Fourteen radiologists, including three senior attending radiologists each with more than 20 years of post-residency experience, four junior attending radiologists each with less than 5 years of practice experience, three senior radiology residents in their 3rd or 4th year of radiology residency, and four junior radiology residents at the end of their 1st year of radiology training, interpreted each case twice: once as a lateral-only study and again as a three-view study. Multireader-multicase receiver operating characteristic analysis was performed. Difficult cases were reviewed for trends in the errors. RESULTS: Eight of 14 readers detected fractures better with the three-view series. Among junior attending radiologists, the differences were statistically significant. Most improvements were in fractures of the dens and fractures and unilateral dislocations of the articular mass. Overall, sensitivity increased from 81.8% to 83.3%. The reliability of fracture classification improved. Less experienced readers performed better with the three-view series. CONCLUSION: A three-view screening radiographic series will allow most readers to detect a few more fractures than a single-view series. The improvements occur primarily in a subset of difficult-to-diagnose injuries.

Acute Disease↗
PubMed1997

Perfusion scintigraphy in the evaluation for lung volume reduction surgery: correlation with clinical outcome.

PURPOSE: To identify preoperative pulmonary perfusion scintigraphic findings that might be associated with clinical outcomes after lung volume reduction surgery. MATERIALS AND METHODS: Preoperative perfusion scintigrams in 103 patients (56 men, 47 women; age range, 41-76 years; mean age, 61 years +/- 9) were reviewed and graded for emphysematous heterogeneity (from isolated areas to diffuse distribution), extent of maximally perfused lung, and lobar predominance (upper-lobe vs lower-lobe asymmetry). These findings were correlated with clinical outcome on the basis of pulmonary function, arterial blood gas levels, and exercise test results before and 6 months after surgery. RESULTS: Among the 96 patients who survived surgery, there was an average improvement of 47% in the forced expiratory volume in 1 second (FEV1), of 20% in arterial oxygen tension, and of 20% in the 6-minute walking distance. Scintigraphic markers correlated best with FEV1 improvement. The strongest scintigraphic predictor of increase in FEV1 was upper-lobe predominance (r = .38, P < .001), which was followed by heterogeneity (r = .31, P = .002). The seven patients who died had a significantly lower percentage of maximally perfused lung than the survivors (25% vs 34%, P = .004). CONCLUSION: Perfusion scintigraphy can provide modest prognostic information in patients who undergo evaluation for lung volume reduction surgery.

Adult↗
PubMed1997

Personality attributions based on speech samples of children with repaired cleft palates.

OBJECTIVE: This study examined whether or not assumptions made about personality characteristics based on speech samples differed for children with repaired cleft palates (CP) versus unaffected children. DESIGN: Audiotapes of speech samples were presented in random order to blind raters. PATIENTS/PARTICIPANTS: The subjects were 20 children (10 females, 10 males) with repaired CP and 16 control (i.e., unaffected) children (8 females, 8 males). All children were 8 to 12 years of age, Caucasian, living in the St. Louis area, and lower-middle to upper-middle class. The raters were 20 (13 females, 7 males) 6th grade Caucasian students who attend a private school in the area. SETTING: Raters heard tapes in a group setting, but with individual headphones, in their school's cafeteria. MAIN OUTCOME MEASURE: Each speech sample was rated (7-point Likert scale) by each student rater on a variety of personality characteristics based on the "Big Five" personality factors. RESULTS: A factor analysis of the items revealed a two-factor solution, although the factors were highly negatively correlated. No significant differences were found between ratings for the CP sample and the control sample for either factor scale (ANOVA, p = .93; p = .67). Similarly, when the two factors were combined to form a single factor, no significant differences were found between the ratings for the CP sample and the control sample (ANOVA, p = .79). CONCLUSIONS: Overall, it does not appear that children differentially associated personality characteristics based on speech to children with repaired CP versus unaffected children, in the absence of visual input.

Analysis of Variance↗
PubMed1997

Quantification of the radial torsion angle with computerized tomography in cadaver specimens.

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).

Aged↗
PubMed1997

Doppler sonography findings associated with transjugular intrahepatic portosystemic shunt malfunction.

OBJECTIVE: Our purpose was to determine the overall accuracy of Doppler sonography and the accuracy of specific Doppler parameters associated with a compromised transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: For 43 patients who had undergone TIPS, 64 correlated sonogram-venogram paired examinations were analyzed. Sonographic parameters assessed included absolute velocities plus absolute and percentage changes in velocities measured in the main portal vein (MPV) and in several intrashunt locations (including peak and minimum velocity). Direction of flow and change in direction of flow in the left and right portal veins were also examined. TIPS malfunction was defined as any shunt with greater than or equal to 50% stenosis or any stenosis with a portosystemic gradient greater than 15 mm Hg. RESULTS: The prospective interpretation of the sonograms using all available parameters resulted in a sensitivity of 92% and a specificity of 72% for detecting TIPS malfunction. Peak shunt velocity (absolute velocity and velocity change), distal shunt velocity, MPV velocity (absolute velocity and percentage change in velocity), change in minimum shunt velocity, and direction of flow in branch portal veins were found to have statistically significant differences between normal and abnormal shunts. Sensitivities for these individual parameters ranged from 64% to 84%, and specificities ranged from 70% to 100%. When either the MPV velocity or the distal shunt velocity was abnormal, the sensitivity was 94%. When both parameters were abnormal, the specificity for detecting TIPS malfunction was 100%. CONCLUSION: Doppler sonography is a sensitive and relatively specific means of revealing TIPS malfunction. Accuracy depends on analysis of multiple sonographic parameters.

