bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographic Evaluation of the Digital Artery
Authors: Keener Tom S. , Drose Julia A.
Published: March 2006

Color flow imaging and duplex Doppler were used to establish normal peak velocities and resistive indices for the radialis indicis. The digital artery of both index fingers were examined in 59 subjects, including both men and women ranging in age from 21 to 65 years of age. Of the 59 subjects, 20 were eliminated from the normal group due to factors that were thought to potentially affect digital artery blood flow. The normal resistive index range was found to be between 39% and 77%. The normal range for peak systolic velocities was between 5.3 and 59.7 cm/sec.
Prenatal Sonogra phic Evaluation of Beckwith-Wiedemann Syndrome
Authors: Dahl Kristin R. , Rouse Glenn A. , de Lange Marie
Published: March 2006

Beckwith-Wiedemann syndrome (BWS) was first described by Beckwith in 1963 and Wiedemann in 1964 as a syndrome of macroglossia, visceromegaly,. omphalocele, gigantism, and neonatal hypoglycemia. Additonal features of the syndrome, which occurs in approximately 1 in every 14,000 births, have been subsequently described. The authors report 2 cases of fetal BWS observed sonographically, and review 16 previously reported cases. Pohydramnios and growth acceleration may occur before 20 weeks, but macrlossia has not been reported before 28.5 weeks. Searching for ear creases in a fetus with suspected BWS may be merited, but visualization of normal ear lobes does not exclude the possibility of BWS.
Transient Moderate Bilateral Maternal Hydronephrosis at 7 Weeks Gestation Resolving Imzmediately After Micturition
Authors: Sherer David M. , Nowell Renee M. , Abramowicz Jacques S.
Published: March 2006

A case in which moderate bilateral maternal hydronephrosis was documented sonographi cally at 7 weeks0 gestatio, and resolved spontane ously immediately after micturition, is presented. This occurrences emphasizes the importance of obtaining an empty bladder before renal sono graphic examination to avid false positive diag nosis of pathologic or pregnancy-associated uri nary tract dilatation.
Use of Duplex Doppler Sonography and Color Flow Imaging to Demonstrate Hemodynamic Changes in Portal Circulation Before and After Portosystemic Shunts
Authors: Deliquina Minerva F. , Elerick Colleen C. , Green David W. , Cummings Felicia E.
Published: March 2006

The objective of this study is to demonstrate the feasibility, usefulness, and efficacy of duplex Doppler ultrasound and color flow imaging (CFI) in assessing hepatic vessel patency, blood flow direction, and quantitative estimation of blood flow velocities, before and after placement of a transjugular intrahepatic portosystemic shunt (TIPSS). Doppler ultrasound is a reliable method of evaluating vessel and shunt hemodynamics, and is also noninvasive. In this limited study, Doppler provides a noninvasive technique for estimating portosystemic pressure gradients; and these Doppler-derived measurements are correlated to data obtained by angiography, using angiography as the gold standard.
Aortic Dissection
Authors: Ruffin John D.
Published: March 2006

Aortic dissection is a lethal condition that requires immediate medical and, many times, surgical intervention. A case involving a patient with such a condition and in which the findings were incidental is presented.
Phlegmasia Cerulea Dolens
Authors: Dempsey Rich
Published: March 2006

The use of duplex ultrasound in the detection of deep veint thrmbosis i's widespread. A particularly severe form of iliofemoral thrombosis, phlegmasia cerulea dolens, is discussed.
Quantitative Echocardiography, Part 2
Authors: Waggoner Alan D. , Dávila-Román Víctor G. , Barzilai Benico , Miller James G. , Pérez Julio E.
Published: March 2006

Two-dimensional echocardiography is widely used for assessment of cardiac chamber size and function. A new method for real-time quantitative assessment of left ventricular systolic function using automatic boundary detection (ABD) has been developed based on principles of quantitative ultrasound backscatter imaging of the myocardium. The clinical accuracy of ABD for measurement of cardiac chamber areas and volumes has been validated against conventional two-dimensional echocardiography, transesophageal echocardiography, radionuclide ventriculography, and left ventriculography. Left ventricular diastolic function can also be evaluated by ABD, and the results complement those obtained indirectly by pulsed Doppler echocardiographic recordings of the diastolic mitral flow velocity. Recently, ABD has also been used to evaluate left atrial chamber dimensions and atrial function. Thus, real-time ABD is a new echocardiographic method for quantitative assessment of cardiac function that obviates the need for off-line analysis of video images.
Writing To Learn In Ultrasound
Authors: Jones Felicia M.
Published: March 2006

Writing to learn is a relatively new concept that is designed to help improve student learning and retention through writing assignments. These assignments are often short and specific. This is a learning tool that can be easily incorporated into any study program, even a clinically based one. This method of learning can also be used by working sonographers as they complete continuing education requirements.
Ultrasound Techniques and Follow-Up Exaninations in Placenta Previa
Authors: Duncan Bruce C.
Published: March 2006

