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Biomedical subjects

D Goldsher

Publications and source records attributed to D Goldsher.

At least 37 records · Page 2Linked to original sources

Massive haematemesis--presenting symptoms of cystadenocarcinoma of the pancreas.

A 43 year old woman presented with attacks of abdominal pain, haematemesis and hyperamylasaemia. Gastrointestinal X-rays and repeated upper gastrointestinal endoscopy failed to reveal the source of bleeding. Ultrasound and computed tomographic scan demonstrated a calcified mass in the tail of the pancreas. Surgical exploration revealed a solitary mass in the pancreas and histological examination showed cystadenocarcinoma. The patient died 2 years later because of local recurrence, but haematemesis and melaena did not recur. This case presents an unusual manifestation of cystadenocarcinoma of the pancreas with massive bleeding from the tumour via the pancreatic duct and associated pancreatitis. Other possible reasons for bleeding with cystadenocarcinoma of the pancreas are discussed.

Adult↗

Transient osteoporosis of the hip: case report and review of the literature.

A case of idiopathic transient osteoporosis of the hip is reported and the literature reviewed. The clinical and radiological features of this syndrome are described, as well as the diagnostic contribution of bone scintigraphy. The need for conservative treatment and avoidance of invasive diagnostic procedures is emphasized.

Adult↗

Stress fractures of the sacrum following strenuous activity.

Three military recruits developed stress fractures in the sacral wing during rigorous elite basic training. Stress fractures in the sacrum have previously not been reported in a healthy population. Sacrum, like every bone of the pelvis and the lower limb that participates in weight bearing, may be susceptible to stress fracture following sustained excessive physical activity.

Adolescent↗

Cerebral thrombosis in a newborn with a congenital deficiency of antithrombin III.

An Israeli Arab family with type I antithrombin III (AT-III) deficiency with several affected symptomatic members in three generations is reported. The propositus presented with deep vein thrombosis and pulmonary emboli associated with gestation. The propositus infant presented at the age of 2 weeks with superior sagittal and rectus sinus thrombosis. Hereditary AT-III deficiency should be considered in infants with cerebral thrombosis, especially if they have a family history of thromboembolism. The role of prophylactic therapy by AT-III concentrates in these infants should be further assessed.

Adult↗

The incidence of multiple meningiomas--do solitary meningiomas exist?

Since the advent of computed tomography (CT) the recognition of the occurrence of multiple intracranial meningiomas (MIM) in the same individual has been on the increase. In our material the incidence of MIM at first assessment of CT films was 20%, with distant multiplicity prevailing over the regional one. This incidence will probably change in the course of time as MIM develop not only concurrently but also consecutively. On the other hand our surgical macroscopic incidence of regional multiplicity alone was 49%. The discrepancy between the CT and surgical findings prompted us to reevaluate the CT studies of 100 consecutive patients. This reevaluation demonstrated: 1. in two cases, small meningiomas were overlooked at first assessment; 2. nineteen cases of solitary globoid meningiomas seemed to be the consequence of the coalescence of adjacent smaller masses. Thus, the CT incidence of MIM increased to 40%, with regional multiplicity prevailing over the distant one. The authors think that the aforesaid findings question the very existence of solitary meningiomas as a pathological entity. They would be the end product of a coalescence of multiple adjacent smaller growths. Accordingly, a more aggressive surgical approach is suggested to include the resection of a generous fringe of dura mater around the main tumour. As this is not always possible, or too risky, a comprehensive complement to surgery like radiotherapy could be given a reasonable randomized trial.

Dura Mater↗

Calcified thoracic disc with herniation of the nucleus pulposus in a child.

A twelve year old boy presented with acute cervical and interscapular pain, torticollis and low grade fever. The neurological examination was normal. Roentgenograms showed calcification of the T3-T4 disc and posterior herniation of the nucleus pulposus was demonstrated by computed tomography. A rapid and dramatic amelioration of the symptoms was produced by treatment with a non-steroidal anti-inflammatory drug. Intervertebral disc calcification in childhood is an uncommon and usually benign condition. Its clinical and radiological features are discussed in the light of the relevant literature.

