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P J Woodward

Publications and source records attributed to P J Woodward.

At least 19 recordsLinked to original sources
PubMed1999

A multisite phase III study of the safety and efficacy of a new manganese chloride-based gastrointestinal contrast agent for MRI of the abdomen and pelvis.

The purpose of this study was to evaluate the safety and efficacy of a manganese chloride-based oral magnetic resonance (MR) contrast agent during a Phase III multisite clinical trial. Two hundred seventeen patients were enrolled who were already scheduled for MRI of the abdomen and/or pelvis. In this group of patients, it was postulated that the use of an oral agent would better allow discrimination of pathology from bowel. Patients with known gastrointestinal pathology including peptic ulcer disease, inflammatory bowel disease, obstruction, or perforation were excluded to minimize confounding variables that could affect the safety assessment. Of these 217 patients, 18 received up to 900 mL of placebo, and 199 patients were given up to 900 mL of a manganese chloride-based oral contrast agent, LumenHance (Bracco Diagnostics, Inc.). Safety was determined by comparing pre- and post-dose physical examinations, vital signs, and laboratory examinations and by documenting adverse events. Efficacy was assessed by unblinded site investigators and two blinded reviewers who compared pre- and post-dose T1- and T2-weighted MRI scans of the abdomen and/or pelvis. In 111 (57%) of the 195 cases evaluated for efficacy by site investigators (unblinded readers), MRI after LumenHance provided additional diagnostic information. Increased information was found by two blinded readers in 52% and 51% of patients, respectively. In 44/195 cases (23%) unblinded readers felt the additional information would have changed patient diagnosis and in 50 patients (26%), it would have changed management and/or therapy. Potential changes in patient diagnosis or management/therapy were seen by the two blinded readers in 8-20% of patients. No clinically significant post-dose laboratory changes were seen. Forty-eight patients (24%) receiving LumenHance and four patients (22%) receiving placebo experienced one or more adverse events. Gastrointestinal tract side effects were most common, seen in 29 (15%) of LumenHance patients and in 3 (17%) of the placebo patients. LumenHance is a safe and efficacious oral gastrointestinal contrast agent for MRI of the abdomen and pelvis.

Abdomen↗
PubMed1999

MRI of the female pelvis.

MRI is a proven modality to evaluate the female pelvis. Excellent soft tissue contrast, sensitivity for the detection of fluid, and the multiplanar imaging capabilities of MR allow noninvasive demonstration of normal anatomy and pathological processes. Most female pelvic MRI studies are performed to answer specific questions and must, therefore, follow carefully developed protocols, which are discussed in this article. The principal MRI techniques and strategies outlined in this work include: (1) the evaluation of reproductive dysfunction, anatomic variants; (2) specific obstetrical applications; (3) oncologic evaluation and tumor staging; (4) problem solving (i.e., the characterization of abnormalities detected by ultrasound); and (5) the evaluation of urethral disease.

Female↗
PubMed1999

Suicide and violence prevention: parent education in the emergency department.

OBJECTIVE: To determine prospectively whether parental receipt of injury prevention education is associated with new action limiting access to lethal means and if so, what action was taken for which means. METHOD: Prospective follow-up of 103 adults whose children made an emergency department visit for mental health assessment or treatment. Record review assessed whether hospital staff provided injury prevention education. Logistic regression was used to determine the likelihood of new caretaker action limiting access to the following potentially lethal means: firearms, alcohol, prescription medications, and over-the-counter medications. RESULTS: Significant associations were found between exposure to injury prevention education and action to limit access (adjusted odds ratio = 3.6, 95% confidence interval = 1.1-12.1, p = .04). Five of 8 adults whose households contained firearms took new action to limit access after injury prevention education, whereas none of the 7 firearm-owning families who did not receive injury prevention education took new action to limit firearm access. Similar patterns were seen for other means. Adults more often chose to lock up rather than dispose of lethal means. CONCLUSIONS: Injury prevention education should be provided to parents during child/adolescent emergency department mental health-related visits. Potential for violence prevention is real because parents do take new action to limit access to lethal means when means restriction education is provided.

Adolescent↗
PubMed1998

MR imaging of the adrenal glands and kidneys.