In placenta previa, the placenta occupies a position near the internal os at or after 28 weeks of gestation. Ultrasound examination has been used to diagnose placenta previa in 6% of the general population during the first trimester of pregnancy. More than 90% of these cases undergo placental conversion by the third trimester. This conversion (commonly called migration) is caused by the differing growth patterns of the uterine corpus and the lower uterine segment. To correctly diagnose placenta previa, it is crucial to utilize all available ultrasound techniques, including endovaginal and translabial scanning. This retrospective study examines the timing and the techniques of follow-up ultrasound examination in placenta previa.
Single Fetal Umbilical Artery
Authors: Persutte Wayne H.
Published: March 2006

An interesting variant of single fetal umbilical artery that presented with intermittent cord segments of three patent vessels is described. The ultrasound findings and clinical significance of the case are also discussed.
Ureteral Encasement and Medial Deviation Demonstrated by Ultrasound in a Case of Retroperitonea1 Fibrosis
Authors: Ghazle Hamad H. , Abu-Yousef Monzer M. , Brown Bruce P. , Barloon Thomas J.
Published: March 2006

The sonographic findings in a case of retroperitoneal fibrosis, which demonstrated encasement and medial deviation of the ureters by the mass, are discussed. Since sonography is the primary screening modality for hydronephrosis, it is possible to use graded-compression sonography in the same setup to make a specific diagnosis of this entity.
Prolapsed Placental Polyp
Authors: Richmond L. Braden , Carlan Stephen J. , Danna Penny , Roth Lynn
Published: March 2006

Chronic retained placental fragments usually result in late postpartum bleeding. Rarely, the rtained pacenta presents as a placental polyp. The sonographic findings in a case in which a placental polyp prolapsed through a dilated cervix into the vaginal canal are described.
Ultrasound Examination of a Retained Cervical Stump
Authors: Smith Patricia A.
Published: March 2006

Supracervical; hysterectomy is a seldom-used procedure, but there are many women with a cervical stump. Manual pelvic examination of these women is&t oftenI diffult,: and identification :otf a pelvic mass in: women with a retained cervicalt stump often requires additional diagnostic testing, as problems in both the ovaries and cervix must be considered. A case of a benign cystic cervical stump with characteristics similar to ovarian cys tadenoma or cystadenocarcinoma is discussed.
Sonographic Appearance of Omental Implants
Authors: Davis Heather , Gwin-Stewart Juli
Published: March 2006

The importance of recognizing omental implants during physical and sonographic examinations is discussed. Identification of the sources of these implants, their clinical appearance, radiologic assessment, and diagnosis may alter a patient's treatment options.
Ultrasound Diagnosis of Medullary Neplrocalcinosis in a Pediatric Patient
Authors: Simons Lisa S.
Published: March 2006

The sonographic diagnosis and possible etiologies of medullary nephrocalcinosis in a neonate are described. Ultrasound findings include non-shadowing echogenic pyramids throughout the kidney. Possible etiologies in this patient include milk-alkali syndrome, hypervitaminosis D, and amphotericin B exposure.
Mid-Trimester Ruptured Cornual Pregnancy
Authors: Pisani Albert L. , Davis Jane L. , Carlson Dru E. , Platt Lawrence D.
Published: March 2006

A case involving a woman with normal sonographic findings at genetic amniocentesis who had a ruptured cornual ectopic pregnancy at 19 weeks gestation is discussed.
Autocorrelation Detection in Color Doppler Imaging
Authors: Hedrick W. R. , Hykes D. L.
Published: March 2006

Autocorrelation is the most common method used to estimate velocity in color flow imaging. Measurement of reflector velocity is obtained by manipulating the echo-induced signals generated from consecutive transmitted pulses. The processing steps in autocorrelation, including quadrature detection, gating, fixed echo cancellation, and mean frequency calculation, are discussed. Aliasing, which arises from limited sampling rate of pulsed wave instruments, is described.
Ultrasound Evaluation of Heterotopic Pregnancy
Authors: Gross Paula R.
Published: March 2006

Transabdominal ultrasound combined with transvaginal scanning is a valuable tool for the diagnosis of heterotopic pregnancies. A case of a concurrent intrauterine and extrauterine pregnancy is discussed. Also included is a discussion of the incidence, symptoms, and causes of heterotopic pregnancy, and the findings and treatments associated with ectopic pregnancies.
Antenatal Diagnosis of Infantile Polycystic Kidney Disease in a Twin Gestation
Authors: Chenoweth-Mitchell C. K. , Neperud Julia , Cohen Gary R. , Sims Micquelynne G.
Published: March 2006

Infantile polycystic kidney disease is an autosomal recessive disorder characterized by bilateral and symmetric enlargement of the kidneys. The renal parenchyma is characteristically replaced by cystic dilatation of the collecting tubules.1 This case report discusses the sonographic criteria used to antenatally diagnose infantile polycystic kidney disease.
Sonographic Evaluation of Sialolithiasis
Authors: Keener Thomas S. , Winter Thomas C.
Published: March 2006

