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Biomedical subjects

H L Neiman

Publications and source records attributed to H L Neiman.

At least 55 records · Page 3Linked to original sources
PubMed1982

Ultrasound assessment of normal renal dimensions.

This study confirms the accuracy and reliability of sonographic assessment of renal dimensions when meticulous scanning techniques are employed. Sonographic renal dimensions are smaller than those obtained by radiography, since there is neither the geometric magnification nor the change in size related to an osmotic diuresis from iodinated contrast material. Sonographically, with patients in the prone position, the mean right renal length was 10.74 cm (+/- 1.35 SD) and the mean left renal length was 11.10 cm (+/- 1.15 SD). A prospective sample demonstrated the mean depth (ventral-dorsal dimension) to be approximately 4.5 cm when the transducer was angulated for the lie of the kidney.

Adult↗
PubMed1981

Percutaneous transluminal angioplasty: an angiographer's viewpoint.

We outline the present role of angioplasty in the management of peripheral vascular disease and its application to other portions of the arterial and venous systems; we summarize several large series, including our own, which encompass more than 4,000 cases; and we discuss the pathophysiology of balloon dilation techniques and the criteria for patient selection. With appropriate patient selection, initial (90%) and long-term (85%) patency results are now comparable with surgical techniques when the iliac arteries are involved. Treatment of femoropopliteal disease is slightly less successful but is indicated in appropriate patients. We present the role of angioplasty in conjunction with grafting procedures and in the management of renal vascular hypertension, and we review the potential complications (2% to 3%), adjunctive medical management, and areas for further investigation.

Angiography↗
PubMed1981

Congenital renal arteriovenous malformation: ultrasonic appearance.

We report a case in which a congenital renal arteriovenous fistula was detected using gray scale ultrasonography and arteriographically confirmed. This abnormality should be considered when renal ultrasonography reveals anechoic structures located centrally or peripherally within the kidney in association with an enlarged renal vein.

Aged↗
PubMed1981

Ultrasound of the prostate. Analysis of tissue texture and abnormalities.

Thirty-nine patients with benign prostatic hypertrophy, prostatic carcinoma, or prostatitis underwent ultrasonography using a transabdominal suprapubic approach. In both benign hypertrophy and prostatitis, the gland was enlarged and exhibited a homogeneous echo pattern, being hypoechoic in prostatitis and either hypo- or hyperechoic in hypertrophy. Carcinoma was characterized by focal areas of increased or decreased echogenicity with irregular margins. The various sonographic appearances are explained by correlation with the histological findings, and the advantages of the transabdominal approach are discussed. The authors suggest that widespread application of this technique will improve early detection of prostatic carcinoma.

Adenocarcinoma↗
PubMed1981

Intraoperative angiography in intestinal angiodysplasia.

Intraoperative angiography is quite useful in locating the site of bleeding in patients with angiodysplasia of the small intestine. We recommend the placement preoperatively of an angiographic catheter in these patients. We have described a technique that complements this procedure with metallic clip labeling to locate precisely the area of bleeding. This method of treatment is illustrated in the present study by reports of patients bleeding from vascular malformations of the ileum, duodenum and the head of the pancreas.

Aged↗
PubMed1981

Correlation of foot arterial anatomy with early tibial bypass patency.

The detailed arterial anatomy of the foot in severe limb ischemia is not well known. This study was undertaken to define foot arterial anatomy and correlate these findings with the early results (6 months) of femoral-distal bypass. After completion of the bypass, operative arteriography was performed by direct injection of contrast media into the graft. A lateral view of the distal limb and foot was obtained. Foot vessel anatomy was classified into primary and secondary pedal arches, analogous to the superficial and deep volar arches of the hand. For peroneal bypass, special attention was paid to perforating branches and their communications with these two pedal arches. A total of 56 distal bypass operations was analyzed. Femoral--anterior tibial bypass was performed in 26 cases. When either a primary or a secondary pedal arch was intact, early graft patency (6 months) was achieved in 20 of 21 patients. When neither pathway was present, graft failure occurred in four of five cases. Similarly, of 10 femoral--posterior tibial grafts, seven remained patent with at least one pedal arch intact, whereas six of seven grafts failed when neither arch was patent. Bypass to the peroneal artery was successful in eight of nine limbs when a patent primary or secondary arch was reconstituted via either the anterior or posterior perforating branches. None of four peroneal grafts remained patent when both arches were occluded. As a whole, in 40 limbs with either a patent primary or secondary pedal arch, early graft success was achieved in 35 limbs (87.5%). In contrast, in 16 limbs with no patent arch, only two (12.5%) were successfully reconstructed (P less than 0.001). Analysis of the results of femoral-distal bypass based on a single plantar arch as the sole determining anatomic factor in graft patency is not adequate. The secondary pedal arch and communicating branches of the peroneal artery are also of surgical significance. Operative arteriography can define runoff in the foot, and this information has prognostic significance. It may allow rational judgment regarding reintervention in patients with failed grafts.