Calcinosis↗

Spontaneous intracranial hemorrhage in immune thrombocytopenic purpura.

Spontaneous intracranial hemorrhage (ICH) is a rare but devastating complication in patients with chronic immune thrombocytopenic purpura (ITP). We report four patients with chronic ITP unresponsive to steroid treatment who developed ICH. One patient had systemic lupus erythematosus; in another patient, the ICH originated from an arteriovenous malformation. High dose steroids, platelet concentrates, emergency splenectomy, and subsequent evacuation of intracranial hematoma, if necessary, can lead to a reasonable outcome of ICH in patients with chronic ITP.

Adolescent↗

[Acute circumferential epidural spinal hematoma. Apropos of a case].

A case of spinal circumferential acute epidural hematoma is presented. The diagnostic procedures are discussed, and particularly the interest of computerized tomography is stressed. Surgical management of this entity and prognostic implication are considered through a pertinent review of the literature.

Acute Disease↗

Leptomeningeal involvement by epithelial ovarian carcinoma: a case report.

A patient with epithelial ovarian carcinoma, who developed meningeal carcinomatosis, is hereby presented. A review of the literature revealed that only a few cases of this entity have been reported. With the prolonged survival of ovarian cancer patients treated by combination chemotherapy, it is expected that meningeal involvement will be found more often.

Cystadenocarcinoma↗

Involvement of the central nervous system by ovarian carcinoma.

Ovarian carcinoma rarely metastasizes to the central nervous system (CNS). Of 110 patients with epithelial ovarian carcinoma treated at the Northern Israel Oncology Center between the years 1979 and 1985, only five (4.5%) had CNS involvement. The median age of the patients with 54.5 years. All of them had treatment with cisplatin and Adriamycin (doxorubicin). The median duration from diagnosis to the development of brain involvement was 17 months. The median survival time was 28 months from diagnosis of carcinoma and 2 months from diagnosis of CNS disease. The increased incidence of this kind of metastasis in patients achieving local control of their advanced disease suggests that a change in the pattern of metastatic spread or the prolonged survival permits occult CNS metastases to become apparent. A routine computerized axial tomography (CAT) scan of the brain should therefore be performed on patients with ovarian carcinoma with prolonged survival.

Antineoplastic Combined Chemotherapy Protocols↗

Recurrence of intracranial meningiomas: the role played by regional multicentricity. Part 2: Clinical and radiological aspects.

Globular single meningiomas are generally regarded as benign tumors that can be completely removed. Nevertheless, after a total macroscopic resection including the insertion zone (Grade 1 operation according to Simpson's classification), the incidence of recurrence ranged from 9% to 14% at the 5-year follow-up review. The authors have shown that single meningiomas represent only the visible predominant growth in the midst of a wide neoplastic field in the dura mater. Regional multiplicity in meningiomas would thus seem to be the rule. With this in mind, the authors propose to divide recurrences after Grade 1 operations into true local and false regional. A local recurrence is defined as a regrowth within the limits of the previous dural flap. Regional recurrence is when new growth develops outside the previous craniotomy site; this should not be considered as a recurrence but as a new primary site. These regional recurrences might explain some unexpected late tumor growth occurring after a Grade 1 operation. Five illustrative cases in which regional recurrence was detected by computerized tomography are presented. The authors also propose to add a supplementary grade to Simpson's surgical grading: Grade 0. This operation would entail a wide resection of the dura around the attachment zone of the meningioma. The authors hope that with a Grade 0 operation the incidence of recurrence might be reduced.

Adult↗

Radiology in war.

Explore the source record for details and available documents.

Abdominal Injuries↗

Computed tomographic diagnosis of abdominal abscesses.