Salivary gland diseases are relatively common disorders. One of these is salivary calculi (sialoliths), which occurs in the submandibular and parotid glands of middle-aged adults. These are relatively common and often give rise to inflammation and infection of the gland. Radiologic methods used to evaluate these stones include computed tomography, magnetic resonance imaging, and sialography. With improvements in diagnostic ultrasound equipment and, very recently, amplitude power mapping, the diagnosis of sialolithiasis and sialodochitis was made non-invasively. This is the first report of sialodochitis diagnosed using amplitude power mapping.
Mitral Value Replacement Using the Konsari Procedure: Unusual Two-Dimensional Echocardiography Findings
Authors: Rhodes Michelle
Published: March 2006

A 49-year-old woman with myxomatous mitral valve degeneration complicated by severe mitral regurgitation caused by endocarditis and left ventricular dilatation underwent successful mitral valve replacement using the Khonsari technique. Preoperative two-dimensional Doppler echocardiography showed severe mitral regurgitation, progressive left ventricular dilatation, left atrial enlargement, and marked calcification of the posterior anulus. Color-flow imaging revealed severe mitral regurgitation. Cardiac catheterization revealed normal coronary arteries. Postoperative findings detected by transthoracic two-dimensional and Doppler echocardiography are shown and a review of the procedure used in conjunction with mitral valve replacement is presented.
Ultrasound Diagnosis of Mammographicaily Occult Minimal Carcinoma of the Breast
Authors: Schiller Vicki L. , Gurfinkel Faina , Wolke Joyce , Kushwaha Dawn
Published: March 2006

Minimal cancer, defined by the Breast Cancer Detection Demonstration Project, includes tumors up to 1 cm in size. The detection of these malignancies by either mammography or ultrasound has great prognostic importance because axillary lymph node involvement correlates directly with tumor size. Although ultrasound is a complimentary technique to mammography, tumors can be detected sonographically when mammography is negative. Additionally, cancers may be seen sonographically in instances where only subtle architectural distortion is seen mammographically. In younger women, who have denser breasts, ultrasound is often the primary diagnostic modality used to work-up a palpable mass.
Normal Fetal Growth Assessment: A Review of Literature and Current Practice
Authors: Hearn-Stebbins Bobbi
Published: March 2006

A review of literature and current practice of normal fetal growth assessment is presented. Ultrasonographic dating of pregnancy in the first, second, and third trimester is reviewed. Individual biometric parameters are examined, and the proper use of the fetal growth profile is explained. Use of this information is discussed as it pertains to the single pregnancy.
Antenatal Diagnosis of Absent Pulmonary Valve Syndrome
Authors: Chenoweth-Mitchell Carol , Cohen Gary R. , Sims Micquelyne , Nepperud Julie
Published: March 2006

With the widespread use of antenatal ultrasonography and the rising popularity of fetal echocardiography, complex cardiac anomalies are being diagnosed more frequently during the antenatal period. This is a case report of an absent pulmonary valve syndrome in a fetus with an intact ventricular septum and a patent ductus arteriosus. This combination of cardiac defects is very rare.
Unusual Sonographic Findings of Acute Appendicitis Mimicking Right Hydrosa lpinx
Authors: Sherer David M. , Abulafia Ovadia
Published: March 2006

A case of acute appendicitis involving an appendix located unusually low in the pelvis was preoperatively misdiagnosed, using ultrasound, as hydrosalpinx. We discuss factors that led to this error and how similar occurrences may be avoided. This case emphasizes that gynecologic sonographers should to be familiar with the sonographic characteristics of acute appendicitis.
Ultrasound on the Internet Surfing the Ultrasound Wave
Authors: Lockhart Andrea Clapp
Published: March 2006

This project shows the value development of an ultrasound resource on the Internet and provides an overview of the process involved in its creation. The research behind this project is intended to provide the ultrasound community with the benefit of this resource and the encouragement to develop others like it.
Fetal Echogenic Lung Mass Spontaneous Kesolution In Utero
Authors: Hurton Toni , Bromley Bryann
Published: March 2006

Echogenic fetal lung masses diagnosed by prenatal sonography are not always associated with poor outcome. Two cases are presented with spontaneous resolution in utero and delivery of normal newborns.
Sonographic Evaluation of the Fetal Femur Length in the Chinese Population
Authors: Lachman Yosefa , Shen Bo
Published: March 2006

Sonograms of 128 Chinese fetuses scanned between 16-20 weeks' gestational age, with last menstrual period and average sonographic age corresponding by ± 10 days, were evaluated retrospectively. The fetal femur length was measured longitudinally using a linear phased array transducer. The observed femur lengths were compared with the corresponding data in Hadlock's chart, which is based on a white middle class population. Results indicated that the Chinese femur length was shorter than the Hadlock values by 0.56 mm. The analysis of variance revealed that this difference was consistent throughout pregnancy. Although the findings were statistically significant, they do not indicate a need for an adjustment to the Hadlock chart, as 0.56 mm would suggest a difference of only O.3 weeks.
Ultrasound Diagnosis of a Torsed Appendix Testis
Authors: Peterson Jeri , Rapp Cindy
Published: March 2006

