Intramural duodenal hematoma after endoscopic biopsy in leukemic patients.
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Adolescent↗
Biomedical subjects
R B Goldstein
Publications and source records attributed to R B Goldstein.
Challenging the embryogenesis of cloacal exstrophy.
As presently understood, cloacal exstrophy results from a migration failure of the lateral mesodermal folds of the infraumbilical anterior abdominal wall, and rupture of the resulting enlarged, persistent cloacal membrane before the eighth week of gestation. The authors present ultrasonographic evidence that disputes this embryological theory. Routine ultrasonography of a twin gestation at 18 weeks showed that one twin had a dilated cloacal abnormality, bilateral hydronephrosis, and oligohydramnios. Repeat ultrasonography at 24 weeks demonstrated rupture of the cloacal anomaly, with resolution of both the hydronephrosis and oligohydramnios. This twin was born with classic cloacal exstrophy. This striking ultrasound evidence of an intact cloacal membrane at 18 weeks, which ruptured before 24 weeks, relieving the urinary tract outlet obstruction, forces us to rethink how this surgically correctable anomaly develops.
Abnormalities, Multiple↗
Sonographic anatomy of the developing cerebellum: normal embryology can resemble pathology.
OBJECTIVE: The aims of this study were to evaluate sonographically observable fetal cerebellar development by use of MR image and anatomic correlations to determine what aspects of this development can be visualized by sonography and to define the normal sonographic appearance of cerebellar development to assist in the differentiation of normal development from pathologic development during prenatal sonography. MATERIALS AND METHODS: The posterior fossae of 19 normal, whole, fixed fetal specimens of 11-21 weeks' gestational age were imaged by sonography and MR imaging. Images were correlated with anatomic atlases and anatomic sections. RESULTS: By 13-14 weeks, both sonography and MR imaging demonstrated the vermis between the hemispheres rostrally, but the caudal vermis was undeveloped. Although visualized on MR images, the caudal fourth ventricular roof was not yet appreciated on sonograms, giving the false impression of communication between the fourth ventricle and the cisterna magna. Separation of these CSF spaces was not appreciated at all levels sonographically until 16 weeks. CONCLUSIONS: The sonographic appearance of normal cerebellar development can resemble pathology early in the second trimester. Caution is warranted in making an early diagnosis of fetal cerebellar dysgenesis.
Cerebellum↗
Prenatal diagnosis of hypospadias.
Despite the fact that hypospadias is one of the most common congenital abnormalities of the genitalia, it is often missed on prenatal sonograms. In this paper, sonographic findings of six fetuses who were prospectively suspected to have hypospadias are presented. Of the six patients, isolated hypospadias was found in three, hypospadias with chordee in two, and isolated chordee in one. Additional malformations were present in four of the six fetuses. Sonographic findings of fetal hypospadias are described, and the embryology, anatomy, and associated abnormalities are discussed.
Congenital Abnormalities↗
Evaluation of a sonographic PACS in clinical practice: analysis of technical and analytical time savings.
The aim of this study was to generate quantitative data regarding technical and analytical time savings obtained by use of an ultrasonographic PACS. Data/time cards were recorded for each patient encountered in an outpatient diagnostic ultrasound facility for a 4 week period immediately before and a 1 year period after installation of a PACS environment. Use of a sonographic PACS resulted in a per case time savings of 293 s in the technical component and 51 to 63 s in the analytical component of an average ultrasonographic examination. We conclude that use of a PACS workstation has the potential to increase productivity for both the sonographer and the radiologist.
Ambulatory Care Facilities↗
Persistent intrahepatic right umbilical vein: a prenatal sonographic series without significant anomalies.
Umbilical venous anatomy variation is considered extremely rare. The intrahepatic persistent right umbilical vein represents one version in the spectrum of umbilical vein variations. Prior reports of a prenatally diagnosed persistent right umbilical vein suggest it is strongly associated with severe fetal anomalies including congenital heart disease and gastrointestinal malformations. Our experience contrasts with these findings. Nine cases of intrahepatic persistent right umbilical vein were identified via prenatal sonography between July 1992 and January 1994. The gestational ages of the fetuses ranged from 20 to 36 weeks. Targeted fetal surveys were performed in all nine fetuses and formal fetal echocardiograms were obtained in six. All nine infants have been delivered. In nine cases, the intrahepatic persistent right umbilical vein was an isolated observation with no abnormalities identified pre- or postnatally except one case of hypospadias. Formal fetal echocardiography was normal in all six of the fetuses studied. Given previous reports describing a high risk of congenital malformations in association with the presence of a persistent right umbilical vein, the sonographic finding of this anomaly should still prompt targeted fetal sonography and fetal echocardiography. However, our series indicates that this vascular variant may occur as an isolated abnormality and may not necessarily represent the ominous finding suggested previously.
