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Biomedical subjects

C R McArdle

Publications and source records attributed to C R McArdle.

At least 19 recordsLinked to original sources
PubMed1999

Salivary gland enlargement and elevated serum amylase in bulimia nervosa.

BACKGROUND: Clinical reports have described salivary gland enlargement in bulimia nervosa, particularly in patients with elevated serum amylase concentration. The goal of the current study was to provide a controlled comparison of salivary gland size in patients with bulimia nervosa and healthy volunteers. METHODS: Subjects included 17 women with bulimia nervosa and 21 healthy female control subjects. Dimensions of the parotid and submandibular salivary glands were estimated by ultrasonography. Blood samples for amylase measurement were obtained after overnight fast. RESULTS: Parotid gland size was enlarged 36% in patients with bulimia nervosa in comparison to control subjects (p < .01). For the patient group, salivary gland size was significantly correlated with frequency of bulimic symptoms and with serum amylase concentration. CONCLUSIONS: These results provide new quantitative data demonstrating increased salivary gland size in bulimia nervosa. Further studies are needed to evaluate factors responsible for salivary gland enlargement and hyperamylasemia in this disorder.

Adult↗
PubMed1999

Diagnostic accuracy with US: remote radiologists' versus on-site radiologists' interpretations.

PURPOSE: To compare the diagnostic accuracy of radiologists interpreting static ultrasonographic (US) images electronically transmitted to an academic medical center (remote radiologists) with that of radiologists performing "hands-on" US at a community-based outpatient site (on-site radiologists). MATERIALS AND METHODS: During 8 months, 80 patients underwent pelvic US at a community-based outpatient site. Images were electronically transmitted to a remote medical center as they were acquired at the community site and were printed on a laser printer identical to the one used at the outpatient site. The reference standard for correct diagnosis was based on histopathologic findings (n = 13), additional imaging results (n = 34), or review by a second independent observer (n = 33). Both an on-site and a remote radiologist interpreted the images, and their interpretations were rated as agree, both correct; agree, both incorrect; or disagree. Cases of disagreement were rated as major or minor. RESULTS: On-site and remote radiologists agreed in 69 of 80 patients (86%), and both radiologists were correct in all of these cases. There were 10 minor discrepancies and one major discrepancy. The diagnostic accuracies of the one-site and remote radiologists were 92% and 94%, respectively. CONCLUSION: High levels of diagnostic accuracy can be achieved by radiologists interpreting static US images. Strict protocols and excellent communication between the radiologist and sonographer are necessary to avoid diagnostic errors.

Academic Medical Centers↗
PubMed1999

Clinically suspected pulmonary embolism: use of bilateral lower extremity US as the initial examination--a prospective study.

PURPOSE: To determine the prevalence of deep venous thrombosis (DVT) and evaluate the use of symptoms and risk factors as selection criteria in the patient population undergoing lower extremity ultrasonography (US) as an initial examination for suspected pulmonary embolism (PE). MATERIALS AND METHODS: One hundred eighty-two consecutive patients referred for bilateral lower extremity US as the first examination for suspected PE were evaluated prospectively for predisposing factors and symptoms of DVT. Patients were placed into four groups: group 1, no symptoms or risk factors; group 2, both symptoms and risk factors; group 3, only risk factors; group 4, only symptoms. The prevalence of DVT detected at lower extremity US in each group was determined. RESULTS: There were 89 patients in group 1, 12 in group 2, 43 in group 3, and 38 in group 4, with a DVT prevalence of 0%, 25%, 14%, and 24%, respectively. There was no significant difference in DVT prevalence between groups with symptoms or risk factors but a significant difference between these groups and the group lacking both symptoms and risk factors. CONCLUSION: Lower extremity US as the initial examination in patients suspected of having PE should be used only in those patients who have symptoms or risk factors for DVT. This would substantially decrease the number of examinations performed without a decline in DVT detection.