The role of ultrasound is key in the diagnosis of torsed appendix testis. Testicular torsion is a surgical emergency, whereas torsion of the appendix testis is managed conservatively with medication. The authors present an example of sonographically diagnosed torsed appendix testis.
Detection of a Vascular Ring With Fetal Echocardiography
Authors: Meyer Karla B. , Wiles Henry B.
Published: March 2006

Aortic arch anomalies may have major clinical significance after birth. Prental diagnosis of an aortic arch anomaly creating a vascular ring was detected by two-dimensional ultra-sound and is presented in this case report.
Sonographic Evaluation of the Two Vessel Umbilical Cord
Authors: Bornemeier Shaun , Carpinito Lisa A. , Winter Thomas C.
Published: March 2006

Evaluation of the umbilical cord is an important part of a fetal ultrasound examination. The gold standard for documenting the umbilical cord has been an axial section of a free loop of umbilical cord within the amniotic fluid. There are normally two umbilical arteries and one umbilical vein, but in approximately 1% of pregnancies, only one umbilical artery is present. The presence of a two vessel umbilical cord or a single umbilical artery has been associated with an increase in other fetal abnormalities. When axial views of the umbilical cord are not obtainable, it is common practice to use color Doppler to determine the presence or absence of the umbilical arteries as they course adjacent to the fetal bladder. The three-vessel cord is confirmed by identifying the right and left umbilical arteries on each side of the bladder.

This study compared axial views of free-floating two vessel umbilical cords with color Doppler evaluation of the umbilical arteries adjacent to the bladder and attempted to answer three questions regarding the single umbilical artery: 1) Does the presence of two umbilical arteries next to the fetal urinary bladder validate the documentation of a three vessel umbilical cord; 2) When one umbilical artery was absent, was there a prevalence as to which side was affected; and 3) Does the side of the absent umbilical artery correlate with an increase or decrease in risk for other anomalies?

This study showed that there were three sonographic variations with respect to a two vessel umbilical cord when axial gray scale images of the umbilical cord were compared with color Doppler images of the umbilical arteries adjacent to the fetal urinary bladder. The most prevalent variation, occurring in 17 (49%) of 35 cases, was the two-vessel cord with the left umbilical artery absent. The right umbilical artery was absent in 13 (37%) of 35 cases. The third and least prevalent variation, occurring in five (14%) of 35 cases, was a two vessel umbilical cord with both umbilical arteries present adjacent to the fetal urinary bladder. Each of the single umbilical artery variations in the study were associated equally with other sonographically identifiable abnormalities. We conclude that a two vessel umbilical cord may be missed by relying solely on color Doppler views of the umbilical arteries adjacent to the bladder.
Sonographic Diagnosis of Reteinal Detachnents
Authors: Jorgensen Ellen
Published: March 2006

Real-time sonography is a valuable tool in establishing the diagnosis of retinal detachment in eyes with visually opaque media. It also can add valuable information regarding the condition of the subretinal space in all patients with retinal detachment. This paper reviews basic anatomy of the eye and types and descriptions of retinal detachments, their causes, and some of the abnormal processes involved. A basic scanning method for evaluating the eye is discussed, followed by methods of differentiating between abnormal conditions with similar appearances. It is within the scope of the general sonographer to provide accurate, reliable information and ultimately affect the timing and planning of surgery.
Comparison of Conventional Color Doppler With Power Doppler Sonograhy to Depict Normal Prostatic Vasculature
Authors: Keener Thomas S. , Nghiem Hanh Vu , Krieger John N. , Berger Richard E. , Rothman Ivan , Winter Thomas C. , Mack Laurence
Published: March 2006

Transrectal sonograms of the prostates of 30 healthy men were performed using conventional gray-scale sonography, color Doppler sonography (CDS), and power Doppler sonography (PDS). Representative images were recorded at each of six defined anatomical zones. Images were characterized independently by two reviewers for the degree of capsular and parenchymal vascularity, using semiquantitative scales. Color Doppler sonography showed complete capsular flow in only 3 (10%), sparse capsular flow in 18 (60%), and no capsular flow in 9 (30%) of the 30 subjects. In contrast, PDS showed complete capsular flow in 20 (67%), sparse capsular flow in 10 (33%), and no capsular flow in 0 of the 30 subjects (chi square = 23.85, df = 2, P < 0.0901). These findings suggested that PDS was more sensitive than CDS for demonstrating capsular blood flow. Although both techniques showed parenchymal flow in all subjects, PDS showed more radiating and penetrating parenchymal vessels than CDS. Color Doppler sonography showed short segments of vessels in 20 (67%) of the 30 subjects and complete linear vessels in the remaining 10 subjects (33%). In contrast, PDS showed short segments of vessels in 11 (37%) and complete linear vessels in 19 (63%) of the 30 subjects (chi square = 5.41, df = 1, P = 0.02). Subjectively, both reviewers also found that PDS demonstrated prostatic vasculature better than CDS. Power Doppler sonography proved superior to CDS to demonstrate normal prostatic vasculature.
Quality Control for Real-Time Ultrasound Equipment
Authors: Hedrick W. R. , Hykes D. L.
Published: March 2006

