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Biomedical subjects

L Needleman

Publications and source records attributed to L Needleman.

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

Hand-held and automated sonomammography. Clinical role relative to X-ray mammography.

A retrospective analysis of 73 patients who had undergone X-ray mammography (XRM), automated sonomammography (ASM), and hand-held sonomammography (HSM) was performed to evaluate the clinical role of both types of sonomammography (SM) relative to XRM. The results were classified on the basis of mammographic and sonographic findings. Clinical and/or surgical proof was obtained in all 73 patients. The SM was complementary to XRM, depending on the radiographic breast density. When comparison was made between ASM (4.5 MHz) and the HSM (7.5 MHz), the pathologic condition was better identified by HSM in 86% of the cases. Moreover, in no cases was ASM better than HSM.

Adult↗
PubMed1988

Neonatal brain: color Doppler imaging. Part I. Technique and vascular anatomy.

Color Doppler imaging (CDI) can demonstrate the relative direction and velocity of blood flow in color, superimposed on a conventional gray-scale ultrasound image that depicts stationary tissue. Twenty-five infants were studied with portable CDI in the coronal, sagittal, and axial planes. Bilateral antegrade flow was noted in the anterior, middle, and posterior cerebral arteries in all patients. Multiplanar CDI can image flow in the circle of Willis and its tributaries and branches.

Arteries↗
PubMed1988

Neonatal brain: color Doppler imaging. Part II. Altered flow patterns from extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO), a lifesaving procedure in neonates with severely impaired lung function, requires ligation of the right common carotid artery. In an investigation of the collateral pathways that maintain perfusion of the brain after right common carotid artery ligation, ten infants were studied with color Doppler imaging during and after ECMO. The circle of Willis was seen in all infants, and in every case there was retrograde flow in the distal internal carotid artery and the proximal (A1) segment of the anterior cerebral artery. Bilateral flow in the middle cerebral arteries and in distal branches of the anterior cerebral arteries was also seen, documenting flow to both cerebral hemispheres.

Carotid Arteries↗
PubMed1988

Ultrasound for guidance of breast mass removal.

Hand-held sonomammography was used intraoperatively to localize 52 masses in 45 women in an out patient operating suite. All but five women had a positive X-ray mammogram. The ultrasound mammogram was able to identify all lesions. In 42 women studied by a preoperative ultrasound examination before the operating room procedure, all the masses were successfully identified. Precise localization was successfully performed in the operating room before sterile preparation in less than 10 minutes. Relocalization after incision in the sterile operating field was necessary in two cases. This technique requires no ionizing radiation and expedites outpatient surgical removal of the lesion. Of the 52 masses, there were 32 fibroadenomas, three carcinomas, three cysts, six cases of focal fibrous mastitis, and eight patients with focal fibrocystic disease. In patients with positive sonograms for nonpalpable masses, ultrasound localization is a fast, accurate alternative to X-ray needle placement.

Adenofibroma↗
PubMed1987

The periportal collar: a CT sign of liver transplant rejection.

A low-attenuation region around the peripheral portal tracts (periportal collar) was noted on 13 of 43 computed tomographic studies obtained in 17 patients who had undergone 20 orthotopic liver transplantations. This region was then correlated with acute liver transplant rejection. The periportal collar as a sign of rejection has a sensitivity of 1.0, a specificity of 0.86, a negative predictive value of 1.0, and a positive predictive value of 0.62. This sign corresponds histopathologically with the lymphocytic portal infiltration that occurs during acute liver transplant rejection. Though viral hepatitis and nonspecific portal triad edema can also result in a periportal collar, acute liver rejection is strongly suggested when this sign is seen after liver transplantation. Early diagnosis and confirmation of rejection permit faster and more appropriate clinical intervention.

Adolescent↗
PubMed1987

Complicated first-trimester pregnancies: evaluation with endovaginal US versus transabdominal technique.

Endovaginal ultrasound (US) was performed in 38 pregnant women at 5-12 menstrual weeks, when the initial transabdominal sonograms had been considered inconclusive or equivocal. Clinical follow-up disclosed 32 intrauterine pregnancies (12 living, 18 spontaneous incomplete abortions, and two embryonic demises) and six ectopic pregnancies. In the 32 intrauterine pregnancies (normal and abnormal), the correct diagnosis was made in all cases with endovaginal US. The endovaginal images demonstrated the intrauterine embryo, its heart motion, and the yolk sac more clearly and more often when these structures were not apparent on the transabdominal scans. Abnormal gestational sacs were better resolved. In the six cases of ectopic pregnancy, while an extrauterine ectopic sac was visualized in only three, absence of an intrauterine gestational sac was confirmed in all cases with endovaginal scanning. No endovaginal study yielded less information than its transabdominal counterpart. Endovaginal sonography is likely to be diagnostic when transabdominal images fail to yield a definitive diagnosis in early pregnancies.

Abdomen↗
PubMed1987

Femoral artery pseudoaneurysm: diagnosis with conventional duplex and color Doppler US.

