Biomedical subjects

E M James

Publications and source records attributed to E M James.

At least 19 recordsLinked to original sources

PubMed1992

Prediagnostic malakoplakia presenting as a chronic inflammatory mass in the soft tissues of the neck.

Malakoplakia presenting in the head and neck is very rare. We present a case of an inflammatory mass in the neck, clinically mimicking actinomycosis in a 67-year-old man. Repeated culture of E. coli and histological and electron microscopic examination of biopsy material showed an infiltration of granular macrophages and intracellular gram negative bacilli, but no classical Michaelis-Gutmann bodies. The clinical and pathological findings and criteria for the diagnosis of malakoplakia are discussed.

Aged↗

PubMed1991

Oxalate, silicon and vanadium in acquired cystic kidney disease.

We have investigated the importance of several clinical and laboratory parameters on the development of acquired cystic kidney disease (ACKD) as detected by ultrasonography in 19 patients who had received dialysis therapy for at least three years. We were particularly interested on the possible effect of the serum levels of oxalate and silicon, which can produce tubular obstruction, and that of vanadium, which can affect cell proliferation. The severity of ACKD increased with the duration of dialysis and was greater in men than in women. Positive correlations were observed between the grades of ACKD and the levels of hemoglobin, hematocrit, and parathyroid hormone, while there was a negative correlation between ACKD and serum ferritin levels. The serum levels of oxalate, silicon, and vanadium, pre- and postdialysis, were markedly and significantly higher than those in normal controls, but there was no significant correlation between these levels and the duration of dialysis therapy or severity of ACKD. The pre- and postdialysis levels of vanadium were not significantly different, while the levels of oxalate and silicon were significantly lower in the postdialysis samples. No significant correlations were detected between ACKD and age of the patients, blood pressure, protein catabolic rate, efficiency of dialysis index, or the serum levels of iron, sodium, potassium, calcium, phosphorus, aluminum, and beta 2-microglobulin.

Dialysis Solutions↗

PubMed1991

Vasculogenic impotence. Duplex and color Doppler imaging.

Varicoceles, although only occasionally symptomatic, are reported to occur in 20% to 50% of infertile or subfertile men. Ligation or occlusion of the spermatic vein in these patients has improved semen quality in many instances. Recently, it has been recognized that varicoceles can be bilateral or subclinical and thus detected only by imaging. Sonographic diagnosis of varicoceles and percutaneous occlusive therapy are reviewed in this article.

Color↗

PubMed1990

Intraoperative ultrasonographically guided biopsy in testicular sarcoidosis: a case report.

We present a case of sarcoidosis with involvement of a solitary testis that was discovered incidentally on an ultrasonogram of the scrotum. This appears to be case 8 of sarcoidosis with genitourinary involvement limited to the testis. We believe it is the second report of intraoperative ultrasonography used to locate and perform a biopsy of impalpable testicular lesions. We consider this technique to be useful in instances of solitary gonads or in cases of bilateral lesions.

Adult↗

PubMed1990

Applications of duplex ultrasonography in the liver transplant patient.

Duplex ultrasonography plays an important role in the preoperative and postoperative assessment of liver transplant patients. Before surgical intervention, the principal use of sonography is to assess the patency of the extrahepatic portal vein because a narrowed or thrombosed portal vein may preclude transplantation. Postoperatively, several potential complications can lead to allograft dysfunction (rejection, infection, vascular thromboses, and biliary tract complications). Because these complications often manifest with variable and nonspecific symptoms, diagnosing them can be difficult. Sonography is a valuable noninvasive means of evaluating postoperative complications in liver transplant patients. When vascular complications are suspected, duplex sonography is the optimal screening procedure for assessment of the vascular anastomoses. Focal parenchymal abnormalities (hematomas, infarcts, and bilomas) and localized collections of abdominal fluid are readily detected by ultrasonography and can be safely aspirated and, when infected, percutaneously drained under sonographic guidance. Sonography is less useful in the detection of biliary tract complications early after transplantation.

Humans↗

PubMed1990

Positive predictive value of clinical suspicion of abdominal aortic aneurysm. Implications for efficient use of abdominal ultrasonography.

