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Biomedical subjects

A Ahuja

Publications and source records attributed to A Ahuja.

At least 37 records · Page 2Linked to original sources
PubMed2001

Power Doppler sonography of cervical lymphadenopathy.

AIMS: The supraclavicular region is a common site for tuberculous and metastatic nodes from infraclavicular carcinomas. Grey scale sonographic features differentiating the two have been previously described. However, as power Doppler sonography is now frequently used in the assessment of neck nodes, power Doppler features that may help to differentiate the two are discussed. MATERIALS AND METHODS: In 78 patients, power Doppler sonograms of nodes involved by metastases from infraclavicular carcinomas (n = 24) and tuberculosis (n = 54) were evaluated. The intranodal distribution of vessels and the intranodal vascular resistance of vessels was assessed and compared. In addition, the power Doppler features of metastatic nodes from infraclavicular carcinomas were compared with metastatic nodes from a head and neck primary (n = 38) such as nasopharyngeal carcinoma (NPC). RESULTS: Tuberculous nodes frequently demonstrated displaced hilar vascularity or avascularity and the intranodal vascular resistance was low. Metastatic nodes from infraclavicular primaries demonstrated capsular or mixed vascularity and their intranodal resistance was significantly (P < 0.05) higher. In general, metastatic nodes from infraclavicular primaries had a higher intranodal vascular resistance compared to metastatic nodes from NPC, but this was not statistically significant. CONCLUSION: In the supraclavicular region, the presence of displaced low resistance hilar vascularity or avascularity in nodes is suggestive of tuberculous nodes. Metastatic nodes from infraclavicular primaries have a capsular or mixed vascularity with high resistance.

Adult↗
PubMed2001

Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

OBJECTIVE: To investigate the difference in the nodal hilus evaluated by gray scale and power Doppler sonography. METHODS: One hundred ninety-two patients with proven cervical lymphadenopathy were included in the study (metastases, n = 118; tuberculosis, n = 56; and lymphoma, n = 18). Lymph nodes were evaluated by gray scale sonography for the echogenic hilus and power Doppler sonography for hilar vascularity. RESULTS: Hilar vascularity was found even though the lymph node did not show an echogenic hilus on gray scale sonography (metastases, 59%; tuberculosis, 66%; and lymphoma, 91%). CONCLUSIONS: Sonologists should be aware that gray scale and Doppler sonography show different aspects of the hilus, and the absence of the hilus on gray scale sonography does not necessarily imply an associated absence of hilar vascularity.

Adolescent↗
PubMed2001

Gray scale and power Doppler sonography in cases of Kimura disease.

SUMMARY: Kimura disease is a rare chronic inflammatory disorder mimicking malignancy. Nodes are present in the submental and submandibular regions, within the parotid gland, and in the upper cervical chain. On gray scale sonograms, they are hypoechoic and round, with normal hilar architecture and homogeneous internal echoes. On power Doppler sonograms, the nodes show prominent intranodal vessels with a hilar pattern and low intranodal resistance. The soft tissue and parotid lesions also show low-resistance vascularity within.

Adult↗
PubMed2001

Power Doppler sonography to differentiate tuberculous cervical lymphadenopathy from nasopharyngeal carcinoma.