Blood Flow Velocity↗
PubMed1996

Prevalence of red marrow around the knee joint in adults as demonstrated on magnetic resonance imaging.

RATIONALE AND OBJECTIVES: We determined the prevalence of red marrow around the knee joint in adults and evaluated variations with age, gender, and other variables. METHODS: One hundred ninety-nine adult patients presenting for routine knee magnetic resonance (MR) imaging completed a questionnaire that covered age, gender, menstrual history, past pregnancies, smoking history, and medications. The presence or absence of visible red marrow in the distal femur and proximal tibia on both coronal and sagittal MR images was recorded for each patient. Associations between the presence of red marrow and the other recorded variables then were evaluated. RESULTS: Red marrow was present in more than half of the women and less than one sixth of the men, a statistically significant difference. The age distribution of red marrow in men and women also was different. Red marrow was the most common in women aged 30-60 years. In men, there was no clear-cut age trend. Red marrow also was more likely to be present in obese individuals and smokers. No association was found between the presence of red marrow and any of the other recorded variables. CONCLUSION: There are clear gender, age, obesity, and smoking-related differences in the prevalence of red marrow around the knee joint in adults. Red marrow is relatively common in this site in all age groups, and its presence should not be a cause for clinical concern.

Adolescent↗
PubMed1996

Plagiocephaly: differential diagnosis based on endocranial morphology.

Plagiocephaly is a descriptive term that connotes an asymmetrically oblique or twisted head. Such cranial dysmorphology has a number of etiologies, the most common of which are unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis. Use of the term plagiocephaly in the literature is often ambiguous in that at times it is used inclusively for all etiologies while at other times it is used exclusively as a synonym for unicoronal synostosis. Although differentiation by physical examination among unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis usually is possible for an experienced observer, inexperienced observers often have difficulty making an anatomically accurate diagnosis even with the assistance of conventional skull radiographs. High-resolution CT scans, including three-dimensional osseous surface re-formations, have become a standard element in the evaluation of craniofacial anomalies in many centers. We hypothesized that the three major etiologies of plagiocephaly could be unambiguously differentiated by means of endocranial three-dimensional CT osseous surface re-formations. Archival pretreatment CT data on 15 unicoronal synostosis, 4 unilambdoid synostosis, and 15 plagiocephaly without synostosis patients were reviewed to define, qualitatively and quantitatively, the characteristics of the endocranial base morphologies for each group; in addition to visual dysmorphology specific to each group, there was a statistically significant difference in the angle of deviation from the midlines of the anterior and posterior cranial fossae among unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis. Four radiologists experienced in reading images of craniofacial anomalies were oriented to the group characteristics and then instructed to perform differential diagnosis for each of the 34 patients using only the endocranial three-dimensional CT images. The raters were blind to all other clinical and diagnostic information. The raters correctly diagnosed unicoronal synostosis. Errors were made in differentiation of unilambdoid synostosis and plagiocephaly without synostosis. These errors resulted from the raters' reliance on image inspection rather than quantitation of anteroposterior fossae midline angulation. Such quantitation unambiguously differentiated between unilambdoid synostosis and plagiocephaly without synostosis in the "error" cases. The endocranial base dysmorphology of patients with plagiocephaly is etiology-specific for unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis. Three-dimensional CT endocranial base images can assist differential diagnosis of plagiocephaly.

Cephalometry↗
PubMed1996

Speech outcome following palatoplasty in primary school children: do lay peer observers agree with speech pathologists?

The aim of this study was twofold: (1) to test the ability of normal children to discriminate the speech of children with repaired cleft palate from the speech of unaffected peers and (2) to compare these naive assessments of speech acceptability with the sophisticated assessments of speech pathologists. The study group (subjects) was composed of 21 children of school age (aged 8 to 12 years) who had undergone palatoplasty at a single cleft center and 16 matched controls. The listening team (student raters) was composed of 20 children who were matched to the subjects for age, sex, and other variables. Randomized master audio-tape recordings of the children who had undergone palatoplasty were presented in blinded fashion and random order to student raters who were inexperienced in the evaluation of patients with speech dysfunction. The same sound recordings were evaluated by an experienced panel of extramural speech pathologists whose intrarater and interrater reliabilities were known; they were not direct care providers. Additionally, the master tape was presented in blinded fashion and random order to the velopharyngeal staff at the cleft center for intramural assessment. Comparison of these assessment methodologies forms the basis of this report. Naive raters were insensitive to speech differences in the control and cleft palate groups. Differences in the mean scores for the groups never approached statistical significance, and there was adequate power to discern a difference of 0.75 on a 7-point scale. Expert raters were sensitive to differences in resonance and intelligibility in the control and cleft palate groups but not to other aspects of speech. The expert raters recommended further evaluation of cleft palate patients more often than control patients. Speech pathologists discern differences that the laity does not. Consideration should be given to the utilization of untrained listeners to add real-life significance to clinical speech assessments. Peer group evaluations of speech acceptability may define the morbidity of cleft palate speech in terms that are most relevant to the patients themselves and may safeguard against the possibility of offering treatment that may be unnecessary.