MR imaging of the adrenal glands and kidneys can completely and accurately assess these organs for a variety of abnormalities. One of the major strengths of MR imaging of the adrenal glands is the ability of chemical shift imaging to determine the presence of intracellular lipid, thus enabling distinction of benign adrenal adenomas from other adrenal masses. The multiplanar imaging capability of MR can assist in determining the origin of large retroperitoneal masses. MR imaging of the kidneys has many applications, including staging of renal cell carcinomas and evaluating the renal vasculature. Gadolinium is a safe and non-nephrotoxic contrast agent that can be used to evaluate the kidneys in patients with renal compromise. The many advances and current research being performed in the rapidly expanding field of abdominal MR make performing these cases both exciting and challenging.

Adrenal Gland Neoplasms↗
PubMed1998

Magnetic resonance imaging of the female pelvis.

Evaluation of pelvic pathology is an important part of most radiology practices. Magnetic resonance imaging (MRI) has proven itself to be a useful and cost-effective method in evaluating many of these diseases. This article reviews appropriate MR imaging techniques and findings of common gynecologic disorders. Uterine pathology is categorized into congenital anomalies, benign lesions (leiomyomas, adenomyosis, endometrial polyps, and nabothian cysts), and malignancies (endometrial and cervical carcinoma). Adnexal pathology reviewed includes endometriosis, polycystic ovaries, teratomas, and benign and malignant ovarian epithelial tumors.

Female↗
PubMed1997

Child and adolescent suicide attempts: an opportunity for emergency departments to provide injury prevention education.

The study objectives were to ascertain whether caretakers of suicidal children and adolescents received emergency department (ED) injury prevention education and to determine if injury prevention education and the medical outcome after a drug overdose are associated with caretakers restricting access to means of suicide. Participants were adult caretakers of children and adolescents who deliberately ingested a drug and received ED evaluation. Information was obtained by poison center chart review and phone interview. Fourteen percent of caretaker reported receiving injury prevention education concerning restriction of access to potential means of suicide at home. ED injury prevention education is significantly associated with caretakers restricting access to suicidal means, even when controlling for medical outcome from the attempt. Because parents are less likely to restrict access to means of suicide without education, injury prevention education about restricting access to means of suicide should be given in the ED.

Adolescent↗
PubMed1997

Postmortem fetal MR imaging: comparison with findings at autopsy.

OBJECTIVE: The purpose of this study was to prospectively compare findings from postmortem fetal MR imaging with findings at autopsy. SUBJECTS AND METHODS: Twenty-six fetuses were imaged on a 1.5-T MR scanner using two-dimensional and high-resolution three-dimensional fast spin-echo techniques immediately before autopsy. The MR images were reviewed independently by three radiologists who evaluated then for major and minor malformations. These findings were then compared with those at autopsy. RESULTS: The 26 subjects had 47 major and 11 minor malformations. All three radiologists correctly identified 37 of the major malformations on the MR images (detection rate, 79%), and at least one of the three reviewers correctly identified 43 of the abnormalities (detection rate, 91%). Only one of the 11 minor anomalies was identified by any reviewer. Reviewers made six false-positive diagnoses. In two cases, both with major CNS malformations, MR imaging was superior to autopsy in defining in situ relationships. CONCLUSION: Although autopsy remains the study of choice for evaluating causes of fetal death, MR imaging is an excellent alternative when autopsy is refused. Additionally, MR imaging may be a valuable adjunct to autopsy for fetuses with CNS anomalies.

Abnormalities, Multiple↗
PubMed1996

From the archives of the AFIP. Gestational trophoblastic disease: radiologic-pathologic correlation.

Gestational trophoblastic disease (GTD) is a manifestation of an aberrant fertilization event that leads to a proliferative process and, potentially, to an invasive neoplasm. The spectrum of GTD includes hydatidiform moles (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic disease (rare). Increased levels of human chorionic gonadotropin (beta-hCG) are associated with all forms. Ultrasonography (US), performed late in the first trimester of a pregnancy complicated by hyperemesis gravidarum, toxemia, or bleeding, is essential in the early detection of hydatidiform mole, the most common form of GTD (80% of cases). In these cases, US typically reveals a central heterogeneous mass with anechoic spaces, which correspond to hydropic villi. In cases of invasive mole, imaging may show a central uterine process (similar to that seen in noninvasive moles), occasionally with myometrial invasion. Choriocarcinoma is often seen as a mass enlarging the uterus, with a heterogeneity that correlates with necrosis and hemorrhage. Because of the widespread availability of serum measurement of beta-hCG, diagnosis of the more severe, persistent manifestations of GTD seldom depends on radiologic examinations. However, imaging studies may alert the referring physician to the diagnosis in cases of early disease. Also, imaging studies may have a problem-solving role in examining patients with recurrent GTD or a confusing clinical picture.