BACKGROUND AND PURPOSE: Tuberculous lymphadenitis and metastatic nodes from nasopharyngeal carcinoma are common in Asians and are often indistinguishable clinically. Because their treatment depends on prompt diagnosis, we undertook this study to evaluate if power Doppler sonography could distinguish these two pathologic abnormalities. The intranodal vascular appearances of tuberculous neck nodes are compared with benign reactive neck nodes and metastatic nodes from nasopharyngeal carcinoma. METHODS: The appearances of power Doppler sonograms of 42 tuberculous nodes were compared with 28 metastatic nodes from nasopharyngeal carcinoma and 27 benign reactive nodes. The intranodal distribution of vessels and the intranodal vascular resistance of vessels were compared among these three groups. All examinations were performed by the same sonologist (A.A.), who had more than 3 years' scanning experience, and all data analysis was performed by the same investigator (M.Y.). RESULTS: The intranodal vascular distribution in tuberculous nodes was varied and simulated both benign and malignant disease. Avascularity of nodes and displacement of hilar vascularity were frequent in tuberculous nodes. Metastatic nodes from nasopharyngeal carcinoma (resistive index [RI], 0.81+/-0.09; pulsatile index [PI], 1.91+/-0.81) had a higher vascular resistance than did tuberculous nodes (RI, 0.71+/-0.11; PI, 1.34+/-0.55). Tuberculous nodes had a higher vascular resistance than did reactive nodes (RI, 0.66+/-0.09; PI, 1.10+/-0.26). CONCLUSION: Avascularity, displaced hilar vessels, and low intranodal vascular resistance are clues that may suggest the tuberculous nature of neck nodes. However, there is overlap of appearance between tuberculous nodes, benign reactive neck nodes, and metastatic nodes. Thus, histologic analysis is often required for a definitive diagnosis.

Adolescent↗
PubMed2000

Carotid stenting in patients older than 65 years with inoperable carotid artery disease: a single-center experience.

Carotid angioplasty and stenting to treat extracranial carotid stenosis is an alternative (as yet not widely accepted) to high-risk surgery, but its safety and efficacy are little known, especially in elderly patients. We reviewed our 3-year experience of treating 100 elderly patients (> 65 years old) considered to be inoperable (76 men, 24 women, mean age 76+/-10 years, mean follow-up 18+/-9.2 months) and present two case histories. Most (85%) were symptomatic (transient ischemic attacks in 60, stroke in 25); 80 had concomitant coronary artery disease (severe in 30 [defined by > 70% stenosis in two or more epicardial coronary arteries or the left main coronary artery]) and 25 had severe left ventricular dysfunction (ejection fraction < or =20%). The procedure was technically successful in all patients; there was one major stroke and no patient died. Postprocedure, 15% had minor complications: reversible neurological deficit (5%), pulmonary edema (3%), prolonged hypotension (3%), vascular access complications (3%), and neck hematoma (1%). Over 90% of patients were discharged home within 24 hr.

Age Factors↗
PubMed2000

Grey-scale sonography in assessment of cervical lymphadenopathy: review of sonographic appearances and features that may help a beginner.

Ultrasound examinations of the neck in 218 patients with confirmed cervical lymphadenopathy were reviewed. Lymph nodes were assessed for their size, shape, internal architecture, echogenicity, nodal border, posterior enhancement, and ancillary features (adjacent soft tissues oedema, and matting). The hilus is a linear, echogenic, non-shadowing structure containing nodal vessels, and is continuous with fat around the node. Coagulation necrosis is an ill-defined, rounded, non-shadowing echogenic area within a node. It is less echogenic than the hilus and is not continuous with the fat around the node. Calcification is a highly echogenic focus within the node, which may be dense or punctate echogenic foci. It is not continuous with the fat around the node. Dense intranodal calcification usually produces shadowing. However, fine punctate calcification may not have posterior shadowing though, if the transducer frequency is increased, it may show thin lines. Cystic necrosis is focal, often ill-defined echolucent area within the node. Echogenicity of lymph nodes is usually compared with the adjacent muscles, and is classified as hypoechogenicity, isoechogenicity, and hyperechogenicity. The nodal border is assessed for its sharpness. Posterior enhancement is when the structures posterior to the node look more echogenic than neighbouring areas. Oedema of soft tissues is an ill-defined, hypoechoic area around the node with loss of adjacent fascial planes. Nodes are considered matted when they are clumped or adherent to each other with no normal intervening soft tissue between them. Ultrasound features that help only in identifying abnormal nodes include size, shape, echogenic hilus, hypoechogenicity or isoechogenicity, echogeneity, coagulation necrosis, and a sharp nodal border. Ultrasound features that help to identify abnormal nodes as well as giving clues to the primary lesion include hyperechogenicity, intranodal calcification, intranodal cystic necrosis, ragged nodal border, posterior enhancement, adjacent soft tissue oedema, and matting.

