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Biomedical subjects

R H Gold

Publications and source records attributed to R H Gold.

At least 91 records · Page 5Linked to original sources
PubMed1986

Sonography of adrenal glands in neonates and children: changes in appearance with age.

The sonographic appearance of the normal adrenal gland in children varies with age. In newborns, the cortex is large and hypoechoic, whereas the medulla is relatively small and hyperechoic. With increasing age, the cortex becomes smaller and the medulla relatively larger. The cortex remains hypoechoic and the medulla hyperechoic until age 5-6 months, by which time the gland has become hyperechoic and smaller, with poor or absent sonographic differentiation between cortex and medulla. After 1 year of age, the appearance of the gland is similar to that of the adult gland, with straight or concave borders and a hypoechoic character.

Adolescent↗
PubMed1986

Radionuclide evaluation of skeletal metastases: practical considerations.

The indications for radionuclide bone scanning to evaluate possible metastatic disease are reviewed. The causes of false-positive and false-negative interpretations are discussed and illustrated. Since breast cancer leads all malignant tumors in incidence of skeletal metastases found at autopsy, the efficacy of preoperative bone scans in patients with breast cancer is analyzed in detail. A routine preoperative bone scan for patients with Stage I breast cancer produces negligible immediate benefits, but may serve a useful purpose as a baseline to enhance the detection of subtle changes that could represent metastases in a subsequent scan. However, the clinical usefulness of this screening procedure for Stage I disease must be balanced with its cost. Clinical Stage II is a grey area and may include patients with large primary tumors and axillary nodal involvement, implying a greater chance for the occurrence of skeletal metastases and hence a significant yield in bone scans. Patients with clinical Stages III or IV disease have the greatest chance of harboring metastases and should have an extensive diagnostic evaluation including bone scans prior to definitive treatment. Selected radiographs of sites of abnormally increased radionuclide activity and an anteroposterior radiograph of the pelvis should be correlated with the scan to permit a single comprehensive diagnostic impression.

Bone Neoplasms↗
PubMed1986

Meniscal injuries: detection using MR imaging.

Both retrospective and blinded analyses of thin-section, high-resolution magnetic resonance (MR) images of the knee joint, produced using a solenoid surface coil, indicate that MR imaging is an effective technique for evaluating meniscal injuries. Images of 49 patients were evaluated, and the results were correlated with those of subsequent arthroscopy. A grading scale was developed to rate the index of suspicion of a meniscal tear based on the MR images. Overall, approximately 80% of menisci rated grade 4 (definite tear) or 3 (probable tear) were found to have corresponding tears at arthroscopy. In many other patients with a grade 4 or 3 meniscus in whom a corresponding tear was not found arthroscopically, meniscal tears at other sites or other abnormalities were correctly diagnosed using MR. A majority of the false-positive MR images involved the posterior horns of the menisci, the sites of most false-negative arthroscopic diagnoses. The predictive value of a negative MR image was almost 100%. Even in patients with moderate-to-large effusions, the menisci were accurately evaluated. The results imply that MR imaging is useful in the preoperative evaluation of suspected meniscal tears.

Adolescent↗
PubMed1986

Screening mammography: referral practices of Los Angeles physicians.

The American Cancer Society (ACS) recommends annual screening mammography for asymptomatic women over 50 years old. In a survey of attitudes and referral practices toward screening mammography, one-fifth (886) of the 4200 physicians queried returned a postage-paid questionnaire. Only 11% of respondents followed the ACS guidelines. Physicians under 40 years old, in group practice, or in surgical specialties were more apt to refer their patients for screening. The major deterrent to referral was the perceived high cost and low yield of screening. However, 80% of the physicians indicated they would refer patients over 50 who requested annual screening. Annual mammography screening is underused; greater efforts must be directed toward educating physicians and patients regarding its value and toward lowering its cost.

California↗
PubMed1986

MR imaging of the lumbar spine: anatomic correlations and the effects of technical variations.

A correlative anatomic study, a retrospective review of MR images performed in 35 patients, and a series of tests of the effectiveness of various MR scanning techniques were performed in order to improve comprehension of lumbar spine anatomy depicted on MR images, and thereby facilitate development of an optimal scanning protocol. Correlation of MR images with cryomicrotomed cadaver specimens enhanced understanding of the MR depiction of the intervertebral disks, ligamentum flavum, nerve roots, epidural fat, and epidural veins. Experiments were performed to assess the efficacy of a surface coil applied to the back, a solenoidal surface coil, a standard body coil, and an abdominal compression device in optimizing image quality. Experiments were also performed to determine the effect of alterations in the pulse sequence and variations of the phase-encoding axis. Based on these results, a protocol is proposed for routine imaging of the lumbar spine that yields high-resolution sagittal and oblique images and that does not require a surface coil. The recommended protocol employs heavily T1-weighted images with phase encoding along the z axis for sagittal images and along the x axis for axial images. This protocol yields multiple sagittal and oblique axial images through each of the lumbar disks, a larger field of view than obtained with surface coils, and a reduction of total imaging time to as little as 10 min.

