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Biomedical subjects

T K Pilgram

Publications and source records attributed to T K Pilgram.

At least 73 records · Page 4Linked to original sources
PubMed1996

Evaluation of selective wrist arthrography of contralateral asymptomatic wrists for symmetric ligamentous defects.

OBJECTIVE: The objective of this investigation was to study the role of selective wrist arthrography of the asymptomatic wrists of patients with unilateral wrist pain and the efficacy of three-compartment and selective-compartment injections of contrast medium into the asymptomatic wrist in demonstrating symmetric and asymmetric intercarpal ligament and triangular fibrocartilage communicating defects. SUBJECTS AND METHODS: Wrist arthrography with bilateral three-compartment injections was performed for 62 patients with unilateral wrist pain. The numbers of bilateral intercarpal ligament and triangular fibrocartilage communicating defects were recorded. The results obtained with three-compartment injections in each wrist of these patients were compared with those obtained with single-compartment injections. RESULTS: Bilateral three-compartment injections identified 110 communicating defects (59 in the symptomatic and 51 in the asymptomatic wrists). Midcarpal injections showed all 36 scapholunate and lunatotriquetral ligament defects that were also shown by three-compartment injections in asymptomatic wrists. However, only 26 (72%) of these 36 ligament defects were shown by radiocarpal injections. No single-compartment injection showed all triangular fibrocartilage defects that were shown by three-compartment injections. Ten bilateral symmetric triangular fibrocartilage communicating defects were shown by three-compartment injections. All 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by radiocarpal injections. However, only five of the 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by injection of the distal radioulnar joints. CONCLUSION: Selective midcarpal injection of an asymptomatic wrist showed all matching defects in that wrist when only intercarpal ligament defects were found in the symptomatic wrist. Similarly, selective radiocarpal injection of an asymptomatic wrist showed all matching defects of the triangular fibrocartilage in that wrist. In either situation, routine injection of all three compartments of the asymptomatic wrist should not be necessary.

Adolescent↗
PubMed1995

Dynamic contrast-enhanced MR imaging of the liver: parenchymal enhancement patterns.

A retrospective study of 164 patients undergoing dynamic contrast-enhanced magnetic resonance (MR) imaging was performed to assess hepatic parenchymal enhancement patterns and to correlate these patterns with hepatic function and disease. Rapid T1-weighted images were acquired before and after gadolinium administration. Hepatic enhancement patterns were analyzed blindly by two observers. Medical records were reviewed to document known liver pathology and liver function test results. A total of 72% of patients had homogeneous enhancement of the liver parenchyma; 28% had heterogeneous enhancement. Of the latter group, 61% of patients had enhancement conforming to segmental or lobar boundaries. Patients with heterogeneous enhancement patterns were more likely to have abnormal liver function test results and hepatic morphological abnormalities on their MR examinations than patients with homogeneous enhancement patterns. Heterogeneous hepatic enhancement on dynamic MR images is associated with a higher likelihood of liver disease and biochemical evidence of hepatic dysfunction than homogeneous enhancement.

Adult↗
PubMed1995

Transfusion requirements for craniosynostosis surgery in infants.

Retrospective review of the records of 73 consecutive young children who underwent craniosynostosis surgery between 1978 and 1992 in one center was conducted to determine transfusion requirements, to document morbidity, and to identify causative variables associated with transfusion. Operative age and weight, affected suture(s), craniofacial surgeon, neurosurgeon, anesthesiologist, preoperative and postoperative hematocrit, and transfusion volumes of blood and crystalline products were recoded. Transfusion volumes were converted to percent estimated red cell mass for analysis. Affected sutures were unicoronal (22), sagittal (17), bicoronal (11), multiple (11), metopic (10), and lambdoid (2). Mean operative age was 6.4 months. Mean preoperative hematocrit was 34 percent. Eighty percent of patients were discharged with hematocrit of 29 percent or greater. Discharge hematocrit was unrelated to year of surgery. Mean intraoperative transfusion was 72.1 +/- 56.6 percent estimated red cell mass. Transfusions differed statistically among suture(s), neurosurgeons, and anesthesiologists. Extensive cranio-orbital surgery for synostosis in young children does not produce excessive hemorrhage or transfusion morbidity. The anesthesiologist and neurosurgeon may be equally or more important than the affected suture(s) as causal variables in transfusion.

Blood Loss, Surgical↗
PubMed1995

Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty.

