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Wieslander CK, Grimes CL, Balk EM, Hobson DTG, Ringel NE, Sanses TVD, Singh R, Richardson ML, Lipetskaia L, Gupta A, White AB, Orejuela F, Meriwether K, Antosh DD. Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications: A Systematic Review. Obstet Gynecol 2023; 142:1044-1054. [PMID: 37826848 DOI: 10.1097/aog.0000000000005389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/30/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications. DATA SOURCES PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022. METHODS OF STUDY SELECTION The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies. TABULATION, INTEGRATION, AND RESULTS Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy. CONCLUSION Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021234511.
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Affiliation(s)
- Cecilia K Wieslander
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; the Division of Urogynecology & Reconstructive Pelvic Surgery, Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Howard University College of Medicine, Washington, DC; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Florida Health, Jacksonville, Florida; Occom Health, Newton, Massachusetts; the Division of Urogynecology & Reconstructive Pelvic Surgery, Cooper Health University, Cooper Medical School at Rowan University, Camden, New Jersey; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville Health, Louisville, Kentucky; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas at Austin Dell Medical School, Austin, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Baylor College of Medicine, the Division of Urogynecology, Department of Obstetrics & Gynecology, Houston Methodist Hospital, Houston, Texas; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico
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Winkelman WD, Jaresova A, Hacker MR, Richardson ML. Salary Disparities in Academic Urogynecology: Despite Increased Transparency, Men Still Earn More Than Women. South Med J 2020; 113:341-344. [PMID: 32617594 PMCID: PMC10152895 DOI: 10.14423/smj.0000000000001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To understand the compensation differences between male and female academic urogynecologists at public institutions. METHODS Urogynecologists at public universities with publicly available salary data as of June 2019 were eligible for the study. We collected characteristics, including sex, additional advanced degrees, years of training, board certification, leadership roles, number of authored scientific publications, and total National Institutes of Health funding projects and number of registered clinical trials for which the physician was a principal or co-investigator. We also collected total number of Medicare beneficiaries treated and total Medicare reimbursement as reported by the Centers for Medicare & Medicaid Services. We used linear regression to adjust for potential confounders. RESULTS We identified 85 academic urogynecologists at 29 public state academic institutions with available salary data eligible for inclusion in the study. Males were more likely to be an associate or a full professor (81%) compared with females (55%) and were more likely to serve as department chair, vice chair, or division director (59%) compared with females (30%). The mean annual salary was significantly higher among males ($323,227 ± $97,338) than females ($268,990 ± $72,311, P = 0.004). After adjusting for academic rank and leadership roles and years since residency, the discrepancy persisted, with females compensated on average $37,955 less annually. CONCLUSIONS Salaries are higher for male urogynecologists than female urogynecologists, even when accounting for variables such as academic rank and leadership roles. Physician compensation is complex; the differences observed may be due to variables that are not captured in this study. Nevertheless, the magnitude of disparity found in our study warrants further critical assessment of potential biases within the field.
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Affiliation(s)
- William D Winkelman
- From the Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrea Jaresova
- From the Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michele R Hacker
- From the Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Monica L Richardson
- From the Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Hanks LM, Mongold-Diers JA, Atkinson TH, Fierke MK, Ginzel MD, Graham EE, Poland TM, Richards AB, Richardson ML, Millar JG. Blends of Pheromones, With and Without Host Plant Volatiles, Can Attract Multiple Species of Cerambycid Beetles Simultaneously. J Econ Entomol 2018; 111:716-724. [PMID: 29361020 DOI: 10.1093/jee/tox373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pheromone components of cerambycid beetles are often conserved, with a given compound serving as a pheromone component for multiple related species, including species native to different continents. Consequently, a single synthesized compound may attract multiple species to a trap simultaneously. Furthermore, our previous research in east-central Illinois had demonstrated that pheromones of different species can be combined to attract an even greater diversity of species. Here, we describe the results of field bioassays in the northeastern, midwestern, southeastern, south-central, and southwestern United States that assessed attraction of cerambycids to a 'generic' pheromone blend containing six known cerambycid pheromone components, versus the individual components of the blend, and how attraction was influenced by plant volatiles. Nineteen species were attracted in significant numbers, with the pheromone blend attracting about twice as many species as any of the individual components. The blend attracted species of three subfamilies, whereas individual components attracted species within one subfamily. However, some antagonistic interactions between blend components were identified. The plant volatiles ethanol and α-pinene usually enhanced attraction to the blend. Taken together, these experiments suggest that blends of cerambycid pheromones, if selected carefully to minimize inhibitory effects, can be effective for sampling a diversity of species, and that plant volatiles generally enhance attraction. Such generic pheromone blends may serve as an effective and economical method of detecting incursions of exotic, potentially invasive species.
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Affiliation(s)
- L M Hanks
- Department of Entomology, University of Illinois at Urbana-Champaign, Urbana, IL
| | - J A Mongold-Diers
- Department of Entomology, University of Illinois at Urbana-Champaign, Urbana, IL
| | - T H Atkinson
- University of Texas Insect Collection, Lake Austin Center, Austin, TX
| | - M K Fierke
- Department of Environmental and Forest Biology, State University of New York, Syracuse, NY
| | - M D Ginzel
- Department of Entomology, Purdue University, West Lafayette, IN
| | - E E Graham
- Department of Entomology, Michigan State University, East Lansing, MI
| | | | - A B Richards
- Aquatic Bioassessment Laboratory, California State University, Chico, CA
| | - M L Richardson
- College of Agriculture, Urban Sustainability, and Environmental Sciences, University of the District of Columbia, Washington, DC
| | - J G Millar
- Department of Entomology, University of California, Riverside, CA
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Ohno MS, Richardson ML, Sokol ER. Abdominal sacral colpopexy versus sacrospinous ligament fixation: a cost-effectiveness analysis. Int Urogynecol J 2015; 27:233-7. [PMID: 26282093 DOI: 10.1007/s00192-015-2819-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS For the surgical correction of apical prolapse the abdominal approach is associated with better outcomes; however, it is more expensive than the transvaginal approach. This cost-effectiveness analysis compares abdominal sacral colpopexy (ASC) with sacrospinous ligament fixation (SSLF) to determine if the improved outcomes of ASC justify the increased expense. METHODS A decision-analytic model was created comparing ASC with SSLF using data-modeling software, TreeAge Pro (2013), which included the following outcomes: post-operative stress urinary incontinence (SUI) with possible mid-urethral sling (MUS) placement, prolapse recurrence with possible re-operation, and post-operative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) of less than $50,000 per quality-associated life year (QALY). Base-case, threshold, and one-way sensitivity analyses were performed. RESULTS At the baseline, ASC is more expensive than SSLF ($13,988 vs $11,950), but is more effective (QALY 1.53 vs 1.45) and is cost-effective (ICER $24,574/QALY) at 2 years. ASC was not cost-effective if the following four thresholds were met: the rate of post-operative SUI was above 36 % after ASC or below 28 % after SSLF; the rate of MUS placement for post-operative SUI was above 60 % after ASC or below 13 % after SSLF; the rate of recurrent prolapse was above 15 % after ASC or below 4 % after SSLF; the rate of post-operative dyspareunia was above 59 % after ASC or below 19 % after SSLF. CONCLUSIONS Abdominal sacral colpopexy can be cost-effective compared with sacrospinous ligament fixation; however, as the post-operative outcomes of SSLF improve, SSLF can be considered a cost-effective alternative.