Although selective screening for an abdominal aortic aneurysm (AAA) by abdominal palpation aimed at detecting AAAs has engendered considerable support, no population-based data pertaining to the positive predictive value (PPV) of the clinical assessment of AAAs in routine clinical practice are available. Therefore, we used the unique resources of the Rochester (Minn) Epidemiology Project and the Mayo Clinic computerized abdominal ultrasonography database to identify all residents of Olmsted County, Minnesota,who underwent ultrasound examination for a clinically suspected AAA between November 1, 1985, and October 31, 1987. Of 116 residents who were suspected of having an AAA on abdominal palpation and were referred for an ultrasound examination for confirmation, 17 patients had a 3.5-cm or greater AAA by ultrasound examination (PPV = 14.7%). The probability of AAA by ultrasound examination (PPV = 14.7%). The probability of AAA documentation by ultrasound examination given clinical suspicion of an AAA was associated with higher body mass index, older age,and presence of other macrovascular disease. In 17 patients aged 70 years or younger, without other macrovascular disease and with body mass index of 24 or less, only 1 had an AAA of 3.5 cm or greater (PPV = 6%), while 10 of 20 patients aged 70 years or older, with macrovascular disease,and with body mass index greater than 24 had an AAA of 3.5 cm or greater (PPV = 50%). These population-based data that highlight the poor PPV of the clinical assessment for AAAs indicate that abdominal palpation aimed at detecting AAAs as part of a periodic health examination may lead to a much higher rate of false-positive results than indicated by previous referral-based data. Further research is needed to identify patient subgroups in whom abdominal palpation for detection of AAAs will be cost-effective with respect to reduction in AAA mortality.

Aged↗

PubMed1989

Current applications of duplex and color Doppler ultrasound imaging: carotid and peripheral vascular system.

Recent advances in ultrasound technology have made possible the development of diagnostic instruments that combine cross-sectional imaging and Doppler analysis. These instruments have expanded the role of diagnostic ultrasonography to the assessment of carotid and peripheral vascular disease. The current applications of duplex Doppler and color Doppler imaging in evaluating the extracranial carotid arteries, vertebral artery, peripheral venous system, and peripheral arterial system are reviewed. The indications for and limitations of these examinations, as well as the potential future uses, are discussed.

Arteries↗

PubMed1989

Current applications of duplex and color Doppler ultrasound imaging: abdomen.

Duplex ultrasound studies and color Doppler imaging have substantially enhanced the diagnostic capabilities of abdominal ultrasonography. The status of the flow in the major abdominal vessels is routinely obtainable along with anatomic information about the organs that they supply. The current applications of duplex and color Doppler imaging in evaluating the hepatic vascular system, hepatic transplants, aorta, splanchnic arterial system, renal artery and vein, renal transplants, and penile arterial system are reviewed. The indications for and limitations of these examinations, as well as the potential future uses, are discussed.

Abdomen↗

PubMed1989

Current applications of color Doppler imaging in the abdomen and extremities.

Recent advances in ultrasound technology have resulted in the development of diagnostic instruments that combine cross sectional imaging with spectral and color flow Doppler analysis. These instruments have expanded the role of diagnostic ultrasonography in the assessment of disease states involving the extracranial carotid artery, the peripheral vascular system, and the major abdominal vessels. The current applications of color Doppler imaging (CDI) combined with conventional spectral Doppler are demonstrated.

Abdomen↗

PubMed1989

Duplex and color Doppler sonographic evaluation of vasculogenic impotence.

One hundred eighty patients with suspected vasculogenic impotence were evaluated with conventional penile duplex sonography with spectral analysis and color Doppler imaging. Measurements of mean peak systolic and end-diastolic velocities were obtained from the cavernosal arteries before and after intracavernosal injections of papaverine. Sixty-one patients were examined with dynamic cavernosography and cavernosometry, and 12 patients were studied with selective internal pudendal and penile arteriography. All five patients with abnormal arteriography had mean peak systolic velocities in the cavernosal arteries of less than or equal to 25 cm/sec (sensitivity, 100%; 95% confidence interval, 48-100%) after the injection of papaverine. Six of the seven patients with normal arteriography had mean peak systolic velocities of greater than 25 cm/sec (specificity, 85.7%; 95% confidence interval, 42-100%) after injection of papaverine. By using data from a receiver-operating-characteristic curve, we determined that end-diastolic velocities in the cavernosal arteries of greater than or equal to 5 cm/sec after the injection of papaverine correctly identified patients with excessive venous leakage on cavernosometry; the sensitivity was 90% (95% confidence interval, 77-97%) and the specificity was 56% (95% confidence interval, 30-80%). The addition of color Doppler sonography made the detection of vessels easier and the correction of the Doppler angle more accurate, resulting in more rapid and accurate acquisition of data. Penile duplex sonography with spectral analysis and color Doppler imaging are sensitive and noninvasive means of examining patients with potential vasculogenic impotence.

Adolescent↗

PubMed1988

Reoperative parathyroid surgery.

