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Biomedical subjects

B A Carroll

Publications and source records attributed to B A Carroll.

At least 37 records · Page 2Linked to original sources
PubMed1996

Urinary bladder diverticula: sonographic diagnosis and interpretive pitfalls.

Diverticula of the urinary bladder can occasionally appear as complex pelvic masses not obviously connected to the bladder. Such presentations can lead to diagnostic confusion and interpretative error. Sonographic findings and clinical histories were reviewed in 11 patients in whom bladder diverticula were initially mistaken for other types of pathologic pelvic processes. Sonographic techniques that were helpful in elucidating the true nature of the lesions included scanning from different perspectives with increasing increments of bladder distention, postvoid images, endovaginal views, and color Doppler interrogation. The diagnosis of bladder diverticula should be considered and actively pursued when sonologists are confronted with pelvic masses of ambiguous origin.

Adolescent↗
PubMed1996

Doppler sonography in the evaluation of corporovenous competence after penile vein ligation surgery.

Doppler ultrasonographic findings in patients after penile vein ligation surgery are described and compared to the results of cavernosometry and cavernosography. Peak systolic and end diastolic velocities were recorded for both cavernosal arteries at 5 min intervals after papaverine injection for a total of 30 min. Peak end diastolic flow rates were compared with cavernosometric and cavernosographic results at 0-10 min, 11-20 min, and 21-30 min. Cavernosography identified venous leakage in nine patients. The end diastolic velocities were greater than the 5 cm/s threshold level generally considered to be indicative of venous leakage in nine of the nine patients (100%) at 0-10 min, in eight of the nine (89%) at 11-20 min, and in nine of the nine (100%) at 21-30 min. Although peak end diastolic velocities at or near the 5 cm/s threshold could be found in patients both with and without recurrent venous leakage in the initial 10 min of the studies, only patients with recurrent venous leakage had diastolic velocities that exceeded the 5 cm/s level when measured 10 min or more after injection. Measurement of end diastolic velocities between 21 and 30 min after injection seemed to discriminate most effectively the patients with recurrent venous leakage from those without leakage in the postoperative population.

Adult↗
PubMed1996

Doppler sonography in the diagnosis of antepartum pyelonephritis: value of intrarenal resistive index measurements.

This study aims to define the effects of pyelonephritis on intrarenal resistive indices and to determine the role of Doppler sonography in the diagnosis of pyelonephritis in pregnant patients. Twenty pregnant women with pyelonephritis underwent renal Doppler sonography with calculation of intrarenal resistive indices. The resistive index was calculated for the upper, lower, and interpolar areas of each kidney in the patients with pyelonephritis (40 kidneys) and was compared to the resistive indices for a control group of 153 normal asymptomatic pregnant women (306 kidneys). Doppler findings were correlated with the location (sidedness) of flank pain in the pyelonephritis group. The mean resistive index values of patients with pyelonephritis were 0.04 higher than in the controls, and this difference was statistically significant (P < 0.001). Four patients with pyelonephritis had a mean resistive index > or = 0.70, whereas the remaining 16 patients had resistive indices within the normal range of < or = 0.70. In patients with confirmed pyelonephritis and unilateral pain, the average resistive index in the kidney on the side of pain was 0.03 greater than that on the asymptomatic side (P = < 0.01). The mean renal resistive index is significantly greater in pregnant patients with pyelonephritis than in pregnant women without pyelonephritis. Even so, the magnitude of the differences in resistive index is too small and the overlap between the groups too large for this parameter to be of discriminating clinical value.

Diagnosis, Differential↗
PubMed1996

Carotid ultrasound.

Carotid ultrasonography has become the preferred imaging technique for screening patients with suspected atherosclerotic cerebrovascular disease. The principles underlying duplex Doppler sonography and color and power Doppler ultrasonography are discussed. A standard approach to the performance and interpretation of carotid ultrasonography is presented, together with a discussion of potential diagnostic pitfalls. Brief discussion of transcranial Doppler and vertebral sonography are included.

Arteriosclerosis↗
PubMed1995

Ultrasonography.

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Humans↗
PubMed1995

Acoustic shadowing from uterine leiomyomas: sonographic-pathologic correlation.

PURPOSE: To investigate the origin of discrete shadowing from uterine leiomyomas at ultrasound (US) that does not progress from an echogenic origin. MATERIALS AND METHODS: Seven hysterectomy specimens with leiomyomas were scanned in a water bath. With US guidance, 13 self-retaining needles were placed at the origin of shadows that did not (12 cases) or did (one case) arise from an echogenic focus. The localized tissues were inspected for gross pathologic features and microanatomic detail. RESULTS: In the 12 cases, the shadow originated from transitional zones: the margins of the fibroid with adjacent myometrium (three needles), the edges of nodular whorls of smooth muscle (four needles), and the margin between smooth muscle bundles and hyalinized connective tissue (five needles). There was no evidence of calcification, hemorrhage, or necrosis. In the other case, microcalcifications were found. CONCLUSION: Discrete shadowing not arising from echogenic foci resulted from the structural features of the leiomyomas and occurred at transitional boundaries between juxtaposed tissue types or at the curved margins of organized anatomic structures.