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Affiliation(s)
- Mika S Ohno
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA.
| | - Monica L Richardson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA
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Oakley SH, Brown HW, Yurteri-Kaplan L, Greer JA, Richardson ML, Adelowo A, Lindo FM, Greene KA, Fok CS, Book NM, Saiz CM, Plowright LN, Harvie HS, Pauls RN. Practice patterns regarding management of rectovaginal fistulae: a multicenter review from the Fellows' Pelvic Research Network. Female Pelvic Med Reconstr Surg 2015; 21:123-8. [PMID: 25730438 PMCID: PMC4994526 DOI: 10.1097/spv.0000000000000162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Rectovaginal fistulae (RVFs) are often debilitating and there are no established treatment algorithms. We sought to describe current diagnosis and management strategies for RVFs across the United States. METHODS This institutional review board-approved multicenter retrospective study included 12 sites. Cases were identified using International Classification of Diseases, Ninth Revision codes during a 5-year period. Demographics, management, and outcomes of RVF treatment were collected. RESULTS Three hundred forty-two charts were identified; 176 (52%) met criteria for inclusion. The mean (SD) age was 45 (17) years. Medical history included hypertension (21%), cancer (17%), Crohn disease (11%), and diabetes (7%). Rectovaginal fistulae were often associated with obstetric trauma (42%), infection/inflammation (24%), and cancer (11%). Overall, most RVFs were primary (94%), small (0.5-1.5 cm; 49%), transsphincteric (31%), and diagnosed via vaginal and rectal (60%) examination. Eighteen percent (32/176) were initially managed conservatively for a median duration of 56 days (interquartile range, 29-168) and 66% (21/32) of these resolved. Almost half (45%) of RVFs treated expectantly were tiny (<0.5 cm). Eighty-two percent (144/176) of subjects were initially managed surgically and 81% (117/144) resolved. Procedures included simple fistulectomy with or without Martius graft (59%), transsphincteric repair (23%), transverse transperineal repair (10%), and open techniques (8%), and 87% of these procedures were performed by urogynecologists. CONCLUSIONS In this large retrospective review, most primary RVFs were treated surgically, with a success rate of more than 80%. Two thirds of RVFs managed conservatively resolved spontaneously, and most of these were tiny (<0.5 cm). These success rates can be used in counseling to help our patients make informed decisions about their treatment options.
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Affiliation(s)
- Susan H. Oakley
- Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH
| | - Heidi W. Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego Health System & Kaiser Permanente, San Diego, CA
| | - Ladin Yurteri-Kaplan
- Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC
| | - Joy A. Greer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Monica L. Richardson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stanford University School of Medicine, Stanford, CA
| | - Amos Adelowo
- Division of Urogynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Fiona M. Lindo
- Female Pelvic Medicine and Reconstructive Surgery, Scott & White Hospital/Texas A&M Health Science Center, Temple, TX
| | | | - Cynthia S. Fok
- Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL
| | - Nicole M. Book
- Center for Female Pelvic Surgery, Riverside Methodist Hospital, Columbus, OH
| | - Cristina M. Saiz
- Institute for Female Pelvic Medicine and Reconstructive Surgery, Allentown, PA
| | - Leon N. Plowright
- Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Heidi S. Harvie
- Division of Urogynecology and Pelvic Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rachel N. Pauls
- Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, Cincinnati, OH
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Richardson ML, Sokol ER. A cost-effectiveness analysis of conservative versus surgical management for the initial treatment of stress urinary incontinence. Am J Obstet Gynecol 2014; 211:565.e1-6. [PMID: 25019485 DOI: 10.1016/j.ajog.2014.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/02/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to determine whether conservative or surgical therapy is more cost effective for the initial treatment of stress urinary incontinence (SUI). STUDY DESIGN We created a decision tree model to compare costs and cost effectiveness of 3 strategies for the initial treatment of SUI: (1) continence pessary, (2) pelvic floor muscle therapy (PFMT), and (3) midurethral sling (MUS). We identified probabilities of SUI after 12 months of use of a pessary, PFMT, or MUS using published data. Parameter estimates included Health Utility Indices of no incontinence (.93) and persistent incontinence (0.7) after treatment. Morbidities associated with MUS included mesh erosion, retention, de novo urge incontinence, and recurrent SUI. Cost data were derived from Medicare in 2012 US dollars. One- and 2-way sensitivity analysis was used to examine the effect of varying rates of pursuing surgery if conservative management failed and rates of SUI cure with pessaries and PFMT. The primary outcome was an incremental cost-effectiveness ratio threshold <$50,000. RESULTS Compared to PFMT, initial treatment of SUI with MUS was the more cost-effective strategy with an incremental cost-effectiveness ratio of $32,132/quality-adjusted life year. Initial treatment with PFMT was also acceptable as long as subjective cure was >35%. In 3-way sensitivity analysis, subjective cure would need to be >40.5% for PFMT and 43.5% for a continence pessary for the MUS scenario to not be the preferred strategy. CONCLUSION At 1 year, MUS is more cost effective than a continence pessary or PFMT for the initial treatment for SUI.
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Affiliation(s)
- Monica L Richardson
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA
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Richardson ML, Balise RR, Comiter CV. Chronic sacral nerve stimulation as a novel treatment for stress urinary incontinence-A rat model. Neurourol Urodyn 2013; 34:270-3. [DOI: 10.1002/nau.22550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/25/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Monica L. Richardson
- Female Pelvic Medicine and Reconstructive Surgery; Department of Urology and Ob/Gyn, Stanford University School of Medicine; Palo Alto California
| | - Raymond R. Balise
- Department of Health and Research Policy; Stanford University; Palo Alto California
| | - Craig V. Comiter
- Department of Urology; Stanford University School of Medicine; Palo Alto California
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Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Lopes VV, Harvie HS, Sung VW. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol 2013; 209:470.e1-6. [PMID: 23921090 DOI: 10.1016/j.ajog.2013.08.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/16/2013] [Accepted: 08/01/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. STUDY DESIGN This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression. RESULTS Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation. CONCLUSION A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for a sense of self were predictors of preference for uterine preservation.
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Affiliation(s)
- Nicole B Korbly
- Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI.
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Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Lopes VV, Harvie HS, Sung VW. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol 2013. [PMID: 23921090 DOI: 10.1016/j.ajog.2013.08.003,pmid23921090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. STUDY DESIGN This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression. RESULTS Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation. CONCLUSION A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for a sense of self were predictors of preference for uterine preservation.
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Affiliation(s)
- Nicole B Korbly
- Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI.
