Hydrops fetalis: sonographic evaluation and clinical implications

A systematic sonographic evaluation of hydropic fetus is presented, based on 21 cases and a literature review. The clinical implications of fetal ascites with or without anasarca, maternal hydramnios, maternal oligohydramnios, or an abnormally thick placenta are discussed as they relate to fetal outcome. It is concluded that sonography could play a major role in determining the optimal approach to perinatal management of the fetus in hydrops fetalis, and thus contribute to a reduction in the perinatal mortality and morbidity associated with this disorder.

Sonographic monitoring of ovarian follicular development

Serial sonographic examinations were performed on 15 volunteers five days during the expected midcycle. The 75 sonographic studies were evaluated in a nonbiased manner, and the following features were assessed: 1) the presence or absence of a follicle within the ovary; 2) if present, the average dimension of the follicle; 3) the ability to delineate both ovaries; and 4) the presence of associated changes, such as involution of the follicle, echogenic texture within the follicle, or fluid in the cul-de-sac. The sonographic findings were correlated with serial leutinizing hormone (LH) assays as well as basal body temperature charts. As defined in the study, the correlation between the sonographic findings and hormonal determination were considered excellent in 70% of the cases, good in 20%, and poor in 10%. Both ovaries were delineated in 73% of the examinations performed, thus substantiating the ability of sonography to detect maturing ovarian follicles.

The role of sonography and the radiologist-ultrasonologist in the detection and follow-up of intracranial hemorrhage in the preterm neonate

Intracranial hemorrhage (ICH), specifically hemorrhage in the subependymal germinal matrix, is a common disorder affecting preterm neonates. The authors discuss the relative virtues and limitations of portable, real-time ultrasonography (US) and computed tomography (CT) in detection and follow-up of sequelae of this disorder. The importance of cooperative effort on the part of the radiologist-ultrasonologist, neonatologist, pediatric neurologist, neurosurgeon and ultrasound technologist is emphasized.

Sonographic assessment of the bowel wall

The thickness and regularity of the bowel wall can often be assessed by sonographic imaging. In 26 normal patients, the bowel wall averaged 3 mm in thickness when distended and 5 mm when nondistended. In contrast, in 12 patients with an abnormally thickened bowel wall, bowel wall thickness averaged 23 mm and the affected bowel segment exhibited decreased or absent peristalsis on real-time scanning. The data derived from this study may enable the sonographic distinction of abnormally thickened bowel wall from normal bowel segments in the collapsed and distended state.

Sonographic characteristics of congenital uterine abnormalities and associated pregnancy

Faulty development of the mullerian duct system results in various uterine, vaginal, and renal abnormalities. Complete or partial absence of mullerian duct fusion and/or canalization results in septate, bicornuate, or double uterus; the specific anomaly depends upon the degree of fusion and canalization. Unilateral renal agenesis is frequently associated. Three cases of uterine anomalies associated with pregnancy are presented. When a pregnancy occurs in one side of a double uterus, the nonpregnant side may simulate a solid pelvic mass, such as a leiomyoma. In anomalies where there is a communication between two uterine cavities, the nonpregnant side may require the appearance of a cystic mass. Pregnancy associated with uterine anomalies carries significant morbidity.

Nuclear magnetic resonance and computed tomography: comparison of normal human body images

Normal human body images of the thorax and abdomen were obtained using nuclear magnetic resonance (NMR) and computed tomography. Correlation of the images allowed precise anatomic identification of organs and structures. Differences between the images appear to be significant. NMR has potential as a methodology for assessing and imaging nuclear composition. Certain clinical implications from this technique are discussed.

Diagnostic imaging in pediatric emergencies

Evaluation of pediatric emergencies by diagnostic imaging technics can involve both invasive and noninvasive procedures. Nuclear medicine, conventional radiography, ultrasound, computerized axial tomography, and xeroradiography are the major nonangiographic diagnostic technics available for patient evaluation. Appropriate decisions regarding choice of these imagining technics can be made only if the advantages and limitations of each are known. We will emphasize the use of computerized axial tomography, nuclear medicine, xeroradiography, and ultrsound in the evaluation of emergencies in the pediatric age group. Basic principles with specific reference to clinical disorders will be presented. Since the radiologist is the primary consultant with regard to diagnostic imaging, his knowledge of these modalities can greatly influence patient care and clinical results.