Cadaver↗
PubMed1986

Breast imaging. State-of-the-art.

The underlying goal of all breast imaging procedures is the detection of cancer. X-ray mammography places greatest emphasis on the disclosure of early, nonpalpable, curable cancer. Diagnostic ultrasonography stresses the differentiation of benign cysts from diagnostically indeterminate solid masses that require biopsy. Evolving experimental procedures such as transillumination light-scanning and magnetic resonance imaging currently are undergoing preliminary evaluation. An older procedure, thermography, seems to operate at a high level of effectiveness only for advanced cancer. Since x-ray mammography is the technique that has proven most successful in detecting early breast cancer, it is the standard to which all imaging alternatives must be compared.

Adult↗
PubMed1985

Rheumatoid bursitis extending into the clavicle and to the skin surface.

A woman with rheumatoid arthritis developed persistent sterile drainage from a cutaneous fistula after biopsy of an inflamed supraclavicular mass. Radiographs showed several cavities in the underlying clavicle. Inability to culture a pathogen and failure of the fistula to heal despite empirical courses of antibiotic therapy led to surgical intervention. The final diagnosis, based on careful histological analysis by special staining techniques, was rheumatoid bursitis extending into the clavicle and to the skin surface.

Adult↗
PubMed1985

Urinary tract infection in infants and children evaluated by ultrasound.

Fifty-nine pediatric patients with urinary tract infection (UTI) underwent renal ultrasonography, excretory urography, and voiding cystourethrography. The imaging procedures were analyzed retrospectively to determine their relative effectiveness in detecting abnormalities that might predispose the patient to UTI. Voiding cystourethrography provided valuable information, particularly the presence or absence of vesicoureteral reflux, that could not be obtained from the other procedures. Excretory urography was less specific than ultrasonography in the majority of patients, with the exception of those who had renal scarring. The authors recommended ultrasonography as the initial imaging procedure in the evaluation of children with UTI. When the sonogram is normal, excretory urography is not considered necessary, but voiding cystourethrography is thought to be essential. If sonography is abnormal, excretory urography and/or other follow-up studies are indicated.

Adolescent↗
PubMed1985

High-resolution magnetic resonance imaging of the knee joint: normal anatomy.

Excellent morphologic detail was depicted in thin-section, high-resolution magnetic resonance (MR) images obtained with the use of a solenoid surface coil specifically designed for the knee joint. The multiplanar anatomy of the knee was determined by correlating MR images of six fresh cadavers and 10 normal adult knees with corresponding photographs of cryoplaned specimens and by a cross-referencing multiplanar imaging technique.

Adult↗
PubMed1985

High-resolution magnetic resonance imaging of the knee joint: pathologic correlations.

Highly detailed pathologic morphology of 25 knees with suspected structural abnormalities was depicted in thin-section, high-resolution magnetic resonance images (MRI) produced with the aid of a specially designed solenoid surface coil. Scans were obtained on a 0.3-T permanent magnet system with 4-mm-thick slices and 0.75-mm pixel size. The images were correlated with clinical, arthrographic and/or bone scan, and surgical findings. In 10 of 11 cases of clinically suspected meniscal tears, the MRI findings corresponded with those of arthroscopy. In the three cases of clinically suspected injury to the anterior cruciate ligament which underwent surgery, the MRI findings of tears in two cases and a normal ligament in one case were confirmed. MRI was also useful in the evaluation of possible injury to the patellar tendon, in the detection of intraarticular loose bodies, and in the diagnosis of osteonecrosis.

Adult↗
PubMed1984

High-resolution spinal sonography in infants.

High-resolution, real-time sonography of the spine revealed significant anatomic details in 29 infants, including nine with congenital malformations. Transverse sections were most useful for detecting osteochondral anomalies and for evaluating the symmetry of the spinal column and its soft-tissue contents. Longitudinal sections augmented the transverse sections and provided the most detailed anatomy of the cord and spinal arteries. A normal screening sonographic examination obviates ionizing radiation and invasive procedures, while an abnormal study implies the need for further, complementary diagnostic investigations.

Humans↗