PURPOSE: To determine the distribution of stenoses and results of angioplasty in patients with similar forearm dialysis grafts made of polytetrafluoroethylene (PTFE). MATERIALS AND METHODS: Diagnostic radiographs of the fistula obtained in 215 patients were reviewed; 90 patients had similar, unrevised forearm PTFE loop dialysis grafts. The location, morphology, and results of angioplasty were reviewed for each measurable stenosis. Surgical, radiologic, and dialysis records were reviewed to document the subsequent patency rate of each patient's dialysis access. RESULTS: On the initial diagnostic fistulogram, 93 stenoses were identified. The anatomic distribution included 47% at the venous anastomosis and 11% within 1 cm of the anastomosis. Life table analysis revealed a 6-month patency rate of 63% and a 1-year patency rate of 41% for the first angioplasty in a given graft, and a 6-month patency rate of 44% and a 1-year patency rate of 22% [corrected] for the second angioplasty. CONCLUSION: Performance of serial venous angioplasty procedures may help prolong the life of a graft, but the patency rates diminish with subsequent interventions.

Aged↗
PubMed1995

Lung transplant edema: chest radiography after lung transplantation--the first 10 days.

PURPOSE: To determine the imaging spectrum and clinical correlates of lung transplant edema within the first 10 days after lung transplantation. MATERIALS AND METHODS: The study group consisted of 105 consecutive lung transplant recipients. Lung infiltrates on chest radiographs were scored and characterized. Findings that satisfied the accepted description of reperfusion edema were identified. Lung ischemia times and the clinical or biopsy diagnosis of acute rejection were correlated with radiographic findings. RESULTS: Lung infiltrates compatible with reperfusion edema were seen in 97% of transplanted lungs without a demonstrable correlation with lung ischemia times. Lung scores between groups of patients treated and not treated for acute rejection were not statistically significantly different. CONCLUSION: The spectrum of findings attributable to lung transplantation or reperfusion edema is variable and diminishes the use of chest radiography as an early postoperative modality for monitoring acute rejection.

Adult↗
PubMed1995

Do palatal lift prostheses stimulate velopharyngeal neuromuscular activity?

The purpose of this investigation was to evaluate the ability of palatal lift prostheses to stimulate the neuromuscular activity of the velopharynx. Nasendoscopic evaluations were audio-videotaped preprosthetic and postprosthetic management for 25 patients who underwent placement of a palatal lift prosthesis for velopharyngeal dysfunction (VPD). These audio-videotapes were presented in blinded fashion and random order to three speech pathologists experienced in assessment of patients with VPD. They rated the tapes on the following parameters: VP gap size, closure pattern, orifice estimate, direction and magnitude of change, and qualitative descriptions of the adequacy of VP closure during speech. VP closure for speech was unchanged in 69% of patients and the number of patients rated as improved or deteriorated was nearly identical at about 15%. Postintervention gap shape remained unchanged in 70% of patients. The extent of VP orifice closure during speech remained unchanged in 57% of patients. Articulations that could impair VP function improved in 30% of patients, deteriorating in only 4%. Results of this study neither support the concept that palatal lift prostheses alter the neuromuscular patterning of the velopharynx, nor provide objective documentation of the feasibility of prosthetic reduction for weaning.

Adolescent↗
PubMed1994

Binary nature and radiographic identifiability of craniosynostosis.

RATIONALE AND OBJECTIVES: Two independent gold standards and diagnoses from three-dimensional computed tomography (CT) images were used to examine the possibility that craniosynostosis is a binary abnormality that potentially may be diagnosed without error. METHODS: Surgical reports, histology of excised sutures, and three-dimensional CT images were compared for 25 children undergoing surgical management of craniosynostosis. Surgical reports identified sutures as normal or abnormal. Histology reported suture closure on a 5-point scale. Four radiologists used three-dimensional CT images to diagnose sutures on a 6-point rated response scale. RESULTS: Sutures with histology 0, 1, or 2 were normal on surgical reports, and those with histology 3 or 4 were abnormal. Most readers achieved nearly perfect sensitivity and specificity. Reader confidence was unrelated to degree of pathology. CONCLUSION: Craniosynostosis appears to be binary in our sample. Surgical reports, pathology results, and three-dimensional CT images read by experienced viewers achieved nearly perfect agreement.

Cranial Sutures↗
PubMed1994

Fractures of the tibial plateau: value of spiral CT coronal plane reconstructions for detecting displacement in vitro.

