Biomedical subjects

Z L Barbaric

Publications and source records attributed to Z L Barbaric.

At least 19 recordsLinked to original sources

PubMed2001

Magnetic resonance imaging of the perineum and pelvic floor.

The aim of this article is to review the magnetic resonance (MR) findings of pelvic floor descent and pelvic organ prolapse in women. In addition, a detailed grading system of pelvic organ prolapse and pelvic floor relaxation based on dynamic MR imaging is presented. The technique described here uses very fast MR sequences, is reproducible and easily learned by radiologists and technologists, is well accepted by patients, and provides as much information as traditional projectional X-ray imaging. Reference points are the pubococcygeal line and puborectalis muscle sling. The grading system is based on degree of organ prolapse through the hiatus and the degree of puborectalis descent and hiatal enlargement.

Female↗

PubMed2000

Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis.

PURPOSE: We assessed the merit of dynamic half Fourier acquisition, single shot turbo spin-echo sequence T2-weighted magnetic resonance imaging (MRI) for evaluating pelvic organ prolapse and all other female pelvic pathology by prospectively correlating clinical with imaging findings. MATERIALS AND METHODS: From September 1997 to April 1998, 100 consecutive women 23 to 88 years old with (65) and without (35) pelvic organ prolapse underwent half Fourier acquisition, single shot turbo spin-echo sequence dynamic pelvic T2-weighted MRI at our institution using a 1.5 Tesla magnet with phased array coils. Mid sagittal and parasagittal views with the patient supine, relaxed and straining were obtained using no pre-examination preparation or instrumentation. We evaluated the anterior vaginal wall, bladder, urethra, posterior vaginal wall, rectum, pelvic floor musculature, perineum, uterus, vaginal cuff, ovaries, ureters and intraperitoneal organs for all pathological conditions, including pelvic prolapse. Patients underwent a prospective physical examination performed by a female urologist, and an experienced radiologist blinded to pre-imaging clinical findings interpreted all studies. Physical examination, MRI and intraoperative findings were statistically correlated. RESULTS: Total image acquisition time was 2.5 minutes, room time 10 minutes and cost American $540. Half Fourier acquisition, single shot turbo spin-echo T2-weighted MRI revealed pathological entities other than pelvic prolapse in 55 cases, including uterine fibroids in 11, ovarian cysts in 9, bilateral ureteronephrosis in 3, nabothian cyst in 7, Bartholin's gland cyst in 4, urethral diverticulum in 3, polytetrafluoroethylene graft abscess in 3, bladder diverticulum in 2, sacral spinal abnormalities in 2, bladder tumor in 1, sigmoid diverticulosis in 1 and other in 9. Intraoperative findings were considered the gold standard against which physical examination and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 100%, 83% and 97% for cystocele; 100%, 75% and 94% for urethrocele; 100%, 54% and 33% for vaginal vault prolapse; 83%, 100% and 100% for uterine prolapse; 87%, 80% and 91% for enterocele; and 76%, 50% and 96% for rectocele. CONCLUSIONS: Dynamic half Fourier acquisition, single shot turbo spin-echo MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for rectocele, pelvic floor prolapse is accurately staged and pelvic organ pathology reliably detected. The technique is rapid, noninvasive and cost-effective, and it allows the clinician to visualize the whole pelvis using a single dynamic study that provides superb anatomical detail.

Adult↗

PubMed1999

Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging.

OBJECTIVES: With significant vaginal prolapse, it is often difficult to differentiate among cystocele, enterocele, and high rectocele by physical examination alone. Our group has previously demonstrated the utility of magnetic resonance imaging (MRI) for evaluating pelvic prolapse. We describe a simple objective grading system for quantifying pelvic floor relaxation and prolapse. METHODS: One hundred sixty-four consecutive women presenting with pelvic pain (n = 39) or organ prolapse (n = 125) underwent dynamic MRI. The "H-line" (levator hiatus) measures the distance from the pubis to the posterior anal canal. The "M-line" (muscular pelvic floor relaxation) measures the descent of the levator plate from the pubococcygeal line. The "O" classification (organ prolapse) characterizes the degree of visceral prolapse beyond the H-line. RESULTS: The image acquisition time was 2.5 minutes per study. Each study cost $540. In the pain group, the H-line averaged 5.2 +/- 1.1 cm versus 7.5 +/- 1.5 cm in the prolapse group (P <0.001). The M-line averaged 1.9 +/- 1.2 cm in the pain group versus 4.1 +/- 1.5 cm in the prolapse group (P <0.001). Incidental pelvic pathologic features were commonly noted, including uterine fibroids, ovarian cysts, hydroureter, urethral diverticula, and foreign body. CONCLUSIONS: The HMO classification provides a straightforward and reproducible method for staging and quantifying pelvic floor relaxation and visceral prolapse. Dynamic MRI requires no patient preparation and is ideal for the objective evaluation and follow-up of patients with pelvic prolapse and pelvic floor relaxation. MRI obviates the need for cystourethrography, pelvic ultrasound, or intravenous urography and has become the study of choice at our institution for evaluating the female pelvis.