Female↗
Is the comorbidity between social phobia and panic disorder due to familial cotransmission or other factors?
BACKGROUND: We previously reported significantly elevated rates of social phobia in relatives of probands with panic disorder compared with relatives of other proband groups. This study further investigates the relationship between social phobia and panic disorder. METHOD: This sample is from a family study that included 193 probands from four mutually exclusive groups (patients with panic disorder, patients with panic disorder and major depression, patients with early-onset major depression, and normal controls) and 1047 of their adult first-degree relatives. Best-estimate diagnoses were completed using DSM-III-R criteria. RESULTS: Social phobia and agoraphobia aggregate in the families of probands with panic disorder without major depression. Social phobia frequently co-occurs with panic disorder in relatives, but the risk for comorbidity does not vary across proband groups. CONCLUSIONS: The familial aggregation of social phobia with panic disorder may be explained by the aggregation of panic disorder in relatives of probands with panic disorder combined with the tendency for panic disorder to occur comorbidly with social phobia in individuals.
Adult↗
Prenatal diagnosis of esophageal atresia.
The prenatal sonographic detection of esophageal atresia (EA) has been possible for more than a decade and relies on the finding of a small or absent fetal stomach bubble associated with maternal polyhydramnios. The aims of this study were to assess the accuracy of this technique and to determine whether the outcome of prenatally diagnosed EA differs from its postnatal counterpart. All fetal sonograms performed between January 1989 and October 1993 demonstrating a small or absent fetal gastric bubble were reviewed together with all neonates with EA treated during the same period. Eighty-seven fetuses with a small (n = 53) or absent stomach bubble (n = 34) were identified, representing 1.4% of all fetal sonographic surveys. Esophageal atresia was present in 15; in 13 of these, the maternal amniotic fluid volume was increased. The positive predictive value of an absent stomach bubble and polyhydramnios was 56%, and the sensitivity of prenatal sonography in the diagnosis of EA was 42%. One neonate with EA had the prenatal diagnosis established at another institution, yielding a total of 16 cases of prenatally diagnosed EA for analysis. Seven (44%) of these had trisomy 18. Of the remaining nine, two had isolated EA, two had laryngeal atresia and EA, and there were two late-gestational unexplained fetal deaths. Only four (25%) survived through the neonatal period. The prognosis of the fetus with EA is radically different from that of the neonate with EA.
Esophageal Atresia↗
Fetal diaphragmatic hernia without visceral herniation.
Many cases of congenital diaphragmatic hernia (CDH) are currently detected before birth. The authors hypothesized that there is a subgroup of patients with CDH who have no evidence of visceral herniation in utero and who would be expected to have less pulmonary hypoplasia and a good prognosis. Among 41 neonates with left-sided CDH treated between January 1990 and October 1993, 17 cases were diagnosed after birth. Ten of the 17 had undergone detailed fetal sonographic imaging at or after 20 weeks' gestation. After independent review of the prenatal scans of these 10 patients, one was found to have evidence of a diaphragmatic hernia and was excluded from further analysis. The other nine fetuses survived, and prosthetic repair of the diaphragmatic defect and extracorporeal membrane oxygenation (ECMO) were each required in only one patient. This contrasted with the outcome for 18 control patients with prenatally diagnosed CDH: 4 (22%) died, 13 (72%) required prosthetic repair, 9 (50%) were supported with ECMO and the duration of ventilatory support and hospital stay were significantly longer. There is a spectrum of severity among both pre and postnatally diagnosed cases of CDH. In the neonate with an isolated left-sided diaphragmatic hernia, a good prognosis is to be expected if the condition was not detectable by detailed prenatal sonography in the second half of pregnancy.
Female↗
A paradigm for computer-assisted radiology resident rotation scheduling.
