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Biomedical subjects

A M Zagdanski

Publications and source records attributed to A M Zagdanski.

At least 19 recordsLinked to original sources
PubMed2000

Image-guided core-needle biopsy in patients with suspected or recurrent lymphomas.

BACKGROUND: It is now commonly admitted that the diagnosis of recurrence of lymphoma can be assessed by image-guided needle biopsy (IGNB). However, the means of obtaining tissue for the original diagnosis of lymphoma is often surgery. The aim of this study was to compare the accuracy of IGNB at the time of diagnosis and at the time of recurrence or progression. METHODS: The authors performed 212 IGNBs on 194 patients who eventually had a diagnosis of lymphoma. One hundred three IGNBs were obtained at original diagnosis and 109 at recurrence or progression. Large-cutting core-biopsy needles, ranging in size from 20 gauge to 14 gauge, were used. Immunohistochemistry studies were performed in all lymphoma cases. RESULTS: A diagnosis of lymphoma with subtyping was obtained in 88% of all cases, in 85% at initial diagnosis, and in 89% at follow-up. Therapy was initiated on the basis of IGNB in 93% of all cases, in 91% at initial diagnosis, and in 94% at follow-up. Benign complications occurred in 7.5% of cases and did not require specific treatment. IGNB was equally effective for making a specific diagnosis of lymphoma and initiating therapy at the time of original diagnosis and at follow-up. CONCLUSIONS: The authors recommend that IGNB be performed as the initial procedure for the diagnosis of lymphoma in the absence of peripheral lymph nodes, either at presentation or at recurrence.

Adolescent↗
PubMed2000

[Role of MRI in the diagnosis of breast diseases].

UNLABELLED: ADVANTAGES AND LIMITATIONS: Magnetic resonance imaging of the breast is probably the most sensitive method for detecting or ruling out breast disease. It is however not as specific as expected. TECHNIQUE: All examinations are performed with and without gadolinium intravenous administration, excepted in the case of silicone implant reconstruction mammoplasty. Dynamic contrast-enhanced MRI sequences are necessary with a permanent balance between temporal resolution, spatial resolution, and signal. MRI of the breast is not indicated as a routine examination in a screening program, neither to improve the specificity of infra-clinic lesions, nor in simply dense breasts without any known risk factor or in circumscribed masses. INDICATIONS: MRI is best used to improved the sensitivity of mammography and sonography in selected patients. The selected indications are: evaluation of the volume and extension of breast lesions evaluation of the therapeutic response after chemotherapy, and detection or exclusion of the local recurrence in patients with breast conservation therapy. PERSPECTIVES: The future indications and perspectives of MRI include interventional breast radiology (MRI-guided core biopsy), and thermocoagulation therapy. It may be interesting for the evaluation of patients with contrast enhanced MRI lesions with normal mammography and sonography, and also in woman with a genetically defined high breast cancer risk.

Biopsy↗
PubMed2000

[Techniques to improve the accuracy of CT-guided abdominal biopsy].

STUDY AIM: The aim of this paper is to present an overview of the various technical progresses made in the field of CT-guided abdominal biopsies. Recent improvements allowed to markedly increase the efficiency of biopsies and to decrease the number of complications. The main innovations concern the guidance technique itself with the availability of ultra-fast CT systems, the development of automated biopsy systems, which allow to improve the size and quality of tissue samples and numerous technical tricks, allowing an easier access to target lesions, either in patient positioning or in displacement of anatomical structures. A better management of tissue samples favored by a close collaboration with pathologists is also mandatory. The last section of the paper is an overview of the rare complications of CT-guided biopsies.

Abdomen↗
PubMed2000

Diagnostic imaging of choroid plexus disease.

Disorders of the choroid plexus, a central nervous system structure, are rare, but can pose diagnostic difficulties. The purpose of this review is to illustrate the computed tomography and magnetic resonance imaging findings of a wide spectrum of lesions that affect the choroid plexus. The areas covered include (1) neoplasms (papilloma, leukaemia, meningioma, lymphoma and metastases); (2) infections (bacterial, fungal and viral); (3) cysts; (4) haemorrhage; (5) congenital abnormalities (Sturge-Weber syndrome, Klippel-Trenaunay-Weber syndrome and vascular malformations); and (6) non-infectious inflammatory disorders (xanthogranulomas, inflammatory pseudotumour, neurosarcoidosis, rheumatoid nodule and villous hypertrophy). Few of the patterns of choroid plexus involvement are specific for a particular pathological process. Guermazi, A. (2000) Clinical Radiology 55, 503-516.