Female↗

PubMed1997

Percutaneous nephrostomy: placement under CT and fluoroscopy guidance.

OBJECTIVE: The purpose of this paper is to present our experience with CT- and fluoroscopy-guided percutaneous nephrostomy tube (PNT) placement and to describe the technique of placement with patients in the supine-oblique position. MATERIALS AND METHODS: A CT scanner was coupled with a ceiling-mounted C-arm for fluoroscopy at the CT table, PNT was done with CT localization and fluoroscopic control. We attempted 148 placements in 129 patients, with most patients in the supine or the supine-oblique position. RESULTS: Successful PNT placement was achieved in 144 (97%) of 148 kidneys. In the native kidney group, 101 (81%) of 124 PNTs were placed with the patients in the supine-oblique position. We experienced no major complications, three (2%) minor complications, and two (1%) catheter dislodgments. CONCLUSION: CT-fluoroscopy control allows routine PNT placement with patients in the supine or the supine-oblique position and is associated with the lowest complication rate to our knowledge.

Adolescent↗

PubMed1996

Imaging work-up: is it renal carcinoma and is it operable?

In detection and work-up of a renal carcinoma, imaging plays the most critical role. Differentiation of renal cell carcinoma from angiomyolipoma and complex cysts is highly accurate, but differentiation from benign oncocytoma is not. The most important discoveries regarding local staging are presence of venous tumor thrombus and its cephalad extension, followed by regional lymph node metastases. Biopsy of a renal mass is indicated when a concomitant primary malignancy is present elsewhere, but only if treatment will be influenced by findings. Preoperative embolization is reserved for the most difficult cases, and palliative embolization is useful in selected cases. Helical computed tomography is the most sensitive method for detecting small lung metastases.

Carcinoma, Renal Cell↗

PubMed1993

Fluoroscopically guided incision of ureteral strictures in pigs with the cautery-wire balloon catheter: a phase 1 study.

We investigated a catheter that can longitudinally incise ureteral strictures under fluoroscopic guidance without the need for ureteroscopy and its attendant risks. The catheter consists of a low-pressure balloon and an overlying cautery wire; the balloon allows precise localization of the stricture, seen as a waist in the balloon, and the overlying cautery wire can be fluoroscopically oriented at the stricture. One to two centimeter ureteral strictures were created in 6 swine. Two to four weeks later strictures were incised in a retrograde or antegrade fashion with the cautery-wire balloon catheter, and double J stents placed for a duration of three weeks. In 5 of 6 renal units strictures improved anatomically with resolution of hydronephrosis at 3 to 4 months' follow-up. Urodynamic absence of obstruction was verified by Whitaker testing. In one animal, the tip of the catheter dislodged in the ureter with subsequent loss of the renal unit. The engineering error that lead to this complication has since been rectified. With correction of the aforementioned problem, this Phase 1 study has demonstrated the feasibility, safety and preliminary efficacy of the cautery-wire balloon catheter for endourologic management of ureteral strictures.

Animals↗

PubMed1991

Percutaneous nephrostomy tube placement: an outpatient procedure?

The authors report their experience with 56 percutaneous nephrostomies (PCNs) performed on an outpatient basis on 55 patients. Complications included pain that required use of parenteral medication in four patients, bleeding in three that resolved spontaneously, and shaking chills or fever in 12. This last complication, considered to be a sign of sepsis and treated with antibiotics, occurred more frequently than the 1.4%-4.5% infectious complication rate reported in the literature. Antibiotic use during and after PCN significantly decreased the likelihood of sepsis. In the high-risk group, antibiotic administration during and after PCN decreased the risk of developing signs of sepsis from 50% to 9%. On the basis of the authors' results and the findings in the literature about antibiotic prophylaxis, guidelines are recommended to improve the safety of PCN as an outpatient procedure. In the majority of instances PCN should still be considered to be more safely performed as an inpatient procedure at this time.

Adult↗

PubMed1989

MR imaging: vascular anatomy of the abdomen.