OBJECTIVE: The purpose of this in vitro study was to determine the value of spiral CT for detecting displacement of fractures of the tibial plateau. The exact amount of inferior plateau depression, if any, is a primary criterion for deciding between surgical management and conservative management. MATERIALS AND METHODS: An artificial fracture was produced in a cadaveric tibial plateau. Inferior displacements of 0, 1, 3, and 5 mm were created at the fracture. Spiral CT scans of each displacement were obtained with table speeds of 2, 3, and 5 mm/sec. Section collimation equaled table increment. Coronal image reconstructions were produced by use of standard scanner software. The images were interpreted by six musculoskeletal radiologists. RESULTS: Interpretation accuracy was greatest with coronal images created from the 2 mm/sec scans. For distinguishing 5-mm fracture displacements, the average diagnostic sensitivity and specificity were 96% and 93%, respectively; when a 2-mm depression was used as the criterion for clinical significance, the sensitivity was 100% and the specificity was 69%. CONCLUSION: When minimal table increment and collimation are used, spiral CT can detect clinically important inferior depressions of tibial plateau fractures. On the basis of the results of this study, when spiral CT is used for tibial plateau fracture assessment, we recommend 2-mm section collimation, 2-mm table speed, and reconstruction of images at 1-mm increments.

Algorithms↗
PubMed1994

Craniosynostosis: diagnostic imaging with three-dimensional CT presentation.

PURPOSE: To measure diagnostic performance and preference of two three-dimensional CT reconstruction modalities (voxel-gradient and surface-projection) displayed two ways (conventional and unwrapped) in craniosynostosis confirmed by surgical inspection and histologic analysis of resected sutures. METHODS: High-resolution 2-mm contiguous CT sections were obtained and three-dimensional reconstruction images generated for 25 infants and children with skull deformities before surgical treatment of craniosynostosis. Two pediatric radiologists and two neuroradiologists first ranked images by their own preferences for diagnostic use. Then they diagnosed craniosynostosis from images presented in random order and blinded. The standard of reference was inspection during surgery and histologic evaluation of excised sutures. Finally, reviewers repeated their subjective preference tests. RESULTS: The least experienced radiologist had 100% sensitivity for all imaging modalities and specificities ranging from 43% to 83%. The two most experienced radiologists performed nearly identically, with sensitivities of 96% and specificities of 100%. After performing diagnostic tasks using all image types, all radiologists preferred conventional surface projections. CONCLUSION: Experienced readers can achieve nearly perfect diagnostic performance using the latest three-dimensional CT reconstruction images, making it a contribution to the diagnostic process. Although performance is nearly identical for all modalities, readers strongly prefer conventionally presented surface-projection images.

Algorithms↗
PubMed1994

Does reduced hospital stay affect morbidity and mortality rates following cleft lip and palate repair in infancy?

Insurance carriers affected decisions regarding admissions and length of stay in our hospital in 1987. Charts were reviewed retrospectively to determine whether this affected morbidity and mortality rates following cleft lip and palate operations in infants. Two periods were studied: May of 1983 through April of 1987 (group I) and April of 1987 through May of 1991 (group II). A total of 248 infants with cleft lip and/or palate underwent 398 operations: lip adhesion (74), definitive lip repair (130), and palatoplasty (194). Half were performed in each period. Admission status, length of stay, length of operation, and short-term morbidity were documented. Morbidity included spontaneous and traumatic lip dehiscence, palatal dehiscence, and palatal fistula. Intergroup analysis was performed by the chi-squared method; p < or = 0.05 was statistically significant. In group I, 93 percent of patients were admitted before surgery. In group II, 5 percent were admitted before surgery and 79 percent the day of surgery. Hospital stay decreased nearly 2 days for each operation. There was no statistically significant difference between groups in distribution of operations, length of operations, or morbidity: lip surgery complications (p = 0.263), palatoplasty complications (p = 0.624). Reductions of hospital admissions and length of stay do not affect outcome of cleft lip and palate surgery in infants. The reduction in hospital days is equivalent to a savings of $138,000 (1991 dollars).

Ambulatory Surgical Procedures↗
PubMed1993

Quantitative three-dimensional assessment of face-lift with an optical facial surface scanner.