Biopsy, Needle↗
PubMed2000

Thyroid function and psychiatric morbidity in patients with manic disorder receiving lithium therapy.

Euthyroid hyperthyroxinemia as a result of a transient increase in thyroid-stimulating hormone (TSH) levels may contribute to the development of manic disorder. Lithium has a potent short-term antithyroidal effect that may account for its antimanic action. The thyroid function and psychiatric morbidity of 46 adult patients with manic disorder were assessed prospectively before and 1 and 6 months after lithium treatment. At baseline, the free thyroxine level (FT4, 16.23 +/- 3.11 pmol/L) was at the high end of the normal range, whereas the free triiodothyronine (FT3, 4.24 +/- 0.65 pmol/L) and TSH (1.47 +/- 0.73 mIU/L) levels were within the normal range. All patients were clinically euthyroid, but five of them (11%) had elevated FT4 levels. Baseline FT3 and FT4 levels were positively correlated with past psychiatric morbidity. The FT4 level at baseline and after 1 month of treatment was positively correlated with scores on the Brief Psychiatric Rating Scale (p < 0.02) and negatively correlated with scores on the Global Assessment Scale (p < 0.005). During the first month of treatment, the reduction of FT3 and FT4 levels was significantly correlated with a decrease in psychiatric symptoms. By 6 months, the FT3 level was no longer significantly different from that at the baseline, but FT4 levels remained significantly lower. The TSH level increased progressively from baseline to 6 months. Multilevel models showed that FT4 and serum lithium levels were positively and negatively associated with psychiatric symptoms, respectively. The findings of the study lend support to the notion that euthyroid hyperthyroxinemia contributes to acute mania and suggest that lithium's short-term antimanic action may be mediated by its antithyroid effect.

Adult↗
PubMed2000

Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease.

BACKGROUND AND PURPOSE: Intracranial large-artery occlusive disease is the predominant vascular lesion found in stroke patients of Asian, African, and Hispanic ancestry, making it numerically perhaps the most common vascular cause of stroke in the world. Relatively little is known about the clinical significance of finding such lesions. We investigate whether the presence and the extent of these vascular lesions help predict outcome after stroke. METHODS: On the basis of transcranial Doppler of the intracranial arteries with supplementary duplex ultrasound of the carotid arteries, we determined the number of occlusive arteries in the craniocervical circulation of consecutive patients who were hospitalized for acute cerebral ischemia. Patients were followed for 6 months for further vascular events (including transient ischemic attack, stroke, and acute coronary syndrome) or death. RESULTS: Among 705 consecutive Chinese patients studied, occlusive arteries were found in 345 patients (49%): 258 patients (37%) had intracranial lesions only, 71 (10%) had both extracranial and intracranial lesions, and 16 (2.3%) had extracranial lesions only. Sixty-three (18%) of the 345 patients with occlusive arteries and 35 (9.7%) of the 360 patients without occlusive arteries had further vascular event or death within 6 months. The risk of vascular events or death increased rapidly with rising numbers of occlusive arteries, after adjustment for vascular risk factors and stroke severity (adjusted odds ratio [OR] 1.25 per occlusive artery, 95% CI 1.12 to 1.39). Other independent risk factors included age (OR 1.03 per year of age, 95% CI 1.01 to 1.05) and atrial fibrillation (OR 3.00, 95% CI 1.40 to 6.69). CONCLUSIONS: In patients with predominantly intracranial large-artery occlusive disease, the presence and the total number of occlusive arteries in the craniocervical circulation predict further vascular events or death within 6 months after stroke. Transcranial Doppler ultrasound is an important investigation for the evaluation of patients with stroke in populations at risk of intracranial atherosclerotic disease.

