Search PubMed⌕ Search

Biomedical subjects

D A Hall

Publications and source records attributed to D A Hall.

At least 91 records · Page 5Linked to original sources

Localization of occult breast lesions: practical solutions to problems of triangulation.

The preoperative triangulation and localization of some occult breast lesions can be complicated if the lesion is located deep in the breast. Based on the authors' experience of 1,400 localization procedures, standard breast positions were modified to help locate lesions that were difficult to see in two projections. Standard compression plates were also modified, allowing placement of fenestrations over deep lesions--especially those in the axillary tail of the breast--to facilitate safe, accurate localization.

Breast Neoplasms↗

Sonography in the follow-up of 100 patients with thyroid carcinoma.

High-frequency, high-resolution sonography was used to detect recurrent thyroid carcinoma in 73 patients with papillary carcinoma, 16 with medullary carcinoma, 10 with follicular carcinoma, and one with small-cell carcinoma. Of the 36 patients with negative sonograms, 35 had no other evidence of recurrence, while one had surgical proof of recurrence. Of 25 patients with positive sonograms, confirmed with surgery or radioactive iodine (I131) scanning (sonographic sensitivity 96%, specificity 83%), palpation was negative in 17 (palpation sensitivity 32%, specificity 100%). Thirty-two patient with positive sonographic findings had no objective clinical proof of recurrence. There were seven false-positive studies. This study suggests that sonography may be the method of choice for earliest detection and localization of recurrent carcinoma of the thyroid.

Adenocarcinoma↗

Mammographic density and physical assessment of the breast.

We studied the relationship between the radiographic density of the breast as measured by parenchymal pattern vs age, breast size, thickness after compression, and compressibility. Two hundred consecutive women were evaluated. None of the three parameters or the patient's age correlated with the degree of radiographic density. Although more older women had lucent parenchyma, 37% of women more than 50 years of age had dense patterns. Thus, these factors cannot be used to predict radiographic density. Phototiming is required to maintain image quality, and only a test exposure can accurately predict breast density.

Adult↗

Localization of breast lesions identified on only one mammographic view.

Occasionally, a breast lesion is visible in only one mammographic projection. A simplified method of using parallax in a dedicated mammographic system has been devised to locate accurately lesions that are not visible in two orthogonal projections. In eight patients, a parallax approach from essentially a single mammographic position was used to place a hookwire preoperatively at nonpalpable suspicious abnormalities detected by mammography. Needles were inserted parallel to the chest wall while the breast was compressed in the mammographic unit. In each case, the tissue containing the lesion was pierced by a needle chosen to be longer than the distance from the skin to the abnormality. Simple geometric ratios were used to determine the position of the lesion along the needle shaft after slightly changing the mammographic projection and viewing the needle obliquely. In all cases, this parallax approach permitted accurate localization of the lesion.

Breast Diseases↗

The halo sign and malignant breast lesions.

The halo sign, described as a complete or partial radiolucent ring surrounding the periphery of a breast mass, has long been considered a mammographic sign indicating a benign process. The phenomenon is most frequently seen with cysts and fibroadenomas. Over the past 8 years, 25 malignant breast lesions with a partial or complete halo on mammography have been identified in 19 women. These cases suggest that a halo sign does not guarantee a benign process.

Adult↗

Chronic cholecystitis. An analysis of diagnostic strategies.

To define the optimal diagnostic approach for suspected chronic cholecystitis comprehensive management strategies were developed. Using a computer model, the frequency of appropriate surgery, inappropriate surgery, complications, death, and medical costs were compared in populations of patients with various disease prevalences. The optimal strategy began with ultrasonography, followed by an oral cholecystogram when the ultrasonogram was inconclusive. Oral cholecystogram also was employed when additional diagnostic studies failed to provide another explanation for the patient's symptoms. Compared with strategies using only ultrasonography or oral cholecystography, the combination strategy lowered the frequency of inappropriate surgery from 7.1 to 4.4% and direct medical costs from $1,877 to $1,766 per patient in a population with a 20% prevalence of chronic cholecystitis. The differences persisted at higher prevalences of cholecystitis and when sensitivities and specificities of the tests were varied over ranges reported in the literature. Diagnostic accuracy and direct medical costs could be improved by a more frequent interpretation of subtle abnormal ultrasonographic findings as inconclusive and by a more liberal use of oral cholecystography. This analysis demonstrates that a strategy combining ultrasonography and oral cholecystography is superior to the use of either test alone and is cost-efficient.