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Good MM, Korbly N, Kassis NC, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Harvie HS, Sung V. Prolapse-related knowledge and attitudes toward the uterus in women with pelvic organ prolapse symptoms. Am J Obstet Gynecol 2013; 209:481.e1-6. [PMID: 23748108 DOI: 10.1016/j.ajog.2013.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/26/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to describe the basic knowledge about prolapse and attitudes regarding the uterus in women seeking care for prolapse symptoms. STUDY DESIGN This was a cross-sectional study of English-speaking women presenting with prolapse symptoms. Patients completed a self-administered questionnaire that included 5 prolapse-related knowledge items and 6 benefit-of-uterus attitude items; higher scores indicated greater knowledge or more positive perception of the uterus. The data were analyzed using descriptive statistics and multiple linear regression. RESULTS A total of 213 women were included. The overall mean knowledge score was 2.2 ± 1.1 (range, 0-5); 44% of the items were answered correctly. Participants correctly responded that surgery (79.8%), pessary (55.4%), and pelvic muscle exercises (34.3%) were prolapse treatment options. Prior evaluation by a female pelvic medicine and reconstructive surgery specialist (beta = 0.57, P = .001) and higher education (beta = 0.3, P = .07) was associated with a higher mean knowledge score. For attitude items, the overall mean score was 15.1 (4.7; range, 6-30). A total of 47.4% disagreed with the statement that the uterus is important for sex. The majority disagreed with the statement that the uterus is important for a sense of self (60.1%); that hysterectomy would make me feel less feminine (63.9%); and that hysterectomy would make me feel less whole (66.7%). Previous consultation with a female pelvic medicine and reconstructive surgery specialist was associated with a higher mean benefit of uterus score (beta = 1.82, P = .01). CONCLUSION Prolapse-related knowledge is low in women seeking care for prolapse symptoms. The majority do not believe the uterus is important for body image or sexuality and do not believe that hysterectomy will negatively affect their sex lives.
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Affiliation(s)
- Meadow M Good
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
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Richardson ML, Elliott CS, Shaw JG, Comiter CV, Chen B, Sokol ER. To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol 2013; 190:1306-12. [PMID: 23524201 DOI: 10.1016/j.juro.2013.03.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We compare the cost-effectiveness of 3 strategies for the use of a mid urethral sling to prevent occult stress urinary incontinence in patients undergoing abdominal sacrocolpopexy. MATERIALS AND METHODS Using decision analysis modeling we compared cost-effectiveness during a 1-year postoperative period of 3 treatment approaches including 1) abdominal sacrocolpopexy alone with deferred option for mid urethral sling, 2) abdominal sacrocolpopexy with universal concomitant mid urethral sling and 3) preoperative urodynamic study for selective mid urethral sling. Using published data we modeled probabilities of stress urinary incontinence after abdominal sacrocolpopexy with or without mid urethral sling, the predictive value of urodynamic study to detect occult stress urinary incontinence and the likelihood of complications after mid urethral sling. Costs were derived from Medicare 2010 reimbursement rates. The main outcome modeled was incremental cost-effectiveness ratio per quality adjusted life-years gained. In addition to base case analysis, 1-way sensitivity analyses were performed. RESULTS In our model, universally performing mid urethral sling at abdominal sacrocolpopexy was the most cost-effective approach with an incremental cost per quality adjusted life-year gained of $2,867 compared to abdominal sacrocolpopexy alone. Preoperative urodynamic study was more costly and less effective than universally performing intraoperative mid urethral sling. The cost-effectiveness of abdominal sacrocolpopexy plus mid urethral sling was robust to sensitivity analysis with a cost-effectiveness ratio consistently below $20,000 per quality adjusted life-year. CONCLUSIONS Universal concomitant mid urethral sling is the most cost-effective prophylaxis strategy for occult stress urinary incontinence in women undergoing abdominal sacrocolpopexy. The use of preoperative urodynamic study to guide mid urethral sling placement at abdominal sacrocolpopexy is not cost-effective.
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Affiliation(s)
- M L Richardson
- Pathological Laboratory of the University of Wisconsin, Madison
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Abstract
Native grasslands are among the most imperiled of the North American ecosystems, but abandoned agricultural areas may provide suitable habitat for animal taxa that are endemic to grasslands. We studied how species diversity of orb-weaving spiders was influenced by secondary succession of a grassland plant community by monitoring the abundance and species diversity in study plots that were cultivated at 6-yr intervals and left uncultivated in the interim. We tested the hypothesis that local abundance and species diversity of spiders would be positively associated with time since cultivation because plant communities in older habitats would be more architecturally complex. Local abundance of spiders in general was not associated with time since cultivation, but abundance of Mangora gibberosa (Hentz) was positively associated with the abundance of perennial plants. Species richness and diversity of spiders also were positively associated with the abundance of perennial plants and reached a threshold a few years after cultivation. Species diversity of orb-weaving spiders seems to be strongly influenced by species composition of the plant community. Therefore, effective restoration of the structure and function of endemic communities of orb-weaving spiders may depend on preserving endemic grassland plant communities.
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Affiliation(s)
- M L Richardson
- Program in Ecology, Evolution, and Conservation Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Abstract
Partitioning of niches can play an important role in structuring faunal communities. We tested the hypothesis that differences between four species of orb-weaving spiders (Araneidae) in body size and the structure and position of their webs resulted in their partitioning the available prey. The study species are sympatric in a grassland habitat and included Argiope trifasciata (Forskål), Cyclosa turbinata (Walckenaer), Mangora gibberosa (Hentz), and Neoscona arabesca (Walckenaer). The spider species differed in body size, web diameter, height of web above the ground, spacing of mesh within webs, and the type of plant to which the web was attached. The spider species had a generalist diet and captured prey of multiple trophic levels. Nevertheless, the hypothesis was supported: the spider species differed in the types of prey that they captured. Partitioning of the available prey was influenced by body size, with larger spiders capturing larger prey, but not by the structure or position of their webs. Differences between spider species in niche may reduce competitive interactions and allow them to coexist in sympatry.
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Affiliation(s)
- M L Richardson
- Program in Ecology, Evolution, and Conservation Biology, University of Illinois at Urbana-Champaign, 505 South Goodwin Ave., Urbana, IL 61801, USA
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of California at San Francisco 94143, USA
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Wherry KL, Dubinsky TJ, Waitches GM, Richardson ML, Reed S. Low-resistance endometrial arterial flow in the exclusion of ectopic pregnancy revisited. J Ultrasound Med 2001; 20:335-342. [PMID: 11316311 DOI: 10.7863/jum.2001.20.4.335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The objective of this study was to evaluate the efficacy of endometrial arterial flow in the exclusion of ectopic pregnancy. From October 1997 to June 1999, 66 women with elevated beta-human chorionic gonadotropin titers and clinical indications of ectopic pregnancy were evaluated by endovaginal sonography. Women with a gestational sac containing an embryo, a yolk sac, or both were excluded from the study. Doppler ultrasonography was performed in the remaining cases when a definite intrauterine pregnancy could not be visualized. In all cases the thermal index was kept to less than 1.0, consistent with as-low-as-reasonably-achievable principles. Trophoblastic flow was defined as a resistive index of less than 0.6 within the endometrium. Statistical analysis was performed using a 2-tailed t test. Twenty women had ectopic pregnancies; 33 had spontaneous pregnancy losses; and 13 had normal intrauterine pregnancies. A total of 29 women had endometrial trophoblastic flow: 11 of 13 with intrauterine pregnancies, 1 of 20 with ectopic pregnancies, and 17 of 33 with spontaneous pregnancy losses. The negative predictive value for the presence of endometrial low-resistance flow for excluding ectopic pregnancy was 97%. The presence of low-resistance arterial endometrial flow can be a useful sign in diagnosing an early intrauterine pregnancy and decreasing the probability that an ectopic pregnancy is present, particularly in patients with otherwise normal ultrasonographic findings.