A quality control program for the routine monitoring of real-time ultrasound equipment is described. To be effective, the quality control program must incorporate performance tests that are most likely to detect common system problems. These selective tests include assessment of penetration, distance accuracy, uniformity, and fidelity of image recording. A tissue equivalent phantom with an attenuation rate of 0.7 dB/MHz/cm is recommended for quality control testing. Mechanical inspection of transducer housing, connector, power cord, and console must also be conducted.
Fetal Hydrothorax
Authors: Hurton Toni , Morrill Heather , Bromley Bryann
Published: March 2006

Fetal pleural effusions have a variable course in pregnancy. An unusual case of dynamic variation in the extent of fetal hydrothorax is presented.
Attitudes, Trends, and Standard of Practice for the Sonogra her
Authors: Persutte Wayne H.
Published: March 2006

Diagnostic medical sonographers have been important members of the health care team for more than 25 years. This longevity notwithstanding, their current role in clinical care remains unclear. The purpose of the following study was to investigate the attitudes and opinions of sonographers in the United States. A random, prospective, cross-sectional study of 200 sonographers who were members of the American Institute of Ultrasound in Medicine was conducted in both 1991 and 1996. This survey was used to evaluate demographics, education, nature of clinical practice, and attitudes regarding sonographic education, standards, practices, regulation, and professional relationships. Sonographers' responses were summarized and analyzed. Approximately 57% and 59% of sonographers surveyed responded to the survey in 1991 and 1996, respectively. Except for respondent age and experience, the demographic information did not change significantly when the two survey periods were compared. Respondents were observed to support “formal” educational programs in sonography, and supported both personal and programmatic certification. Significant variability regarding the reported typical standards of practice were observed. In addition, when attitudes and responses were compared based on the clinical duties of the respondents, significant differences in the frequency of affirmative responses were also found. The traditional model for sonographer scope and nature of practice is no longer valid in all circumstances. Significant latitude is observed regarding sonographer education. In addition, significant diversity was observed regarding institutional standards of practice. These data suggest a dramatic disparity between the perceived role of the sonographer and his traditionally defined role. The role of the sonographer in the usual practice of medicine should be further investigated.
Do Sonographers Practice Proper Infection Control Techniques?
Authors: Kartaginer Ruthie , Pupko Adina , Tepler Chavie
Published: March 2006

The Occupational Safety and Health Administration has established guidelines to help prevent the spread of infection in health care environments. Although there are no guidelines established specifically for ultrasound departments, general infection control protocols exist. In previous studies, researchers evaluated the compliance with infection control techniques among health care professionals, yet few researchers have focused on the field of ultrasound. Therefore, the authors sent 100 surveys to ultrasound departments located within the five boroughs of New York. Specific questions were asked regarding practiced infection control technique, including hand washing, glove use, transducer cleaning, disinfection and sterilization, wearing of additional protective clothing when necessary, and examination room maintenance. A 51% response rate was obtained. A number of statistically significant correlations were found between the personal characteristics of the sonographer and the adherence to universal precautions. With strict adherence to Occupational Safety and Health Administration guidelines, and with proper support and enforcement by ultrasound departments, sonographers should be able to provide a clean, infection-controlled environment.
Endomnetriomna of the Anterior Abdominal Wall Not Related to a Previous Scar
Authors: Bedi Deepak G. , Mostafa Hosam
Published: March 2006

Endometriosis of the abdominal wall usually occurs in a scar, and rarely in the intact rectus abdominis muscle. A 38-year-old woman presenting with an abdominal wall mass, which was cyclically tender with her menstrual periods, had an endometrioma not related to a previous scar. Based on a sonogram, the mass was solid, hypoechoic, and situated entirely within the rectus muscle. The differential diagnosis includes abscess, hematoma, and neoplasm, but the cyclical tenderness and enlargement of the mass confirms the diagnosis.
Renal Cell Carcinomla in Tuberous Sclerosis
Authors: Ruff Cullen , Rumack Carol M. , Wootton-Gorges Sandra , Ingram J. David
Published: March 2006

Renal cell carcinoma within an angiomyolipoma was diagnosed in a 21-year-old man with tuberous sclerosis. Ultrasound characteristics are discussed. A review of the 21 cases reported since 1969 suggests an increased incidence of renal cell carcinoma in patients with tuberous sclerosis. Genetic studies in humans and animals support this observation. Awareness of predisposition to renal carcinoma is important to help identify this malignancy in patients with tuberous sclerosis and to differentiate carcinoma from other renal lesions that commonly occur in these patients.
The Sonographic Appearance of Placenta Accreta
Authors: Isaacs Dirk L. , Rouse Glenn A. , de Lange Marie , Goeser Christopher D. , Lyko Ewa
Published: March 2006

