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Biomedical subjects

E V Miller

Publications and source records attributed to E V Miller.

At least 19 recordsLinked to original sources
PubMed1997

Renal hilar Doppler analysis is of value in the management of patients with renovascular disease.

BACKGROUND: An increasing interest in the role of Doppler ultrasound and duplex scan in screening for renovascular hypertension has recently been noted. We conducted this study to define the role of renal hilar Doppler ultrasound (RHDU) in evaluating renal artery stenosis and its value in the postoperative follow-up after renal revascularization. METHODS: One hundred and fourteen patients are included in this study with a mean age of 63.7 (11 to 89) years. Seventy-two patients underwent renal revascularization. The most frequent revascularization procedure was renal artery bypass in 82%. The RHDU results were compared with 130 angiograms done within 1 month of the RHDU study. The Doppler velocity signal in a segmental artery in the renal parenchyma was recorded, and the waveform was analyzed. An acceleration index (AI) less than 3.78 KHz/sec/MHz and an acceleration time (AT) greater than 0.1 seconds were used to indicate the presence of a significant renal artery stenosis. RESULTS: The overall technical success rate of all RHDU studies was 93.5%. The AI value was higher in the group of patients with normal renal arteries than those with a stenosis (4.7 +/- 1.4 KHz/sec/MHz versus 1.23 +/- 1.13 kHz/sec/MHz, respectively, P <0.0001), and the AT was lower in the former group compared with the latter (0.052 +/- 0.011 sec versus 0.122 +/- 0.069 sec, P <0.0001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for AI were 89%, 92%, 85%, 94%, and 92%, respectively; and for AT were 62.5%, 97.5%, 91%, 86.5%, and 87% respectively. There was a significantly high agreement between the AI and AT results and those of arteriography (Kappa of 0.82 and 0.66, respectively, P < 0.0001). There were 10.6% kidneys with multiple renal arteries by arteriography. In these kidneys the accuracy was lower for both AI and AT and the agreement with arteriography was nonsignificant. In the postoperative period the accuracy of RHDU was 86% for AI and 95% for AT. CONCLUSIONS: Renal hilar Doppler ultrasound has a high accuracy and agreement with arteriography in the diagnosis of renal artery stenosis. Its value is limited by the presence of multiple renal arteries, renal artery occlusion, and high incidence of postoperative false-positive results. It can be useful as a noninvasive screening test for patients suspected of having renal artery stenosis and for surveillance following renal revascularization.

Adolescent↗
PubMed1995

Should all in situ saphenous vein bypasses undergo permanent duplex surveillance?

OBJECTIVE: To evaluate the need for color duplex surveillance (CDS) for pure in situ bypasses beyond 6 months. DESIGN: We reviewed our in situ surveillance data from August 1987 to April 1994. Lower-extremity revascularization was performed using 245 pure in situ greater saphenous vein bypasses in 219 patients. The CDS of the entire bypass and inflow and outflow arteries was done prior to discharge, at 1 month, every 3 months in the first year, every 6 months in the second year, and annually thereafter. A peak systolic velocity of less than 45 cm/s throughout the bypass or a velocity ratio of greater than 3 (peak systolic velocity at the stenosis divided by peak systolic velocity at an adjacent normal bypass segment) were defined as abnormal during the review of this patient subset. The outcomes were analyzed. Patency and limb salvage rates were calculated by life-table analysis. PATIENTS: The mean age of this population (120 men and 99 women) was 67 years (range, 32 to 97 years). We analyzed all bypasses that were subjected to CDS for 6 months or more and identified 171 such bypasses. These bypasses were followed up for a mean duration of 30 months (range, 6 to 82 months). RESULTS: The primary and secondary patency and limb salvage rates at 5 years were 60.4%, 89%, and 92.1%, respectively (SE, < 10%). During the first 6 months of surveillance, 54 bypasses had abnormal CDS findings, and 117 had normal CDS findings. Arteriography was performed on 42 of these bypasses with abnormal CDS findings, and 37 had significant findings requiring direct surgical or endovascular intervention. Only two of 117 bypasses that had normal CDS findings for up to 6 months had to be revised later, compared with 43 of the 54 bypasses with abnormal CDS findings prior to 6 months, which were occluded or were revised (significantly different by chi 2 test [P < .001]). CONCLUSIONS: Vigorous CDS of pure in situ bypasses for up to 6 months is useful to detect bypass-threatening lesions. Continued CDS of a normal in situ bypass after 6 months may not be justifiable, as the incidence of lesions requiring later revision is minimal.