Arterial Occlusive Diseases↗
PubMed2000

Power Doppler sonography of normal cervical lymph nodes.

This study was undertaken to investigate the vascular patterns and resistance of normal cervical nodes by power Doppler sonography. In 101 subjects who had a sonographic examination of the neck, 1050 lymph nodes were detected. Only central vascularity was found in normal cervical nodes. The degree of vascularity in submental and submandibular nodes was higher than that in other regional nodes. Submental nodes had a higher vascular resistance in association with a lower blood flow velocity than other regional nodes. No significant difference was found in blood flow velocities and vascular resistance between male and female subjects. The vascular resistance increased significantly with age. This study provides a baseline for vascularity within normal cervical nodes, as seen by power Doppler sonography.

Adult↗
PubMed1999

Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism.

CONTEXT: Intravenous tissue-type plasminogen activator can be beneficial to some patients when given within 3 hours of stroke onset, but many patients present later after stroke onset and alternative treatments are needed. OBJECTIVE: To determine the clinical efficacy and safety of intra-arterial (IA) recombinant prourokinase (r-proUK) in patients with acute stroke of less than 6 hours' duration caused by middle cerebral artery (MCA) occlusion. DESIGN: PROACT II (Prolyse in Acute Cerebral Thromboembolism II), a randomized, controlled, multicenter, open-label clinical trial with blinded follow-up conducted between February 1996 and August 1998. SETTING: Fifty-four centers in the United States and Canada. PATIENTS: A total of 180 patients with acute ischemic stroke of less than 6 hours' duration caused by angiographically proven occlusion of the MCA and without hemorrhage or major early infarction signs on computed tomographic scan. INTERVENTION: Patients were randomized to receive 9 mg of IA r-proUK plus heparin (n = 121) or heparin only (n = 59). MAIN OUTCOME MEASURES: The primary outcome, analyzed by intention-to-treat, was based on the proportion of patients with slight or no neurological disability at 90 days as defined by a modified Rankin score of 2 or less. Secondary outcomes included MCA recanalization, the frequency of intracranial hemorrhage with neurological deterioration, and mortality. RESULTS: For the primary analysis, 40% of r-proUK patients and 25% of control patients had a modified Rankin score of 2 or less (P = .04). Mortality was 25% for the r-proUK group and 27% for the control group. The recanalization rate was 66% for the r-proUK group and 18% for the control group (P<.001). Intracranial hemorrhage with neurological deterioration within 24 hours occurred in 10% of r-proUK patients and 2% of control patients (P = .06). CONCLUSION: Despite an increased frequency of early symptomatic intracranial hemorrhage, treatment with IA r-proUK within 6 hours of the onset of acute ischemic stroke caused by MCA occlusion significantly improved clinical outcome at 90 days.

Aged↗
PubMed1999

Relationship of thyroid blood flow to reproductive events in normal Chinese females.

The purpose of this study was to investigate the blood flow characteristics in the superior thyroid artery (STA) in normal females of prepubertal, reproductive, and postmenopausal age. The study was performed in 29 prepubertal girls, 27 females of reproductive age, and 26 postmenopausal women. The peak systolic velocity (PSV) and the pulsatility index (PI) of the STA were measured repeatedly during one menstrual cycle in females of reproductive age, and measured once in each prepubertal and postmenopausal subject. Different waveforms were observed in females of prepubertal, reproductive, and postmenopausal age. The PSV of the STA increased progressively in females from prepubertal to postmenopausal phases. The PI of the STA in all of the prepubertal girls was lower than that of adult females in different phases of the menstrual cycle. In adult females, the PI in the follicular phase was significantly higher than those in the ovulatory and luteal phases. In all of the postmenopausal women, the PI was comparable to that in older prepubertal subjects and in adult females during the ovulatory and luteal phases. The results suggest that oestrogen may affect thyroid blood flow during the normal menstrual cycle. Growth and progressive change of arterial structure are suggested to affect the thyroid blood flow in prepubertal and postmenopausal states.