Placenta accreta is an uncommon entity in which the placental villi invade the myometrium. The classic sonographic findings include the absence of a hypoechoic retroplacental zone, the presence of dilated vessels extending from the placenta through the myometrium, irregular cystic spaces in the placenta, and pulsatile maternal blood flow within these hypoechoic spaces. It is often accompanied by placenta previa. In this study, the authors report findings in six cases, four of which were accurately diagnosed sonographically as placenta accreta, one which resulted in a false-positive diagnosis, and one which resulted in a false-negative diagnosis. We review the roles of two-dimensional imaging, color-flow Doppler, and power Doppler in assessing this condition. Because of the associated high risk of maternal exsanguination, ultrasonography is an important and reliable tool in diagnosing accreta.
The Use of Myocardia1 Performance Index on Pediatric Heart Transplant Patients
Authors: Gonzalez Remijio , Dyar Daniel , De Lange Marie
Published: March 2006

The Myocardial Performance Index (MPI) is a relatively simple, noninvasive method of assessing ventricular function. Previous studies established normal and abnormal MPI values in adult populations and in normal pediatric populations. Values for pediatric heart transplant patient have not been reported. In this study, normal MPI values for pediatric heart transplant patients were recorded. These values were measured during routine echocardiograms. A sample population of 33 patients with a mean age of 4.9 years old was tested. These patients underwent heart biopsies to assess rejection status, and all patients were found to be free from rejection. The results of this study show that MPI values for pediatric heart transplant patients range from a low of 0.25 to a maximum of 1.3, with a mean value of 0.56 and a standard deviation of 0.06.
Sonograhic Diagnosis of Oriental Cholangioheatitis
Authors: Kent Martha G.
Published: March 2006

Oriental cholangiohepatitis, also known as recurrent pyogenic cholangitis, intrahepatic pigmented stone disease, or oriental cholangitis, is a disease commonly seen in countries in Southeast Asia. As immigration to the United States from these regions increases, the medical community encounters this disease more frequently. Symptoms of Oriental cholangiohepatitis include repeated attacks of abdominal pain, fever, chills, and jaundice. Localized stenosis of the bile ducts occurs, leading to stasis, infection, and obstruction. Symptoms usually reoccur throughout a period of time until a chronic condition exists. Sonographers and sonologists should familiarize themselves with the ultrasound findings associated with this entity.
Investigating Patient Satisfaction as an Outcome for Ultrasound-Guided Breast Procedures
Authors: Evans Kevin D.
Published: March 2006

An investigation of patient satisfaction with ultrasound-guided breast procedures (fine needle biopsy and cyst aspiration) was performed. The research was designed around a proposed imaging loop added to the Health Related Quality of Life model. A patient questionnaire, devised to assess three areas of the imaging loop—preanalytical, postanalytical, and overall satisfaction with the procedure—was administered. Results show a population of patients satisfied with these invasive procedures. Study patients' satisfaction levels were comparable with those of control subjects. Procedure anxiety was identified as a patient perception, but did not hamper level of satisfaction. Study patients also reported that ultrasound-guided breast procedures contributed to a perception of favorable overall health and gave a high level of patient satisfaction.
Intraoperative Sonographic Localization of Renal Calculi
Authors: Sarram Ali , Oottamasathien Siam , Meacham Randall B.
Published: March 2006

Intraoperative ultrasound is a quick and safe method for aiding in the surgical removal of renal calculi. Multiple calculi may be identified readily, resulting in a time effective and thorough surgical procedure.
Findings of Abdomninal Heterotaxia and Associated Congenital Heart Disease
Authors: Mayhew Bridgett , Chenoweth-Mitchell Carol K. , Sims Micquelyne
Published: March 2006

The prenatal finding of abdominal heterotaxia in conjunction with complex congenital heart defects should indicate the possible diagnosis of cardiosplenic syndrome—specifically, asplenia or polysplenia. Unfortunately, the prognosis for patients with either of these syndromes is usually poor. In this case, antenatal findings were indicative of asplenia, but neonatal testing revealed a normal-functioning spleen. This finding, along with detailed documentation of the congenital heart defects by fetal echo examination, dramatically improved the patient's prognosis and ultimate outcome.
Power Doppler
Authors: Lin G. Sharat , Milburn Donald T. , Briggs Sandra
Published: March 2006