Adult↗
PubMed1993

Intraoperative B-mode ultrasonography is a useful adjunct to peripheral arterial reconstruction.

We used an ultrasound imaging system with a 10 MHz probe during 118 vascular procedures. These procedures included 56 cerebrovascular, 38 infrainguinal, 16 renal, 4 mesenteric, and 4 aortic reconstructions. In 29 procedures, intraoperative ultrasonography was used to supplement or replace preoperative arteriography to better define the extent of disease for the optimal placement of an anastomosis or to determine the need for an additional reconstructive procedure. In 106 cases, ultrasonography was used for postreconstruction assessment. Of the 21 (20%) defects found, 11 (10%) were deemed important enough to warrant correction. Defects were significantly more common following endarterectomy procedures (p < 0.01). All 11 of the major defects were successfully repaired, and neither the corrected defects nor the 10 uncorrected minor defects were associated with postoperative complications. Patients (with and without defects) underwent routine early postoperative follow-up assessment of the technical adequacy of their reconstruction using color duplex imaging; no residual defects were discovered. Two (2%) postoperative occlusions (one femorofemoral and one aortorenal bypass) occurred without a technical defect noted on reexploration. This clinical experience demonstrates that B-mode ultrasonography can supplement or replace preoperative arteriography in selected cases and is a valuable technique for identifying defects intraoperatively so that they can be immediately corrected.

Aorta↗
PubMed1984

Skene's duct cyst.

Skene's duct cysts are rare. A review of the medical literature revealed Skene's duct cysts in 2 newborns and 1 adult in whom the cyst caused superficial external dyspareunia. A case of Skene's duct cyst is reported, which was associated with spraying of the urinary stream during voiding. Differential diagnosis includes urethral diverticulum, ectopic ureterocele, cystocele and Gartner's duct cyst.

Adult↗
PubMed1982

Comparison of continuous-wave Doppler imaging, oculopneumoplethysmography, and the cerebrovascular Doppler examination.

Previous reports of continuous-wave Doppler imaging have combined that technique with periorbital Doppler studies. In the present report, 75 patients with findings suggestive of cerebrovascular insufficiency were evaluated using continuous-wave Doppler imaging, oculopneumoplethysmography (OPG-G) and the cerebrovascular Doppler examination (CDE). Each test was interpreted independently. Doppler imaging had an overall accuracy of 85%, with a 68% accuracy in identifying 50-70% stenoses and a 69% accuracy in identifying high-grade stenoses (greater than 70%) and occlusion. OPG-G had an overall accuracy of 85%, with a 55% sensitivity for 50-70% stenoses and an 89% sensitivity for high-grade stenoses and occlusion. The CDE had an overall accuracy of 84% and a 50% sensitivity for stenoses of 50-70% and an 88% sensitivity for high-grade stenoses and occlusion. As an independent technique, continuous-wave Doppler imaging achieves an overall accuracy comparable to that of OPG-G or the CDE. Its sensitivity to high-grade stenosis and occlusion, however, is less than that of the other techniques. Since CDE and OPG-G had a 94% sensitivity to carotid occlusion and a combined sensitivity to high-grade stenoses and occlusion of 88% and 89%, respectively, their combined use with Doppler imaging offers sensitivity to and differentiation of stenoses from occlusion.

Carotid Artery Diseases↗
PubMed1981

Oculopneumoplethysmography, Doppler examination, and supraorbital photoplethysmography: a comparison of hemodynamic techniques in assessing cerebrovascular occlusive disease.