Three-dimensional computed tomographic scan images of facial deformities provide information that has been useful in planning and evaluating therapy. However, the benefits of computed tomographic imaging in cosmetic plastic surgery are often insufficient to justify exposing the patient to radiation. This report describes application of an optical, noncontact, three-dimensional surface digitizer with subsecond scanning time for 360-degree examination of the human head. The resultant three-dimensional surface data are suitable for computer graphics display and manipulation, and for noncontact skin surface measurement. The scanner provides accurate and complete coverage of complex facial surfaces. This system was applied to digitization of the human head in the planning and evaluation of facial plastic surgery. The results indicate that the resulting image is accurate enough to detect subtle dimensional changes resulting from surgery, including postoperative edema and surface changes due to face-lift. This type of scanning can assist in a number of tasks performed by plastic surgeons, including collecting anthropomorphic measurements, preoperative and postoperative assessment, volume monitoring, customizing of implants, and interactive planning.

Algorithms↗
PubMed1992

Screening mammography in 350 women with breast implants: prevalence and findings of implant complications.

OBJECTIVE: A series of screening mammograms in asymptomatic women with breast implants was reviewed to determine the prevalence of clinically silent sequelae of breast augmentation and to analyze the mammographic findings. MATERIALS AND METHODS: The screening mammograms of 350 consecutive women with implants were reviewed retrospectively by experienced mammographers. Any women who reported problems had a diagnostic examination and therefore were not included in our sample. Mammographic features of sequelae specific to implantation such as development of a fibrous capsule, periprosthetic calcification, implant herniation, and silicone leaks were tabulated. Additionally, modified compression (push-back) views, when obtained, were evaluated for their usefulness. RESULTS: Fibrous encapsulation of breast implants was seen in 257 (73%) of 350 women. Periprosthetic calcification was seen in 90 (26%), and 60 women (17%) had implant herniations. Sixteen women (5%) had implant failure as evidenced by silicone leak. Two of these women had bilateral implant failures. Surgical confirmation was attainable in only five of 16 women. Analysis of modified compression views demonstrated an overall improvement in visualization of breast tissue with this technique. Although the sample size is small, there was a significant increase in the amount of breast tissue seen with push-back views in women with submuscular implants. CONCLUSION: Our analysis revealed a wide range of mammographic findings in this group of asymptomatic women with breast augmentation. Especially worrisome is the 5% prevalence of unsuspected silicone extravasation. Additionally, we have demonstrated the usefulness of push-back views in this screening group, especially in women with submuscular implants.

Breast Diseases↗
PubMed1991

ROC analysis of observer-response subjective rating data--application to periodontal radiograph assessment.

Many physical anthropological studies require that an observer or device discriminate between states that can be easily confused. Receiver operating characteristic (ROC) analysis currently offers the best method for determining the accuracy of such choices, particularly for small sample sizes. Although ROC analysis is widely accepted in psychophysical and biomedical testing, its use in anthropological studies has not been reported. ROC analysis is used here to determine the usefulness of enhanced dental radiographs to assess vertical alveolar bone defects for quantitative studies of human variation with regard to periodontal disease. The presence or absence of vertical-bony defects (truth) for 75 human skulls was established by the consensus of two trained observers. Dental bitewing-radiographs were taken of the alveolar processes, the radiographs digitized, and the brightness and contrast of the digital images enhanced. The two observers who established truth then rated 1) plain bitewing radiographs, 2) unenhanced digital images of bitewings, and 3) enhanced digital images of bitewings for vertical bony defects. The rating scale varied from 1 (vertical defect definitely or almost definitely present) to 5 (definitely or almost definitely absent). ROC analysis was used to compared the diagnostic value of the 3 imaging modalities. All modalities had nearly identical diagnostic performance, measured as Az values (areas beneath ROC curves) that were less than 0.80, which indicates only moderate usefulness. It is concluded that enhancement does not increase success in vertical-bony-defect diagnosis from digital dental radiographs processed in this manner. Moreover, it is suggested that conventional bitewing radiographs may be unsuitable for accurate quantification of such defects.

Alveolar Bone Loss↗
PubMed1991

Calcaneal and pelvic fractures: diagnostic evaluation by three-dimensional computed tomography scans.