Cholecystitis↗

Sonographic monitoring of LHRH analogue therapy in idiopathic precocious puberty in young girls.

Precocious puberty in young girls is defined as the development of secondary sexual characteristics and gonadal growth before 8 years of age. Approximately 60% of isosexual precocious development in girls has no organic cause and is termed idiopathic precocious puberty. Thirteen young girls with idiopathic precocious puberty were treated with LHRH analogue under a well-established protocol. Pelvic ultrasound was added to the protocol to examine ultrasound's role in supplying a morphologic parameter of suppression of the pubertal process. Initially, 11 patients had ovarian volumes greater than normal, and ovarian cysts measuring 0.5 cm to 4 cm in diameter were identified in seven patients. All 13 patients had enlarged pretreatment uteri greater than 3 cm in length. Eleven of these patients had a pubertal or adult uterine configuration. After 1 year of therapy, 11 patients had normal prepubertal ovarian volumes, and 12 of 13 patients had a decrease in ovarian volume. No demonstrable cysts were present at 1 year. Eleven had a reduction in uterine length. Nine of the 11 patients with a pubertal uterine configuration reverted to a more prepubertal-like morphology. The sonographic morphologic changes correlated well with laboratory and clinical data indicating suppression of the hypothalamic-pituitary-gonadal axis.

Child↗

Sonographic visualization of the normal postmenopausal ovary.

The pelvic sonograms of 30 postmenopausal women who demonstrated no pathology in 8-18 months of clinical follow-up were reviewed. In 19 cases both ovaries were visualized. Only one ovary was seen in three patients and neither ovary identified in eight patients. Ovarian volumes were all less than or equal to 2.5 cm3. The authors suggest that, contrary to previous experience, a large proportion of normal postmenopausal ovaries can be depicted sonographically. Further data are necessary before definite normal volumes are known but sonography may be useful to screen patients to help detect early ovarian carcinoma.

Aged↗

Postmenopausal endometrial fluid collections: always an indicator of malignancy?

An endometrial collection in a postmenopausal woman is abnormal. Its potential for heralding pelvic malignancy has been emphasized. Although malignancy must always be excluded, the authors' experience with a large outpatient population indicates that benign causes of uterine fluid collections may be more common than previously reported. During a 14-month period eight postmenopausal women with endometrial fluid collections were identified in the outpatient ultrasound department of the Massachusetts General Hospital. Seventy-five per cent of these were secondary to benign processes.

Aged↗

The significance of the postmenopausal simple adnexal cyst.

In order to help clarify the clinical problem of the postmenopausal woman with an adnexal cyst, 13 patients with sonographically detected relatively simple adnexal cysts were reviewed. Only one patient had a "borderline" malignancy; the remaining cysts were all benign. The 8 per cent malignancy rate in this small series suggests that the simple postmenopausal adnexal cyst may not necessarily be an ominous finding.

Adnexal Diseases↗

The effect of age on the relationship between plasma elastase and ingested lipid.

In human subjects ranging in age from 57 to 99 years the elastase content of the plasma increased following the ingestion of a lipid-rich meal. Animal experiments have shown that peak elastase levels are attained after 3 to 4 hours, which are similar to the appearance of peak levels of triglyceride. The difference between the postprandial and fasting levels of elastase is age-dependent, being greatest among the lowest ages studied and falling exponentially at ages above 65-70. Since it has already been shown that individuals aged 65-75 with high fasting levels of plasma elastase are less likely to survive into their ninth or tenth decades it is suggested that the measurement of the increase in elastase associated with the intake of a lipid-rich meal can provide an acceptable indication of survival potential.

