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Biomedical subjects

A J Doyle

Publications and source records attributed to A J Doyle.

At least 19 recordsLinked to original sources
PubMed1998

Implementation of image-guided large-core needle biopsy of the breast on a limited budget.

Image-guided large-core needle biopsy (LCNB) of the breast is becoming widely accepted as an accurate, minimally invasive and economical way to obtain a tissue diagnosis of breast lesions. However, much of this work has been done with expensive dedicated equipment, often favouring stereotaxic guidance. Image-guided LCNB was introduced to Middlemore Hospital based around existing inexpensive equipment, and stereotaxic or ultrasound guidance was chosen depending on which showed the lesion best. Multidisciplinary clinical, radiological and pathological assessment of each case was performed. The results of 213 biopsies (112 stereotaxic and 101 ultrasound guidance) are reported here. Malignancy was shown or suspected in 85 biopsies (40%). The absolute sensitivity for malignancy was 97% with complete sensitivity of 100%. The absolute specificity was 100% and the complete specificity 98.5%. Large-core needle biopsy can be successfully implemented in a large institution without investment in expensive equipment while maintaining high ratios of malignant/benign biopsies. Attention to technique and careful multidisciplinary review are important to the success of such a programme.

Biopsy, Needle↗
PubMed1997

Prevertebral soft-tissue measurements in cervical spine injury.

To clarify normal values for cervical prevertebral soft-tissue measurements and evaluate when they are useful as a marker of cervical spine injury, the prevertebral soft-tissue measurements of 79 control and 57 acutely injured patients were retrospectively compared by two independent observers. The second, blinded, observer made a provisional diagnosis and indicated if increased soft-tissue measurements had assisted in making a diagnosis of injury. If measurements > 7 mm at C2/3 and > 21 mm at C6/7 were considered abnormal, a true positive rate of 53% and false positive rate of 5% were observed. The differences between the mean measurements in the control and injured groups were statistically significant (P < 0.0001 at C2/3 and P < 0.01 at C6). Soft-tissue measurement improved the diagnostic confidence of the blinded second reviewer in 17.5% of the injured group. Analysis of this subgroup revealed a 50% error rate in initial reporting. In all of these cases, the abnormal soft-tissues had been ignored prospectively Routine measurement of the prevertebral soft tissues is a simple procedure that may provide an important due to subtle cervical spine injury.

Adolescent↗
PubMed1996

Justification for decreasing the number of views taken in radiologic follow-up of Casper plate cervical spine hardware.

RATIONALE AND OBJECTIVES: We tested the null hypothesis that there would be no difference between the diagnostic yield of the lateral radiograph alone and the yield of the lateral and anteroposterior views combined when assessing patients after placement of an anterior cervical appliance. METHODS: We evaluated 630 radiographic examinations obtained from 117 consecutive patients who had anterior cervical plating. For each examination, we looked at the lateral radiograph first and then at the anteroposterior radiography to determine whether there would be any additional information on the anteroposterior film. RESULTS: Of 501 examinations in which the lateral and anteroposterior views were available, we found that the anteroposterior view added information in 18. In eight of the 18, the added information consisted only of clinically insignificant tilting of the plate. Significant findings were seen in 209 examinations in the lateral view and in 219 examinations with the lateral and anteroposterior views combined. This was not significantly different. CONCLUSION: The anteroposterior view rarely adds significant information. It probably should be obtained early postoperatively to check for tilting of the plate but after that only for specific indications. This will save money and reduce the patient's exposure to radiation.

Adolescent↗
PubMed1995

Selective use of image-guided large-core needle biopsy of the breast: accuracy and cost-effectiveness.

OBJECTIVE: We examined the accuracy and cost-effectiveness of large-core needle breast biopsy in a selected group of patients with mammographically detected lesions. MATERIALS AND METHODS: We selectively used large-core needle biopsy to sample breast lesions that were intermediate (neither clearly benign nor clearly malignant) and wire localization biopsy to sample breast lesions that were strongly suggestive of cancer. We compared 2 years' experience using this protocol with the preceding 2 years at the University of Utah Health Sciences Center during which we did only a few large-core needle biopsies on a nonselective basis. RESULTS: Our biopsy rate increased from one biopsy per 36 mammographic screening examinations to one per 26 (p = .001) when the protocol was used. The cost of biopsy per cancer detected decreased from $11,555 to $8356. The specificity of large-core needle biopsy was 98%; the sensitivity based on limited follow-up was 100%. CONCLUSION: Large-core needle biopsy is an accurate and cost-effective method for sampling breast lesions when used in a selective fashion.