The CT signs of abdominal abscess are evaluated, based on experience gained with 41 abscesses in 38 patients. The majority of abscesses were located in the upper abdomen, the largest groups being 12 hepatic and 9 subphrenic. In 16 patients the abscesses were postoperative. The most common CT sign of an abdominal abscess was a homogenous low density lesion. Other primary signs were: well defined wall, mass effect and pathological extraintestinal gas. The role and types of contrast enhancement are discussed. Contrast enhancement are discussed. Contrast enhancement was not essential for the diagnosis of abdominal abscess in the majority of cases. The diagnosis of abdominal abscess by CT is compared to ultrasonography and conventional radiography.

Abscess↗

Clinical and radiographic response in three children with recurrent malignant cerebral tumors with high-dose tamoxifen.

The purpose of this study was to deliver tamoxifen as antiangiogenic therapy to children with recurrent progressive malignant brain tumors. Tamoxifen was administered orally in very high dosage to one child as monotherapy and to two children in combination with oral etoposide and dexamethasone. One boy was diagnosed with high-grade astrocytoma in the brain stem, one girl with anaplastic ependymoma of the fourth ventricule, and one girl with high-grade astrocytoma in the midbrain. Conventional treatment with multiple surgeries, first- and second-line chemotherapy, and external beam therapy had failed. Tumor reduction was seen in radiographic images together with clinical improvement in 2 children, and clinical and radiographic halting of tumor progression was demonstrated in the patient with anaplastic ependymoma. None of the patients developed complications from the treatment. Follow up of the patients ranged from 15 to 30 months with a mean of 17 months. These encouraging preliminary results suggest a potential for this type of therapy. More studies are needed to start clinical trials and prove that angiostatic activity may contribute to the therapeutic effect of antiestrogens in estrogen receptor-negative tumors.

Adolescent↗

Traumatic carotid aneurysm secondary to cavernous sinus penetration by wood: CT features.

Transorbital penetration of the cranial cavity by a small wooden object can pass unnoticed, while producing severe, life-threatening consequences. The occurrence of a traumatic intracranial aneurysm secondary to a wooden foreign body has not been reported previously in the English literature, to our knowledge. Familiarity with the CT features of this complication is crucial since the CT findings may be the first to suggest penetration of the cavernous sinus by wood, as well as the possibility of a traumatic carotid aneurysm. The CT features of this rare complication are discussed and the pertinent literature is reviewed.

Carotid Artery Diseases↗

Occipital aneurysmal bone cyst: CT features.

A case of aneurysmal bone cyst arising from the lower occipital squama with intracranial extension is presented. The case is unique in that the cyst showed fluid levels on CT. Another peculiarity of this case was postoperative recurrence.

Bone Cysts↗

Posterior cortical atrophy variants of Alzheimer's disease.

Posterior cortical atrophy (PCA) was first described by Benson in 1988 and, since then, has been regarded as a variant of Alzheimer's disease. We present 2 patients with symptoms suggestive of PCA and 2 patients with apraxia as the initial manifestation. Primary motor and sensory modalities were intact. Mild memory impairment was present early in the course of the disease and gradually worsened. Parieto-occipital atrophy was evident on brain MRI. HMPAO-SPECT demonstrated parieto-occipital hypoperfusion significantly different from the temporoparietal hypoperfusion usually described in senile dementia of the Alzheimer type. These findings suggest that HMPAO-SPECT can help in diagnosing atypical variants of Alzheimer's disease. We suggest that PCA represents two clinically related behavioral phenotypes: PCA with predominantly apraxia manifestations and PCA with predominantly visuospatial disturbances. Copyrightz1999S.KargerAG,Basel

Aged↗

Radiation-induced primary brain lymphoma: a case report.

A patient who developed primary brain lymphoma 6 years following whole brain irradiation due to a low-grade glioma is described. The patient had no evidence of congenital or acquired immunodeficiency state and achieved a good and prompt response to aggressive chemotherapy, including high-dose methotrexate. The previous radiation therapy is implicated in the etiology of the lymphoma because of the geometric coincidence, the relatively long latency period and the different histology. A brief review of current literature is reported.

Adult↗