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Biomedical subjects

P H Arger

Publications and source records attributed to P H Arger.

At least 19 recordsLinked to original sources
PubMed1996

Strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia detected by prostate needle biopsy.

PURPOSE: We evaluated the strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia without concurrent carcinoma detected on prostate needle biopsy. MATERIALS AND METHODS: Of 1,275 consecutive patients undergoing prostate needle biopsy 61 were identified with prostatic intraepithelial neoplasia but without concurrent prostate carcinoma. Of the 61 patients 53 had undergone repeat biopsy. The medical records, transrectal ultrasound, and operative and pathological reports of these patients were reviewed. RESULTS: Repeat biopsy was done in 53 patients with prostatic intraepithelial neoplasia, yielding carcinoma in 15, prostatic intraepithelial neoplasia without carcinoma in 8 and benign tissue in 30. The yield of carcinoma from repeat biopsy of a prostatic intraepithelial neoplasia site was 8.3% (7 of 84 sites). A total of 18 sites of carcinoma was detected by repeat biopsy of a previous random biopsy site (8), a prostatic intraepithelial neoplasia site only (5), a transrectal ultrasound nodule (3), a palpable nodule and prostatic intraepithelial neoplasia site (1), and a transrectal ultrasound nodule and prostatic intraepithelial neoplasia site (1). Carcinoma was as frequently detected by repeat biopsy of a prostatic intraepithelial neoplasia site (6 patients) as by random repeat biopsy (6 patients). CONCLUSIONS: Repeat prostate needle biopsy of patients with prostatic intraepithelial neoplasia should include random repeat biopsy and repeat biopsy of transrectal ultrasound abnormalities as well as previous sites of prostatic intraepithelial neoplasia.

Adenocarcinoma↗
PubMed1994

Pancreatic sparing of focal fatty infiltration.

PURPOSE: To describe typical findings of focal fatty sparing of the pancreas. MATERIALS AND METHODS: Computed tomography, ultrasonography, and/or magnetic resonance imaging were performed in seven patients. RESULTS: In these patients, the area of sparing of fatty change was within the head or uncinate process of the pancreas. CONCLUSION: Differentiating pancreatic fatty sparing from true neoplasm by means of cross-sectional imaging obviates the need for invasive diagnostic studies.

Adipose Tissue↗
PubMed1994

Emergency department screening for ectopic pregnancy: a prospective US study.

PURPOSE: To determine the effectiveness of pelvic sonography as a screening test for ectopic pregnancy. MATERIALS AND METHODS: Pelvic sonograms were prospectively analyzed in 1,427 consecutive patients with a serum level of the beta subunit of human chorionic gonadotropin of over 1,500 IU/L. RESULTS: Sonograms were diagnostic in 1,158 patients and indeterminate in 269. When indeterminate studies were considered falsely negative, the diagnostic accuracy was 81%. Twenty-four percent of patients with indeterminate studies were subsequently proved to have ectopic pregnancy. In ectopic pregnancy (n = 103), the most common finding was a complex adnexal mass (specificity = 92% [P < .001]). The sensitivity and specificity of screening sonography for ectopic pregnancy were 99% and 84%, respectively. CONCLUSION: Pelvic sonography is an effective screening test for ectopic pregnancy. Having a one in four chance of harboring an ectopic pregnancy, patients with indeterminate studies require close follow-up. The presence of a complex adnexal mass is a strong predictor of ectopic pregnancy.

Adult↗
PubMed1994

Follow-up of benign hypoechoic peripheral zone lesions of the prostate gland: US characteristics and cancer prevalence.

PURPOSE: To evaluate the role of biopsy-proved benign peripheral zone hypoechoic lesions of the prostate gland, ultrasonographic (US) characteristics at follow-up, prostate-specific antigen (PSA) levels, and digital rectal examination (DRE) in prediction of cancer risk. MATERIALS AND METHODS: Retrospective analysis was performed for 105 consecutive patients with 148 benign hypoechoic lesions discovered at transrectal US (TRUS) and diagnosed with US-guided needle biopsy. At least one repeat TRUS study was performed in each patient. RESULTS: Among the benign lesions, 72% changed at follow-up TRUS, either disappearing or becoming smaller, less hypoechoic, and more vague. Cancer developed in 13% of patients. In 93% of patients in whom cancer developed, the appearance changed in the peripheral zone at follow-up TRUS. In this patient population, the positive predictive value for development of cancer was 16% with a changing TRUS appearance, 19% with an abnormal DRE result, and 27% with an elevated level of PSA; only the latter was statistically significant. CONCLUSION: The PSA value, alone or in combination with a changing TRUS appearance, is the best indicator for development of cancer.

Adult↗
PubMed1994

Three-dimensional US and volumetric assessment of the prostate.