Brain Neoplasms↗
PubMed1995

Patients with dementia and their caregivers 3 years after diagnosis. A longitudinal study.

OBJECTIVES: To document caregivers' perceptions of the deterioration in functional ability of persons with dementia over time, to identify the most problematic behavior for caregivers at two stages of dementing illness, and to compare the perceived informational needs of caregivers at diagnosis and 3 years later. DESIGN: Single cohort. Surveys were mailed at time 1 and respondents were followed up after 3 years (time 2). SETTING: Midwestern hospital dementia assessment clinic with a family physician director. Continuing care was by community physicians. SUBJECTS: Thirty elderly patients with dementia who were evaluated at the dementia clinic. Data were provided by their caregivers. RESULTS: Patients' scores on the Activities of Daily Living section of the questionnaire declined (bathe self, P = .03; transfer from bed or chair, P = .03; and groom self, P = .06). Significant deterioration in behaviors over time was found in incontinence (P = .04). Fewer patients were depressed at time 2 (P = .02). The patient behaviors found most troublesome at time 1 were worrying about memory loss, losing or hiding things, feeling blue, experiencing restlessness, having difficulty calculating, experiencing a lack of interest, and having false ideas. At time 2, the greatest problems were having a short attention span, failing to recognize persons or things, experiencing a lack of interest, experiencing restlessness, repeating himself or herself, forgetting where he or she is, speaking incoherently, and being incontinent. Questions caregivers most wanted answered at time 1 concerned possible treatment, the future course of illness, and the cause of the symptoms. At time 2, the concerns were the future course of illness, possible treatment, and disease inheritance. There was significantly more interest in family agreement about care (P = .004) and the need for legal guardianship (P = .001) at time 2. CONCLUSIONS: Caregivers' perceptions of the most frequent and troublesome behaviors of patients with dementia were documented at different stages of the disease. The importance caregivers attached to their requests for information reflected changing but continuing needs for reassurance about the patient's diagnosis and treatment and for help with the psychosocial consequences of dementia. Physicians must be aware of caregivers' needs at different stages of the disease process and be equipped to help them appropriately.

Activities of Daily Living↗
PubMed1995

Bone mineral density of eating disorder subgroups.

OBJECTIVE: We tested nine hypotheses among eating disorder subgroups and a control group on spinal bone density and investigated the relationship of their spinal bone density with a critical fracture threshold and five clinical variables--age of onset, years ill, percentage of ideal body weight (IBW), months of amenorrhea, and hours per week of exercise. METHOD: Dual photon absorptiometry measured spinal bone density. RESULTS: Anorectic patients had significantly less spinal bone mass than bulimic patients with no history of anorexia nervosa or control patients. Eating disordered patients with past or present anorexia nervosa had significantly more spinal bone density values below a critical fracture threshold. Duration of amenorrhea and exercise significantly predicted spinal bone density. DISCUSSION: Anorectic women were unlikely to reach their peak bone density, thus possibly developing osteoporosis later in life, and were likely to be at risk for nontraumatic spinal fractures. Predicting spinal bone density of anorectic women could be done by knowing their duration of amenorrhea and exercise.

Adolescent↗
PubMed1995

Radiological evaluation of infertility.

With unwanted infertility on the rise, the radiologist is becoming increasingly involved both in the diagnosis and treatment of these patients. Assessment of the six most common factors causing infertility should be performed during the initial clinical evaluation. These six factors include the cervical factor, endometrial-uterine factor, tubal factor, ovarian factor, peritoneal factor, and male factor. Each of these groups will be discussed in detail with special attention to optimal methods of diagnosis. Hysterosalpingography and ultrasound play the major roles in evaluation; however, there is an important emerging role for newer techniques such as MRI and selective fallopian tube catheterization.

Diagnostic Imaging↗
PubMed1995

Intraoral ultrasound evaluation of peritonsillar abscess.

Peritonsillar cellulitis and peritonsillar abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment. This pilot study was designed to evaluate the sensitivity and specificity of intraoral ultrasound as a noninvasive method of differentiating abscess from cellulitis. Sixteen consecutive patients suspected of having peritonsillar abscess were prospectively evaluated with intraoral ultrasound. The results were confirmed with imaging or surgical drainage. Correct diagnoses were made in 9 (90%) of 10 abscesses and in 5 (83%) of 6 cases of cellulitis. Our results suggest that, while there is a learning curve for intraoral ultrasound, it is an accurate, noninvasive, and inexpensive tool to differentiate abscess from cellulitis. We believe that this will be a clinically useful technique in the future.