In support of the thesis that MRI may replace more invasive angiography in some applications, a total of 28 MR sections are presented to illustrate the vascular anatomy of the abdomen in coronal, transverse and sagittal planes. More than 20 vessels are identified ranging in size from the aorta to the left inferior adrenal vein and the spermatic veins. There is no anatomic continuity in sections made in the coronal and transverse planes; sequential sections of a single patient are presented in sagittal and parasagittal planes, however. The polarity of the images is reversed for ease of comparison with angiograms.

Abdomen↗

PubMed1988

Percutaneous nephrostomy in conjunction with ESWL in treatment of nephrolithiasis.

The use of percutaneous nephrostomies (PCNs) in 1456 patients (1660 kidneys) treated with extracorporeal shock-wave lithotripsy (ESWL) was evaluated. In this group, 138 PCNs (130 patients) were performed in 133 kidneys. Forty-seven percent of PCNs were placed in patients with staghorn calculi; 24% were for stones in the renal pelvis, and 20% for ureteral stones. The most common indication for PCN was fever and obstruction (57%). In 15%, the indications were failure to decompress an obstructed system from a retrograde direction, clogged double-J ureteral stents, and perforation of the ureter. Prophylactic PCN placement in the treatment of staghorn calculi and large stones in the renal pelvis accounted for 12%. Five percent were placed for miscellaneous other reasons, and for 11% there was no documentation of the indication because they were placed before the patients came to our center. Localization of the collecting system for optimal placement of PCN is unique in ESWL patients because the residual stone fragments provide natural contrast. This eliminates the need for administration of contrast material in 50% of the patients. Twenty-six percent of PCN tracts were subsequently used for other procedures (e.g., percutaneous nephrolithotomy, fragment irrigation, ureteral stone manipulation). Bleeding complications from PCN occurred in 7%. Other minor complications occurred in 12% of cases. PCN is a useful adjuvant to ESWL treatment of kidney stones. Although its major use is to relieve urinary tract obstruction, it is also used as a preliminary step in planning other percutaneous interventional procedures. This is particularly the case in the treatment of large bulky stones in the renal pelvis and staghorn calculi.

Adolescent↗

PubMed1988

Evaluation of lopamidol and diatrizoate in excretory urography: a double-blind clinical study.

Image opacification, patients' tolerance, and clinical and laboratory findings were evaluated in patients having excretory urography at three centers. In a double-blind, parallel study, iopamidol was compared with diatrizoate (50-ml dose), and in an open-label trial, the administration of a 100-ml dose of iopamidol was evaluated. In the double-blind study, a total of 84 patients received 50 ml of either iopamidol or diatrizoate. In the open-label study, another 42 patients received a 100-ml dose of iopamidol. Image opacification scores after the administration of the 50-ml doses showed better opacification with iopamidol than with diatrizoate in the renal calices (p less than .05) and in the composite kidney (p less than .05). Opacification scores were higher for 100-ml doses of iopamidol than for 50-ml doses in all anatomic regions as well as in the composite kidney (p = .0001). Patients' tolerance to iopamidol was significantly better than their tolerance to diatrizoate (p less than .025). Investigators observed adverse drug reactions in a total of 10 patients. In the double-blind study, one of 43 patients had transient bradycardia after the administration of iopamidol. In the same study, four of 41 patients who received diatrizoate had five minor adverse drug reactions. With 100-ml doses of iopamidol, five of 42 patients had adverse reactions. No adverse side effects required therapy in either study. There were no significant changes in vital signs or laboratory values after drug administration. The results of this study show that iopamidol is a suitable agent for excretory urography at doses of 50 and 100 ml. Patients report fewer unpleasant side effects with iopamidol than with diatrizoate. Overall image quality was better with iopamidol than with diatrizoate. Overall evaluation of drug performance was better with iopamidol than with diatrizoate.

Adolescent↗

PubMed1987

Extracorporeal shock wave lithotripsy: impact on the radiology department of a stone treatment center.

Extracorporeal shock wave lithotripsy (ESWL) was performed on 925 patients (1,222 treatments) for 446 calyceal, 345 pelvic, 172 ureteral, and 108 staghorn calculi. ESWL necessitated 6.3 KUB and 1.2 renal ultrasound studies per treatment session. Intravenous urography was required in 6% of patients after ESWL. Percutaneous nephrostomy tube placement was performed by the radiologists in 10% of patients. Procedures related to nephrostomy tube placement included percutaneous nephrolithotripsy, tube changes, nephrostography, and stone fragment irrigations and retrievals. Staghorn calculi treatment with ESWL required the most procedures by radiologists (34% for partial staghorn and 56% for complete staghorn) compared with 3%, 8%, and 11% for calyceal, pelvic, and ureteral stones, respectively. In all, 8,478 radiologic examinations and procedures were performed pertaining to ESWL. This is approximately 35 studies per day. While this number may be high because it represents the early experience of the authors with ESWL, the impact on the radiology department can be substantial.

