Biomedical subjects
M Graif
Publications and source records attributed to M Graif.
Infected renal cysts: sonographic diagnosis and management.
IRC are rare entities characterized by fever and unilateral flank pain resistant to antibiotic therapy. In our series of nine IRC in eight patients, the predominant sonographic finding was an abnormal echogenic texture of the cyst contents, in contrast to previous reports that stressed the frequency of wall thickening as a sign of infection. Sonographically guided cyst aspiration and drainage of eight cysts in seven patients provided diagnostic material and resulted in relief of symptoms. Although the cause of IRC is uncertain, these entities may be more common than previously suspected.
Pseudoaneurysm of the inferior epigastric artery mimicking abdominal wall hematoma.
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Renal pyelectasis in pregnancy: correlative evaluation of fetal and maternal collecting systems.
OBJECTIVE: The current study is aimed at assessing the possibility of a statistical relationship between fetal and maternal collecting system dilatation during pregnancy. STUDY DESIGN: Two hundred thirty consecutive pregnant women and their fetuses (20 to 40 weeks' gestation) were simultaneously examined by ultrasonography. The renal collecting systems were measured, and the frequency of dilatation was subjected to chi 2 analysis. The temporal incidence of fetal pyelectasis was compared with the maternal incidence. RESULTS: Dilatation of maternal collecting systems was detected in 91 of 230 patients (40%) and fetal pyelectasis occurred in 60 of 230 (26%). Fetal pyelectasis was 5.6 times more likely to occur in fetuses of mothers with dilated collecting systems. Furthermore, the temporal incidence of fetal pyelectasis throughout pregnancy appeared similar to that of maternal pyelectasis. CONCLUSION: This study points out the existence of a statistically significant association between maternal and fetal collecting system dilatation during pregnancy.
Occult infection of hip prosthesis: sonographic evaluation.
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Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations.
Sonographic analysis of the sciatic nerve was performed in vitro (anatomic specimen), in vivo (healthy volunteers), and in 16 patients with suspected peripheral sciatic nerve lesions. The ultrasound (US) examinations were performed with standard and high-resolution US equipment with linear-array configuration. The normal nerve displayed an echogenic fibrillar texture with round cross-sectional structure on both in vitro and in vivo sonograms. Satisfactory delineation of the nerve was obtainable in all cases. Nerve displacement was the main sonographic finding in cases of extrinsic compression. The lesion displayed variable echotexture, ranging from hypoechogenicity or mixed echogenicity in hematomata to hyperechogenicity in cases of fibrosis. Primary nerve tumors (neurofibroma) or infiltrating tumors (desmoid) caused clear disruption of the nerve structure. Use of sonography enabled assessment of the continuity of the nerve margins with the interposed graft in a case of reconstructive surgery. The potential to image sciatic nerve lesions noninvasively may have an important impact on diagnosis, treatment, and prognosis in symptomatic patients.
Sonographic liver changes prior to clinical signs of preeclampsia.
Abnormal liver findings on sonography consistent with subcapsular hematoma were seen in a patient prior to clinical and laboratory evidence of preeclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.
Optimal needle length of automatic injectors.
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High-resolution sonography of the undescended testis in childhood: an analysis of 45 cases.
A prospective study correlating the ultrasound and operative findings was carried out in 45 consecutive pediatric patients with undescended testes. Thirty-six of 37 (97%) palpable testes were located preoperatively by ultrasound. Six of eight impalpable testes (75%) were correctly localized by ultrasound. The three testes missed by the ultrasound examination were found to be atrophic at surgery. Three intra-abdominal (palpable) testes were found at surgery just proximal to the internal ring; all three had been identified by ultrasound preoperatively. The main contribution of ultrasound was the preoperative detection of impalpable testes (six of eight), which modified the consequent surgical approach. Ultrasound also helped in providing objective support to the clinical diagnosis in 36 of 37 children with palpable undescended testes. The ultrasound examination is noninvasive, nonionizing, readily available and of low cost. It is therefore suitable as the initial routine procedure for the evaluation of undescended testis.
Hydrops of gallbladder as a presenting symptom of Kawasaki disease.
Hydrops of the gallbladder is a rare symptom in young children and might appear in Kawasaki disease (KD) patients. We report this unusual manifestation as a presenting symptom in a 15 month old boy with KD.
Magnetic resonance imaging: comparison of four pulse sequences in assessing primary bone tumours.
A prospective magnetic resonance imaging (MRI) study was carried out in 13 patients (19 examinations) with primary bone tumours to assess the relative value of each of four pulse sequences in showing the extent and nature of the lesion. The four pulse sequences used were a T1-weighted spin-echo (SE544/44), a T2-weighted spin echo (SE1500/80), a short TI inversion recovery (STIR) (IR500/100/44), and a partial saturation (PS) (PS500/22) with field echo data collection. For soft tissue disease the combination of PS and STIR gave better definition of the boundary of the tumour than the more conventional T1 and T2-weighted spin echo sequences. For the demonstration of bone cortex, periosteal change and calcification, T1 and T2-weighted spin echo sequences were better. However, for calcified tissues, plain radiographs were better than either MRI combination. On the assumption that plain films will be available in all cases, PS and STIR sequences could therefore be substituted for T1 and T2-weighted spin echo sequences allowing an increase in soft tissue detectability for lesions in both red and yellow marrow.