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Affiliation(s)
- K L Wherry
- Department of Radiology, The University of Washington Medical Center, Seattle 98195, USA
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Abstract
OBJECTIVE This study was designed to assess the usefulness of liver window settings when performing abdominal CT for the detection and characterization of hepatic and splenic injuries. SUBJECTS AND METHODS We prospectively evaluated helical abdominal CT scans for hepatic and splenic injuries in 300 consecutive patients with blunt abdominal trauma over a 4-month period. There were 204 males and 96 females with a mean age of 34 years (age range, 1-87 years). For each patient, initial CT diagnosis of hepatic or splenic injury was made from images obtained with standard abdominal window settings. CT scans were then immediately reinterpreted using additional images obtained at narrow window width (liver windows). Changes in conspicuity and characterization of injury were recorded. All CT examinations were performed with helical 7-mm collimation at a pitch of 1.5 after oral ingestion of diluted barium and during bolus IV administration of 125 mL of ioversol at a rate of 2-3 mL/sec. RESULTS We detected hepatic or splenic injuries in 34 patients (11.3%). There were 19 hepatic injuries and 18 splenic injuries. Three patients had injuries to both liver and spleen. Conspicuity of hepatic or splenic injuries was mildly increased (+1 H) on liver windows in 16 patients, whereas the injury was equally conspicuous on both liver window and standard window images in 19 cases. In no case did review of the liver windows result in a change in grade of injury or reveal an injury that was not seen on standard abdominal window images. The total increased cost for printing liver windows was $5748. CONCLUSION Routine use of liver window settings for abdominal CT in trauma patients has little clinical usefulness and is not cost-effective.
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Affiliation(s)
- R M Patten
- Department of Radiology, MC 0024, Denver Health Medical Center, 777 Bannock St., Denver, CO 80204, USA
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Takasugi JE, Wood DE, Godwin JD, Richardson ML, Benditt JO, Albert RK. Lung-volume reduction surgery for diffuse emphysema: radiologic assessment of changes in thoracic dimensions. J Thorac Imaging 1998; 13:36-41. [PMID: 9440837 DOI: 10.1097/00005382-199801000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patients with severe, diffuse emphysema may be candidates for pneumectomy (lung-volume reduction surgery, LVRS) to improve lung and respiratory muscle function. To identify candidates who might benefit from this surgery, it is necessary to understand how lung volumes and respiratory function are effected. In this article, the authors demonstrate a significant difference in lung size on chest radiographs obtained before and after surgery. Thirty-five of 71 consecutive patients undergoing LVRS had both preoperative and postoperative chest radiographs and pulmonary function tests available for retrospective review. Preoperative and postoperative measurements of lung height, transthoracic diameters, mediastinal width, heart size, diaphragmatic arc, and intercostal spaces were compared using paired t-tests. Radiographic measurements where also correlated with changes in lung volumes as measured by pulmonary function tests. Lung heights (right, left, mean lateral) and coronal diameter at the aortic arch were reduced after surgery (all p < 0.05). Forced vital capacity, forced expiratory volume in 1 second (FEV1), and vital capacity increased, and total lung capacity and residual volume decreased after surgery (all p < 0.05). Left lung height showed a significant correlation (p = 0.025) with FEV1; all other correlations between radiographic changes and pulmonary function test changes were not significant. The explanation for improved lung function in patients after LVRS is not completely clear and is probably multifactorial. Radiologic alterations reflect anatomic changes caused by surgery and support the theory that modifications of chest wall configuration occur and are likely responsible, in part, for improved symptomatology and respiratory function.
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Affiliation(s)
- J E Takasugi
- Department of Radiology, Seattle VA Medical Center, Washington 98108, USA
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Gillespy T, Richardson ML. Publishing radiology educational material on the Internet: analysis of e-mail responses. J Digit Imaging 1997; 10:193. [PMID: 9268880 PMCID: PMC3452866 DOI: 10.1007/bf03168698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- T Gillespy
- Department of Radiology, University of Washington, Seattle 98195, USA
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Abstract
OBJECTIVE On-line continuing medical education (CME) courses offer at least two potential advantages: They are extremely convenient and relatively inexpensive. Before expanding our department's 2-year-old on-line category 1 accredited CME program, we conducted a survey to assess the need for more courses of this type and to document those topics of most interest to our responders. MATERIALS AND METHODS An on-line survey form was designed and linked to the home page of our departmental Web server. The 8-month survey asked whether responders were interested in earning category 1 CME hours, how many hours they desired, how much they were willing to pay for each hour, and which topics would interest them most. Responders were also asked to specify their medical practice and medical specialty. All responses were tabulated, and simple descriptive statistics were calculated. RESULTS Our survey received 317 responses: 188 from physicians, 42 from radiology technologists, 11 from physician assistants and nurse practitioners, and the remainder from 26 other categories of practice. Physician specialties identified included 86 diagnostic radiologists, 24 internists, 18 emergency medicine specialists, 15 family practitioners, and 45 from 14 other specialties. Responses came mainly from the United States; however, 32 responses were received from 15 other countries. The median number of on-line CME hours desired was 15 (range, 1-1324). Physician responders were willing to pay a median amount of $10 per credit hour (range, $0-400). The most commonly suggested topic was general radiology, followed by general reviews of MR imaging, CT, sonography, and various organ-based specialties in radiology such as mammography, neuroradiology, and musculoskeletal radiology. CONCLUSION Physicians and many other health care workers are interested in on-line CME and are willing to pay for such a service. This information, as well as the suggested topics collected in this survey, may prove helpful in planning future offerings of on-line CME.
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of Washington, Seattle 98195-7115, USA
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Abstract
In the arena of managed care and large delivery systems, professional associations find it increasingly difficult to influence the environments in which their members practice. Physician executives appear likely to play key roles in the response of medicine to change. This article discusses how an analysis of the work of physicians involved in management fails to yield a clear analytic distinction between physicians engaged in management and the behavior of others who have managerial responsibility.