Adult↗
PubMed1995

Color Doppler sonographic appearance of patent needle tracts after femoral arterial catheterization.

PURPOSE: To determine the color Doppler sonographic characteristics and clinical relevance of persistent needle tracts after femoral arterial puncture. MATERIALS AND METHODS: After diagnostic (n = 18,825) or interventional (n = 8,489) cardiac catheterization, 1,327 color Doppler sonograms of the groin were obtained over a 54-month period. Gray-scale images, color flow images, pulsed Doppler spectra, and clinical records were evaluated. RESULTS: Twenty-one cases of linear tracts of pulsatile color flow were identified with accompanying Doppler waveform analysis. The mean length and width of the tracts were 21.6 mm (range, 6-33 mm) and 2.7 mm (range, 1-5 mm), respectively. Doppler analysis revealed monophasic flow only in systole in seven cases, triphasic flow in seven cases, and monophasic flow in systole with continued forward flow during diastole in seven cases. No tract required surgical repair. CONCLUSION: Color Doppler sonography of the groin after femoral arterial catheterization may demonstrate a linear tract of color flow that corresponds to the expected path of the needle. These tracts do not seem to be clinically important and do not require further color Doppler imaging when they represent isolated findings.

Catheterization↗
PubMed1995

Color Doppler sonography of groin complications following femoral artery catheterization.

Color Doppler sonography has proved to be an excellent technique for the evaluation of groin complications following femoral artery catheterization [1-4]. With the widespread use of fibrinolytic therapy, anticoagulants, and large-diameter vascular sheaths, a marked increase has been noted in the number of such complications [5, 6]. Accurate diagnosis of groin injuries is critical for establishing whether surgical or nonsurgical treatment is required. In this pictorial essay we review the color Doppler sonography findings of these complications, emphasizing unusual complications such as pseudoaneurysms coincident with arteriovenous fistulas, multilobulated pseudoaneurysms, ruptured pseudoaneurysms, and patent needle tracts. We also discuss the diagnostic pitfalls and mimics of groin injuries, including lymphadenopathy, varicosities, true aneurysms, and atypical but normal branch vessels.

Adult↗
PubMed1995

Ultrasonographically guided manual compression of femoral artery injuries.

To determine the success and complication rates of ultrasonographically guided manual compression in patients with femoral arterial injuries after femoral arterial catheterization, we performed 53 sonographically guided compression repairs in 51 patients. Ultrasonographically guided compression repair was performed on 40 pseudoaneurysms in non-anticoagulated patients, seven pseudoaneurysms in anticoagulated patients, four arteriovenous fistulas on non-anticoagulated patients, and one pseudoaneurysm combined with an arteriovenous fistula. One pseudoaneurysm underwent two separate ultrasonographically guided compression repairs: once when the patient was anticoagulated and once after anticoagulants were withheld. Ultrasonographically guided compression repair was successful in 37 of 48 pseudoaneurysms (77%). Of the 40 pseudoaneurysms in non-anticoagulated patients, ultrasonographically guided compression repair was successful in 36 (90%). This repair technique failed in all seven pseudoaneurysms in anticoagulated patients. Ultrasonographically guided compression repair was successful in 13 of 16 (81%) multilobulated pseudoaneurysms but failed in all arteriovenous fistulas and the one case of pseudoaneurysm combined with an arteriovenous fistula. Ultrasonographically guided compression repair is a safe and effective alternative to surgery for the repair of pseudoaneurysms, including multilobulated pseudoaneurysms. The procedure does not appear to be effective in the anticoagulated patient or in patients with an arteriovenous fistula.

Aged↗
PubMed1995

Lipomatous uterine masses: potential to mimic ovarian dermoids on endovaginal sonography.

Lipomatous uterine masses are uncommon hyperechoic pelvic neoplasms composed partly of adipose tissue. Because of the high level of echogenicity, these uterine masses can produce produce a sonographic appearance strikingly similar to the "dermoid plug" that is considered characteristic of benign cystic teratomas. The key to distinguishing the two tumors is to ascertain the parent organ: the lipomatous uterine mass should clearly originate from the myometrium. In our experience, however, the origin of some echogenic pelvic masses can be difficult to determine, particularly from the endovaginal perspective. This report describes the transabdominal and endovaginal ultrasonographic findings in three patients with lipomatous uterine masses for whom the endovaginal perspective alone, without supplemental transabdominal views, would have resulted in misdiagnosis.

Dermoid Cyst↗
PubMed1995

The diagnostic approach to deep venous thrombosis. Which technique?

Current approaches to the diagnosis of deep venous thrombosis are presented in the context of the clinician's perspective. The historical evolution of these current studies, accuracy of various diagnostic imaging modalities, and extensive references dealing with clinical research in the area of deep venous thrombosis are included. Diagnostic algorithms for the management of patients with suspected deep venous thrombosis are suggested.

Diagnostic Imaging↗
PubMed1994

Prospective trial of pulse oral versus intravenous calcitriol treatment of hyperparathyroidism in ESRD.

