Search PubMed⌕ Search

Biomedical subjects

R A Older

Publications and source records attributed to R A Older.

At least 19 recordsLinked to original sources
PubMed2001

Radioactive implant migration in patients treated for localized prostate cancer with interstitial brachytherapy.

PURPOSE: In several of the initial patients undergoing brachytherapy at our institution radioactive implants were visible in the thorax on chest radiography. The clinical ramifications of this unanticipated finding were unclear. Thus, we investigated the incidence of brachytherapy seed migration to the chest and whether these seeds were associated with any clinical significance. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients who underwent ultrasound or computerized tomography guided brachytherapy of 103palladium seeds from March 1997 to March 1999. This list of patients on brachytherapy was then matched against the radiology computer system to determine those who had undergone chest X-ray after brachytherapy. When the radiology report was unclear regarding brachytherapy seeds, chest x-rays were reviewed by one of us (R. O.) to determine the presence and position of the seeds. RESULTS: Post-brachytherapy chest x-rays were available in 110 of the 183 patients. In 78 cases no brachytherapy seeds were identified. Radioactive implants were identified on chest radiography in 32 patients (29%), including 1 to 5 seeds in 20, 8, 1, 2 and 1, respectively. No patients complained of any change in pulmonary symptoms after brachytherapy. CONCLUSIONS: Radioactive implants migrated after brachytherapy for localized prostate cancer in 29% of the patients who underwent post-procedure radiography. There did not appear to be a pattern to the seed distribution. However, while the incidence was not negligible, no patient appeared to have any acute pulmonary symptoms. Therefore, while the migration of radioactive implants to the chest is a real phenomenon, it appears to have no adverse clinical consequences in the early post-procedure period.

Brachytherapy↗
PubMed2000

Stone disease.

Imaging studies used for the detection and characterization of urinary tract calculi are presented in this article. Comparisons of traditional imaging studies are made with noncontrast helical CT scanning, the most recent addition to stone imaging. Imaging findings for noncontrast helical CT and an approach to dealing with various combinations of CT studies are also presented.

Humans↗
PubMed1998

Hemodialysis access stenosis: early detection with color Doppler US.

PURPOSE: To evaluate color Doppler ultrasound (US) in detection of subclinical stenosis of hemodialysis access grafts and fistulas. MATERIALS AND METHODS: Doppler US was performed in 40 consecutive patients with no clinical or laboratory findings of hemodialysis access dysfunction. To assess the presence and percentage of stenosis, the maximum systolic blood velocity and velocity ratios were measured and the US images were assessed visually. Fistulography was recommended in patients who demonstrated stenosis greater than 50% at US. RESULTS: At US, 32 of the 40 patients had evidence of stenosis greater than 50%. In 23 of the 32 patients, a follow-up fistulogram was obtained. Hemodynamically significant stenosis was confirmed in 19 of the 23 patients at fistulography. Percutaneous transluminal angioplasty was then performed in 18 of the 19 patients and was successful. CONCLUSION: Color Doppler US is more sensitive than clinical or laboratory methods for detection of hemodialysis access stenosis. Screening with US appears to enable earlier detection and therapy.

Arteriovenous Shunt, Surgical↗
PubMed1997

Interactive multimedia presentations that use photo CD software for teaching.

Interactive educational programs provide an excellent adjunct to traditional lectures. Unfortunately, interactive programs often require more computer resources and financial support than are available to most educators. Photo CD technology provides individual radiologists a way to create relatively inexpensive interactive teaching programs on PCs.

Compact Disks↗
PubMed1997

Clinical value of renovascular resistive index measurement in the diagnosis of acute obstructive uropathy.

PURPOSE: We evaluated the clinical use of the renal resistive index in identifying patients with acute urinary tract obstruction. MATERIALS AND METHODS: Of 54 patients with suspected acute urinary tract obstruction who underwent measurements of renal resistive index 19 had unilateral obstruction documented with excretory urography and comprise our study sample. The contralateral nonobstructed kidneys served as controls. Criteria for obstruction were a resistive index of 0.70 or greater or a side to side difference of 0.10 or greater. We calculated sensitivity, specificity, and positive and negative predictive values. RESULTS: Sensitivity for obstruction was 42% with 11 false-positive cases, specificity was 79%, and positive and negative predictive values were 67 and 57%, respectively. CONCLUSIONS: Renal resistive index measurements are not valuable in detecting acute urinary tract obstruction.

Acute Disease↗
PubMed1997

The impact of sonography on the diagnosis of scrotal disorders.