Adolescent↗

PubMed1986

Nephrocolic fistula: a complication of percutaneous nephrostolithotomy.

Percutaneous nephrostolithotomy has proved to be a safe and effective approach to the management of upper tract calculi, which is associated with a low rate of significant complications. Bowel perforation is an unusual complication of this technique. We report a case of a nephrocolic fistula following percutaneous nephrostolithotomy, and discuss the diagnosis and management of this rare complication.

Adult↗

PubMed1984

Interventional radiologic procedures in the renal transplant.

Percutaneous interventional procedures can be valuable in the evaluation and treatment of urologic complications of renal transplantation. Thirty-three patients underwent percutaneous procedures, including relief of obstruction by catheter nephrostomy, diagnostic antegrade pyelography with Whitaker testing, aspiration of various fluid collections (lymphocele, hematoma, urinoma, and abscess), and renal artery angioplasty, during a three year period at three institutions, to provide temporizing treatment and anatomic data. Surgical intervention was sometimes avoided, but more often it could be deferred to allow the patient to stabilize prior to surgery. Complications that required surgery occurred in two patients.

Adolescent↗

PubMed1984

Digital subtraction angiography with an Isocon camera system: clinical applications.

A new imaging system for digital subtraction angiography (DSA) was evaluated in 30 clinical studies. The image receptor is a 25 X 25 cm, 12 par gadolinium oxysulfate rare-earth screen whose light output is focused to a low-light-level Isocon camera. The video signal is digitized and processed by an image-array processor containing 31 512 X 512 memories 8 bits deep. In most patients, intraarterial DSA studies were done in conjunction with conventional arteriography. In these arterial studies, images adequate to make a specific diagnosis were obtained using half the radiation dose and half the amount of contrast material needed for conventional angiography. In eight intravenous studies performed either to identify renal artery stenosis or for evaluation of congenital heart anomalies, the images were diagnostic but objectionably noisy.

Angiography↗

PubMed1984

Percutaneous nephrostomy for urinary tract obstruction.

Percutaneous nephrostomy is a very valuable radiologic procedure for providing temporary or permanent urinary diversion of an obstructed upper urinary tract. While changes in catheter and guide wire technology have allowed for marked enhancement of the indications for percutaneous nephrostomy, the classic indications remain, such as decompression in patients with urosepsis and azotemia, especially with concomitant medical problems that require time to bring under control.

Humans↗

PubMed1983

Urachal abnormalities in the adult.

A spectrum of rare urachal abnormalities in the adult is described, including urachal cyst, infected urachal cyst and abscess, and urachal carcinoma. The clinical and radiographic features are presented, and diagnosis using ultrasound, computed tomography, and needle aspiration is discussed. Treatment of infected urachal cysts with percutaneous catheter drainage is described.

Abscess↗

PubMed1983

Digital subtraction angiography in the evaluation of hypertension.

Thirty-five patients with high blood pressure underwent digital intravenous subtraction angiography (DSA) for evaluation of renovascular disease. Eight had recurrent hypertension after renal transplantation, and four after aortorenal bypass. Twenty-three had DSA as part of a hypertensive screening workup for renovascular disease. Diagnostic studies were obtained in 33 patients. Twelve patients had confirmatory arteriograms and agreement occurred in 10. DSA detected significant pathology in nine of the post-renal-surgery patients. DSA followed by a minimal number of overhead abdominal films to evaluate the renal parenchyma, ureters, and bladder was found to be a preferable alternative to the conventional rapid-sequence excretory urogram as a screening test for patients with suspected renovascular disease.

Adolescent↗

PubMed1982

Thermo-magnetic surgery for experimental renal cancer.

Thermo-magnetic surgery is an innovative modality in the treatment of malignancies. This unique combination can produce selectively controlled destruction of deep tumors. Heating of the magnetic metallic compounds of ferrosilicone by hysteresis produces temperatures which are incompatible with cancer cell survival. The intense focal heating causes a coagulation necrosis. Damage to surrounding normal tissue can be avoided by careful temperature monitoring and power control of the magnetic field. Cell destruction in the target tissue has been demonstrated by light and electron microscopy. Reproducible and predictable VX2 renal carcinomas in rabbits have been produced and used as the tumor model in the initial experiments of this research project. A clinical trial with selected cancer patients, performed with this technique of thermo-magnetic surgery, is now a reasonable and feasible procedure.

Animals↗