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Biomedical subjects

K Grumbach

Publications and source records attributed to K Grumbach.

At least 91 records · Page 5Linked to original sources
PubMed1989

The impact of sonography on the management of extratesticular abnormalities of the scrotum.

The results of scrotal sonography performed in a recent one-year period (1987) were retrospectively reviewed to assess the role of sonography in the management of patients with extratesticular abnormalities. The study included 226 examinations performed in 204 men. In extratesticular abnormalities, scrotal sonography confirms the clinical impression of the referring physicians, monitors the progress of conservative treatment, and guides the surgical approach. Patients with sonographically classic cystic extratesticular abnormalities rarely come to surgery. Those with complicated cystic abnormalities are usually followed clinically but have a higher incidence of surgery. Those with solid-appearing echogenic abnormalities usually have surgical removal.

Adolescent↗
PubMed1989

Shoulder soft tissue width as a predictor of macrosomia in diabetic pregnancies.

Sonographic evaluation of 43 pregnant women with diabetes mellitus was performed in the third trimester of gestation for evidence of fetal macrosomia. The width of the soft tissues of the shoulder from the skin surface to the proximal humerus was compared with previously reported measurements for their ability to predict fetal macrosomia. The abdominal circumference and shoulder soft tissue measurements were the best individual predictors of macrosomia, but a combination of an abdominal circumference greater than the 90th percentile for gestational age or a shoulder soft tissue width greater than 12 mm was the best predictor with a sensitivity of 96%, specificity of 89%, and accuracy of 93%. The shoulder soft tissue width should be evaluated for evidence of macrosomia in diabetic pregnancies.

Female↗
PubMed1989

Adult celiac disease and its complications.

Classic radiographic findings described in adult celiac disease--lumen dilatation, flocculation of barium, hypersecretion, thickening of folds--are nonspecific or are secretion related artifacts. The small bowel enema technique and CT make it possible to demonstrate specific diagnostic features of the disease and its complications. This substantially modified approach to the diagnosis of adult celiac disease is presented together with correlative pathology. Examples of the complications of celiac disease--ulcerative jejunoileitis, lymphoma, hyposplenism, carcinoma, and the cavitary lymph node syndrome--are illustrated.

Adult↗
PubMed1989

Hepatic and biliary tract abnormalities in patients with AIDS. Sonographic-pathologic correlation.

A retrospective evaluation of hepatobiliary sonograms in 22 patients with AIDS was performed and the sonographic abnormalities were correlated with pathologic findings in 10 patients. Hepatic parenchymal abnormalities noted on ultrasound include a hyperechoic parenchymal echo pattern in 45.5%, hepatomegaly in 41%, and focal masses in 9% of patients. Etiologies for the diffuse hyperechoic pattern based on pathologic correlation in eight cases were hepatic steatosis and granulomatous hepatitis. Biliary tract abnormalities identified included gallbladder wall thickening in 55% of patients, dilated gallbladder in 18%, biliary sludge in 23%, and gallstones in 5% of patients. Extrahepatic ductal dilation was seen in 23% of patients, but the intrahepatic ducts were dilated in only 5% of patients. Possible etiologies for biliary tract abnormalities suggested by pathologic correlation in five patients and literature review were cytomegalovirus and cryptosporidial infection, although constitutional factors may have played a role. Hepatobiliary ultrasound is, therefore, an effective screening tool for directing further diagnostic and therapeutic procedures in AIDS patients presenting with clinical evidence of hepatobiliary dysfunction.

Acquired Immunodeficiency Syndrome↗
PubMed1989

National health insurance in America--can we practice with it? Can we continue to practice without it?

Health insurance in the United States is failing patients and physicians alike. In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine. Competitive strategies have also failed their most ostensible goal--cost control. In contrast, Canada offers a model of a national health insurance plan that provides universal and comprehensive coverage, succeeds at restraining health care inflation, and does little to abrogate the clinical autonomy of physicians in private practice. I propose that American physicians relent in their historical opposition to national health insurance and participate in the development of a universal, public insurance plan responsive to the needs of both patients and physicians.

Canada↗
PubMed1988

Metoclopramide-ceruletide assisted small bowel examination.

We investigated the feasibility of performing a combined upper gastrointestinal and small bowel examination. Metoclopramide was given at the start of the examination and ceruletide was injected to hasten small bowel transit. The quality and duration of fifty examinations (Group I) was compared to that of fifty patients receiving metoclopramide alone (Group II) and fifty patients undergoing unaided examinations (Group III). The mean duration of the entire study was 29.3 minutes for Group I patients, 37.6 minutes for patients in Group II and 69.1 minutes for Group III subjects. The combination of agents produced contracted fold patterns in the jejunum and ileum that rendered individual loops more accessible to individual study under fluoroscopy in approximately 50% of subjects.

Barium Sulfate↗
PubMed1988

Transvaginal and transabdominal sonography: prospective comparison.