RATIONALE AND OBJECTIVES: The scheduling of radiology residents remains a major annual undertaking of chief residents. In this article, we describe a paradigm to implement interactive computer programs to reduce the inefficiencies and inequities of planning the yearly schedule. METHODS: We used the programming language, Prolog, to develop a compact program that provides faster and more flexible performance than those reported in the literature. This interactive program stores scheduling requirements in data files separated from the control program and runs on a Macintosh computer. RESULTS: The schedule of any residency year is generated within 3-7 sec. The fast computation and query capabilities of this scheduling program have helped chief residents to identify conflicting requirements that were previously overlooked. CONCLUSION: Using our programming paradigm, we have developed a portable Prolog-based scheduling program that is quick and easy to use.
Cost-Benefit Analysis↗
Psychiatric disorders in relatives of probands with obsessive-compulsive disorder and co-morbid major depression or generalized anxiety.
The authors report findings from a blind, controlled study of obsessive-compulsive disorder (OCD). Prevalence rates of generalized anxiety disorder (GAD) and major depressive disorder (MDD) were compared among first-degree relatives of probands with OCD and co-morbid GAD or MDD, respectively. Rates of MDD were not increased in relatives of probands with OCD and MDD; neither were rates of GAD increased in relatives of probands with OCD and GAD, although rates of GAD were increased among relatives of probands with OCD compared to relatives of healthy controls. The authors explore the implications of the findings.
Adolescent↗
Prenatally detected fetal myelomeningocele: is karyotype analysis warranted?
PURPOSE: To determine the prevalence of karyotype abnormalities in fetuses with prenatally detected spina bifida and evaluate the ability of prenatal sonography to enable prediction of chromosomal abnormalities. MATERIALS AND METHODS: Sonograms from 63 fetuses with prenatally detected spina bifida were reviewed, and associated sonographic abnormalities were recorded. Sonographic findings were correlated with autopsy or clinical findings when possible. RESULTS: Associated sonographic abnormalities were present in 15 (24%) of fetuses with spina bifida. Among 52 fetuses with known karyotypes, the prevalence of chromosome abnormalities was 17%. Karyotype abnormalities included trisomy 18, trisomy 13, triploidy, and translocation. Twenty-two percent of chromosomally abnormal fetuses had sonographically isolated spina bifida. CONCLUSION: Prenatal sonography can help predict most karyotypically abnormal fetuses with spina bifida, but approximately 20% will be missed with this technique alone in the second trimester. The authors believe cytogenetic analysis is justified in the setting of prenatally detected spina bifida.
Chromosome Aberrations↗
Fetal cerebral ventricular atrium: difference in size according to sex.
PURPOSE: To determine whether the diameter of the fetal lateral ventricular atrium is larger in male than in female fetuses. MATERIALS AND METHODS: The atrial diameter in 219 fetuses retrospectively identified from a consecutive group of healthy newborns was measured without knowledge of the subject's sex. RESULTS: Atrial size demonstrated a near-normal distribution, with mean size for all subjects 6.1 mm +/- 1.3 (standard deviation). When separated by sex, the mean atrial diameter of 122 female fetuses was 5.8 mm +/- 1.3, and the mean atrial diameter of 97 male fetuses was 6.4 mm +/- 1.3. The difference in mean size is statistically significant (P < .005). CONCLUSION: Male fetuses have a slightly larger atrial size than female fetuses. This discovery has implications for defining the upper limit of normal for fetal ventricular atrial size.
Cerebral Ventricles↗
Small or absent fetal stomach: prognostic significance.
PURPOSE: To investigate the outcome of fetuses with a small or absent stomach. MATERIALS AND METHODS: We retrospectively reviewed sonograms in 87 fetuses with a small or absent stomach. Gestational age, amniotic fluid volume, stomach size, morphologic defects, and karyotypes were correlated with clinical follow-up or autopsy findings. RESULTS: Eight pregnancies were excluded because of oligohydramnios due to ruptured membranes. Seventy-nine fetuses with an absent (n = 27) or small (n = 52) stomach were included in the study group. Gestational ages ranged from 18 to 39 weeks (mean, 27 weeks). An abnormal outcome (structural abnormalities, intrauterine fetal or postnatal death) occurred in 23 (85%) of 27 fetuses with an absent stomach and 27 (52%) of 52 fetuses with a small stomach (combined, 63%). Karyotype was abnormal in eight (38%) of 21 fetuses with an absent stomach and two (4%) of 46 fetuses with a small stomach. CONCLUSION: An absent or small fetal stomach after 18 weeks gestation is associated with a guarded prognosis.
Abnormalities, Multiple↗
The empty amnion: a sign of early pregnancy failure.