Adolescent↗
PubMed2000

The clinical and radiological features of Fanconi's anaemia.

Fanconi's anaemia is a severe refractory anaemia, associated with congenital malformations in approximately two-thirds of cases. Although these malformations may involve every organ system, suggestive dysmorphic features include growth retardation, radial ray deformities and urinary malformations. These malformations are not specific for Fanconi's anaemia, but should be recognized during pregnancy, or later in childhood, and suggest the possibility of inherited haematopoiesis disorders.

Abnormalities, Multiple↗
PubMed1999

Imaging findings in patients with myelofibrosis.

The purpose of this review is to illustrate the wide range of radiological abnormalities in myelofibrosis. Myelofibrosis, also called myeloid metaplasia, is a myeloproliferative disorder of unknown etiology. The common imaging findings in patients with myelofibrosis are osteosclerosis, hepatosplenomegaly, and lymphadenopathies. In addition, extramedullary hematopoiesis may develop in multiple sites such as chest, abdomen, pelvis, and central nervous system, simulating malignant disease. Selected plain-film, CT, and MR images in patients with myelofibrosis are shown as pictorial essay to allow ready recognition of the most common imaging abnormalities of the disease.

Bone and Bones↗
PubMed1999

Prognostic value of vertebral lesions detected by magnetic resonance imaging in patients with stage I multiple myeloma.

We assessed the role of spinal magnetic resonance imaging (MRI) and bone densitometry as prognostic factors in patients with asymptomatic stage I multiple myeloma (MM) and negative skeletal survey. 55 consecutive patients underwent spinal MRI and 41 of them underwent bone densitometry by dual-energy X-ray absorptiometry (DEXA). Spinal MRI studies showed evidence of bone marrow involvement in 17/55 patients (31%). A diffuse pattern was present in three patients and a focal pattern in 14 patients, nine of them with only one nodular lesion. During a median follow-up of 25 months, 10 patients had disease progression, 8/17 patients with abnormal MRI and 2/38 patients with normal MRI. Median time to disease progression was not reached in both groups but was significantly different for patients with normal and those with abnormal patterns on MRI (P < 0.0001). Lumbar BMD was only slightly decreased compared with normal people (median lumbar Z score -0.43) and was not of prognostic value. Using a multivariate analysis the only two independent significant prognostic parameters were abnormal MRI (P<0.001, HR 30.4, 95% CI 4.3-213) and bone marrow plasmacytosis >20% (P=0.004, HR 16.4, 95% Cl 2.6-104). Thus, spinal MRI but not bone densitometry, appeared to be justified in patients with stage I asymptomatic MM and negative skeletal survey.

Absorptiometry, Photon↗
PubMed1999

Neurolymphomatosis in Waldenström's macroglobulinaemia.

We report four patients with Waldenström's macroglobulinaemia with an unusual neurologic complication, neurolymphomatosis, characterized by meningeal and root nerve infiltration by lymphoplasmacytic cells. Patients presented with rapidly progressive leg proximal weakness. Examination of cerebrospinal fluid disclosed lymphoplasmacytic cells. Magnetic resonance imaging of the lumbar spine was suggestive of a tissular infiltration of leptomeninges and nerve roots. Chemotherapy and irradiation of involved tissues led to a remarkable and sustained neurological improvement.

Aged↗
PubMed1999

Cervicomediastinal magnetic resonance imaging in persistent or recurrent papillary thyroid carcinoma: clinical use and limits.