Transvaginal (TV) and transabdominal (TA) sonography were compared in a prospective study. A total of 230 examinations (126 pelvic, 104 pregnancy) were performed on 215 patients, ranging in age from 14 to 80 years. The improved anatomic detail on TV scans yielded new information in 138 (60%) examinations and better visualization of pelvic structures in 51 (22%) examinations. There was no important difference in diagnostic information provided by the two imaging modalities in 36 (16%) cases, and TV images were worse in five (2%). The clinical diagnosis was altered on the basis of TV sonographic findings in 54 (24%) cases and confirmed with certainty in 166 (72%). Diagnostic problems posed by TA scanning were not resolved by TV scanning in ten (4%) instances. Statistical analysis indicated that TV scanning was significantly better than TA scanning in the visualization of gestational sac contents (P less than .005), detection of fetal heart motion (P less than .001), and evaluation of the endometrial canal in the retroverted or retroflexed uterus (P less than .001). TV scanning was significantly better than TA scanning in visualization of the ovaries in patients with uterine leiomyomas (P less than .005) but not significantly better in peri- and postmenopausal patients (P greater than .05).

Adult↗
PubMed1988

Esophageal disruption: evaluation with iohexol esophagography.

Twenty-six patients with possible esophageal disruption who were also at risk for aspiration or direct communication of the esophagus with the tracheobronchial tree were examined with iohexol esophagography. Fifteen patients had normal studies confirmed by findings at a barium examination performed immediately after. In 11 patients abnormalities were diagnosed on the basis of iohexol esophagograms; the abnormalities included extraluminal extravasation of contrast material (n = 7), aspiration (n = 1), esophageal stricture with intramural diverticulosis (n = 1), edema of the gastroesophageal junction (n = 1), and epiphrenic diverticulum (n = 1). Eight of these patients were immediately reexamined with barium esophagography, which yielded no additional information. Low-osmolality, water-soluble contrast agents are a safe alternative for patients in whom barium esophagography poses a risk of mediastinitis and esophagography with diatrizoate meglumine and diatrizoate sodium (Gastrografin) poses a risk of pulmonary edema.

Adult↗
PubMed1988

Renal allografts: prospective analysis of Doppler sonography.

Fifty-six consecutively transplanted renal allografts were prospectively evaluated with serial Doppler sonographic examinations. Thirty-eight episodes of transplant rejection in 32 patients (63% proved pathologically) and 24 episodes of acute tubular necrosis (ATN) in 24 patients were encountered. The Doppler spectral waveform was characterized by means of the pulsatility index (PI), systolic/diastolic ratio (SDR), diastolic/systolic ratio (SDR), diastolic/systolic ratio (DSR), and resistive index (RI). Accuracy was optimized with use of top normal values as follows: PI = 1.8, SDR = 4.0, DSR = 0.25, RI = 0.75. There were no significant differences in the indices for those patients undergoing rejection versus those with ATN. The sensitivity for predicting transplant rejection was adversely affected by the history of either ATN or a previous rejection episode in the same allograft. Comparison with concurrent radionuclide examinations revealed similar sensitivities for rejection with scintigraphy and sonography. Differentiation of ATN from rejection was more reliable with scintigraphy than with sonography.

Acute Kidney Injury↗
PubMed1987

Enterobronchial fistula.

An unusual case of a fistula originating from the jejunum and crossing the diaphragm to involve the pleura and bronchial tree is presented. The presence of the fistula was first suggested on a computed tomographic examination of the chest. An upper gastrointestinal series verified the origin of the fistula.

Barium Sulfate↗
PubMed1987

Twin gestations: monitoring of complications and anomalies with US.

An evaluation of 227 consecutive twin gestations was undertaken to assess the role of ultrasound (US) in the diagnosis of major obstetric complications and congenital anomalies. US accurately depicted the growth and development of fetuses in 65 patients with underlying maternal disorders that produced additional risks to the pregnancy. Complications such as malpresentations (104 cases), polyhydramnios (15 cases), oligohydramnios (five cases), and uterine myomas (seven of 11 cases) were demonstrated prenatally with US. Fetal anomalies included anencephaly (two cases), hydrocephalus (two cases), conjoined twins (three cases), twin-twin transfusion syndrome (five cases), and acardiac monsters (two cases). Demise of one twin in 20 gestations and demise of both twins in 18 gestations (overall mortality of 17%) were correctly identified with US. These 38 gestations included intrauterine demise in 12, spontaneous abortion in 13, and neonatal deaths in 13. Therefore, when multiple gestations are suspected clinically, serial real-time US scans should be obtained beginning in the first trimester.

Adolescent↗
PubMed1987

Magnetic resonance imaging in young adults with cystic fibrosis.

It is difficult to distinguish between atelectasis, mucoid impaction, and peribronchial inflammation on chest roentgenograms (CXR) in patients with cystic fibrosis (CF). Differentiation between hilar adenopathy and prominent pulmonary vessels is also sometimes difficult. We studied 16 young adults with CF using both magnetic resonance imaging (MRI) and CXR to evaluate the usefulness of MRI in this clinical context. The same patients were studied with abdominal ultrasound and MRI for evaluation of the pancreas, gallbladder, liver, and spleen. The MRI was superior to CXR in detecting hilar and mediastinal adenopathy and in differentiating nodes from prominent vessels. It was useful in the evaluation of bronchiectasis. The CXR was superior for assessing infiltrates, hyperinflation, sternal bowing, volume loss, and hilar retraction. The MRI was only slightly better than sonography in depicting fatty infiltration of the pancreas. The modalities were equally effective in detecting hepatosplenomegaly and signs of portal hypertension. Gallbladder evaluation was far superior with sonography.

Adolescent↗