To examine the most effective route (intravenous vs. "pulse" oral), dose (physiologic vs. pharmacologic) and long-term efficacy of calcitriol therapy for secondary hyperparathyroidism in patients with end-stage renal disease (ESRD), we randomized 19 hemodialysis patients with severe hyperparathyroidism to receive over a 36-week study period either pulse orally administered calcitriol and intravenous placebo (pulse oral group; N = 9) or intravenous calcitriol and oral placebo (intravenous group; N = 10). Calcitriol was given intermittently in a double-blinded fashion at an initial dose of 2 micrograms thrice weekly and increased as tolerated up to a maximum dose of 4 micrograms per treatment. All patients received similar daily calcium supplementation (2.5 g of elemental calcium) and low dialysate calcium (1.25 mmol/liter) throughout the study period. At the maximum tolerated calcitriol dose, serum 1,25-dihydroxyvitamin D levels were significantly greater 60 minutes following intravenous (389 pmol/liter) compared to oral administration (128 pmol/liter). In spite of the different pharmacologic profiles, intravenous and oral administered calcitriol resulted in similar reductions of serum PTH over the 36 week period of observation (P = 0.300), achieving an overall maximum average PTH reduction of 43% (P = 0.016). Long-term intensive calcitriol therapy (independent of administration route), however, failed to decrease parathyroid gland size as assessed by high resolution ultrasound and/or magnetic resonance imaging. Calcitriol therapy also failed to alter the calcium sensitivity as assessed by serial PTH measurements in response to calcium loading. Increases in serum calcium, but not calcitriol dose or parathyroid gland size, predicted decrements in serum PTH, whereas hyperphosphatemia and the level of PTH suppression derived from the PTH/ionized calcium response curves predicted refractoriness to calcitriol therapy. Episodes of hypercalcemia and hyperphosphatemia were similar in both treatment groups and limited the dose of calcitriol that could be administered. These data indicate that intermittent intensive calcitriol therapy, regardless of administration route, is poorly tolerated, fails to correct parathyroid gland size and functional abnormalities, and has a limited ability to achieve sustained serum PTH reductions in end-stage renal failure patients with severe hyperparathyroidism.

Administration, Oral↗
PubMed1994

Ultrasonography.

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Abdomen↗
PubMed1994

Diagnosis of acute cholecystitis with color Doppler sonography: significance of arterial flow in thickened gallbladder wall.

OBJECTIVE: Thickening of the gallbladder wall is a common though nonspecific sonographic finding. The purpose of this study was to determine if color Doppler sonography shows arterial flow in thickened gallbladder walls more frequently in patients with cholecystitis than in patients with other causes of thickening of the wall. SUBJECTS AND METHODS: Seventy-six patients with thickened gallbladder walls (> or = 3 mm) were prospectively examined with color Doppler sonography. When arteries were detected, Doppler waveforms were used to determine resistive indexes. The final diagnosis was based on pathologic reports, results of percutaneous cholecystostomy, and clinical records. RESULTS: Of the 23 patients (30%) with cholecystitis (11 acute, 12 chronic), nine (39%) had arterial flow and 14 (61%) had no arterial flow. Of the 53 patients (70%) without cholecystitis, 20 (38%) had arterial flow and 33 (62%) had no arterial flow (p = 1.00). The mean resistive indexes (+/- 1 SD) for patients with and without cholecystitis were 60% +/- 13% and 65% +/- 9%, respectively (p = 0.33). No significant difference in the detection of arterial flow was found between patients with acute cholecystitis and those with chronic cholecystitis. CONCLUSION: The presence of arterial flow in the thickened gallbladder wall is nonspecific and of limited value in the diagnosis of cholecystitis.

Acute Disease↗
PubMed1994

Doppler evaluation of renal artery stenosis: interobserver agreement in the interpretation of waveform morphology.

OBJECTIVE: Analysis of Doppler waveform morphology for features of the tardus-parvus phenomenon has been promoted as a useful and accurate means for detecting renal artery stenosis. The purpose of this study was to examine and quantify the interobserver agreement of such an analysis and to determine if interobserver differences limit the value of this approach for predicting renal artery stenosis. SUBJECTS AND METHODS: Four observers independently categorized renal artery waveforms of 47 patients (94 kidneys) clinically selected for renovascular hypertension. Waveforms were classified into five categories based on the presence and severity of tardus-parvus changes in the systolic upstroke and early systolic peak. This categorization was then compared with angiographic findings, and the results were analyzed with receiver-operating-characteristic curves. Kappa statistics and agreement tables were computed to evaluate interobserver agreement. RESULTS: Interobserver agreement in the waveform analysis for the four interpreters was statistically significant (p < 0.001). The receiver-operating-characteristic areas produced by the observers indicated, however, that such waveform classification was not strongly predictive of renal artery stenosis. CONCLUSION: We conclude that substantial agreement in the interpretation of waveform morphology can be obtained between independent observers, and that such differences that do exist do not preclude the use of the pattern-recognition approach to waveform analysis. Even so, the specific application of this strategy to the waveform contours of early systole was not successful in predicting the presence or severity of renal artery stenosis.

Humans↗