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Affiliation(s)
- E S Schneller
- School of Health Administration and Policy, Arizona State University, Tempe, USA
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Abstract
OBJECTIVE Radiation therapy is often used to treat bone und soft tissue neoplasms, and commonly results in soft tissue edema in the radiation field. However, the time course, distribution and degree of this edema have not been well characterized. Our study was carried out to better define these features of the edema seen following neutron and photon radiation therapy. DESIGN AND PATIENTS Two hundred and twenty-six patients underwent radiation therapy as part of combined modality management for musculoskeletal sarcomas between 1985 and 1993. Of these, 15 had surgical resection of their neoplasm, had no clinical evidence of recurrent disease, and had adequate MR follow-up that allowed sequential assessment of soft tissue following irradiation. Ten patients received photons with an average dose of 52.8 Gy. Five patients received neutrons with an average dose of 17.3 nGy. Sequential MR follow-up was available in these patients for an average of 22.8 months following radiation therapy. On each of the serial MR imaging studies, subcutaneous fat, muscle, and the intramuscular septa/fascial planes were graded subjectively as to size and signal intensity. RESULTS In general, soft tissue signal intensity in the radiation field initially increased over time, peaking at about 6 months for neutron-treated patients and at about 12-18 months for photon-treated patients. Signal intensity then decreased slowly over time. However, at the end of the follow-up period, signal intensity remained elevated for most patients in both groups. Signal intensity in a particular tissue was greater and tended to persist longer on STIR sequences than on T2-weighted sequences. Survival analysis of signal intensity demonstrated much longer edema survival times for neutron-treated patients than for photon-treated patients. Signal intensity increase in the intramuscular septa persisted for much longer than for fat or muscle. A mild increase in size was noted in the subcutaneous fat and intramuscular septa. Muscle, on the other hand, showed a decrease in size following treatment. This was mild for the photon-treated group and more marked for the neutron-treated group. CONCLUSIONS There is a relatively wide variation in the duration and degree of post-irradiation edema in soft tissues. This edema seems to persist longer in the intramuscular septa than in fat or muscle. Although the duration of follow-up was limited, our study suggests that this edema resolves in roughly half the photon-treated patients within 2-3 years post-treatment and in less than 20% of neutron-treated patients by 3-4 years post-treatment. Muscle atrophy was seen in both photon- and neutron-treated patients, but was more severe in the neutron-treated group.
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Affiliation(s)
- M L Richardson
- Department of Radiology SB-05, University of Washington, Seattle 98195, USA
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26
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Abstract
OBJECTIVE Intra-arterial chemotherapy (IAC) is frequently used as an adjuvant treatment for musculoskeletal tumors. Past studies have noted that IAC not only induces favorable effects in tumor, but may also cause muscle edema and necrosis in previously normal tissue, reflected as increased signal on T2-weighted scans. In order to evaluate the prevalence of these effects, we reviewed all patients receiving IAC and MRI at our institution. METHODS Our study population consisted of 24 patients who underwent IAC. All subjects were studied with MRI both pre- and post-IAC. None of the subjects in this study underwent surgery or radiation therapy until after the post-IAC MRI examination. Any muscle group involved by the tumor or peritumoral edema on the initial scan was excluded from the study. Catheter position during IAC was recorded as central or peripheral. Scans were scored positive if muscle groups in regions remote from the tumor site demonstrated increased T2 signal following IAC. RESULTS Six out of these 24 patients (25%) were found to have positive results. A significant association was found between peripheral catheter position and a positive scan post-IAC (Fisher's exact test, P = 0.024). CONCLUSION Because of our exclusion criteria, we are convinced that the finding of increased T2 signal in 25% of our patients was caused by IAC and represents muscle edema or necrosis. Knowledge of this post-chemotherapy MR finding should help prevent confusion during the interpretation of follow-up MR examinations.
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Affiliation(s)
- R C Kuno
- University of Washington School of Medicine, Department of Radiology, Seattle 98195-7115, USA
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Holman AJ, Gardner GC, Richardson ML, Simkin PA. Quantitative magnetic resonance imaging predicts clinical outcome of core decompression for osteonecrosis of the femoral head. J Rheumatol 1995; 22:1929-33. [PMID: 8991993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether the course of femoral head osteonecrosis after core decompression can be predicted from the extent of necrotic bone in the preoperative magnetic resonance imaging (MRI). METHODS In 31 femoral head lesions (Ficat stage I or II), the percentage volume of necrotic bone was calculated by dividing the sum of the necrotic areas from all MRI slices by the sum of the femoral head areas. Osteonecrosis risk factors, pain scores, and the need for further surgery were assessed at a minimum of 12 mo post-core decompression. Clinical outcomes were considered good when post-core decompression pain scores improved and further surgery was not required. RESULTS Fourteen of the 15 hips with good outcomes after a mean followup of 32 mo had less than 21% femoral head involvement. All 16 hips with poor outcomes after a mean followup of 17 mo had more than 21% of the femoral head affected. CONCLUSION Quantitative MRI of femoral head necrosis was a useful predictor of clinical outcome following core decompression.
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Affiliation(s)
- A J Holman
- Department of Medicine, University of Washington, Seattle 98195, USA
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Moore EH, Shelton DK, Wisner ER, Richardson ML, Bishop DM, Brock JM. Needle aspiration lung biopsy: reevaluation of the blood patch technique in an equine model. Radiology 1995; 196:183-6. [PMID: 7784564 DOI: 10.1148/radiology.196.1.7784564] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To reexamine the blood patch technique in a laboratory model of lung biopsy free of confounding clinical variables. MATERIALS AND METHODS An equine model of lung biopsy was developed with an excised lobe connected to an insufflation bulb and pressure monitor. Patched and control unpatched punctures were made in the lung surface, and the pressure within the lung was raised to the maximum achievable. Whether air leakage from the puncture sites could be induced was determined and, if so, at what pressure it occurred. RESULTS At statistical analysis with the Kaplan-Meier test and the Cox proportional hazards regression model, the difference between failure of the patched and unpatched punctures was statistically significant (P < .0001). CONCLUSION The blood patch technique is effective in the laboratory setting and deserves reevaluation in a clinical series with updated biopsy techniques.
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Affiliation(s)
- E H Moore
- Department of Radiology, University of California Davis Medical Center, Sacramento 95817, USA
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Abstract
OBJECTIVE Radiology departments have traditionally used film-based collections of interesting cases for teaching purposes. Film-based files are expensive to create and duplicate, and they physically occupy considerable space. As one solution to these problems, our department created an on-line radiology teaching file in digital format. MATERIALS AND METHODS Our teaching file resides on a Macintosh Quadra 700 computer that is connected to the Internet, a worldwide network of interconnected computers, via our campus Ethernet network. Our digital teaching file images and text are composed in HyperText Markup Language (HTML) and are made available to the world with Webserver software known as MacHTTP. These teaching files are accessed using World-Wide Web (WWW) client software such as Mosaic, MacWeb, or Netscape. RESULTS Our digital teaching file is available at no charge to anyone in the world with access to the Internet and WWW client software. Our radiology residents can access this file via several workstations in our department. Mosaic is an easy-to-use interface, and the use of our digital teaching file has increased significantly. In the 3 months since its creation, our teaching file has been accessed not only by our radiology residents but also by hundreds of other users in 33 countries. CONCLUSION Use of Mosaic and the WWW format has resulted in an easy-to-use hypertext interface to the Internet, which allows even persons with little computer experience to navigate through the Internet, read text files, view images (stills and movies), and download files by merely pointing with the mouse and clicking on items of interest. This has allowed us to maintain a central teaching file that is physically small and easy to share with all the hospitals in our system. We invite the worldwide radiology community to access these files and to submit cases from their own teaching files to share with the rest of the world.