Adolescent↗
PubMed1995

Sonographic diagnosis of peritoneal inclusion cysts.

Peritoneal inclusion cysts have not received the attention they merit in the imaging literature. We present a series of peritoneal inclusion cysts and describe their sonographic features. Our findings lead us to encourage more conservative therapies. All seven patients in our series had pelvic pain and had undergone surgery previously. An ovary surrounded by septations and fluid was the most common finding by transvaginal sonography. Doppler examination showed low resistive flow in the septations. Conservative therapy was used in five cases with excellent results. We found that a confident diagnosis of peritoneal inclusion cysts is possible with ultrasonography. This diagnosis should encourage the use of more conservative therapy.

Adolescent↗
PubMed1994

Magnetic resonance evaluation of congenital uterine anomalies.

Congenital malformations of the uterus (also known as müllerian duct anomalies) exist as a spectrum of disorders; each of these, to some extent, is associated with reproductive dysfunction. Significant improvements in imaging methods such as ultrasound and magnetic resonance have the potential to eliminate the need for invasive evaluation of patients with suspected uterine anomalies. This article reviews the relevant embryology and classification of müllerian duct anomalies as well as the relationship between the imaging features and general therapeutic options.

Congenital Abnormalities↗
PubMed1993

Body size and shape characteristics of personal ("in search of") ads.

This study investigated sociocultural norms for height, weight, and body shape by analyzing 481 personal ads in a large metropolitan city magazine to determine self-report characteristics of males and females seeking companionship as well as the desired height, weight, and shape characteristics of the person being sought. Seventy percent of ads specified weight, shape, or height characteristics and of those ads most were heterosexual Caucasian males and females. Male searchers described themselves as tall, fit, and athletic, but of average weight. Female searchers described themselves as petite or tall and fit with body weight as significantly less (89.4%) than the ideal body weight. Male searchers sought females 5 years younger, thin, fit, petite or tall. Women seekers sought men 3 years older, tall, fit, and athletic. These ads confirmed the use of stereotyped and highly athletic body size and shape for self-descriptions and for characteristics of companions sought.

Adult↗
PubMed1993

MR imaging in the evaluation of female infertility.

Magnetic resonance (MR) imaging has proved useful in evaluating various conditions associated with female infertility. With T2-weighted pulse sequences, uterine zonal anatomy can be clearly delineated, and with images obtained in a plane coronal and perpendicular to the long axis of the uterus, the external uterine contour can be evaluated. This latter capability allows the differentiation of a bicornuate uterus from a septate one, a distinction that has not been possible with hysterosalpingography and that enables improved treatment planning. MR imaging accurately demonstrates leiomyomas, providing improved preoperative localization compared with that achievable with hysterosalpingography or ultrasonography, and may be useful in differentiating these tumors from adenomyosis. Endometriosis can be detected with MR imaging, but laparoscopy is more reliable for diagnosis and staging. Although the use of MR imaging is not indicated in every evaluation, the modality is valuable in certain settings, especially those that involve differentiation of congenital anomalies and localization of leiomyomas. In these settings, use of MR imaging can obviate more invasive procedures, such as laparoscopy.

Adnexal Diseases↗
PubMed1987

A factorial study of the Carrow Auditory-Visual Abilities Test with normal and clinical children.

A factor analysis was conducted on the Carrow Auditory-Visual Abilities Test for the purpose of identifying common factors measured by the test. Two sets of scores were used, one from a normal population of 1,032 children and one from a clinical population of 141 children. Two basic factors accounted for a good portion of the total variance. The subtests that loaded on Factor 1 were Visual Discrimination Matching, Visual Discrimination Memory, Visual Motor Copying, Visual Motor Memory, Motor Speed Accuracy, Picture Memory, and Auditory Blending. The subtests that loaded on Factor 2 were Picture Sequence Selection; Digits Forward; Sentence Repetition; Word Repetition 1, 2, 3; and Total. Subtests that did not fall clearly into either factor were Digits Backward and the two Auditory Discrimination subtests. Except for the Auditory Discrimination subtests, there were no essential differences in the factor matrix between normal and clinical populations.

Auditory Perception↗