Adult↗
PubMed1981

Hemodynamic assessment of transluminal angioplasty for lower extremity ischemia.

The results of percutaneous transluminal angioplasty (PTA) for 56 ischemic lower extremities in 51 patients were analyzed. Indications for balloon catheter dilatation were intermittent claudication in 46 limbs (82.1%), rest pain in five (8.9%), and ischemic ulceration in five (8.9%). Balloon dialation was technically successful in 16 of 17 iliac segment lesions (94.1%) with symptomatic improvement in each instance. Nine of the 16 limbs were hemodynamically improved with a significant increase (less than 0.15) in ankle systolic pressure index. Four additional limbs had improvement in the thigh index. The remaining three limbs were hemodynamically unimproved. During average follow-up of 7.1 months, the 13 initially improved limbs remained hemodynamically improved. Thirty-one of 42 femoropopliteal dilatations (73.8%) were technically successful, with uniform symptomatic improvement. Of these 31 limbs, 26 had a significant initial increase in ankle index, one had improvement in distal thigh index only, and the remaining four limbs were hemodynamically unimproved. During mean follow-up of 8.4 months in the 27 limbs that initially were improved after femoropopliteal dilation, the pressure index returned to the pre-PTA level in 12 instances (44.4%). These results indicate that PTA is useful in selected short-segment iliac lesions. Balloon dilation of femoropopliteal lesions was less successful and its application requires further evaluation. This study demonstrates the need for close monitoring of the objective hemodynamic response, as well as symptomatic and angiographic results, in establishing the proper role of PTA in the treatment of lower extremity ischemia.

Adult↗
PubMed1980

Computed tomography in the diagnosis of aortic aneurysm dissection or traumatic injury.

Thirty patients thought to have an atherosclerotic thoracic aneurysm or chronic aortic dissection were evaluated by computed tomography (CT) and the findings compared with those from conventional radiography, thoracic aortography, and surgery. In all cases, CT defined the lesion and correlated well with angiography. Staging of atherosclerotic aneurysms was possible, and CT also demonstrated the relationship between true and false lumina in aortic dissections; however, aortography was often necessary to differentiate a dissection from an aneurysm or for staging. The relative value of CT and aortography is discussed.

Adult↗
PubMed1980

Descending venography: a method of evaluating lower extremity venous valvular function.

Recently developed surgical techniques for the correction of lower extremity venous insufficiency have renewed interest in venous valvular functions. To assess the value of descending venography in the evaluation of venous valvular incompetence, this technique was compared with bidirectional Doppler ultrasound and ascending venography in the examination of 32 patients with clinical signs of chronic venous insufficiency. Twelve of these patients underwent surgery to valvular incompetence, and all underwent descending venography and Doppler ultrasound examinations postoperatively. Descending venography proved to be an effective, accurate method of diagnosing venous valvular incompetence of the saphenofemoral system.

Adult↗
PubMed1980

Diagnosis of hydronephrosis: comparison of radionuclide scanning and sonography.

Diagnostic sonographic and radioisotope scanning techniques have been shown to be useful in the diagnosis of obstructive uropathy. The accuracy of both methods was compared and sonography was found to provide the more accurate data (sensitivity, 90%; specificity, 98%; accuracy, 97%). Sonography provides excellent anatomic information and enables one to grade the degree of dilatation. Renal radionuclide studies were less sensitive in detecting obstruction, particularly in the presence of chronic renal disease, but offered additional information regarding relative renal blood flow, total effective renal plasma flow, and interval change in renal parenchymal function.