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of Washington, Seattle 98195
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of Washington Medical Center, Seattle 98195
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Greene KE, Takasugi JE, Godwin JD, Richardson ML, Burke W, Aitken ML. Radiographic changes in acute exacerbations of cystic fibrosis in adults: a pilot study. AJR Am J Roentgenol 1994; 163:557-62. [PMID: 8079843 DOI: 10.2214/ajr.163.3.8079843] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We set out to determine whether specific findings can be seen on chest radiographs of adult patients with cystic fibrosis who are having acute exacerbation of respiratory disease. MATERIALS AND METHODS Over a 2-year period, 22 adults with cystic fibrosis had both a baseline chest radiograph and a radiograph obtained either because of acute exacerbation or for some other reason (nonexacerbation). Fourteen radiographic features, including mucous plugs, air-space disease, peribronchial thickening, bronchiectasis, fluid levels, and lymphadenopathy, were scored retrospectively by two radiologists, who did not have knowledge of the patient's clinical condition, as being present, absent, increased, decreased, or unchanged. An overall assessment (better, worse, or no change) was also given for each radiograph. Data were analyzed in two ways (per individual episode and per individual patient) by using contingency tables, with statistical significance determined by exact permutation testing. RESULTS Of the 22 patients, 13 had 29 exacerbations and eight had 11 nonexacerbations. The remaining patient had radiographs showing both an exacerbation and a nonexacerbation. With the exception of overall change (p = .06), none of the radiographic variables showed a statistically significant association with exacerbation (mean p value, .66; range, .19-.90). CONCLUSION The 14 specific radiographic findings studied, including peribronchial thickening, mucous plugs, air-space disease, and fluid levels, were not useful in determining whether an adult patient with cystic fibrosis was having acute exacerbation of the disease. With regard to these individual variables, chest radiographs are not helpful in the management of acute exacerbation of cystic fibrosis in adults. However, overall change approached statistical significance (p = .06). The value of chest radiography lies more in excluding the rare major complication, such as pneumothorax, than in diagnosing the usual exacerbation.
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Affiliation(s)
- K E Greene
- Department of Medicine, University of Washington Medical Center, Seattle 98195
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Patten RM, Richardson ML, Zink-Brody G, Rolfe BA. Complete vs partial-thickness tears of the posterior cruciate ligament: MR findings. J Comput Assist Tomogr 1994; 18:793-9. [PMID: 8089331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We sought to define the MRI appearance of both complete and partial-thickness tears of the posterior cruciate ligament (PCL) and to describe patterns of injury and associated MRI findings. MATERIALS AND METHODS Three radiologists retrospectively reviewed MR images and medical records on 32 patients with PCL tears (15 complete, 17 partial) and correlated MRI findings to results of clinical testing and surgery. RESULTS The PCL had indistinct margins in 27 (84%) of 32 patients and was abnormally thick in 25 (78%) patients. In 31 (97%) patients, the torn PCL showed increased signal intensity on both T1- and T2-weighted pulse sequences. Although there was no statistically significant difference between patients with complete tears and those with partial tears with regard to thickness, margination, and signal intensity of the PCL, MR images in patients with complete tears were more likely to show focal areas of ligamentous discontinuity (10 of 15 cases) (p = 0.01). Associated knee injuries were seen in 21 (66%) patients and were seen more frequently in patients with complete PCL tears (p = 0.015). Bony injury (n = 11, 34%) and tears of the medial collateral ligament (n = 13, 41%) and menisci (n = 10, 31%) were common. No specific pattern of bony injury was found. CONCLUSION Posterior cruciate ligament tears can be diagnosed readily by multiplanar MRI using both morphological and signal intensity characteristics. Although differentiation between complete and partial-thickness PCL tears by MRI criteria alone is more problematic, complete tears are more likely to show focal areas of discontinuity and partial tears are more likely to show at least some intact fibers.
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Affiliation(s)
- R M Patten
- Department of Radiology, University of Washington School of Medicine, Seattle
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Abstract
This is the fifth and final article in our series for radiologists and imaging scientists on displaying, manipulating, and analyzing radiologic images on personal computers (PCs). There are many methods of transferring radiologic images into a PC, including transfer over a network, transfer from an imaging modality storage archive, using a frame grabber in the image display console, and digitizing a radiograph or 35-mm slide. Depending on the transfer method, the image file may be an extended gray-scale contrast, 16-bit raster file or an 8-bit PC graphics file. On the PC, the image can be viewed, analyzed, enhanced, and annotated. Some specific uses and applications include making 35-mm slides, printing images for publication, making posters and handouts, facsimile (fax) transmission to referring clinicians, converting radiologic images into medical illustrations, creating a digital teaching file, and using a network to disseminate teaching material. We are distributing a 16-bit image display and analysis program for Macintosh computers, Dr Razz, that illustrates many of the principles discussed in this review series. The program is available for no charge by anonymous file transfer protocol (ftp).
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Affiliation(s)
- T Gillespy
- Department of Radiology, University of Washington, Seattle 98195
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Abstract
PURPOSE To define age-specific patterns of distribution of red and yellow marrow about the shoulder. MATERIALS AND METHODS Red and yellow marrow distribution was reviewed on magnetic resonance images of 189 subjects aged 15-69 years. Double-echo and fast spin-echo, gradient, and short inversion time inversion recovery pulse sequences were used. The acromion, glenoid, and proximal humeral epiphysis, metaphysis, and diaphysis in each shoulder were graded semiquantitatively and qualitatively. RESULTS There was a wide variation in the normal pattern of red-yellow marrow distribution both among subjects and among locations. All five anatomic locations showed an orderly progression from greater to lesser amounts of red marrow with increasing age. Many of the subjects had focal subchondral red marrow in the epiphysis, which was associated with patient age (P = .0001) and gender (P = .04). CONCLUSION Knowledge of normal patterns of marrow distribution can prevent their being misinterpreted as marrow-based disease.
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Affiliation(s)
- M L Richardson
- Department of Radiology SB-05, University of Washington, Seattle 98195
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Affiliation(s)
- M L Richardson
- University of Washington, Department of Radiology, Seattle 98195
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Abstract
Cryotherapy is an increasingly popular mode of therapy adjunctive to surgical curettage in the treatment of certain skeletal neoplasms, such as giant cell tumors or chondrosarcomas. The magnetic resonance (MR) findings following cryotherapy have not been previously reported. We reviewed the MR findings in seven patients with skeletal neoplasms following curettage and cryotherapy. In six cases we found a zone of varying thickness extending beyond the surgical margins, corresponding to an area of cryoinjury to medullary bone. This zone displayed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, consistent with the presence of marrow edema. This zone of edema almost certainly reflects underlying thermal osteonecrosis. This zone may vary in size and intensity over time as the area of cryoinjury evolves or resolves. MR is currently the imaging procedure of choice for follow-up of most musculoskeletal neoplasms. Knowledge of the MR findings following cryotherapy should help prevent confusion during the interpretation of follow-up MR examinations.