Cervicomediastinal magnetic resonance imaging (MRI) was evaluated in 13 consecutive persistent or recurrent papillary thyroid carcinoma (PTC) patients, previously treated by total thyroidectomy and radioiodine ablation. All had elevated thyroglobulin (Tg) levels and were therefore submitted to a new therapeutic radioiodine dose followed by a posttherapeutic whole-body scan (131I-WBS) and subsequent MRI. Patients with known distant metastases were excluded from the study. Group 1 included 7 patients with a negative 131I-WBS, whereas cervical and/or mediastinal 131I-uptake was evidenced in the other 6 patients (group 2). MRI was thus compared to 131I-WBS, and additionally in 8 reoperated cases, to histology. MRI was positive in 11 of 13 (85%) patients, corresponding to 23 of 55 (41.8%) histologically confirmed sites. In group 1, MRI was positive in 5 of 7 patients, with a sensitivity of 47% (15/32 histologically positive sites), allowing appropriate indication of surgery: 4 neck surgery, and 1 mediastinal dissection because of too distant lymph node foci. In group 2, MRI always showed more localization than 131I-WBS; histology was obtained in 3. Because all the foci located in the mediastinal area (0.8 to 1.8 cm) were histologically confirmed (7/7 sites), MRI avoided underestimation of surgery in the 8 reoperated patients. However, additional images were also observed corresponding to a normal thymus, a small neuroma or inflammatory lymph nodes, but pretracheal and very small nodes (less than 0.5 cm) were missed. In conclusion, although less specific than radioiodine scintigraphy, MRI can detect local persistent or recurrent PTC, and seems particularly effective for evaluation of mediastinal involvement.

Carcinoma, Papillary↗
PubMed1999

[Scanner-guided biopsy technic with abdominal compression].

The aim of this study was to present a CT-guided biopsy technique using an abdominal compression device. With this system, the digestive structures (mainly the colon and the small bowel) can be displaced away from the needle track and the distance between the skin and the target lesion can be reduced by approximately one-third. The technique has been used in 29 patients and was successful in 28, allowing node biopsies in the mesenteric, retroperitoneal or pelvic areas. The compression system is easily mounted and used standard sterilizable material. The procedure is well tolerated by patients and complication rate is not raised compared with conventional biopsy techniques.

Abdomen↗
PubMed1998

Computed radiography.

In several medical centers computed radiography has almost completely replaced the use of conventional screen-film systems for general radiography. The aim of this paper is to explain the basic principles of the four most frequently numerical detectors used in the world, with emphasis on the phosphor plates, which are the most frequently used both in hospitals and by practitioners. The other two systems are based on a receptor with selenium. The fourth uses charged coupled device (CCD) detectors. The most important principles of digital processing are then described with concentration on unsharp mask filtering. In the future computed radiography will replace standard radiology and will create a system in medicine using the power of computers to archive--with more efficiency and less space--patient medical data. The transmission of data to workstations and the processing of this data is the topic of a new field in medicine.

Humans↗
PubMed1998

Pulmonary Mycobacterium avium complex disease without dissemination in HIV-infected patients.

Pulmonary disease due to Mycobacterium avium complex (MAC) without evidence of dissemination is uncommon in HIV-infected patients. Five cases were observed over a 2-year period. All patients had AIDS and the median CD4 cell count at the time of presentation was 90 x 10(6)/L. Radiographic patterns included unilobar alveolar infiltrates or diffuse alveolar densities. All patients had a favorable clinical response to antimycobacterial chemotherapy with a median follow-up period of 10 months. MAC should be considered in HIV-infected patients with positive respiratory samples for acid-fast bacilli and pulmonary infiltrates. Patients with such findings in whom presumptive therapy for tuberculosis has failed should receive broad-spectrum antimycobacterial chemotherapy until final identification is available.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Primary cerebral lymphoma in AIDS. Retrospective study of 20 patients].

OBJECTIVES: Analyze the epidemiological pattern of primary central nervous system lymphoma in AIDS patients together with the clinical expression and course under treatment. METHODS: We retrospectively reviewed 20 patients with AIDS-associated primary central nervous system lymphoma hospitalized in our unit between April 1992 and July 1996. Diagnosis was considered probable when an expansive intracranial process was associated with CT-scan enhancement and antitoxoplasma therapy failure in patients with extraneurological localization. Diagnosis was considered to be certain after histological confirmation. RESULTS: Most-patients were male (19/20), with a median CD4 cell count of 9/mm3 (range 0-138). Ninety percent had AIDS before diagnosis. The presenting symptoms were mental status changes (70%), neurologic deficits (55%), fever without another cause (30%), increased intracranial pressure (25%) or seizures (25%). Opportunistic diseases were usually associated (60%). CT-scan (18/20) showed spontaneous iso or hyperdense lesions, most often solitary (67%), with nodular contrast enhancement (72%). When performed (7/20), magnetic resonance imaging showed hypointense lesions on T1-weighted images with marked contrast enhancement. Diagnosis of primary central nervous system lymphoma was suspected in 19 patients because of the failure of antitoxoplasma treatment; 4 patients had stereotactic biopsy which confirmed the diagnosis. Patients were treated with either total brain radiation therapy (10%), corticosteroids (30%), or both (60%). The median survival time after onset of symptoms was better with combined therapy or radiation therapy alone than with steroids alone (6 vs. 2 months). Interestingly, most of the patients died from neurological complications of lymphoma (85%). DISCUSSION: The frequency of lymphoma-related death is probably due to better management of opportunistic infections and the effect of antiretroviral therapy. Further studies combining antiretroviral therapy, radiation and chemotherapy in patients with good performance status should be considered to improve the poor prognosis of AIDS-associated primary central nervous system lymphoma.