Adolescent↗
PubMed1999

Lack of sensitivity of endometrial thickness in predicting the presence of an ectopic pregnancy.

The purpose of this study was to evaluate whether endometrial thickness measurements can be used to differentiate between patients with ectopic pregnancy and spontaneous abortion. Of 676 patients with clinical suspicion of ectopic pregnancy, no intrauterine pregnancy was seen in 128. Of these, 42 (33%) had ectopic pregnancy, 52 (40%) had spontaneous abortion, and 34 (27%) had intrauterine pregnancy. No significant difference was found in endometrial thickness between women with ectopic pregnancy (mean, 9.0 mm; range, 2 to 20 mm) and those with spontaneous abortion (mean, 8.4 mm; range, 2 to 18 mm). A thin endometrium seen on transvaginal sonography cannot be used to exclude the diagnosis of ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1998

Fetal fast MR imaging: reproducibility, technical quality, and conspicuity of anatomy.

PURPOSE: To evaluate the normal appearance of fetal anatomy, the conspicuity of fetal organs, the reproducibility of images, and the limitations to image quality with the use of half-Fourier, single-shot rapid acquisition with relaxation enhancement (RARE) magnetic resonance (MR) imaging. MATERIALS AND METHODS: Fifty-four fetuses of 49 pregnancies underwent MR imaging with the half-Fourier, single-shot RARE technique. Two reviewers attempted to identify 47 organs and anatomic regions in each fetus. Organ or region conspicuity, image quality, and the limitations of image quality were graded. RESULTS: Fetal anatomy was well depicted in fetuses over 20 weeks in gestational age. Fetal imaging was limited by gestational age of 20 weeks or less usually owing to the small size of the organ or region being evaluated and, less frequently, by motion. CONCLUSION: Half-Fourier, single-shot RARE MR imaging provided a detailed and reproducible evaluation of normal fetal anatomy, which can be used as a standard of reference in MR imaging of fetal anomalies.

Artifacts↗
PubMed1998

Chorioamniotic separation after second-trimester genetic amniocentesis: importance and frequency.

PURPOSE: To determine the frequency and importance of chorioamniotic separation (CAS) after second-trimester genetic amniocentesis. MATERIALS AND METHODS: In part 1 of the study, ultrasonography (US) databases were reviewed for cases of CAS. In part 2, a study population of 388 women undergoing amniocentesis underwent directed US examination for assessment of CAS 15 minutes and/or 2 weeks after amniocentesis. CAS, when present, was graded. A control population consisted of 363 women undergoing amniocentesis in whom the membranes were not assessed. RESULTS: In part 1, a review of 23,883 records revealed seven cases of complete CAS, with three deaths, two preterm deliveries, and one emergency cesarean section delivery due to fetal distress. In two of these cases, there were extremity deformities at birth. In part 2, CAS was present in 98 (25%) of 388 women at some point. There was no association between CAS and procedural variables. There was no substantial difference in morbidity between patients with and those without CAS, between patients with different grades of CAS, or between the study and control populations. CONCLUSION: Small degrees of CAS are frequently present after amniocentesis but are not detected because the membranes are not specifically evaluated. Complete CAS is less frequent.

Adult↗
PubMed1997

Imaging of pelvic postpartum complications.

Differentiation between endometritis and RPOC in febrile postpartum patients is commonly requested by clinicians. Sonography is the screening technique of choice to assess the endometrial contents. For cases in which the retained placenta is calcified or still has demonstrable blood flow, a specific diagnosis of RPOC can be made. In more complicated cases, a CT scan or an MR image may be requested. In addition to evaluating the uterus and any intra- or extrauterine fluid collections, attention must be paid to the ovarian veins to exclude the diagnosis of ovarian vein thrombosis.

Adult↗
PubMed1995

Bilateral lower extremity US in the patient with unilateral symptoms of deep venous thrombosis: assessment of need.