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Affiliation(s)
- M L Richardson
- Department of Radiology SB-05, University of Washington, Seattle 98195
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Patten RM, Spear RP, Richardson ML. Diagnostic performance of magnetic resonance imaging for the diagnosis of rotator cuff tears using supplemental images in the oblique sagittal plane. Invest Radiol 1994; 29:87-93. [PMID: 8144344 DOI: 10.1097/00004424-199401000-00018] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES The authors evaluated the diagnostic utility of supplemental imaging in the oblique sagittal (OS) plane for the magnetic resonance imaging (MRI) diagnosis of rotator cuff tears. METHODS Two radiologists with varying levels of MRI experience blindly reviewed shoulder MR examinations of 50 patients for rotator cuff tears. Shoulder examinations were interpreted twice, initially using only double-echo spin-echo images obtained in the oblique coronal (OC) plane and later using double-echo spin-echo images obtained in the both the OC and OS planes. Tears were characterized according to size, location, and extent, and levels of diagnostic confidence were evaluated. RESULTS Sensitivity and specificity of MR for the diagnosis of rotator cuff tear was 85% and 80%, respectively, with the OC series increasing to 95% and 93%, respectively with OCOS scans. However, these increases were not statistically significant. Receiver operating characteristic (ROC) curves suggest a trend toward increased diagnostic confidence when supplemental OS scans are available, especially for the less experienced reader. Characterization of rotator cuff tears was not improved with additional OS images. CONCLUSIONS Supplemental OS scans did not demonstrate a definite improvement in diagnostic accuracy for rotator cuff tears compared to OC scans alone. Estimations based on sample size calculations indicate that a much larger population of patients would be needed to show a statistically significant difference.
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Affiliation(s)
- R M Patten
- Department of Radiology, University of Washington School of Medicine, Seattle
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39
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Affiliation(s)
- M L Richardson
- Birch Assessment Services for Information on Chemicals (BASIC), Rickmansworth, Hertfordshire, England
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40
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Abstract
A chronic need exists for anatomic drawings that are suitable for publication. The best drawings of this type are the result of close collaboration between a trained medical illustrator and the author commissioning the artwork. However, high-quality drawings usually command premium prices and are not within everyone's budget. Similarly, services that can provide such illustrations are not available in all areas. This paper describes several methods of producing high-quality anatomic drawings with a personal computer. These drawings can be produced from the digital images obtained on one's local CT or MR scanners, or from digitized slides and photographs. Other images can be scanned from various sources of anatomic line art that are in the public domain. A final source of anatomic drawings is commercially available medical clip art. The drawings created from any of these sources can be modified to suit one's needs and can provide very satisfactory results.
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of Washington, Seattle 98195
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41
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Vanderhooft JE, Conrad EU, Anderson PA, Richardson ML, Bruckner J. Intradural recurrence with chondrosarcoma of the spine. A case report and review of the literature. Clin Orthop Relat Res 1993:90-5. [PMID: 8358950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Known for its resistance to chemotherapy and radiation therapy, chondrosarcoma remains largely a surgically managed tumor predisposed to local recurrence and late distant metastasis. A 42-year-old man with known thoracic chondrosarcoma developed progressive low back pain, lower extremity weakness, and urinary incontinence. Magnetic resonance imaging and computed tomographic myelography demonstrated multiple filling defects throughout the lumbosacral region. Surgical excision of these lesions disclosed intradural, extramedullary drop metastases of the chondrosarcoma. The spread of neoplasms within the dural space is uncommon, accounting for less than 5% of spinal metastases, and has not previously been reported for chondrosarcoma.
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Affiliation(s)
- J E Vanderhooft
- Department of Orthopaedics, University of Washington, Seattle 98195
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42
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Levitsky DB, Frank MS, Richardson ML, Shneidman RJ. How should radiologists reply when patients ask about their diagnoses? A survey of radiologists' and clinicians' preferences. AJR Am J Roentgenol 1993; 161:433-6. [PMID: 8333389 DOI: 10.2214/ajr.161.2.8333389] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Radiologists must consider several factors when asked by a patient to disclose the results of a radiologic examination. This study represents a survey of radiologists' and clinicians' opinions regarding disclosure of information to patients by the radiologist. A clearer understanding of the preferences of radiologists and clinicians may serve to improve communication and enhance cooperation between the two groups, with the ultimate result being improved patient care.
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Affiliation(s)
- D B Levitsky
- Department of Radiology, University of Washington, Seattle 98195
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43
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Abstract
Despite a decade and a half of digital imaging in radiology, most radiology teaching files remain film-based. The reasons include the high cost or unavailability of digital acquisition and display devices. In the past few years, a number of excellent exhibits that combine inexpensive microcomputers with radiologic education have been shown at national meetings [1-6]. Unfortunately, many of these methods require esoteric hardware, expensive or proprietary software, or special programming skills. We developed a simple method for creating and disseminating a teaching file of imaging studies obtained with digital techniques.
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of Washington, Seattle 98195
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44
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Abstract
We examined the parasites and physical condition of coexisting white-tailed deer (Odocoileus virginianus), axis deer (Axis axis), fallow deer (Dama dama), and sika deer (Cervus nippon) on the YO Ranch (Kerr County, Texas, USA) during December 1982 to January 1984. White-tailed deer harbored 12 species of parasites. Exotic deer were infected with nine species of parasites. All parasites recovered from exotic deer and white-tailed deer have been reported from white-tailed deer. Exotic deer had higher condition ratings than white-tailed deer.
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Affiliation(s)
- M L Richardson
- Caesar Kleberg Wildlife Research Institute, Texas A&I University, Kingsville 78363
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45
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Richardson ML, Van Vu M, Vincent LM, Sangeorzan BJ, Benirschke SK. CT measurement of the calcaneal varus angle in the normal and fractured hindfoot. J Comput Assist Tomogr 1992; 16:261-4. [PMID: 1545023 DOI: 10.1097/00004728-199203000-00015] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The calcaneal varus angle is an important parameter used by orthopedic surgeons in their assessment of calcaneal fractures, and restoration of this angle is a major goal in the intraoperative reduction of such fractures. Plain radiographic techniques for the measurement of this angle may be difficult to apply. It is much simpler to measure this angle on CT, which is superior in demonstrating the complex anatomy of the calcaneus. However, a standardized method of measuring this angle by CT has not yet been developed. We measured the calcaneal varus angle in 48 subjects (31 normal feet and 62 feet with fractured calcanei) with three methods. The axial calcaneocuboid angle (the angle in the axial plane between the longitudinal axis of the calcaneus and a line drawn perpendicular to the calcaneocuboid joint) measured 25.3 +/- 7.3 degrees (mean +/- 1 SD) in normal feet and 28.9 +/- 8.5 degrees in fractured feet. The axial talocalcaneal angle (the angle between the longitudinal axes of the talus and the calcaneus in the axial plane) measured 20.9 +/- 9.2 degrees in normal feet and 29.2 +/- 11.3 degrees in fractured feet. The coronal talocalcaneal angle (the angle between the vertical axes of the talus and calcaneus in the coronal plane) measured 12.5 +/- 3.8 degrees in normal feet and 21.8 +/- 7.6 degrees in fractured feet. There was a statistically significant difference between the varus angle for normals and for fractured calcanei by all three methods of measurement (p less than or equal to 0.05). These measurements provide preliminary normative data for three methods of estimating the calcaneal varus angle in the normal and fractured hindfoot. These may be of value not only in the surgical restoration of the normal anatomic alignment of the fractured hindfoot but also in the preoperative assessment of congenital foot abnormalities. Although clinical validation is not yet available, our study suggests that the axial calcaneocuboid angle has several significant advantages over the other two methods.
