Common carotid artery: variability of Doppler US velocity measurements.

PURPOSE: To determine if Doppler ultrasound (US) measurements of systolic velocity in the common carotid artery vary markedly with distance from the bifurcation. MATERIALS AND METHODS: Bilateral, insonation angle-corrected velocity was measured with US in the common carotid artery. Measurements were obtained 1, 2, 3, 4, and 5 cm from the carotid artery bifurcation in 20 volunteers (aged 25-43 years) with no history of neurologic or cardiovascular disease. RESULTS: Velocity in the common carotid artery increased with distance (toward the aorta) from the bifurcation (mean increase, 9 cm/sec for each centimeter of distance from the bifurcation, up to the 4-cm distance; P < .001). Velocity increased more rapidly in subjects who were younger (P < .001) and in those with a lower pulse rate (P = .001). CONCLUSION: The distance from the bifurcation at which common carotid artery velocity is measured should be standardized. This may increase the accuracy of the systolic velocity ratio for assessment of internal carotid artery stenosis and decrease some of the reported variability between different centers that perform US of the carotid artery.

Pelvic computed tomography of breast carcinoma patients. Should it routinely be added to abdominal computed tomography?

BACKGROUND: This study was conducted to determine if pelvic computed tomography (CT) should routinely be appended to abdominal CT in the workup of patients with breast carcinoma. METHODS: The abdominal-pelvic CTs of 139 breast carcinoma patients (195 exams) were reviewed. Scans were grouped by indication and whether pelvic pathology was known before CT. Pelvic CT results were correlated with their effect on patient management. RESULTS: Among the 119 patients without pre-CT evidence of pelvic disease, a nonosseous pelvic metastasis was identified in only 1; this patient also had liver metastases and management was not changed. No unsuspected pelvic CT finding altered therapy for breast carcinoma. However, three patients underwent surgery for asymptomatic masses discovered on pelvic CT; all were benign. CONCLUSIONS: Pelvic CT is unlikely to affect the management of patients with breast carcinoma by detecting occult metastatic disease.

Ovarian carcinoma: value of CT in predicting success of debulking surgery.

OBJECTIVE: Initial therapy for metastatic epithelial ovarian adenocarcinoma involves aggressive surgery to remove as much tumor as possible. However, this procedure is not beneficial for patients unless tumor implants can be reduced to less than 2 cm in diameter. This study was performed to determine whether CT can be used to predict the success of debulking surgery and thereby spare some patients from an unnecessary operation. MATERIALS AND METHODS: Preoperative CT scans of 28 women who underwent primary surgery for ovarian carcinoma were retrospectively reviewed (18 patients had extrapelvic [stage III or IV] disease at surgery). Five regions were analyzed for evidence and extent of metastatic disease (omentum, liver, small bowel mesentery, paraaortic nodes, and diaphragm), and a score of 0-2 (see below) was assigned to each. These scores were added together for a total score of 0-10, which was compared with the surgical results. Receiver operating characteristic curve analysis was used to assess the ability of the scoring system to predict which patients would benefit from tumor debulking. Patient age, serum CA-125 level, and amount of ascites were also examined. RESULTS: On a 10-point preoperative CT scoring system, a score of 3 or higher identified patients whose tumors were not successfully debulked with a sensitivity of 58% (7/12) and a specificity of 100% (16/16). The area under the receiver operating characteristic curve for this system was 0.94. The use of additional parameters, such as extent of ascites, serum CA-125 level, or age, did not improve accuracy. CONCLUSION: Our results show that CT can be used to predict the success of primary debulking surgery in women with metastatic ovarian carcinoma. A significant number of patients in whom the surgery will have no benefit can be identified.

Pulmonary involvement in the hypereosinophilic syndrome.

Hypereosinophilic syndrome (HES) is an infiltrative disease of eosinophils affecting multiple organs, including the lung. Hypereosinophilic syndrome differs from acute and chronic eosinophilic pneumonia clinically and usually necessitates treatment with alkylating agents and/or corticosteroids. We describe two patients with HES and pulmonary involvement. One of our patients developed the adult respiratory distress syndrome thought to be a complication of the HES. Aggressive treatment of HES in both cases combined with intensive support in the patient with ARDS resulted in prolonged survival.

Ureteric obstruction by the right testicular vein: CT diagnosis.

The close relationship of the ureter and gonadal blood vessels is often clearly demonstrated by computed tomography (CT). A case of ureteral obstruction in a man possibly caused by the crossing testicular vein is presented. Unlike the ovarian vein syndrome in women, which is often related to pregnancy and/or venous thrombosis, no predisposing factors were found.