Delayed diagnosis of a primary psoas abscess mimicking septic arthritis of the hip.
A 5-year-old boy presented with a limp, fever, and right hip pain of 72 hours' duration. An intensive workup of right hip pain synovitis failed to diagnose any local pathology. Delayed diagnosis of psoas abscess was made on the 12th day of hospitalization. A rapid recovery with no further complications followed surgical evacuation of the abscess.
Sonography of the hip joint as part of the evaluation of acute lower abdominal pain.
Ultrasound evaluation of the hip joint was performed in 17 patients as part of the sonographic investigation of lower abdominal pain with referred symptomatology to the groin and thigh. Sonographic features consistent with hip joint effusion were detected in 12 of the patients. In four patients with positive arthrosonogram the possibility of hip joint involvement was not considered by the examining physician. In 11 other cases, hip pathology was included in the differential diagnosis. Of these, hip involvement was confirmed by sonography in eight patients and excluded in three. Sonography was found to be a useful objective method for the confirmation or exclusion of hip joint effusion. The examination had a significant influence on the patient management for shifting the attention of the clinician from the abdomen to the hip joint in four of the cases in this series.
Sonographic detection of occult bone fractures.
Two infants of 24 and 20 months of age with painful local swelling at the femoral and clavicular regions were investigated by ultrasound after a negative radiographic study of the adjacent bones. In both children high resolution ultrasound clearly revealed the presence of bone fractures in addition to the soft tissue hematomas. These fractures were confirmed by a repeat radiographs performed 6 and 8 days later. Although sonography is not the method of choice for the detection of bone fractures, it may be worthwhile to examine the bone contour for a fracture when a painful swelling adjacent to bone is present. The method may be particularly rewarding in children due to its rapid non-invasive nature and to the small tissue thickness that has to be penetrated.
Diagnosis of a small ovarian tumor (androgen secreting) by magnetic resonance: a new noninvasive procedure.
Virilizing ovarian tumors are rare and establishing their exact location before operation is difficult. We report a case in which a small left ovarian tumor was seen with magnetic resonance imaging.
Sonographic evaluation of ovarian torsion in childhood and adolescence.
Emergency sonographic examination of the pelvis was performed in 41 girls (mean age, 13 years old) with clinical suspicion of ovarian torsion. Sonographic features consistent with diffuse swelling of the ovarian parenchyma and follicular enlargement in the cortical zone were detected in eight patients and were considered highly suggestive for torsion of the ovary. Surgery revealed ovarian torsion in seven of these cases and hemorrhagic ovarian cyst in one case. A cystic or complex ovarian mass was detected by sonography in five additional cases, and ovarian torsion was included in the differential diagnosis. Surgery revealed ovarian torsion in four of these cases and hemorrhagic ovarian cyst in one. A 100% sonographic sensitivity for space-occupying disease of the ovary was obtained with a positive predictive value of 88% for the diagnosis of ovarian torsion. The specificity of the method was 93%. Sonography appears to be an excellent method to evaluate patients with suspected torsion of the ovary.
Parathyroid sonography: diagnostic accuracy related to shape, location, and texture of the gland.
The sonographic features of 51 pathological parathyroid glands detected pre-operatively were analysed. Atypical texture was found in 23.5% and variation in shape in 15.6% of the cases. Cystic parathyroid glands are difficult to differentiate from thyroid cysts, and may be the cause of false positive diagnosis, as in three cases in this series. Topographic assessment showed a relatively low sensitivity in detecting disease in the right upper gland (50%) and in the upper mediastinum (70%). The decreased accuracy in these regions is probably because of the particular anatomical location of the right upper gland and sonographic limitations in screening the mediastinal region. Awareness by the radiologist and surgeon of the variations in texture and location may influence both diagnosis and intraoperative detection of the abnormal parathyroid gland.
Sonographic localization of hematomas in hemophilic patients with positive iliopsoas sign.
Sonography was performed on 23 hemophilic patients presenting with positive iliopsoas sign. In 21 of these patients sonography confirmed the presence of hematomas. Comparison of the presumed clinical location and the sonographic location, however, revealed a significant discrepancy. Only seven of 15 hematomas that were clinically suspected to be in the iliopsoas muscle were confirmed by sonography at that location. Of the remaining cases, three were localized in the hip joint, one in the proximal thigh, one in the abdominal wall, and one in the iliac fossa. Hemorrhage was not found in two cases. This study indicates that sonography provides valuable information about the site of hematoma in these patients.