Reoperation for persistent or recurrent primary hyperparathyroidism immediately connotes a complex clinical management problem. Successful cure of hypercalcemia is less frequent whereas complications are more common compared to initial explorations. Of 212 patients operated on at the Mayo Clinic from 1978 through 1986, 189 (89%) were cured. Sporadic disease, multiple endocrine neoplasia, and familial hyperparathyroidism were found in 183 (87%), 20 (9%), and 9 (4%) patients, respectively. Prior to the most recent reoperation, these patients had undergone from one to five operations. Preoperative localization examinations were performed in 192 patients (91%). Cervical high-resolution, real-time ultrasonography, computed tomography, and thallium-technetium scintigraphy had sensitivity rates of 87%, 56%, and 71%, respectively. When the tumor was localized preoperatively, the operative time and cost were significantly reduced compared to nonlocalized tumors. Cervical reexploration only was required in 154 (72%), combined cervical and mediastinal exploration occurred in 46 (22%), and mediastinal exploration only was performed in 12 (6%). There was no perioperative mortality; permanent hypoparathyroidism developed in 33 patients (16%), and six patients (2.9%) suffered permanent unilateral vocal cord paralysis. Anatomically, the most frequent site to find a missed parathyroid adenoma was in the normal location. The large majority of these glands were removed through a cervical incision although, on occasion, they were retracted from the anterior superior mediastinum or the low tracheoesophageal space. These data confirm that reoperative parathyroid surgery can be performed safely, with a rather high degree of success, but too-frequently results in a lifetime morbidity of hypoparathyroidism.

Adolescent↗

PubMed1988

Insulinoma: the value of intraoperative ultrasonography.

Ideally, surgical exploration for insulinomas would be met with uniform success in both finding and removing the tumor, incurring no postoperative mortality or morbidity. In reality, however, insulinomas remain undetected by even experienced surgeons in 10 to 20% of patients, including present-day series. Additionally, postoperative complications may occur in 10 to 25% of patients, principally related to the pancreatic dissection. Although dispensing with any attempt to preoperatively localize the tumor has been advocated, most authors agree that localization efforts are necessary and helpful. To review the results and surgical implications of current localization techniques, 41 adult patients who were surgically treated for insulinomas at the Mayo Clinic from 1980 through June 1987, were reviewed. Tumor size ranged from 5 mm to 4 cm, and the sensitivity of tumor localization using arteriography, computed tomography, preoperative and intraoperative ultrasonography were 55%, 27%, 59%, and 90%, respectively. Since the introduction of intraoperative ultrasonography into our clinical practice in 1982, all 29 of our adult patients' insulinomas have been identified with a combination of this technique and palpation by an experienced surgeon. There were no false positive interpretations with intraoperative ultrasonography, and tumors were imaged in four patients that were not palpable. In 18 of these 29 (62%) patients, the information gleaned from the images appeared to influence the surgical management. While there is no substitute for exploration by an experienced surgeon, his ability is enhanced by the addition of both preoperative and intraoperative ultrasonography.

Adenoma, Islet Cell↗

PubMed1988

Insulinoma. The value of intraoperative ultrasonography.

After establishing the diagnosis of an insulinoma, most surgeons prefer preoperative localization. Selective arteriography has long remained the gold standard for this purpose, but its use has been met with variable success. Despite various attempts at localization, insulinomas remain undetected in 10% to 20% of patients, and there may be a postoperative complication rate of at least 10% to 25%. To review the results and surgical implications of current localization techniques, 36 adult patients who were surgically treated for insulinomas at the Mayo Clinic, Rochester, Minn, from July 1982 through June 1987 were studied. The sensitivities of tumor localization using arteriography, computed tomography, and preoperative and intraoperative ultrasonography were 53%, 36%, 59%, and 90%, respectively. A subset of 29 patients underwent intraoperative ultrasonography, and all of these patients' insulinomas were identified with a combination of this technique and intraoperative palpation, with nonpalpable tumors being imaged in four patients. In 18 patients (62%), information obtained from the images appeared to influence the surgical management. While there is no substitute for exploration by an experienced surgeon, exploration appears to be enhanced by the addition of intraoperative ultrasonography, particularly during reoperation.

Adenoma, Islet Cell↗

PubMed1988

Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography.

Methods of preoperative radiologic localization of insulinoma were compared in 52 patients, 44 of whom had solitary tumors. Examinations performed in these 44 patients were preoperative ultrasonography (US) in 28, angiography in 26, and computed tomography in 23. Prospective sensitivities were 61%, 54%, and 30%, respectively. Imaging sensitivities were lower for the eight patients with multiple insulinomas. In 28 of the 44 patients, intraoperative US was performed without the examiner being aware of the surgical findings. The sensitivity was 84%. Four insulinomas were not palpable but were visualized sonographically. The combined sensitivity of intraoperative US and surgical palpation for detecting solitary insulinomas was 100%. High-frequency intraoperative US is valuable for detecting occult solitary insulinomas and considerably useful for determining the proximity of insulinomas to the pancreatic and bile ducts.

Adenoma, Islet Cell↗

PubMed1988

US-guided biopsy of neck masses in postoperative management of patients with thyroid cancer.