AIDS-Related Opportunistic Infections↗
PubMed1997

Radiologic anatomy of the inferior lung margins as demonstrated on computed radiography with enhancement of low frequencies.

The aim of this work was to describe the radiologic anatomy of the inferior lung margins (ILMs). The method was to enhance the low frequencies of 50 normal chest computed radiographs. On each side, the anterior and posterior ILMs were divided into two halves. The frequency of visibility of each half of each ILM was calculated as their shape, lateral and medial continuities, depth, and vertebral level. The differences were compared by a paired Student t-test. The right posterior ILM was always visible and usually concave upward (94%). Its height was 8.7 +/- 1.6 cm. Its most inferior part faced L1 or L2 in 92% of cases. It was continuous medially inside with the azygo-esophageal recess in 96% of cases. The left posterior ILM was not visible laterally in 34% of cases and medially in 60% of cases. It was most often concave upward (82% of cases). Its height was 6.9 +/- 1.5 cm. Its most inferior part was at the level of L1 or L2. It was continuous medially with either the left paraspinal line or the paraaortic line. The right anterior ILM was visible in 76% of cases. It was most often oblique upward and medially (46%) or concave upward (33%) and often notched (38%). The left anterior ILM was visible in 64% of cases and more often oblique inward and upward (58%). It was continuous medially with the left inferior precardiac recess. The anterior ILMs were more variable than the posterior. The posterior ILMs were very similar in shape and inferior level and differed in depth only by the difference of height of the diaphragmatic cupolas.

Adult↗
PubMed1997

Sternal abscess due to Bartonella (Rochalimaea) henselae in a renal transplant patient.

Bartonella henselae, previously called Rochalimaea henselae, is the causative agent of cat scratch disease (CSD) in immunocompetent subjects and bacillary angiomatosis in immunocompromised ones. Bone lesions are common in bacillary angiomatosis, but not in CSD. We present the case of a patient with a renal transplant treated by immunosuppressive therapy who developed a sternal abscess with a histological pattern of CSD. The CT pattern was that of a lytic bone lesion with adjacent fluid collection. The diagnosis was made on the basis of a polymerase chain reaction amplification performed on bone material. Bartonella henselae is a newly described bacteria that causes CSD in a normal host and bacillary angiomatosis in immunocompromised patients. We report a case of an osteolytic lesions of the sternum with adjacent fluid collection related to CSD, which occurred in a patient with a renal transplant.

Abscess↗
PubMed1997

Cerebral tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). Report of 6 cases and review.

Cerebral tuberculosis (TB) was diagnosed in 6 (4%) of 156 HIV-infected patients with TB seen at our institution over 6 years. We describe here the clinical and radiologic features of these cases and of 15 others reported in the literature. Of the 21 patients, 59% were intravenous drug users. Presenting symptoms were fever (76%), confusion (52%), seizures (38%), and headache (38%). Fourteen patients (66%) had previous or active extracerebral TB at presentation. Cranial CT scan showed ring-(62%) or nodular-(24%) enhancing lesions or mixed forms (14%). Among the 12 patients who underwent a brain biopsy, bacteriologic evidence of TB was found in 9. Four patients (19%) died during hospitalization. Among the 17 others who received antituberculous therapy, only 1 developed neurologic sequelae. Five patients also received steroid therapy to control cerebral edema or paradoxical growth of the cerebral mass lesions. TB should be considered as a cause of cerebral mass lesions in HIV-infected patients, especially if tuberculous infection is suspected at other sites.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Digital radiography of the thorax].

Digital radiography of the thorax can, now be substituted to conventional chest radiography. Computed radiography with phosphor plates and the new selenium detector are emphasized. The major image processing are explained. Successively the main other methods of digital radiography are described: scanning equalization radiography, laser-digitized radiography and multiwire proportional chambers. Then the advantages and the drawbacks of chest computed radiography are extensively reviewed.

Humans↗