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Biomedical subjects

R A Filly

Publications and source records attributed to R A Filly.

At least 199 records · Page 11Linked to original sources
PubMed1984

Alobar holoprosencephaly: ultrasonographic prenatal diagnosis.

Modern ultrasound imaging devices have increasingly allowed sophisticated prenatal diagnoses of fetal disorders. Embryopathologic and ultrasound findings are reported in five cases of alobar holoprosencephaly that were diagnosed prenatally, two cases as early as 23 menstrual weeks. Specific sonographic findings included a large central cranial fluid collection (a monoventricular cavity lacking ventricular horns and midline structures), a fused thalamus at the floor of this cavity, and characteristic facial features (proboscis, single orbit, single nostril, or severe hypotelorism). Differential diagnosis of the fetus with a large intracranial fluid collection is discussed and illustrated.

Abnormalities, Multiple↗
PubMed1984

Benign breast lesions: ultrasound detection and diagnosis.

Experience with 2500 patients over age 30 studied by physical examination, x-ray mammography, and sonography enabled definition of several specific clinical situations in which sonography adds meaningful diagnostic information not provided by either of the other examinations. These include: palpable breast masses for cyst-solid differentiation; nonpalpable mammographic masses for cyst-solid differentiation; and women with a symptomatic area in the breast that shows only uniformly dense fibro-glandular tissue on x-ray mammograms. For women with radiographically dense breasts who have no breast symptoms, abnormal physical findings, or mammographic lesions, sonography will identify many benign cysts and also some benign solid lesions, but at best only rarely (none of the 587 cases in this study) will it detect an otherwise occult breast cancer. Our data suggest that sonography should not be a substitute for physical examination and mammography in women over age 30, but rather that in three specific clinical situations it can be a valuable addition to the standard diagnostic evaluation.

Adult↗
PubMed1984

Severe nonimmune hydrops fetalis: sonographic evaluation.

Reported survival rates in nonimmune hydrops fetalis vary considerably. Among 27 fetuses exhibiting severe sonographic features of nonimmune hydrops fetalis, 33% survived the neonatal period. For five of the nine survivors, the prognosis remains uncertain or poor. On the basis of sonographic features alone neither prognosis nor potential survivors were reliably predicted.

Adult↗
PubMed1984

Fetal renal dysplasia: sonographic evaluation.

In an attempt to predict histologic fetal renal dysplasia among fetuses with obstructive uropathy, three antenatal sonographic features (presence of renal cortical cysts, echogenicity of renal parenchyma, and degree of hydronephrosis) were studied. Identification of renal cortical cysts in the kidneys of fetuses with obstructive uropathy enabled accurate prediction of renal dysplasia. Of 49 fetal kidneys with obstructive uropathy, all 15 kidneys with sonographically visible cortical cysts had severe but not necessarily lethal dysplasia (accuracy of positive prediction = 100%). Of 15 obstructed but nondysplastic fetal kidneys, none had sonographically visible cysts (specificity = 100%). The absence of fetal renal cysts on antenatal sonography, however, did not exclude the presence of dysplasia. Assessment of the echogenicity of renal parenchyma and the degree of hydronephrosis are of only limited value in predicting whether an obstructed fetal kidney will show histologic dysplasia.

Female↗
PubMed1984

The fetal cisterna magna.

Antenatal sonography routinely images the fetal cisterna magna. The identification of a prominent cisterna magna on a routine antenatal sonogram performed for obstetric indications may raise the question of a congenital posterior fossa lesion. To delineate the size of the fetal cisterna magna, standardized measurements for the midsagittal depth of the cisterna magna were prospectively obtained on 219 consecutive antenatal sonograms in fetuses of 15 menstrual weeks or more. The cisterna magna depth measured 5 +/- 3 mm; the largest cisterna magna measured 10 mm in depth. In the absence of other findings to suggest a posterior fossa lesion, a prominent cisterna magna is unlikely to be clinically significant.

Brain↗
PubMed1984

High-resolution sonographic assessment of the fetal extremities.

Recent advances in ultrasound technology, especially phased-array sonography, now permit striking visualization of fetal morphology. Although several reports document the sonographic appearance of the fetal appendicular skeleton, no reports describe the nonosseous structures of the fetal limbs. Prior to the middle of the second trimester of pregnancy, adequate size and intrinsic subject contrast enable distinction among numerous limb structures. The sonographic features of the fetal limbs are described, with emphasis upon the visible nonosseous structures. All images were obtained between August 1983 and January 1984 using a 128-channel phased-array real-time scanner (Acuson) with a 3.5-MHz transducer.

Arm↗
PubMed1984

Ultrasound evaluation of benign sciatic nerve sheath tumors.

The ultrasonograms of three patients with surgically proven benign tumors of the sciatic nerve sheath were reviewed. Two lesions were neurilemmomas and one was a neurofibroma. All lesions appeared hypoechoic and often demonstrated characteristics typically associated with cystic abnormalities. Although the sciatic nerve is not routinely delineated as a separate anatomic structure by ultrasound, neoplastic enlargements of the nerve can be demonstrated.