Child↗
PubMed1996

Evaluation of coagulation tests as predictors of angiographic bleeding complications.

PURPOSE: To determine whether prothrombin time (PT), partial thromboplastin time (PTT), and platelet count are useful predictors of postangiographic hematoma. MATERIALS AND METHODS: The authors prospectively studied 1,000 consecutive patients who underwent femoral arterial puncture for a diagnostic or therapeutic vascular procedure. Demographic and procedural variables were recorded, including patient age and sex, history of medications and bleeding, procedure type and length, catheter size, and experience level of radiologist applying compression for hemostasis. RESULTS: Abnormal results of coagulation tests were not correlated with an increased occurrence of hemorrhagic complications, but bleeding complications did occur more often in patients with thrombocytopenia. Hematomas occurred in 8.1% (10 of 123) of patients with any abnormal coagulation test results and 9.7% (85 of 877) of patients with normal test results. A platelet count of less than 100 X 10(9)/L was correlated with a higher occurrence of hematoma (P = .002). CONCLUSION: Abnormal PT and PTTs do not correlate with an increased risk of postangiographic hematoma, but a low platelet count is associated with more bleeding complications.

Adolescent↗
PubMed1996

Effect of exposure variation on the clinical utility of chest radiographs.

PURPOSE: To study the effects of exposure error on the clinical utility of chest radiographs. MATERIALS AND METHODS: Under- and overexposed screen-film images were simulated by adding exposure offsets to the normalized CR log(10) exposure data from a computed radiography (CR) system and printed by using the sensitometric response of a medium-latitude system. The clinical utility of the overall image, lung, and soft tissue in 48 images were independently graded by eight radiologists. RESULTS: Most variability in image scores was due to differences in exposure. About 95% of the lung regions and 75% of the soft-tissue regions were rated as having good or ideal clinical utility at the nominal exposure. About 80% of the overall images were rated as good or better for exposures within 40% [0.15 log(10) exposure] of the nominal. The overall image scores were heavily influenced by the lung region, and reader tolerance for exposure error was greater for soft tissue than for lung. The optimal exposure for soft tissue was about 60% [0.25 log(10) exposure] greater than for lung; therefore, no single exposure was optimal for the entire image. CONCLUSION: Conventional medium-latitude screen-film systems have intrinsic limitations for capturing and displaying the wide transmittance differences in the thorax. The clinical utility of chest radiographs may be improved by developing better image capture and display techniques.

Adult↗
PubMed1996

Invasive breast cancer: mammographic measurement.

PURPOSE: To establish the accuracy of mammographic measurement of tumor size for invasive carcinoma. MATERIALS AND METHODS: For 85 invasive cancers, mammographic tumor size was determined as the largest dimension observed on any mammographic projection (craniocaudal, lateral, or mediolateral oblique). This was then compared with the largest tumor dimension in the gross specimen. RESULTS: The relationship between the mammographic size and the pathologic size was almost exactly 1:1, with low variability. Mammographic measurements were larger by an average of about 1 mm. Neither breast parenchymal pattern nor the presence of accompanying ductal carcinoma in situ affected accuracy. CONCLUSION: Mammography can allow tumor size to be measured accurately and can be used as an alternative when pathologic staging is not possible.

Breast Neoplasms↗
PubMed1996

Surgeons' decision making in patients with chronic wrist pain: role of bilateral three-compartment wrist arthrography--prospective study.

PURPOSE: To determine if wrist arthrography changes surgeons' diagnoses and treatment plans for patients with chronic wrist pain. MATERIALS AND METHODS: Bilateral, three-compartment wrist arthrography was performed in 64 patients. Prospective questionnaires evaluated surgeons' diagnoses and management plans at three stages: before arthrography, after arthrography of the symptomatic wrist, and after arthrography of the asymptomatic wrist. RESULTS: Surgeons tended to plan more conservative management after receiving the results of arthrography. The number of patients for whom the reported treatment plan included surgery dropped from 28 of 64 patients (44%) to 19 of 64 patients (30%) after review of the arthrography results (P = .05). The number of patients for whom the treatment plan included treatment of any kind dropped from 55 of 64 patients (86%) to 49 of 64 patients (77%) after review of the arthrography results (P = .09). An overall change in treatment plan occurred in 29 of 64 patients (45%). CONCLUSION: Wrist arthrography influences surgeons' decision making. After reviewing the results of arthrography, surgeons tended to change treatment plans toward more conservative, less invasive treatment.

Adult↗