PURPOSE: We assessed the impact of ultrasound on the referring urologist diagnosis of scrotal disorders. MATERIALS AND METHODS: University urologists (6 attending and 3 resident physicians) in a clinic setting completed questionnaires before and after on 35 patients with scrotal symptoms. The physicians were requested to estimate the probability (0 to 100%) of their most likely diagnosis before and after receiving the sonographic information. We calculated the mean change in diagnostic percentage confidence and also the proportion of patients whose pre-sonographic diagnosis was changed. RESULTS: Scrotal ultrasound changed the initial diagnosis in 11 of 35 patients (32%, 95% confidence interval 19 to 49). The mean percentage gain in diagnostic certainty from ultrasound was 29% (95% confidence interval 20 to 39, p < 0.001). CONCLUSIONS: Scrotal ultrasound has considerable impact on referring urologist diagnosis of scrotal abnormalities.

Diagnosis, Differential↗
PubMed1996

Ultrasound anatomy of the normal male reproductive tract.

Ultrasound is being used with increasing frequency in the evaluation of the male reproductive tract. To detect abnormalities, it is important to have a comprehensive understanding of the normal anatomy and normal variations. In this article, the ultrasound anatomy of the scrotum, penis, prostate, and seminal vesicles is presented. Because ultrasound is a very visual process, the anatomy is presented not only with text, but also through the liberal use of ultrasound images and associated diagrams. Ultrasound is both an operator- and equipment-dependent procedure and, where appropriate, we have included technical discussions regarding ultrasound equipment and settings.

Genitalia, Male↗
PubMed1996

Using the photo CD in academic radiology.

Photo CD technology has expanded significantly since its introduction a few years ago. Because it is not strictly considered interactive multimedia, it has been largely overlooked in the medical field, but it has tremendous capabilities for image storage, retrieval, and transfer. Images can be used for both educator-assisted conferences and self teaching. Adding audio technology to the photo CD expands the self-teaching concept. The equipment needed is simple and relatively inexpensive. The time required to learn how to create photo CDs is short, and they can be produced at almost any institution.

CD-ROM↗
PubMed1995

Computed tomography appearance of the prostatic fossa following radical prostatectomy.

RATIONALE AND OBJECTIVES: We assessed the value of postsurgical computed tomography (CT) in detecting locally recurrent prostatic carcinoma and determined the most effective CT findings. METHODS: We studied 13 patients with recurrent disease (prostate specific antigen [PSA] > 0.4 ng/ml) and 11 patients with no evidence of recurrence (PSA < 0.3 ng/ml). Pelvic CT scans were independently interpreted by four readers who were unaware of patient status. Readers measured tissue volume in the prostatic fossa and evaluated each scan for the presence of six potentially discriminating criteria. We determined sensitivity and specificity and developed mean and pooled receiver operating characteristic (ROC) curves for each criterion and for overall rating. RESULTS: The respective mean ROC curves, sensitivity, and specificity for each criterion were as follows: irregular tissue margins = .50, .67, and .32; inhomogeneous tissue density = .35, .76, and .11; asymmetric residual seminal vesicles = .68, .86, and .16; fat infiltration around seminal vesicles = .67, .69, and .43; infiltration of perirectal fat = .60, .71, and .40; and margins of the levator ani = .50, .78, and .09. The overall rating of whether a scan was normal or reflected recurrent cancer was .56, .75, and .32. Mean tissue volume in the prostatic fossa was 15.01 cm3 for the positive cases and 11.06 cm3 for the negative cases (p < .05), but because of a large overlap, this difference was not practically significant. CONCLUSION: CT scanning is not an effective technique for detecting recurrent prostate malignancy. Normally, there is a moderate amount of soft tissue in the prostatic fossa postoperatively that should not be confused for malignancy.

Adenocarcinoma↗
PubMed1994

Tubular ectasia of the rete testis: a benign condition with a sonographic appearance that may be misinterpreted as malignant.

Tubular ectasia of the rete testis is a recently recognized entity whose sonographic appearance has been described principally in the radiological literature. The sonographic features of this benign process must be appreciated by urologists as well so that is not mistaken for malignancy. We report 3 cases showing the spectrum of this process and review the literature.

Adult↗
PubMed1984

Diagnosis of adrenal disorders.

This article considers the various imaging modalities that can be used in the diagnosis of adrenal disorders and their relative role in the evaluation of specific adrenal disorders. Modalities discussed include abdominal radiography, nephrotomography, ultrasound, computed tomography, arteriography, venography, adrenal venous sampling, radioisotope scanning, and nuclear magnetic resonance. Disorders dealt with include Cushing's disease, pheochromocytoma, primary aldosteronism, neuroblastoma, ganglioneuroma, sympathogonioma, and nonfunctioning adrenal tumors.

Adrenal Gland Diseases↗