Analysis of Variance↗
PubMed1995

Tuberculosis: preventing occupational transmission to health care workers.

1. The anticipated reduction in the incidence of tuberculosis (TB) failed to consider four major factors: the advent of human immunodeficiency virus (HIV); the development of multi-drug resistant TB; the decline in public health services and limited access to health care for those in congregative facilities; and the increase in immigration of persons from countries with high prevalence of TB. 2. Some strains of multi-drug resistant TB are resistant to all anti-TB medications and seriously hamper infection control strategies. Unfortunately, MDR-TB is transmitted in the same manner as drug susceptible organisms and studies show comparable infection rates. 3. The role of the occupational health nurse in preventing workplace exposure to TB combines education, disease prevention, early detection, and treatment modalities to maximize the opportunity for a healthy work environment for health care workers.

Health Occupations↗
PubMed1994

Percutaneous native renal biopsy: comparison of a 1.2-mm spring-driven system with a traditional 2-mm hand-driven system.

Over the last few years spring-driven mechanical biopsy guns have been introduced for performing renal biopsies. There has been little research done comparing these guns with traditional hand-driven needles in performing biopsies of native kidneys. We wished to compare our experience with the two needle types. We studied retrospectively the results and complication rates of 155 native kidney biopsies. Sixty-nine were performed with hand-driven 14-gauge needles and eighty-six with 18-gauge, spring-driven biopsy guns. Sufficient tissue for diagnosis was obtained in 96% of cases in the hand-driven group compared with 99% in the biopsy gun group (P = NS). Complications occurred in six cases in the hand-driven group compared with one case in the biopsy gun group (P = 0.02). As expected, the reported number of glomeruli per core in the 14-gauge cores was greater than in the 18-gauge cores (16.5 v 6.2, P < 0.01). This was partially offset by the greater number of passes made with the smaller needle. We conclude that similar results can be expected from both biopsy methods, with a possible slight decrease in complications using biopsy guns with smaller needle diameters.

Adolescent↗
PubMed1994

Myoepithelial lesions of the breast: imaging characteristics and diagnosis with large-core needle biopsy in two cases.

Two mammographically detected myoepithelial lesions (one each in women aged 77 and 73 years) were diagnosed at large-core needle biopsy, with the results confirmed by means of surgical excision. The imaging features were nonspecific. A key clue to the diagnosis at histologic examination was the presence of a well-defined capsule around the lesion; hence, sampling of the margins of the lesion is essential. Radiologists should be familiar with myoepithelial lesions in the differential diagnosis of fairly smoothly marginated solid masses.

Aged↗
PubMed1993

Giant cell tumors of bone.

Giant cell tumor is a lesion that usually presents with a radiographically characteristic appearance in a predictable location and patient population. It has a few rare presentations such as pulmonary metastases and multifocal lesions. Prognosis of ultimate tumor behavior is dependent on surgical staging (which requires careful radiographic analysis to detect cortical breakthrough and joint involvement) and type of treatment. The recurrence rate is relatively high with simple curettage but decreases with adjuvant treatment at the tumor site. Optimal therapy for the more aggressive lesions is wide resection, but compromise is frequently required when such a resection would sacrifice joint function because of the subarticular location of the giant cell tumor. Radiation therapy is reserved for surgically inaccessible or otherwise inoperable lesions because of a relatively poor radiosensitivity and concerns about induction of high grade sarcomas. Radiographic follow-up evaluation for recurrence is recommended for approximately 5 years but may be difficult to interpret in individual patients because of an overlap in the appearance of healing and recurrence.

Bone Neoplasms↗
PubMed1990

Optic chiasm position on MR images.

This article describes the results of a study of the distance from the optic chiasm to the tuberculum sellae as seen on sagittal MR images. Measurements revealed an average chiasm-tuberculum distance of 3.8 mm (2.6 mm for females, 4.3 mm for males) and a sizable group in whom the distance was effectively zero. These results show a fairly close correlation with previous anatomic studies. The closer the chiasm is to the tuberculum, the earlier one may expect clinical manifestations of pituitary disease and the more difficult an intracranial surgical approach to the pituitary will be.

Female↗