High-frequency (10-MHz) sonography demonstrated a cervical mass or lymphadenopathy, or both, during postoperative follow-up of 52 patients who had undergone surgery for thyroid cancer. Percutaneous biopsy with ultrasonographic (US) guidance was performed in all 52 masses, 44 of which were nonpalpable. Malignant cells were obtained in 29 biopsies, and the results of 20 biopsies were negative, yielding benign lymphocytes only. Results in three biopsies were nondiagnostic due to hypocellular specimens. Therefore, 94% of biopsy results (49) of 52) were confidently assigned as either positive (56%) or negative (38%) for malignancy. There were no complications. High-frequency sonography can demonstrate clinically occult thyroid bed tumor recurrence and lymph node metastases. US-guided biopsy is an accurate and safe technique to confirm or exclude malignancy in patients at high risk of recurrence of thyroid cancer.

Adult↗

PubMed1988

Sonographically guided percutaneous biopsy of small (3 cm or less) masses.

Traditionally, sonographically guided percutaneous needle biopsy has been used for the biopsy of large, superficial, and cystic masses. Today, however, many think that small, solid masses also can be biopsied accurately. Real-time sonographically guided biopsies of 126 consecutive solid masses that were less than or equal to 3.0-cm in diameter (less than or equal to 1.0 cm, 24; 1.1-2.0 cm, 42; 2.1-3.0 cm, 60) were performed to diagnose primary or secondary neoplasm. These masses were located in a variety of anatomic regions (abdomen, 92; neck, 31; breast, two; extremity, one). Clear visualization of the biopsy needle was accomplished by continuous real-time monitoring of the needle's position, primarily by using linear, phased-array transducers, large-caliber needles (18- to 19-gauge, when possible), and an echogenic screw stylet inserted coaxially within the biopsy needle. The correct cytologic/histologic diagnosis was established in 91% of the masses (less than or equal to 1.0 cm, 79%; 1.1-2.0 cm, 88%; 2.1-3.0 cm, 98%). No complications other than mild, localized discomfort were encountered. Our experience suggests that sonographically guided biopsy is a highly accurate and safe procedure that can be used to establish the diagnosis in solid masses that are 3.0 cm or less in diameter if proper techniques are used to clearly visualize the biopsy needle.

Biopsy, Needle↗

PubMed1988

Cholangiocarcinoma: diagnosis and evaluation of resectability by CT and sonography as procedures complementary to cholangiography.

The purpose of this study was to evaluate the usefulness of CT and sonography as procedures complementary to cholangiography in the detection and staging of cholangiocarcinoma. The studies of 42 patients with pathologically proved cholangiocarcinoma and preoperative CT (26 patients), sonography (30 patients), and cholangiography (31 patients) were reviewed blindly and retrospectively. The tumor was shown by CT in 69%, by sonography in 47%, and by cholangiography in 97% of patients. Three radiographic types of cholangiocarcinoma were identified: infiltrating stenotic (69%), bulky exophytic (19%), and polypoid intraluminal (12%). CT correctly staged 54%, sonography 50%, and cholangiography 58% of tumors as resectable (40%) or unresectable (60%). The sensitivities in detecting unresectability with CT, sonography, and cholangiography were 44%, 19%, and 43%, respectively; specificities were 78%, 100%, and 100%, respectively. CT and sonography combined with cholangiography increased the sensitivities to 64% and 50%, respectively. CT and sonography were complementary to cholangiography because they helped determine the extrabiliary extent of these tumors and therefore provided information on resectability.

Adenoma, Bile Duct↗

PubMed1987

Suppressive therapy with levothyroxine for solitary thyroid nodules. A double-blind controlled clinical study.

Thyroid nodules are present in up to 50 percent of adults in the fifth decade of life. Patients are often treated with thyroxine in order to reduce the size of the nodule, but the efficacy of thyrotropin-suppressive therapy with thyroxine remains uncertain. In this study, 53 patients with a colloid solitary thyroid nodule confirmed by biopsy were randomly assigned in a double-blind manner to receive placebo (n = 25) or levothyroxine (n = 28) for six months. Before treatment, pertechnetate-99m thyroid scanning showed that 22 percent of the nodules were functional, 25 percent hypofunctional, and 53 percent nonfunctional. High-resolution (10-MHz) sonography was used to measure the size of the nodules before and after treatment. Suppression of thyrotropin release was confirmed in the levothyroxine-treated group by the administration of thyrotropin-releasing hormone; thyrotropin release was normal in the placebo group. Six months of therapy did not significantly decrease the diameter or volume of the nodules in the levothyroxine group as compared with the placebo group. We conclude that the efficacy of levothyroxine therapy in reducing the size of colloid thyroid nodules is not apparent within six months, despite effective suppression of thyrotropin.

Adult↗