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Affiliation(s)
- M L Richardson
- Department of Radiology, University of Washington, Seattle 98195
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46
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Abstract
Fifty-five patients who underwent fluoroscopically guided needle aspiration lung biopsy were randomly assigned to one of two postbiopsy treatment groups: Patients were placed recumbent with puncture site either down (n = 36) or up (n = 19) for at least 1 hour. No significant difference in pneumothorax rate was seen between the two groups. Chest tube placement, however, was required in 21% (four of 19) of the puncture-site-up group versus 3% (one of 36) of the puncture-site-down group, which was a significant difference (P = .04). Puncture-site-down postbiopsy positioning reduces the proportion of patients requiring chest tube placement after lung biopsy.
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Affiliation(s)
- E H Moore
- Department of Radiology, Massachusetts General Hospital, Boston
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47
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Abstract
We evaluated the results of 105 operative repairs of tears of the rotator cuff of the shoulder in eighty-nine patients at an average of five years postoperatively. We correlated the functional result with the integrity of the cuff, as determined by ultrasonography. Eighty per cent of the repairs of a tear involving only the supraspinatus tendon were intact at the time of the most recent follow-up, while more than 50 per cent of the repairs of a tear involving more than the supraspinatus tendon had a recurrent defect. Older patients and patients in whom a larger tear had been repaired had a greater prevalence of recurrent defects. At the time of the most recent follow-up, most of the patients were more comfortable and were satisfied with the result of the repair, even when they had sonographic evidence of a recurrent defect. The shoulders in which the repaired cuff was intact at the time of follow-up had better function during activities of daily living and a better range of active flexion (129 +/- 20 degrees compared with 71 +/- 41 degrees) compared with the shoulders that had a large recurrent defect. Similar correlations were noted for the range of active external and internal rotation and for strength of flexion, abduction, and internal rotation. In the shoulders in which the cuff was not intact, the degree of functional loss was related to the size of the recurrent defect.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D T Harryman
- Department of Orthopaedics, University of Washington, Seattle 98195
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48
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Lehman CD, Goldman ML, Baron RL, Richardson ML, Starr FE, Lee SP. Gallstone susceptibility to in vitro fragmentation by a 480-nm pulsed dye laser. Correlation with computed tomography characteristics. Invest Radiol 1991; 26:799-803. [PMID: 1682289 DOI: 10.1097/00004424-199109000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The object of this investigation was to determine gallstone susceptibility to laser lithotripsy and to discover whether this susceptibility is related to the computed tomography (CT) appearance of gallstones. Gallstones collected from surgery were scanned by CT and classified as homogeneously dense (greater than 90 Hounsfield units [HU]), homogeneously faint (30-60 HU), or rimmed. Sixty stones were subjected to laser energy at 20, 40, 60, 80, or 100 mJ. Fracture and fragmentation (all particles less than 2 mm) were assessed in relation to the energy level setting and number of laser pulses delivered. The authors found that a 480-nm, flashlamp-pumped pulsed dye laser can fragment completely all the types of human gallstones that were tested, although there is significant variability in gallstone susceptibility to laser lithotripsy. This susceptibility varies with CT appearance: dense stones require fewer pulses and lower energies for fracture and fragmentation, compared to faint or rimmed stones. The authors anticipate that CT characterization of gallstones may be a clinically useful screening tool before laser lithotripsy.
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Affiliation(s)
- C D Lehman
- Department of Radiology, University of Washington School of Medicine, Seattle
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49
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Schwartz AN, Lowe M, Berger RE, Wang KY, Mack LA, Richardson ML. Assessment of normal and abnormal erectile function: color Doppler flow sonography versus conventional techniques. Radiology 1991; 180:105-9. [PMID: 2052674 DOI: 10.1148/radiology.180.1.2052674] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The penile arteries were studied with color Doppler flow sonography in 10 subjects with normal and 39 patients with abnormal erectile function. The relationships of systolic and diastolic velocities to spectral waveform changes in the penile arteries in response to tumescence were studied before and after intracorporal injection of vasoactive medications that induce erection. In normal subjects, a characteristic spectral waveform pattern corresponded to increasing intracorporal pressure. Patients with abnormal arterial inflow and/or abnormal venous sinusoidal leakage demonstrated deviation from the patterns noted in normal subjects. Patients with abnormal arterial inflow had lower mean peak systolic velocities than normal subjects. Patients with severe venous sinusoidal incompetence had an arrest of waveform progression with evolution to but not beyond phases 1 or 2 (diastolic flow remained positive). Patients with abnormal arterial inflow and abnormal venous sinusoidal outflow had waveform changes that reflected both processes. Systolic/diastolic velocity and waveform relationships can be used to define the integrity of both the cavernosal artery inflow and venous sinusoidal outflow occlusion mechanisms.
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Affiliation(s)
- A N Schwartz
- Department of Radiology, University of Washington School of Medicine, Seattle
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50
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Shuman WP, Patten RM, Baron RL, Liddell RM, Conrad EU, Richardson ML. Comparison of STIR and spin-echo MR imaging at 1.5 T in 45 suspected extremity tumors: lesion conspicuity and extent. Radiology 1991; 179:247-52. [PMID: 2006285 DOI: 10.1148/radiology.179.1.2006285] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Short inversion time inversion recovery (STIR) imaging and a double-echo spin-echo (SE) sequence at 1.5 T in 45 sequential patients with suspected extremity tumors were compared to assess the number of lesions detected, subjective conspicuity of lesions, approximate volume of abnormality detected in each lesion, and identification of peritumoral brightening in tissues adjacent to each lesion. STIR sequences enabled detection of all 45 lesions; 44 were detected with the SE sequence. Tumor appeared most conspicuous on STIR images in 35 patients (78%) and was most conspicuous on SE images in 10 patients (22%). Peritumoral brightening, which indicated either peritumoral edema or microscopic tumor infiltration, was detected in 20 patients but was detected only with STIR sequences in nine patients. It is concluded that, although STIR and SE sequences are comparable for lesion detection in the extremities, most lesions appear more conspicuous with STIR. STIR may enable detection of a greater volume of abnormality than SE sequences and may therefore have important implications for local staging and surgical and radiation therapy planning.
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Affiliation(s)
- W P Shuman
- Department of Radiology, University of Washington School of Medicine, Seattle
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