A major application of three-dimensional (3D) computed tomography (CT) is in the imaging of the skeleton. 3D CT has a potentially important role in determining the presence, type, and extent of fractures, especially of the calcaneus and pelvis. The objective of this study was to compare the diagnostic sensitivity and specificity of 3D CT, CT slices, and plain radiography in the detection and characterization of calcaneal and pelvic fractures. 3D CT reconstructions were obtained by two methods, surface reconstruction and volumetric techniques. Twenty-eight patients were imaged with CT, 3D CT, and plain radiography. The opinion of a musculoskeletal radiologist with access to all images plus clinical history, surgical findings, and follow-up findings was taken as truth. Four additional musculoskeletal radiologists read these cases in a blinded fashion and ranked the modalities with regard to perceived utility. Receiver operating characteristic analysis was used to determine the relative value of each modality in terms of diagnostic quality. All imaging modalities performed comparably in the diagnosis of fractures. CT slices and plain-films were the most useful for more difficult diagnostic tasks such as fracture stability, and the presence of comminution and estimation of the number of fragments. The results suggest that for skeletal areas with complicated anatomy (such as the pelvis and calcaneus), the diagnostic value of 3D CT is often equivalent to that of conventional methods.

Acetabulum↗
PubMed1991

Evaluation of congenital heart disease by three-dimensional magnetic resonance imaging.

This study was undertaken to compare electrocardiographically gated magnetic resonance imaging (MRI) to established imaging modalities in the detection of complex intra- and extracardiac morphologic defects. Twenty-three patients with congenital cardiac abnormalities were imaged by four methods: cardiac catheterization, echocardiography, two-dimensional (2D) transaxial MRI, and three-dimensional (3D) MRI surface reconstruction. Observers with experience in congenital cardiac disease diagnosis (two for echo, one for catheterization, two for 2D MR, and three for 3D MR) evaluated the images in a blinded fashion, and the results were analyzed with receiver operating characteristic (ROC) analysis. Overall, cardiac catheterization had the best diagnostic performance. The diagnostic value of routine 2D cardiac MR images and 3D MR reconstruction images were similar to that of echocardiography. All of the modalities performed poorly in the diagnosis of extracardiac defects and atrial septal defects.

Cardiac Catheterization↗
PubMed1990

Quantitative evaluation of digital dental radiograph imaging systems.

Two digital imaging systems, a video camera and analog-to-digital converter, and a charge-coupled device linear photodiode array slide scanner, were tested for their suitability in quantitative studies of periodontal disease. The information content in the original films was estimated, and digital systems were assessed according to these requirements. Radiometric and geometric performance criteria for the digital systems were estimated from measurements and observations. The scanner-based image acquisition (digitization) system had no detectable noise and had a modulation transfer function curve superior to that of the video-based system. The scanner-based system was equivalent to the video-based system in recording radiographic film densities and had more geometric distortion than the video-based system. The comparison demonstrated the superiority of the charge-coupled device linear array system for the quantification of periodontal disease extent and activity.

Alveolar Bone Loss↗
PubMed1990

Periodontal disease morbidity quantification. II. Validation of alveolar bone loss measurements and vertical defect diagnosis from digital bite-wing images.

Quantitative alveolar bone loss evaluation by digital processing of dental radiographs was performed. More than 20 contrast and edge enhancement techniques were applied to bite-wing radiographs of adult molar teeth and the results subjectively evaluated. Wallis space variant image enhancement was selected as the most promising candidate for improved visualization of the cemento-enamel junctions and alveolar crests. Seventy-three skulls were radiographed, the films digitized, and enhancement performed on the digital images. Alveolar bone loss measurements from skulls (truth) were compared with those from the original radiographs, unprocessed digital images, and enhanced digital images. The average intraclass correlation coefficient for two observers was 0.83 for radiographs, 0.86 for digital images, and 0.91 for enhanced images. The intraclass correlation coefficient between the 2 sets of dry skull measurements made by two additional observers was 0.88. Means and 95% confidence limits were determined for differences between measurements from dry skulls and radiograph-based images. In the worst case for measurements from enhanced images, the mean difference from truth was -0.40 mm with a 95% confidence interval from -0.54 to -0.25 mm. Receiver operating characteristic (ROC) analysis was used to determine the utility of radiograph-based images for the diagnosis of vertical defects. The ability of two observers to diagnose vertical defects on dry skulls was also tested. All methods of vertical defect diagnosis, including the identification of vertical defects on dry skulls, had relatively low diagnostic performance. Image processing technology has considerable potential in periodontal disease studies for quantitative evaluations of alveolar bone height. The diagnosis of vertical defects using current definitions and techniques is problematic, with considerable room for improvement.

Alveolar Bone Loss↗