PURPOSE: To assess the need for bilateral ultrasound (US) evaluation for lower extremity deep venous thrombosis (DVT) regardless of predisposing factors in patients with unilateral symptoms. MATERIALS AND METHODS: Two hundred six patients with unilateral lower extremity symptoms suggestive of DVT were evaluated prospectively for predisposing factors and symptoms. Bilateral examinations were performed in all patients, and the prevalences of US-diagnosed DVT in symptomatic and in asymptomatic extremities were determined. RESULTS: Thirty-seven of the 206 patients had DVT in the symptomatic extremity. Twenty-five of these 37 patients had predisposing factors. No DVT was found in any asymptomatic extremity. Because compression US has a sensitivity and a specificity of greater than 90% for the diagnosis of DVT, these results were statistically significant (P < .001). CONCLUSION: Regardless of predisposing factors, US screening for DVT in the lower extremities should be limited to the symptomatic extremity in patients with unilateral symptoms. This would decrease scanning time and cost without a decline in the DVT detection rate.

Adolescent↗
PubMed1995

Bilateral lower extremity US in the patient with bilateral symptoms of deep venous thrombosis: assessment of need.

PURPOSE: To assess the frequency of lower extremity deep venous thrombosis (DVT) detected with ultrasound (US) in patients with bilateral symptoms suggestive of DVT. MATERIALS AND METHODS: Fifty patients with bilateral lower extremity symptoms suggestive of DVT were examined prospectively for predisposing factors and type of symptoms. Charts were reviewed for previous lower extremity disease or chronic illness that could explain the patient's symptoms. The frequency of DVT diagnosed with US in this patient group was determined. RESULTS: No DVT was identified in the patients with bilateral symptoms suggestive of DVT. Retrospective review demonstrated that 34 (68%) of the patients had a preexisting condition (cardiac disease, venous insufficiency, chronic swelling, cellulitis or thrombophlebitis, peripheral arterial disease). Because compression US has a greater than 90% sensitivity and specificity for the diagnosis of DVT, these results were statistically significant (P < .001). CONCLUSION: The likelihood of DVT in patients with bilateral lower extremity symptoms is extremely low. Alternative causes should be carefully explored before lower extremity US is considered.

Aged↗
PubMed1993

A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture.

PURPOSE: Although spontaneous thrombosis of femoral false aneurysms (FAs) and arteriovenous fistulas (AVFs) has been reported, the frequency of this occurrence is unknown. This prospective study was designed to establish the natural history of FA and AVF and to evaluate factors that might predict eventual thrombosis of these lesions. METHODS: Twenty-two patients with either femoral FAs (n = 16) or AVFs (n = 6) induced by percutaneous arterial punctures were evaluated prospectively. After an initial duplex scan, all patients were monitored with serial scans, either in hospital or weekly as outpatients, depending on the stability of the process. Operative repair was performed for the following indications: (1) a greater than 100% increase in size of a FA by duplex scan, (2) the development of symptoms, or (3) continued patency of the lesion after 2 months of observation. RESULTS: Nine of 16 FAs and four of six AVFs closed spontaneously; FAs greater than 6 cm3 (1.8 cm in diameter) required repair more often (p = 0.065). However, size was not an absolute predictor of the need for repair because two small aneurysms (1.6 and 0.7 cm3) remained patent, although both patients were discharged safely from the hospital, and two large aneurysms (13.2 and 10.7 cm3) thrombosed spontaneously. Three of seven patients whose aneurysms required repair received anticoagulation continuously from the time of catheterization until repair became necessary. None of the patients whose FAs closed spontaneously were receiving anticoagulants at the time of thrombosis (p = 0.02). Neither length of the FA neck, velocity in the FA cavity, size of original arterial puncture, nor velocity in the AVF correlated with thrombosis. CONCLUSIONS: We conclude that (1) all FAs do not thrombose spontaneously and at least one third require surgical repair, (2) patients receiving continuous anticoagulation should undergo aneurysm repair, (3) discharge of patients with FAs less than 6 cm3 is safe (the majority of these FAs will eventually thrombose spontaneously), and (4) many AVFs close spontaneously and repair is not required unless symptoms or signs of progressive enlargement develop.