The ultrastructural basis of periventricular edema: preliminary studies

The pathophysiology of periventricular lucency (PVL) on CT in primates was evaluated by transmission (TEM) and scanning electron microscopy (SEM). At 100 days after Silastic-induced hydrocephalus, six primate brains showed loss of cilia and ependymal cells over the ventricular surface and abnormal small supraependymal cells. TEM demonstrated communicating pathways between the ventricular lumen and brain parenchyma and the extracellular space was markedly increased. At 1000 days, ependymal changes in two brains were noted at greater distances from the ventricular angle. This study suggests that CT periventricular lucency in patients with hydrocephalus is due to the increased extracellular space. The lack of recognition of PVL by computed tomography in chronic normal pressure hydrocephalus may be due to change in distribution and resolution limits.

Diagnosis of obstructive jaundice with nondilated bile ducts

Obstructive jaundice with nondilated bile ducts was identified by percutaneous transhepatic cholangiography (PTC) in nine of 29 jaundiced patients in whom the etiology of the jaundice was not clearly established by clinical or laboratory means and no dilated ducts were seen at somography or computed tomography (CT). PTC was helpful in these none patients by: (1) differentiating obstructive from nonobstructive jaundice, (2) localizing the site and etiology of the obstructing lesion, and (3) determining operability.

Sonographic patterns of distended, fluid-filled bowel

When small or large bowel is distended with fluid, certain characteristic features can be seen on ultrasound which cannot be visualized when the bowel is collapsed. The proximal and distal portions of the small bowel can frequently be differentiated both in vitro and in vivo by the echoes emanating from the valvulae conniventes ("keyboard sign"). This depends upon the angle at which the bowel segment is scanned in relation to its long axis, the relative amount of intraluminal fluid and gas, the diameter of the bowel in relation to the beam width of the transducer, and the intrinsic resolution of the scanning system. Similarly, the ascending and transverse colon can be recognized by haustral sacculations, the distal rectosigmoid colon and rectum by the rectal valves. The tubular shape, characteristic arrangement and location, and peristaltic motion of most fluid-filled bowel segments are helpful in differentiating loops of bowel from cystic masses in the abdomen or pelvis.

The radiologist and informed consent: a review, comments and proposals

In summary, the physician's duty to inform has been described and discussed. The minority and majority rule have also been defined and analyzed along with the major causes of physician failure and resistance to disclose risks. In a proper physician-patient relationship, informed consent controversy should be rare. A calm, clear, direct and properly documented disclosure of risks of a procedure is the best defense in any jurisdiction.

Cellular attachment as a sensitive indicator of the effects of diagnostic ultrasound exposure on cultured human cells

Dispersed cultured human cells (T-1 kidney, FL embryonic kidney, ES amniotic, and JHA amniotic) were seeded into plastic Petri dishes, incubated for 45 minutes, exposed to a clinical ultrasound source [total power output, 1.76 +/- 0.18 (S.D.) mW] for 0.25-60 minutes, and the medium replaced. Attachment was significantly reduced after only 0.50 minute of exposure. For all exposures, sensitivity of the JHA amniotic cells was greater than that of the kidney lines. Like incremental reduction in attachment, differential sensitivity among cell lines became less pronounced with protracted exposures. Thus cellular attachment is a sensitive parameter for studying the effects of diagnostic ultrasound.

Antitrust law and the practice of radiology

Physicians now find it relevant to acquaint themselves with aspects of the law which heretofore were mainly of concern to the business world. One such area is antitrust, which is beginning to affect the practice of radiology. Three phases of the problem are discussed: exclusive privileges contracts; boycotts of nonphysician consultations (i.e., with chiropractors and cultists); and certificate of need requirements for acquisition of highly technical, sophisticated and expensive equipment.

Relation of age and cerebral ventricle size to central canal in man. Morphological analysis

The central canal of the spinal cord in man with and without hydrocephalus was studied histologically. The lumen was patent in most patients in the first two decades of life. Cells lining the canal in the prenatal and newborn state and in the first decade of life were predominantly pseudostratified ciliated epithelium. In the second decade, the epithelium became simple columnar or cuboidal. The central canal closed in most cases after the age of 20 years, secondary to proliferation of ependymal cells and astrocytes. Mechanisms whereby the number of glial cells increase are considered. The canal was closed in all adults with normal ventricular size, and in 94% of persons with various degrees of hydrocephalus. In the remaining 6% of cases with hydrocephalus, the lining of the canal resembled that seen in the first two decades, and could have acted as a pathway of cerebrospinal fluid (CSF) absorption. Three cases of severe hydrocephalus in the first two decades of life were encountered; the central canal was patent in one, and occluded in two. Based on these data, the canal was not a significant pathway of CSF absorption in most instances of hydrocephalus and in persons with dilated ventricles who were older than 20 years of age.