Three patients with clinically suspected pseudoaneurysm as a complication of femoral puncture were referred for ultrasound (US) evaluation with both conventional duplex Doppler US and color Doppler imaging. Pseudoaneurysm (n = 2) and simple hematoma (n = 2) were depicted with both Doppler systems, and a separate pseudoaneurysm and a hematoma were found in one patient. These diagnoses were confirmed surgically. Distinctive Doppler spectral waveforms and color Doppler findings enabled confident diagnoses. Color Doppler imaging allowed faster detection of intraaneurysmal flow, and the track between the injured artery and the pseudoaneurysm was identified only with color Doppler imaging. Duplex Doppler US with color Doppler imaging allows for the rapid, unequivocal diagnosis of pseudoaneurysm, thus enabling prompt treatment without the need for invasive diagnostic modalities.

Aneurysm↗
PubMed1987

Significance of membrane thickness in the sonographic evaluation of twin gestations.

A retrospective study of 55 twin pregnancies was performed to determine the role of sonography in distinguishing between dichorionic and monochorionic diamniotic gestations solely by evaluating the thickness of the membrane between the fetuses. The presence of a thick dividing membrane indicated a dichorionic diamniotic gestation in 38 (90%) of 42 cases in which it was identified. Inability to identify a membrane between dichorionic diamniotic twins occurred most commonly during the third trimester. A thin membrane indicated monochorionic diamniotic twinning and was seen in three (25%) of 12 cases. Membrane thickness was indeterminate in one case. Therefore, on the basis of the thickness of the dividing membrane imaged by sonography, dichorionic diamniotic gestations can be distinguished from monochorionic diamniotic gestations. Inability to show a separating membrane by sonography, however, can occur with any form of twin gestation, particularly in the third trimester. Membrane thickness should be used in conjunction with other sonographic criteria to predict the amnionicity and chorionicity of twin gestations.

Extraembryonic Membranes↗
PubMed1987

Evaluation of renal transplant rejection by duplex Doppler examination: value of the resistive index.

The increasing use and availability of renal transplantation has resulted in a demand for noninvasive methods to study possible complications. One of the most serious adverse reactions is acute rejection, a possibly reversible cause of transplant failure if treated promptly. Differentiation from other causes of acute renal failure frequently is difficult, and the lack of specificity in many imaging studies has been troublesome. Eighty-one patients with renal transplants, including 41 with acute rejection, were examined. Duplex Doppler examination of the intrarenal arteries and a simplified formula, the resistive index ([peak systolic frequency shift--lowest diastolic frequency shift]/[peak systolic frequency shift]), were used to diagnose rejection. With a resistive index greater than 0.90, a 100% positive predictive value was obtained for the diagnosis of acute rejection. A value less than 0.70 was unlikely to be rejection (negative predictive value, 94%). This approach uses a simple analysis of the waveform. Use of a duplex Doppler examination and the formula described here appears to be an accurate method for the detection of acute rejection and for the differentiation of acute rejection from the various other causes of acute renal failure.

Acute Kidney Injury↗
PubMed1987

The spectrum of sonographic findings in hemorrhagic ovarian cysts.

The sonograms of 76 hemorrhagic ovarian cysts were reviewed to ascertain the full spectrum of sonographic findings. All cases were proved either by surgery or by documented resolution on sonography and/or clinical follow-up. The overwhelming majority (92%) had increased sound through-transmission, signifying the basic cystic nature of the lesion. The sonographic patterns were variable. The most common appearance was that of a heterogeneous mass (83%), almost half of which were predominantly anechoic with hypoechoic material. The other cases (17%) were completely homogeneous, either hypo- or hyperechoic. No masses were completely anechoic. Additional sonographic features included a thick rim, septations, and associated cul-de-sac fluid. A rounded hyperechoic mass, representing blood clot, was contained within 13 masses. In addition, some women appeared to have an increased tendency to form ovarian cysts, suggested by the fact that 26% of them had a past, concurrent, or future episode of simple or hemorrhagic ovarian cysts. Because hemorrhagic ovarian cysts have variable sonographic findings, they should be included in the differential diagnosis of any adnexal mass that has good sound through-transmission.

Adolescent↗
PubMed1987

Endovaginal ultrasound. A technique for evaluation of nonfollicular pelvic masses.

The evaluation of pelvic masses is routinely performed by transabdominal ultrasound. However, by placing the transducer into the vagina (the endovaginal approach), imaging resolution is improved and morphologic detail of true pelvic organs is increased. Twenty-one cases in which nonobstetrical pelvic pathology was suspected clinically were evaluated by both the endovaginal and (conventional) transabdominal approach. Each case was evaluated for efficacy of the two approaches independently and the results compared to the clinical outcome. Endovaginal scanning offered more accurate diagnostic information in 13 of the 21 cases (62%). Additional information was obtained by the endovaginal approach in seven of these 13 cases (55%). No significant difference was observed in 33%. Endovaginal ultrasound offers a diagnostic tool complementary to the transabdominal technique in the evaluation of pelvic masses in the female patient.

Adult↗
PubMed1987

Postasphyxial encephalopathy in term infants. Sonographic demonstration of increased echogenicity of the thalamus and basal ganglia.

Sonographic abnormalities secondary to postasphyxial encephalopathy in neonates are reviewed. This report emphasizes an additional finding, increased echogenicity of the thalamus and basal ganglia, demonstrated in four term infants. This abnormal finding is generally noted in the second week following asphyxia. In some cases, the increased thalamic echogenicity may be a temporary finding. A representative case is described and possible pathologic correlates are discussed.

Asphyxia Neonatorum↗