Aneurysm, False↗
PubMed1993

Book reviews.

Explore the source record for details and available documents.

Book Reviews as Topic↗
PubMed1993

Accuracy of clinical examination in the evaluation of femoral false aneurysm and arteriovenous fistula.

A prospective study was undertaken to define the comparative value of physical examination versus duplex scanning in the detection of femoral false aneurysm and arteriovenous fistula after percutaneous femoral artery puncture. Fifty-three patients were referred to the vascular surgery service after femoral artery catheterization for evaluation of a groin hematoma or a new femoral bruit. All patients were evaluated initially by a vascular surgeon and then by duplex scan. The results of these evaluations were compared with the findings at operation. Physical examination was 100% sensitive and 100% specific in the diagnosis of arteriovenous fistula, whereas duplex scan achieved a sensitivity of only 58% and a specificity of 100%. Physical examination was 92% sensitive and 93% specific in the detection of femoral false aneurysm compared with a sensitivity of 83% and a specificity of 100% for duplex scanning. Physical examination is the best method for detecting and following patients with arteriovenous fistula. False aneurysms can be detected reliably by physical examination, although evaluation with a duplex scan is necessary to identify the precise size and anatomy of these lesions.

Aged↗
PubMed1992

The Simon nitinol filter: evaluation by MR and ultrasound.

In this prospective blinded study of inferior vena caval (IVC) patency, 18 patients underwent 25 duplex ultrasound (US) and magnetic resonance (MR) angiography examinations over an eight-month period following Simon nitinol filter placement. Clinical examination for lower extremity venous stasis and plain abdominal radiography were also performed. Twenty-three of 24 MR examinations and 11 of 24 US examinations were judged technically adequate by the blinded observers. One technically adequate US exam was false positive for intraluminal caval thrombus. Thirteen technically inadequate US examinations missed 3 complete caval occlusions and 2 partial occlusions. MR identified all patients with complete or partial caval occlusion. The authors conclude that duplex US reliably confirms IVC patency only when strict criteria for technical adequacy and interpretation are met (good visualization of filter and IVC above and below filter). MR, although expensive, more reliably identifies nonoccluding intraluminal thrombus and caval occlusion. It should be the noninvasive study of choice in symptomatic patients with venous stasis and patients with recurrent pulmonary emboli.

Adult↗
PubMed1984

Polycystic ovarian disease: sonographic spectrum.

Twenty-eight patients with polycystic ovarian disease (PCOD) as determined by hormonal analysis (with surgical confirmation of the diagnosis in 12 cases) underwent ultrasound examinations. Twenty-nine per cent of patients had normal ovarian volume. Normal ovarian size does not exclude the diagnosis of PCOD in the proper clinical setting. The remaining 71% of patients with PCOD had bilaterally enlarged ovaries in three distinct patterns: discretely resolved cysts (39%), hypoechoic (25%), and isoechoic to the uterus (7%). Understanding the sonographic spectrum of ovarian morphology in PCOD can aid in diagnostic evaluation of this condition in patients who may have a varied clinical presentation.

Adolescent↗
PubMed1984

Coexistent intrauterine and ectopic pregnancy: a reevaluation.

Retrospective analysis of ectopic pregnancies occurring in the past 36 months at the Beth Israel Hospital yielded two cases of concomitant intra- and extrauterine gestation. The incidence of coexistent intrauterine and ectopic pregnancy in this sample is 1/6,778, or 0.015% of all pregnancies. We report these cases and two additional cases from another institution (Leonard Morse Hospital). We postulate that simultaneous intrauterine and ectopic pregnancy may be more common than previous statistics indicate.

Adult↗