Child↗
PubMed1983

Limitations of ultrasound in detecting cerebral ischemic lesions in the neonate.

Ultrasound scans of three newborn infants with cerebral ischemic lesions demonstrated on computed tomographic scan showed unexpected changes in echogenicity of brain parenchyma in addition to lateralized mass effect. Areas of increased echogenicity were present adjacent to regions of infarction identified on computed tomographic scan. The findings suggest that caution should be exercised in the interpretation of echo-dense areas in unusual locations for hemorrhage in infants at risk for cerebral ischemic lesions.

Asphyxia Neonatorum↗
PubMed1983

Ultrasonic evaluation of common bile duct stones: prospective comparison with endoscopic retrograde cholangiopancreatography.

Ultrasound is the modality of choice for the diagnosis of cholelithiasis and for the evaluation of the intra- and extrahepatic biliary tree in the patient with jaundice, but its role in the diagnosis of choledocholithiasis is less certain. We prospectively examined 90 patients who were to undergo endoscopic retrograde cholangiopancreatography (ERCP) by performing right upper quadrant sonography immediately prior to ERCP. We assessed the size of the intra- and extrahepatic ducts and the presence or absence of calculi. ERCP, which was successfully performed in 77 of 94 attempted examinations, percutaneous transhepatic cholangiography, or surgical follow-up composed the diagnostic standard for comparison. Ultrasound was not accurate in the diagnosis (sensitivity, 25%) or exclusion (value of a negative study, 73%) of choledocholithiasis. Furthermore, in the postcholecystectomy patient population, ultrasound assessment of biliary duct size is not a useful predictor of biliary disease. For symptomatic postcholecystectomy patients, we recommend ERCP as the initial diagnostic modality.

Bile Duct Diseases↗
PubMed1983

Ultrasonographic differentiation of the gestational sac of early intrauterine pregnancy from the pseudogestational sac of ectopic pregnancy.

A retrospective review of 128 consecutively scanned pregnant patients who had either early intrauterine pregnancies (IUPs) or ectopic pregnancies was performed to determine the accuracy of the finding of an intrauterine double decidual sac (DDS) in distinguishing between these two groups of patients. The presence of a DDS correlated with an IUP in 59 of 60 patients (98.3%). Of 68 patients who lacked a DDS, only four had normal IUPs; the remaining patients had either ectopic pregnancies or abnormal IUPs. Results of this study suggest that the finding of a DDS at ultrasonography is useful in making an early diagnosis of IUP, while its absence strongly suggests either an ectopic pregnancy or an abnormal IUP.

Decidua↗
PubMed1983

Work in progress: nuclear magnetic resonance imaging of the gallbladder.

A preliminary study of the relation between food intake and intensity of gallbladder bile on nuclear magnetic resonance (NMR) images was made. Twelve subjects (seven volunteers, five patients) were imaged following a minimum of 14 hours of fasting. Six of seven volunteers were reimaged one hour after stimulation by either a fatty meal or an alcoholic beverage. An additional seven patients were imaged two hours after a hospital breakfast. It was found that concentrated bile emits a high-intensity spin echo signal (SE), while hepatic bile in the gallbladder produces a low-intensity SE signal. Following ingestion of cholecystogogue, dilute hepatic bile settles on top of the concentrated bile, each emitting SE signals of different intensity. The average T1 value of concentrated bile was 594 msec, while the T1 value of dilute hepatic bile was 2,646 msec. The average T2 values were 104 msec for concentrated bile and 126 msec for dilute bile. The most likely cause for the different SE intensities of bile is the higher water content, and therefore longer T1 and T2 relaxation times, of hepatic bile. It is suggested that NMR imaging has the ability to provide physiological information about the gallbladder and that it may prove to be a simple and safe clinical test of gallbladder function.

Cholagogues and Choleretics↗
PubMed1983

Ultrasonographic identification of fetal lower extremity epiphyseal ossification centers.

The reliability of the sonographic identification of the fetal distal femoral epiphyseal ossification center (DFE) and the proximal tibial epiphyseal ossification center (PTE) in the estimation of gestational age (GA) was assessed in 84 singleton pregnancies. We used the presence of a DFE to indicate a GA greater than or equal to 33 weeks, and this method was 95% sensitive, 95% specific, and accurate overall in 95% of a selected cohort of 61 cases. In the same cohort, the presence of the PTE was highly predictive (accuracy of a positive prediction 95%) of a GA greater than or equal to 35 weeks. Ultrasonographic evaluation of fetal lower extremity epiphyseal ossification centers is a promising technique for the estimation of GA during the last trimester of pregnancy.

Epiphyses↗
PubMed1983

Congenital diaphragmatic hernia diagnosed prenatally by ultrasound.

Seven infants born at our institution between July 1979 and June 1982 had congenital diaphragmatic hernia (CDH). Four cases of CDH were correctly identified by fetal ultrasonography. Diagnosis relied upon the demonstration of abdominal organs within the thorax. During this period, no false positive diagnoses of CDH were made. Significant associated sonographic features included polyhydramnios, mediastinal displacement, and distorted upper abdominal anatomy.

False Negative Reactions↗