In contrast to frequency-shift color Doppler imaging (CDI), which indicates blood flow velocity and direction, power CDI (PCDI) visualizes the concentration of moving blood scatterers. It is more sensitive than CDI, relatively angle independent, free of aliasing, more accurate in depicting luminal edges, and better in visualizing the continuity of flow. The reasons for this are to be found not so much in the technology but rather in the inherent nature of an amplitude (or power) signal. Nevertheless, recent technologic advances based on PCDI have considerably expanded its clinical use. Topographic PCDI improves delineation of small adjacent vessels. Three-dimensional ultrasound angiography visualizes complex branching and entire vascular trees. Fractional moving blood volume uses power Doppler data to measure the relative amount of blood perfusing an organ. Ultrasound contrast agents and second harmonic imaging significantly increase sensitivity for PCDI detection of small-volume, low-velocity, and deep flows.
Prenatal Diagnosis of Total Anomalous Pulmnonary Venous Connection
Authors: Drose Julia A. , Shaffer Elizabeth M.
Published: March 2006

Total anomalous pulmonary venous connection remains a difficult diagnosis to make prenatally. The absence of normal pulmonary veins entering the left atrium may provide an indication of an abnormality. The authors discuss a case of total anomalous pulmonary venous connection in conjunction with hypoplastic left heart syndrome that was diagnosed in utero.
The Use of Nuchal Lucency as a Screening Tool in First Tritester Sonography
Authors: Stevens Sherri L.
Published: March 2006

Improved ultrasound resolution and continuing attempts to detect congenital abnormalities and chromosomal aberrations in early pregnancy have led to the use of nuchal lucency as a marker for such conditions in the first trimester. Current research has shown the importance of increased nuchal lucency (greater than 3 mm) as an identifying risk marker for aneuploidy and, in the presence of normal karyotype, additional anatomic anomalies.
Target Echo
Authors: Reynolds Terry , Abate Joseph , Arias Manual
Published: March 2006

Changes in the health care system require methods for improving efficiency and quality. In the echocardiographic laboratory, digital acquisition has been introduced. This move towards a digital echocardiographic laboratory will affect how pertinent images are acquired.
Responsibilities of Sonographers in the Neurosonography Specialty
Authors: Prince Patricia A. , Lindler Elizabeth C. , Screen Angela M. , Babyn Paul
Published: March 2006

The American Registry of Diagnostic Medical Sonographers (ARDMS) administers credentials for individuals in the fields of sonography and vascular technology to obtain credentials in those fields. The examinations reflect current practices in each of the specialty areas. Task surveys are used by the ARDMS to determine tasks and instrumentation in practice by registered sonographers in that specialty area. The task surveys are analyzed to reveal current practices, and the content outlines for the examinations are revised using the survey results. The results of the 1998 Neurosonology Task Survey are presented; the outline changes are discussed; and the updated content outline is provided.
Papillary Renal Cell Carcinoma
Authors: Berry Judy S.
Published: March 2006

Papillary renal cell carcinoma comprises approximately 10% of all renal cell carcinomas. This subtype has a slower growth pattern, has less extensive involvement, and portends a better prognosis than do nonpapillary renal cell carcinomas. Papillary renal carcinomas tend to be avascular or hypovascular on ultrasound examination. It is important not to mistake this lack of vascularity as a sign of benign tumor. The sonographic appearance of papillary renal cell carcinomas is variable, but most display low-level echoes. This case study demonstrates an incidental finding of a typical presentation of papillary renal cell carcinoma in a patient with no symptoms.
Sonographic Evaluation of a Dermal Sinus Tract (Occult Spinal Dysraphism)
Authors: Pritchett Gabe
Published: March 2006

Occult spinal dysraphism, also referred to as spina bifida occulta, is a mild form of spinal abnormality. This congenital anomaly may go undetected at birth because of the late onset of neurologic symptoms. It is a correctable anomaly that is not life threatening. If detection occurs early in life and corrective surgery is performed, the child has a good chance of living a normal life, with few or no adverse effects.
Standard Versus Simplified Proxizmal Isovelocity Surface Area: An Echocardiographic Approach
Authors: Le Van Lisa C. , Chadwell Kimberly K.
Published: March 2006

A noninvasive approach to quantitatively assessing mitral valve regurgitation is called the proximal isovelocity surface area (PISA) method. The basis for the PISA technique is to use color and spectral Doppler to measure flow velocity and effective area and then calculate effective regurgitant orifice area and regurgitant flow volumes as defined by the conservation of mass theory. Moreover, the complexity of these calculations leads to the search for a simplified approach to this laborious quantification method. It is with this in mind that a close clinical correlation of the standard PISA and the newly derived simplified PISA is established through the use of noninvasive techniques. In a prospective study, 21 patients (10 men and 11 women; mean age, 68.9 years) with at least mild mitral regurgitation were evaluated by color and spectral Doppler echocardiography. Two-dimensional imaging measurements also were recorded. This study used the simplified proximal convergence flow rate (r2 X Va), the standard PISA calculation, and the left atrial volume measurement. The simplified proximal convergence method correlated well with the standard PISA method but lacked a solid linear relation with the left atrial volume assessment. Simplified PISA shows accuracy in stratifying mild mitral regurgitation and moderately severe to severe mitral regurgitation. However, there remains a range (10-20 mL/s) in which further assessment may be necessary, either invasively or noninvasively, to accurately quantify the degree of mitral regurgitation.
The differentiation program of embryonic definitive hematopoietic stem cells is largely α4 integrin independent
Authors: Gribi Ruby , Hook Lilian , Ure Janice , Medvinsky Alexander
Published: March 2006

