Biomedical subjects
Publications and source records attributed to G A Gooding.
Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.
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Fourteen patients are presented to illustrate the usefulness of ultrasonography in assessing masses of the neck. Included are five patients with primary tumors, two with metastasis to a cervical node, three with cervical adenitis, two with simple cysts, and two with hematoma related to endarterectomy for occlusive disease of the carotid artery.
Thirteen patients with suspected extrathyroidal neck masses were investigated with the combination of fluorescent scanning and echography. Iodine content, the solid or cystic consistency of the lesion, and the position of the lesion with respect to the thyroid were determined preoperatively to estimate thyroidal origin and benignity or malignancy of the lesions. Pathologic diagnoses correlated well with these totally noninvasive studies of extrathyroidal neck masses.
Arteriography of patients with axillary-to-femoral bypass grafts can be performed by direct puncture of the graft and passage of a catheter through the graft. This article reviews some technical considerations as well as some potential complications and how they might be minimized. Three cases are presented.
Carotid artery fixation is an extremely poor prognostic sign in squamous cell carcinoma of the head and neck. Methods more precise than physical exam are necessary to determine whether a neck dissection is sufficient, to exclude patients from surgery, or to plan a carotid artery resection. Thirty-three patients with a suspicion of carotid wall attachment by physical examination or computed tomography (CT) were further evaluated by magnetic resonance imaging (MRI) and ultrasound (US). The criterion for possible carotid involvement on CT was effacement of greater than 25% of the circumference of the artery. On MRI, the criterion that we proposed was any loss of the fascial plane around the internal or common carotid artery. This was considered effacement of the carotid artery wall. For US, the criterion we used was the loss of the echogeneity along the carotid wall. Histopathological correlation was available in 23 patients (24 necks) who either underwent surgery or necropsy (1 patient); 11 patients were felt not to be surgical candidates or declined surgery, though 1 of these 11 patients did undergo surgical resection after radiotherapy. MRI accurately predicted an uninvolved carotid artery in 13 of 15 cases; US accurately predicted an uninvolved carotid artery in 15 of 20 cases. Demonstration by either MRI or US that the carotid artery is free of tumor had a high degree of reliability. Both US and MRI appear superior to CT and physical examination in assessing the carotid wall in suspicious cases. Individually and in combination, MRI and US offer advantages in selecting patients for possible surgery when the issue of carotid artery fixation is raised.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A normal volunteer for magnetic resonance angiography of the carotid arteries had an abnormal examination that suggested a common carotid pseudoaneurysm. High resolution sonography identified a normal carotid artery immediately adjacent to a thyroid lesion, part of which was cystic and which mimicked carotid aneurysmal disease.
Thirty-three patients were examined by color-coded Doppler ultrasound of the thoracoaxillary region or upper arm to review the utility of the method in this local area. The subclavian artery and vein were identified in all but one patient, in whom the subclavian vein was occluded and collateral vessels had developed. Masses and foreign bodies were easily distinguished from vascular abnormalities. Sonographic cephalic/basilic vein mapping was effective in seven patients. Carotid subclavian grafts were noted and evaluated appropriately in two patients. Color-coded sonography offered advantages in speed of localization of vessels and visual assessment of vessel location, direction of flow, turbulence, relationship to adjacent soft tissues, and detection of collateralization. Foreign body detection was not enhanced by color coding.
A retrospective MRI and ultrasound (US) study of 50 patients with hyperparathyroidism and no history of thyroid disease was done. The purpose was to compare the sensitivity of both methods in the detection of asymptomatic thyroid nodules, as well as to determine the prevalence of thyroid abnormalities in patients with hyperparathyroidism. All the patients underwent MR and 33 were also studied by high-resolution US. Magnetic resonance imaging was performed on a 1.5 T unit, using T1-(500-700/20) and T2-(2,000/20 and 70) weighted images. Axial sections (5 mm with a 1 mm interval between them) were obtained along the neck. Ultrasonography was performed using a 10 MHz linear array transducer. The prevalence of thyroid nodules was 46% in the 50 patients studied by MR imaging. In the subgroup of patients studied by both methods, US depicted nodules in 48% of patients, and MR depicted nodules in 45%. Magnetic resonance imaging and US detected a high frequency of thyroid nodules in patients with hyperparathyroidism. This high frequency makes the detection of an intrathyroidal parathyroid adenoma problematic.
