Harris J. Finberg

Arthrosonography--technique, sonographic anatomy, and pathology.

Ultrasound scanning of the hips, shoulders, and elbows was investigated as a noninvasive technique for the diagnosis of joint disorders. Sixteen patients with known intra-articular fluid collections, loose bodies, or periarticular abnormalities were studied. Ultrasound images clearly demonstrated the contours of bony surfaces, normal muscles, and other soft-tissue structures around joints. Intra-articular fluid collections were seen as sonolucent halos around the femoral neck and humeral head and as an oval, sonolucent area anterior to the distal humerus. Collections of fluid as small as 10 ml in the hip and 16 ml in the shoulder were visualized. Intra-articular loose bodies and para-articular fluid collections were also demonstrated. It is concluded that gray-scale ultrasound can demonstrate some of the basic pathologic processes in joint disorders. Further evaluation of its scope and applicability is indicated.

Ultrasound evaluation of the gallbladder wall.

In a series of 526 consecutive, unprepared patients examined by ultrasound, the gallbladder was visualized in 507 (96%). The average wall thickness was 2 mm or less in 97% of asymptomatic subjects without cholelithiasis and 3 mm or greater in 45% of those with choletithiasis. Pathologic correlation of increased thickness and chronic cholecystitis was made in a subgroup of 47 surgical patients. Local tenderness and mucosal thickening were found in 8 patients with acute cholecystitis. Use of electronic sector scanning is emphasized.

Use of the Foley Cordostat grasping device for selective ligation of the umbilical cord of an acardiac twin: A case report

Abstract We report a case of successful treatment of an acardiac twin gestation by selective ligation of the perfused twins umbilical cord, with an intrauterine cord grasping device, the Foley Cordostat, used for assistance.

Arthrosonography: Gray-Scale Ultrasound Evaluation of the Shoulder

Gray-scale ultrasound images of the shoulders of 6 rhesus monkeys were obtained before and after fluid instillation to assess the ability of ultrasound to diagnose joint disorders. The normal bony landmarks and muscular structures were shown. After the fluid was introduced, fluid collections were identified in the axillary pouch and subscapular bursa. Ultrasound is a promising new method of detecting intra-articular effusions of the shoulder.

Evaluation of Hepatobiliary Imaging by Radionuclide Scintigraphy, Ultrasonography, and Contrast Cholangiography

Cholescintigraphy, ultrasonography, and contrast cholangiography were compared in 60 patients. Among those having abdominal pain but no biliary disease or jaundice, cholescintigraphy was normal in 14/14, ultrasound in 10/13, and cholangiography in 13/14. Jaundice due to hepatocellular disease was correctly distinguished from complete biliary obstruction by cholescintigraphy in 17/17 patients and by ultrasound in 14/17. In cholelithiasis, ultrasound was abnormal in 10/12 and cholangiography in 7/9. Cholescintigraphy appeared most sensitive to active cholecystitis; only cholangiography and ultrasound visualized gallstones.

Intrauterine transfusion with the use of phased array ultrasonography: a new technique.

Continuous ultrasonic observation of needle placement for aspiration, biopsy, or catheter placement is a novel and specific use of phased array imaging. In the case of IUTx, catheter placement into the fetal peritoneal space is accomplished rapidly, with reduced risk of fetal trauma, and without exposure to ionizing radiation. Experience with 27 transfusions in 11 patients is presented.

Computed tomography of malignant pleural mesothelioma.

We tabulated the computed tomographic (CT) findings in 14 consecutive patients who had proven malignant pleural mesotheliomas and were studied over a 3-year period. We also staged the disease in these patients, all of whom were men, aged 40-75 years (mean, 59), and had been exposed to asbestos at work. Common presenting symptoms were shortness of breath or chest pain. Pleural thickening was found on the side of the tumor in all of the patients, characterized as nodular and circumferential (6/14 cases), plaque-like (4/14), or strictly nodular (4/14) in appearance. In addition, 86% of the patients demonstrated contralateral pleural thickening, but these lesions did not prove to be tumor deposits. Other common CT findings in the involved hemithorax included: pleural effusions (79% of cases), lung parenchymal disease (79%), decreased hemithorax size (62%), and pleural calcification (50%). Before the chest scans were performed, 13 patients were felt to have Stage I disease and one to have Stage IV. The CT information revised these opinions: four of the Stage I patients were assigned to Stage II (on the basis of chest wall involvement or enlarged hilar/mediastinal lymph nodes). Therapy was altered in these four cases. In two patients pericardial thickening was seen, but it was not possible to determine if this was due to tumor involvement. We conclude that CT can identify several abnormalities that are commonly associated with mesotheliomas. By demonstrating lesions not detectable on conventional imaging studies, CT may alter staging and therapy in many patients with this disease.

Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations

OBJECTIVE The purpose of this investigation was to determine the value of biophysical profile testing in preventing intrapartum death in patients with high-order multiple gestations (triplets or quadruplets). STUDY DESIGN A retrospective review was performed of patients with triplets and quadruplets cared for by Phoenix Perinatal Associates from October 1988 to December 1991. Biophysical profile testing was used as the primary method of fetal surveillance in these pregnancies. Fetal heart rate monitoring on an external monitor was used as back-up and in cases sent to labor and delivery for problems. The ultrasonographic parameters of the biophysical profile score were used without the nonstress test component because of technical difficulty with that test in high-order multiple pregnancies. A score of 6 to 8/8 was therefore considered reassuring, 4/8 equivocal, and 0 or 2/8 possibly abnormal. Testing was done twice per week. RESULTS Eighteen patients with triplets and six patients with quadruplets constituted the study group. The last biophysical profile before delivery was examined to evaluate the value of the test. There were no antepartum deaths in these 78 babies. The last biophysical profile score was 2/8 in nine fetuses of five triplet pregnancies and two fetuses of one quadruplet pregnancy. These six pregnancies (25%) were delivered on the basis of biophysical profile results and clinical circumstances. There was no morbidity or mortality in the 19 babies delivered because of abnormal biophysical profile testing. Four pregnancies had poor outcome at delivery in spite of 8/8 biophysical profile scores on all babies within 4 days of delivery. Of these four, two patients had worsening pregnancy-induced hypertension, one had abruptio placentae, and one had a severely growth-retarded infant. CONCLUSION There were no stillbirths in this series. Twenty-five percent of these pregnancies eventually were delivered for nonreassuring biophysical profile testing, with good outcome. Four pregnancies had poor neonatal outcome in spite of normal biophysical profile testing. All of these pregnancies had active changes in physiologic features leading to delivery (two worsening pregnancy-induced hypertension, one abruptio placentae, one spontaneous rupture of membranes and labor). The biophysical profile appears to be a reliable antepartum test of fetal well-being in triplets and quadruplets.

CT Detection of Intraabdominal Disease in Patients with Lower Extremity Signs and Symptoms

The initial clinical presentation of intraabdominal disease can be in an extraabdominal location. This phenomenon most commonly occurs in the setting of bowel perforation secondary to diverticulitis, appendicitis, or carcinoma, with resultant spread of infection caudal to the abdomen. Hematomas and pancreatic fluid collections may also dissect out of the abdomen. The spread of these disease processes is likely to occur in a predictable fashion along anatomic tissue planes. Computed tomography (CT) is well suited to demonstrate the extraabdominal site of disease, the pathway of spread from the abdomen, and the occult intraabdominal process. We describe four such cases in which CT was useful and discuss the anatomic pathways involved.

Umbilical artery aneurysm: a case report, literature review, and management recommendations.

Background Umbilical artery aneurysm is a rare and often lethal condition frequently associated with fetal anomalies, fetal demise, and neonatal complications. Case We report a case of umbilical artery aneurysm discovered at 21 weeks 2 days of gestation in a fetus of normal karyotype. Maternal hospitalization occurred at 28 weeks for antenatal testing, betamethasone administration, and monitoring for expansion of the aneurysm. Delivery of a live neonate by repeat cesarean delivery was performed at 32 weeks 2 days. Pathology confirmed a 3-vessel cord with an umbilical artery aneurysm. Neonatal course was complicated by respiratory distress of the newborn, hyperbilirubinemia, anemia, difficulty feeding, and cardiac defects. The newborn was discharged from the neonatal intensive care unit on day of life 19. Conclusions Umbilical artery aneurysm is highly associated with fetal complications including trisomy 18, single umbilical artery, cardiac anomalies, and intrauterine fetal demise. A normal karyotype, antenatal monitoring, and early delivery have been suggested to impact the likeliness of survival. Antenatal management strategies include consideration of nonstress testing 3 times daily, serial ultrasound assessments, testing to identify intrauterine growth restriction, and delivery by planned cesarean delivery between 32 and 34 weeks. We recommend that patients be counseled on the high risks associated with umbilical artery aneurysm and be included in discussions regarding antenatal management and delivery planning. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this CME activity, physicians should be better able to diagnose umbilical artery aneurysm using ultrasound and manage pregnant women whose fetuses have umbilical artery aneurysm.