Previous analyses of the roles of α4 integrins in hematopoiesis by other groups have led to conflicting evidence. α4 integrin mutant cells developing in [α4 integrin–/–: wt] chimeric mice are not capable of completing lymphomyeloid differentiation, whereas conditional inactivation of α4 integrin in adult mice has only subtle effects. We show here that circumventing the fetal stage of hematopoietic stem cell (HSC) development by transplantation of embryonic α4 integrin–/– cells into the adult microenvironment results in robust and stable long-term generation of α4 integrin–/– lymphoid and myeloid cells, although colonization of Peyer patches and the peritoneal cavity is significantly impaired. We argue here that collectively, our data and the data from other groups suggest a specific requirement for α4 integrin during the fetal/neonatal stages of HSC development that is essential for normal execution of the lymphomyeloid differentiation program.
Emergency Department Visits for Injury in School‐aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment
Authors: Linakis James G. , Amanullah Siraj , Mello Michael J.
Published: March 2006

Objectives:
To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same‐aged children who were injured outside of school.

Methods:
Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury‐related ED visits were analyzed for patients who were 5 through 19 years of age.

Results:
There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school‐aged children (ages 5–19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school‐aged children when location of injury was known). Males accounted for 63% of injuries at school; middle‐school children (ages 10–14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary‐ (5–9 yr, 24%) or secondary‐school (15–19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary‐school children were injured most (40%), followed by middle‐ (32%) and primary‐aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school‐aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001).

Conclusions:
A significant proportion of injuries to school‐aged children occur at school. Notable differences exist between the epidemiology of in‐ and out‐of‐school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.
Screening for Adolescent Depression in a Pediatric Emergency Department
Authors: Scott Emily Gale , Luxmore Brett , Alexander Heather , Fenn Robin L. , Christopher Norman C.
Published: March 2006

Objectives:
To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms.

Methods:
The Beck Depression Inventory–2nd edition (BDI‐II) was used to screen all patients 13–19 years of age who presented to the ED during the period of study. The BDI‐II is a 21‐item self‐report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening‐program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health).

Results:
Four hundred eighty‐seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI‐II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms.

Conclusions:
Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression.
Comparison of the National Emergency Department Overcrowding Scale and the Emergency Department Work Index for Quantifying Emergency Department Crowding
Authors: Weiss Steven J. , Ernst Amy A. , Nick Todd G.
Published: March 2006

Background:
Emergency department (ED) crowding is just beginning to be quantified. The only two scales presently available are the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN).

Objectives:
To assess the value of the NEDOCS and the EDWIN in predicting overcrowding. The hypothesis of this study was that the NEDOCS and the EDWIN would be equally sensitive and specific for overcrowding.

Methods:
The NEDOCS, the EDWIN, and an overcrowding measure (OV) were determined every two hours for a ten‐day period in December 2004. The NEDOCS is a statistically derived calculation, and the EDWIN is a formula‐based calculation. The overcrowding measure is a composite of physician and charge nurse expert opinion on the degree of overcrowding as measured on a 100‐mm visual analogue scale (VAS). The primary outcome, overcrowding, was based on the dichotomized OV VAS score at the midpoint of 50 mm (≥50, overcrowded; <50, not overcrowded). The area under the receiver operator characteristic curve (AUC) and an index of adequacy (relative prognostic content) of each measure, on the basis of the likelihood ratio chi‐square statistic, were computed to evaluate the performance of NEDOCS and EDWIN.

Results:
There were 130 completed sampling times over ten days. The OV indicated that the ED was overcrowded 62% of the time. The AUC for the NEDOCS was 0.83 (95% CI = 0.75 to 0.90), and the AUC for the EDWIN was 0.80 (95% CI = 0.73 to 0.88). The NEDOCS score accounts for 97% of the prognostic information provided by combining all variables used in each model into one combined model. The EDWIN score accounts for only 86% (χ2 test for difference, p = 0.02).

Conclusions:
Both scales had high AUCs, correlated well with each other, and showed good discrimination for predicting ED overcrowding. This establishes construct validity for these scales as measures of overcrowding. Which scale is used in an ED is dependent on which set of data is most readily available, with the favored scale being the NEDOCS.
Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage
Authors: Carstairs Shaun D. , Tanen David A. , Duncan Timothy D. , Nordling Olaf B. , Wanebo John E. , Paluska Thomas R. , Theodore Nicholas , Riffenburgh Robert H.
Published: March 2006

Objectives:
Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH.

Methods:
Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient's history.

Results:
A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false‐positive CTA. Follow‐up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm.

Conclusions:
In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results.