The authors demonstrate a method for constructing three-dimensional (3D) images of the prostate based on standard two-dimensional ultrasonic (US) images. Transverse US images of the prostate in six patients (aged 61-83 years) and 10 water-filled balloon phantoms were recorded at video rates by manually withdrawing a biplane transrectal probe at a constant speed. Data acquisition time of the images was less than a minute. Typically, 50-70 scans of 0.2-0.5-mm-thick cross sections were acquired. Postprocessing of these data enabled lifelike 3D visualization of the gland and accurate measurement of its volume.

Aged↗
PubMed1992

Transvaginal ultrasonography in postmenopausal patients.

Clearly, TVS has become an important adjunctive procedure in the evaluation of suspected gynecologic disease in postmenopausal women. In our laboratory, the additive value of TVS is approximately 50% in this population. A preliminary diagnosis on TAS may be completely altered--an abnormal finding better characterized or an equivocal lesion confirmed with certainty. Further investigative studies are required to establish firmly the indications for TVS in postmenopausal women.

Female↗
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

Soft tissue osteochondroma. A report of three cases.

Three cases of benign soft tissue osteochondroma, a lesion of uncertain pathogenesis, are reported. Two cases were located in the subcutaneous tissues beneath the calcaneus. The other was located in the soft tissues near the left ankle joint. The diagnosis of soft tissue osteochondroma should be considered when a well-defined osseous mass is located in the soft tissues. The differential diagnosis includes myositis ossificans, tumoral calcinosis, synovial chondromatosis, and soft tissue osteosarcoma.

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

Use of Gd-DTPA and fast gradient-echo and spin-echo MR imaging to demonstrate renal function in the rabbit.

The paramagnetic magnetic resonance (MR) imaging contrast agent gadolinium diethylenetriaminepentaacetic acid (DTPA) is freely filtered at the glomerulus and is neither secreted nor reabsorbed by the renal tubules. Fast MR imaging techniques, either gradient-echo or spin-echo, can be used to document the passage of Gd-DTPA through the renal tubules, as reflected by alteration in the MR signal intensity within the different anatomic regions of the kidney. Gradient-echo (repetition time of 35 msec, echo time of 7 msec, flip angles of 10 degrees-100 degrees) and spin-echo (repetition time of 35 msec, echo time of 8 msec) pulse sequences were used to acquire 20 consecutive images, one every 12 seconds, of the rabbit kidney. Both pulse sequences depicted the time course of Gd-DTPA distribution through the kidney but with distinctly different patterns of MR signal change. These dynamic MR images provide an MR nephrogram that directly demonstrates renal morphology and indirectly reflects the functional status of the renal vasculature, renal perfusion, and tubular concentrating ability.

Animals↗
PubMed1989

Age-related changes of the prostate: evaluation by MR imaging.

The pelvic MR examinations of 40 men without known prostatic disease were reviewed retrospectively. Axial long TR/long TE images were evaluated with respect to prostatic zonal size and signal intensity. Findings were correlated with each patient's age (17-74 years). The central region of the prostate and the peripheral zone enlarged with age; the central gland increased in size by an average of 175% between the second and eighth decades and the peripheral zone increased by an average of 67%. The anterior fibromuscular stroma decreased with increasing age (from an average anteroposterior thickness of 1.2 cm in the second decade to 0.4 cm in the eighth decade) and also became thinner as a function of increasing gland size. The periprostatic venous plexus became less prominent as a function of increasing age, decreasing from 2.5 to 1.5 mm in average maximal diameter, but this venous caliber was not significantly correlated with gland size. The conspicuity of the peripheral zone with respect to the central gland was improved, both as a function of increasing age and increasing gland size, and conspicuity was greatest on long TR/long TE images because of excellent contrast resolution. We conclude that in older age groups, the zonal anatomy of the prostate is more clearly defined than in young patients, both because of morphologic changes in prostate structure and because of physiologic changes resulting in differing zonal MR signal intensities.

Adolescent↗
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↗
PubMed1988

Hyperdense pelvic and inguinal lymph nodes.

This small series reports on the computed tomography appearance of hyperdense iliac, inguinal, and femoral lymph nodes in four cases of lymphoma and one case each of ovarian and breast carcinoma. The mean attenuation value of the lymph nodes was 93.8 Hounsfield units (HU), compared to 61 HU for adjacent muscle and 110.7 HU for blood vessels. A relatively homogeneous enhancement pattern was noted, which could not be directly related to hypervascularity, inflammation, or previous treatment with drugs or radiation.

Adult↗
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

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

Ultrasonic anatomy of hepatic veins.

Whereas the portal veins and hepatic arteries supply the right and left lobes of the liver, the hepatic veins pass along the boundaries between the lobes and segments. Their positions can therefore be used to identify liver segments and allow a precise description of the position of focal lesions. In 104 subjects without liver pathology, the hepatic veins were demonstrated in 101 and followed the classical pattern in 87. Absent and accessory veins were encountered.

Hepatic Veins↗