Adult↗
PubMed1999

Nodal shape (S/L) and its combination with size for assessment of cervical lymphadenopathy: which cut-off should be used?

The short axis to long axis (S/L) ratio is commonly used to assess cervical lymphadenopathy; however, the cut-off value used has been limited to 0.5. The accuracy of the combination of S/L ratio and nodal size has not been documented previously. We evaluated 1143 normal cervical nodes from 95 healthy subjects, and 1441 nodes from 290 patients with proven cervical lymphadenopathy. The optimum cut-off value of the S/L ratio was determined in different regions of the neck: submental (0.5), submandibular (0.7), parotid (0.5), upper cervical (0.4), middle cervical (0.3) and posterior triangle (0.4). In the submandibular and parotid regions, the combination of the S/L ratio and short axis shows substantial improvement in diagnostic accuracy when compared to the S/L ratio alone.

Adolescent↗
PubMed1999

Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis.

Peritonsillar infections include cellulitis and abscess (quinsy). Clinical diagnosis is often supplemented by diagnostic drainage (aspiration or incision) in an effort to distinguish abscess from cellulitis. In a prospective study of 14 patients we have shown that clinical impression alone is unreliable (sensitivity 78 per cent, specificity 50 per cent). Computerized tomography (CT) (sensitivity 100 per cent, specificity 75 per cent) and intraoral ultrasound (sensitivity 89 per cent, specificity 100 per cent) are much more reliable. We propose that intraoral ultrasound could play a useful role in the clinical assessment of peritonsillar infections helping to improve accuracy in distinguishing abscesses from cellulitis.

Adolescent↗
PubMed1999

Echography of metastatic nodes treated by radiotherapy.

The purpose of this study was to evaluate whether the ultrasonographic appearances of nodal metastases in nasopharyngeal carcinoma (NPC) revert to normal after radiotherapy. Serial ultrasonography was performed in 18 patients with palpable nodal metastases in the neck who underwent radiotherapy for NPC. All patients had a pre-radiotherapy baseline and another study at least one year after radiotherapy. The largest node in each patient was evaluated for any change in the ultrasonographic features following radiotherapy. One year after radiotherapy nodes returned to normal size for their respective areas, the shape of the node and the echogenic hilus also reverted to normal. However, the nodes are more echogenic than nodes in normal subjects. This distinguishes these nodes from nodes not affected by radiotherapy. The histological basis for this observation is presumed to be the result of fibrosis. At first glance the post-radiotherapy nodes may resemble normal nodes, however subtle changes within the node and adjacent soft tissues can be recognized on ultrasonography. During long-term follow-up, the appearance of nodes at sites previously uninvolved or any change in the appearance of nodes should alert the sonologist to the possibility of recurrence.

Adult↗
PubMed1999

Short-term objective and long-term subjective results of laser-assisted uvulopalatoplasty for obstructive sleep apnea.

OBJECTIVES: To determine the short-term and long-term effects of laser-assisted uvulopalatoplasty (LAUP) on symptoms and polysomnographic measures in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective assessment of outcomes after LAUP in patients with OSAS. METHODS: Fifty-nine patients with OSAS underwent LAUP, and 36 completed postoperative sleep studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP, 6 to 12 weeks after LAUP, and in the long term (> 2 years). RESULTS: The apnea index decreased from 14.4 to 5.8 (P = .0012), respiratory disturbance index (RDI) decreased from 28.1 to 7.9 (P = .0046), and the mean lowest oxyhemoglobin saturation increased from 80.6% to 84.0% (P = .055). The RDI was reduced to 10 or less in 44.4% of patients. Subjective questionnaires showed statistically significant improvements in snoring, morning fatigue, morning headaches, daytime somnolence, and daytime psychometric measures. The symptomatic improvement persisted in the long term. CONCLUSIONS: LAUP is an effective method for the management of OSAS. We have demonstrated short-term improvement in polysomnographic measures and short-term and long-term improvement in subjective measures.

Adult↗