Age Factors↗

The bile ducts after a fatty meal: further sonographic observations.

The sonographic appearance of the response of the common hepatic duct to physiologic stimulation by a fatty meal was assessed in 131 patients referred because of right upper quadrant symptoms or abnormal liver chemical studies. In the determination of the presence or absence of biliary obstruction, the sensitivity of the examination was 84%, the accuracy of a positive test was 84%, and the accuracy of a negative test was 93%. This test proved helpful in several circumstances: equivocal duct caliber (6-10 mm); abnormal caliber (6-14 mm) with normal laboratory values; normal caliber duct with abnormal laboratory values; persistent question of cholelithiasis or asymptomatic pancreatic duct dilatation. Measurements of bile duct caliber alone may be insufficient to ascertain the presence of bile duct obstruction and fatty meal stimulation significantly improves diagnostic accuracy.

Bile Ducts↗

Comparison of sonography and plain films in evaluation of the acute abdomen.

In 95 patients with acute abdominal pain seen in the emergency ward of a large urban teaching hospital, real-time sonography was performed in conjunction with a plain film of the abdomen in order to detect what, if any, added information was provided by the sonographic examination. In 20 patients (21%) the sonogram contributed important diagnostic information not provided by the plain film of the abdomen. Most of these patients had pathology referable to the biliary tract (14 of 20). In 28 patients (30%), the sonogram confirmed the diagnosis by abdominal film. In 39 (41%) the sonogram added no relevant information, and in three (3%) it was deleterious. In five (5%) the plain film provided more information than the sonogram.

Abdomen, Acute↗

Enzymes and survival.

Age related deficits in enzyme systems, such as those which control lipid metabolism and hence provoke cardiovascular pathologies, can be reversed by replacement therapy either by-passing the enzyme by supplying the product of its reaction or by administering the enzyme itself. There are difficulties associated with enzyme therapy associated with their high molecular weight and protein reactions. Our enzyme preparation which has been shown to be effective in modifying plasma lipid profiles in atherosclerotics, is Vasolastine. Following intramuscular administration of elderly subjects it reduces the circulating cholesterol in the 75-80 age group by 13% but at the extremes of the age range (60-75 and 80-95) increases the level by between 1.5% and 5.0%. HDL-cholesterol levels, however, are raised by 5% over the whole age range. The effect of these changes is to lower the ratio of total plasma cholesterol to HDL-cholesterol at all ages up to the end of the 9th decade by approximately 6%, whereas at ages above 80 years the enzyme preparation lowers the value of the ratio by less than 3%. Since high values of this ratio correlate with a high risk of coronary disease, it may be inferred that over the lower part of this elderly age range Vasolastine reduces the risk, whereas at higher ages when the risk in untreated subjects is lower, the protective effect of the enzyme preparation is less pronounced.

Aged↗

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↗

Sonographic appearance of hematoma in liver, spleen, and kidney: a clinical, pathologic, and animal study.

Following the observation of several cases of localized echogenic foci in abdominal parenchymal organs in patients with acute bleeding due to trauma, an experimental study was designed to define the sonographic appearance of fresh, nonhemolyzed blood. Ultrasound scanning performed before and after the injection of blood or air into the parenchyma of cadaveric organs (liver, spleen, and kidney) resulted in consistent ultrasonic patterns. Linear echogenic foci resulted from the injection of 0.5 to 2.0 ml of blood, rounded echogenic foci were seen with air or 3- to 10-ml injections of blood, and the injection of contrast material (into the liver only) caused poorly defined hypoechoic areas. To determine if the ultrasound appearance of the cadaveric organs could have been caused mainly by air, an in vivo experiment was performed in which computed tomograms of the liver of a dog that had been injected with autologous blood were obtained. It is concluded that CT confirmed the ultrasound findings, and that ultrasound is useful for the investigation of hematoma following blunt, and possibly penetrating, trauma.

Animals↗