Adult↗
PubMed1980

Surgical correction of chronic deep venous insufficiency by valvular transposition.

Twelve limbs in nine patients undergoing venous valve transposition in treatment of severe chronic deep venous insufficiency are the subject of this report. Hemodynamic measurements including venous pressure studies, photoplethysmography, directional venous Doppler assessment, and impedance plethysmography were done pre- and postoperatively in each case, as was ascending and descending venography. The surgical technique is described in detail and diagrams illustrate general features of the reconstruction. The results show that a functioning valve in the deep venous system of the lower extremity may reverse pre-operative pathophysiology. This preliminary view of the operation indicates that it may have great promise in the field of direct venous reconstruction.

Adult↗
PubMed1979

Thoracic aortic imaging without angiography.

Imaging of the thoracic aorta without recourse to angiography has great theoretic appeal. We have used computerized tomography (CT) in the initial evaluation of 297 patients with suspected mediastinal disease. Nineteen of this group had important findings related to the thoracic aorta: aortic dissection (six), descending thoracic aortic aneurysm (nine), suspected aortic trauma (three), and suspected false aneurysm at a coarctation repair (one). In all cases, the aorta and related pathology were readily demonstrated by CT, aided by the intravenous infusion of contrast material. In 13 of 15 cases, aortic dissection and aortic aneurysm could be accurately diagnosed. In two instances of ascending aortic dissection, it was not possible to distinguish the false lumen from mural thrombus in an atherosclerotic aneurysm.

Aorta, Thoracic↗
PubMed1979

Estimation of prostatic size by suprapubic ultrasonography.

Previous ultrasonic scanning of the prostate primarily has involved the transrectal approach. In this study the suprapubic approach was chosen because it uses basic ultrasound equipment and is atraumatic. In 29 patients undergoing prostatectomy there was a highly significant correlation (r equals 0.95) between the prostatic weight determined by this method and the postoperative weight of the adenoma.

Humans↗
PubMed1979

Gray-scale ultrasound diagnosis of peripheral arterial aneurysms.

Diagnostic ultrasound is a feasible technique for demonstrating the presence of an aneurysm in the popliteal, femoral, iliac, and brachial arteries. All aneurysms were correctly identified and confirmed by arteriography, surgery, or examination of the amputated specimen. The popliteal artery in healthy volunteers had a mean size of 0.8 +/- 0.2 cm. Neither the age nor the sex of the patient influenced artery size. In patients with known abdominal aortic aneurysms of significant atherosclerosis, the popliteal size was within two standard deviations from the mean of normal popliteal arteries.

Adolescent↗
PubMed1979

Computed vs. conventional tomography in evaluation of primary and secondary pulmonary neoplasms.

One hundred patients, ultimately proved to have chest malignancies, were evaluated prospectively with conventional chest tomography and computed tomography. In 58 patients with primary malignancies, conventional tomograms were more useful in evaluation of the hilus than CT scans. The mediastinum was better assessed by CT. Thus, evaluation of the presence of neoplasia is better accomplished by conventional examination, while extent of disease is best assessed by CT. Thoracotomy for curative resection was not attempted (in the latter cases of this series) based on CT findings of mediastinal involvement. In 42 patients with metastases to the chest, CT scans of the lung parenchyma were more sensitive than whole lung tomography but had little additional impact on patient treatment. Nevertheless, in 18 patients the results of CT or whole lung tomography directly affected patient therapy.

Aged↗
PubMed1979

Computed tomography of the larynx.

The normal computed tomographic anatomy of the larynx and surrounding structures is illustrated and discussed. An attempt is made to distinguish various types of tissues in cross-sectional display. The advantages of computed tomography over other modalities used for imaging the laryngeal region include the capacity to depict structural relationships in cross-section, to better define cartilaginous involvement by adjacent neoplasms, and to identify vascular components with contrast enhancement. The clinical application of computed tomography with respect to radiation therapy treatment planning of laryngeal tumors in an important feature of this imaging technique.

Humans↗