Between 6.5 to 10 weeks of gestation, the length of the amniotic cavity is similar to that of the embryo. It follows that by the time an amniotic sac is detectable sonographically, an embryo of equal length should also be visualized. Retrospective review of case records at our institution revealed 15 patients in whom the amnion was visualized in the absence of an embryonic pole during first trimester sonography (endovaginal and transvesical). Indications for sonographic examination included gestational age estimation, discrepant size and dates, or vaginal bleeding. The mean sac diameter for the 15 gestations ranged from 14 to 36 mm, corresponding to gestational ages of 6.1 to 9.5 weeks. Ages based on the last menstrual period ranged from 6.1 to 11 weeks. A yolk sac was identified in all cases in addition to the amniotic sac, but neither an embryo nor cardiac pulsations were observed. In 12 of the 15 cases the size of the gestational sac was greater than 16 mm, such that the absence of an embryo also met an accepted criterion for a failed pregnancy. Follow-up in all cases confirmed early pregnancy failure. In this series the demonstration of an "empty amnion" (visualization of an amnion but no identifiable embryonic pole) was always associated with pregnancy loss. The "empty amnion" sign is helpful as an additional finding confirming early pregnancy failure.
Abortion, Spontaneous↗
Imaging the fetal abdomen: how efficacious are the AIUM/ACR guidelines?
This study was performed to evaluate the efficacy of the American Institute of Ultrasound in Medicine/American College of Radiology guidelines for the detection of fetal abdominal abnormalities. In Part 1 of the study, images from 100 fetuses with sonographically diagnosed abdominal anomalies were masked except for one view of the abdominal circumference, stomach, renal area, bladder, and cord insertion. Ninety-six cases were recognized as abnormal by two sonologists. In Part 2, sonograms of 70 normal fetuses and 30 abnormal fetuses were similarly masked and shown to a sonographer and a fourth year radiology resident. Each identified 29 of 30 abnormal cases. Among fetuses with abdominal anomalies detectable at a prenatal diagnostic center, the majority of abnormal fetuses could be identified by evaluation of the five AIUM/ACR recommended views.
Abdomen↗
Psychiatric disorders in relatives of probands with panic disorder and/or major depression.
BACKGROUND: Panic disorder and major depression (MDD) are both highly familial disorders that co-occur in individuals but do not cosegregate in families. Evidence concerning their familial aggregation with other psychiatric disorders, including phobias, substance abuse, and antisocial personality, has been contradictory. In part, the contradictory findings may be due to failure to account for the effects of proband comorbidity on risks in relatives. METHODS: A family study of 1047 adult first-degree relatives of 193 probands in four diagnostic groups (panic disorder without MDD, panic disorder plus MDD, early-onset MDD, and screened normal controls) was used to determine the range of psychiatric disorders associated with panic disorder and MDD and the effects of proband comorbidity on the rates of disorders in relatives. RESULTS: Compared to relatives of normal controls, relatives of probands with panic disorder or panic disorder and MDD showed significantly increased risks of panic disorder, but relatives of probands with early-onset MDD did not. After proband comorbidity was controlled for, relatives of probands with panic disorder were also at a significantly increased risk for social phobia but not for any other psychiatric disorders. Relatives of probands with early-onset MDD were at significantly increased risk for MDD, dysthymia, abuse of or dependence on alcohol and other drugs, and antisocial personality disorders but not for any other psychiatric disorders. CONCLUSIONS: We conclude that panic disorder is a specific familial entity that is not associated with a broad range of other anxiety or other psychiatric disorders, with the possible exception of social phobia. Dysthymia, substance abuse, and antisocial personality appear to be on the spectrum of early-onset MDD.
Adolescent↗
Phenomenology of panic disorder and major depression in a family study.
Family data were used to examine the phenomenology of MDD and panic disorder in relatives with respect to (a) proband diagnoses of PD and MDD, and (b) the occurrence of the disorders comorbidly vs. singly irrespective of family history. PD and MDD do not differ phenomenologically by proband diagnosis. However, PD comorbid with MDD shows more frequent panic attacks and more symptoms than PD without MDD. Endogenous and delusional subtypes and additional comorbidity are more frequent in relatives with MDD plus than in relatives with MDD without PD. The well documented clinical heterogeneities of PD and MDD are not clearly detectable in their phenomenology as a function of whether probands carried both diagnoses or only one. PD and MDD are more severe when they are in the comorbid form compared to when they occur singly.
Adolescent↗