There noninvasive techniques used in the evaluation of carotid occlusive disease were compared in the same population group. The cerebrovascular Doppler examination (CDE) had an accuracy rate of 89%, oculopneumoplethysmography (OPG-Gee) an accuracy rate of 94%, and supraorbital photoplethysmography (SOPPG) an accuracy rate of 86%. With the combined use of the CDE and the OPG-Gee, the accuracy rate increased to 96% when the results were concordant, and the false-negative rate dropped to 3%. The data would suggest that the combined use of the CDE and the OPG-Gee offers an advantage over either technique used individually.

Arterial Occlusive Diseases↗
PubMed1981

Performance evaluation: continuous lumbar epidural anesthesia skill test.

The evaluation of skills in anesthesiology residents is usually subjective and lacks demonstrable reliability. Therefore, an objective criterion-referenced skill test for measuring performance of continuous lumbar epidural anesthesia was developed. For such a test to be useful, it is necessary to demonstrate agreement among rater-observers. Eight performances of continuous lumbar epidural anesthesia were recorded on video tape and simultaneously rated by nine anesthesiology faculty observers to determine inter-rater reliability. Inter-rater agreement was analyzed by determining coefficient kappa for each item and the entire test. Coefficient kappa for the entire test was 0.82 indicating a high degree of agreement between raters on the performance or nonperformance of various items. Development and utility of skill tests are discussed.

Anesthesia, Epidural↗
PubMed1979

Severe prostatic calcification after radiation therapy for cancer.

Severe symptomatic prostatic calcification was seen in 3 patients who had carcinoma of the prostate treated initially with transurethral resection, followed in 2 to 4 weeks by definitive radiation therapy. This complication is probably preventable if an interval of 6 weeks is allowed between transurethral resection of the prostate and radiation therapy.

Aged↗
PubMed1978

Venous thromboembolism in the morbidly obese.

Obesity has been considered as a high risk factor in the development of thromboembolism. To test the validity of this hypothesis, the records of 564 morbidly obese patients who underwent gastric bypass for control of their obesity were reviewed. Four patients, 0.7 per cent, had proved fatal pulmonary emboli and three demonstrated detectable, but not fatal, embolization. Fifty-seven patients were studied prospectively with Doppler examinations of the lower extremities, and only one patient had a transient abnormality of venous thrombosis of the calf, which proved to be associated with a nonfatal pulmonary embolus. The morbidly obese patients are not at high risk from thromboembolism, and the prophylactic use of low dose heparin, which may increase known wound morbidity, is discouraged. Doppler ultrasound of the lower extremities, however, has proved usefulness to differentiate deep venous thrombosis of the lower extremity from other causes of pain in the leg of the morbidly obese.

Adolescent↗
PubMed1976

Simultaneous adrenal and multiple bilateral renal cysts.

Benign cysts of the adrenal gland are rare. This is the first reported case of the simultaneous occurrence of an asymptomatic right adrenal cyst and bilateral multiple renal cysts. Excretory urograms with tomograms, renal aortography and ultrasound scanning were used to establish a non-invasive definitive diagnosis. There was no need for an operation since the lesions were benign.

Adrenal Gland Diseases↗
PubMed1976

Doppler ultrasonic assessment of aortic stenosis by analysis of axillary arterial blood velocity upstroke time.

Rate-corrected velocity upstroke time (VUT) was calculated from analogue Doppler ultrasound recordings of axillary artery blood flow velocity in 25 patients with aortic stenosis documented by cardiac catheterization and in 14 normal individuals. The mean VUT in normal individuals was 0.11 +/- 0.02 second (+/- 1 SD), which was significantly lower than that of patients with aortic stenosis: 0.15 +/- 0.05 second (P less than 0.005). The VUT correlated with the aortic valve index and the aortic valve mean pressure gradient with correlation coefficients of 0.62 and 0.64, respectively (P less than 0.005). Arterial blood flow velocity assessment by Doppler ultrasound may be a useful noninvasive technique to evaluate patients with aortic valve disease.

Adult↗