Malignant invasion of the carotid artery is an ominous complication of squamous cell carcinoma that can be suspected from B-mode sonography. A loss of carotid wall integrity seen as a break or step off of the inner wall suggests early involvement. Frank tumor invading the lumen is an end-stage event. Both ultrasound and magnetic resonance imaging are 100% sensitive in the evaluation that no carotid involvement has occurred. In one study, ultrasound was 75% specific and magnetic resonance was 87.5% specific. If the ultrasound is problematic, magnetic resonance may clarify the issue.
Liquid crystal thermography (LCT) was used to determine temperature variations on the plantar surface of feet. The purpose was to identify thermal emission patterns associated with diabetic foot ulcers. Three population groups were screened: group I, 16 nondiabetic controls; group II, 21 diabetic patients with no history of pedal ulcers; and group III, 28 diabetic patients with active pedal ulceration or history of foot ulcerations. The results demonstrate a generalized increase in plantar foot temperature in group III compared with groups I and II. Temperature readings under metatarsal heads 1-5, great toe, heel, and lateral band were significantly increased (P less than .01) in group III. Additionally, the warm lateral surface displayed by group III patients was not significantly different in temperature from the medial arch of the foot. In groups I and II, the lateral band was significantly cooler (P less than .01) than the medial arch. In group III patients with active ulceration on only one foot, no significant difference in temperature was found between the foot with active ulceration compared with the contralateral nonulcerated foot. When patients with active pedal ulceration were compared with patients with a history of foot ulcers, no significant difference in temperature was seen at five of seven sites tested. A warm concentric color band surrounding active plantar ulcers was identified in group III. This pattern extended from the center of the ulcer to a distance of 8 mm. A significant change in temperature (P less than .01) was noted at 6- and 8-mm distances from the center of the ulcer. In addition, a mottled thermographic pattern was observed more frequently in group III patients than in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)
PURPOSE: To compare magnetic resonance angiography (MRA) with duplex Doppler ultrasound (US) and x-ray angiography (XRA) in the evaluation of the carotid bifurcation. METHODS: The carotid arteries of 61 patients were studied using MRA, US, or XRA; 31 of the patients underwent all three examinations. MRA included both 2D and 3D time-of-flight sequences. Internal and external carotid artery origins were graded normal, mild, moderate, severe, or critical stenosis, or complete occlusion by each of the three studies. RESULTS: Spearman rank correlations of both internal and external carotid artery grades were 0.85 (MRA and XRA), 0.69 (MRA and US), and 0.73 (XRA and US). For internal carotid artery origins only, the correlations were 0.94 (MRA and XRA), 0.85 (MRA and US), and 0.82 (XRA and US). Of discrepancies in internal carotid artery interpretation greater than one grade, seven resulted from US error, three from MRA error, and one from XRA error. A 2-cm partially thrombosed aneurysm detected by US and MRA was missed by XRA. Of 16 possible ulcers on XRA, 11 were noted by MRA, none by US. CONCLUSIONS: MRA and XRA are similar in assessment of carotid bifurcation stenosis. MRA, like US, permits direct visualization of plaque. This preliminary study suggests that MRA may be used to clarify equivocal findings of US, or replace XRA in presurgical planning.
It may be difficult to differentiate between cells of parathyroid and thyroid origin in ultrasound-guided fine needle aspirations of the neck region, even in patients with a clinical history of hyperparathyroidism. A parathyroid hormone antibody was used in an immunohistochemical system to confirm a parathyroid origin in fine needle aspirate smears from nine patients with hyperparathyroidism. Immunoperoxidase positivity for parathyroid hormone confirmed a parathyroid origin in six of nine cases and was strongly suggestive, although equivocal, in the remaining three cases. Technical problems included nonuniform staining and background staining.
Sonography was used to detect and localize intracranial lesions intraoperatively in 16 patients and to examine 31 patients (47 exams) postoperatively for a variety of clinical problems. Current sonographic technology was effective for localizing and differentiating cystic and solid intracranial pathology and for determining the size and boundaries of the intracranial lesions and their distance from the cortical surface. It was used occasionally as an aid for circumventing intracranial vessels during tissue dissection and, when used, determined the completeness of tumor dissection. Sonography also proved to be a reliable postoperative tool when surgically created cranial windows were present, but the location and size of the surgical window were critical to the quality of the images obtained. Both applications of this technique complement computed tomography and therefore can serve as a valuable adjunct in the treatment and follow-up of the neurosurgical patient.