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Biomedical subjects

D M Epstein

Publications and source records attributed to D M Epstein.

At least 55 records · Page 3Linked to original sources
PubMed1985

The troublesome nipple shadow.

In a review of 1000 routine chest examinations, the nipple of the male or female breast was visible about 10% of the time. In 14 instances (1.4%), the reviewing radiologist thought that uncertainty of identification warranted additional films. In four of these instances, the density proved to be something other than nipple. In all other instances when a nipple shadow was identified (8.9%), follow-up was not deemed necessary for various, often somewhat subjective reasons. Thus the frequency of erroneous identification of nipples could have been higher. Certainty of nipple identification would have involved considerable cost and inconvenience in repeat examinations. In another group of 500 patients, identification of the nipple with a lead marker on all patients eliminated uncertainty and the necessity for any repeat examinations. The patients placed low cost markers at the time of disrobing. Convenience and certainty were served by this simple maneuver.

Breast↗
PubMed1984

Investigation of a cluster of anencephaly and spina bifida.

Environmental factors remain undefined as possible causes of spina bifida and anencephaly. The authors noted a fivefold increased incidence for 1979-1980 in the Antioch-Pittsburg , California area, prompting a case-control study. They studied nine case and 27 control mothers as well as eight case and 17 control fathers to evaluate factors including residence, occupation, drug use, illnesses, and pesticide or chemical exposure. Except for fathers' smoking (p less than 0.05), no exposure was associated with neural tube defects.

Adult↗
PubMed1984

MR imaging of the mediastinum: a retrospective comparison with computed tomography.

Magnetic resonance (MR) imaging of the mediastinum was performed with a 0.12 T resistive magnet and compared with the results of CT. On T1 weighted images with partial saturation technique, soft tissue masses, lymphadenopathy, lipomatosis, and vascular anatomy were comparable with MR and CT imaging in 19 of 30 patients (63.3%). In the remaining 11 patients only slight differences between the two modalities were observed. Our experience suggests that MR imaging at low field strength is equivalent to CT in the morphologic assessment of the mediastinum without the need for administration of intravenous contrast medium or exposure to ionizing radiation.

Humans↗
PubMed1984

Improved interpretation of gated cardiac images by use of digital filters.

The authors describe a digital filter that greatly enhances the quality of gated cardiac blood-pool images. Spatial filtering is accomplished with a minimum-mean-square-error (Wiener) filter incorporating measured camera blur and Poisson noise statistics. A low-pass temporal filter is then applied to each pixel, with the cutoff frequency determined from measurements of frequency spectra in 20 patients. This filter was evaluated in routine clinical use for nearly one year and found to significantly improve chamber definition, delineate wall motion abnormalities better, and reduce noise. To quantitatively assess the effect of the filter on image interpretation, four experienced observers evaluated wall motion in a series of mathematically simulated left ventricular images. ROC analysis revealed that accuracy in assessing wall motion was significantly greater with the filtered images.

Evaluation Studies as Topic↗
PubMed1984

Application of ILO classification to a population without industrial exposure: findings to be differentiated from pneumoconiosis.

The International Labour Office (ILO) classification of radiographs of pneumoconiosis is a standard means of assessing the presence or absence of pneumoconiosis in workers exposed to mineral dusts. Using this classification, 200 admission chest radiographs were reviewed on hospitalized patients in an urban university medical center to determine the prevalence and possible significance of "small opacities" in a population without known industrial exposure. Seventy-one men and 129 women were screened with the mean age of 44.2 years (range, 15-84). Thirty-six (18%) of the 200 patients had small opacities at profusion level 1/0 or greater, and this constituted the "positive radiographs" group. Twenty-two patients (11%) with positive radiographs had no documentable dust exposure or other specific medical etiology that would explain the presence of their lung opacities. The high prevalence of small opacities in "normal" older individuals has important implications in the assessment of patients with suspected pneumoconiosis.

Adolescent↗
PubMed1984

Radiographic evaluation of asbestos-related chest disorders.

This paper reviews the radiographic, clinical, pathologic, and epidemiological features of pleural and pulmonary parenchymal disorders which have been related to asbestos exposure. In particular, the following are discussed: (1) pleural plaques--radiographic detection by plain films and computed tomography, normal and abnormal densities which may mimic plaques, the 1980 ILO U/C classification, recent epidemiological data on plaques including their relationship to carcinoma and mesothelioma; (2) diffuse pleural thickening; (3) benign asbestos pleural effusions; (4) mesothelioma--emphasizing recent advances in diagnosis, staging, therapy, and prognosis; (5) parenchymal fibrosis--pathogenesis, relationship to fiber exposure, plaques, and carcinoma; (6) bronchogenic carcinoma; (7) rounded atelectasis--recent observations on its association with pleural thickening. A role of radiology in medicolegal aspects of asbestos-related disease is briefly examined.

Asbestos↗
PubMed1984

A versatile computer simulation of the left ventricle.

A versatile mathematical simulation of a beating left ventricle, as seen in a gated cardiac blood-pool study, is described. The basic model consists of a fifth-degree polynomial rotated about its long axis. Motion is mimicked by sinusoidally varying the lengths of the long and short axes. The quality of clinical images is simulated through addition of Poisson noise and camera blur, determined from the measured line-spread function for Tc-99m. To achieve added realism, the modeled ventricle can be inserted in place of the patient's actual ventricle in clinical images. The dimensions, activity, and ejection fraction can all be adjusted. In addition, regional wall-motion abnormalities can be generated in any of the walls. To illustrate applications of the model in testing and evaluating cardiac computer programs, the performances of two ejection-fraction programs are compared, and use of the model in evaluating digital filtering algorithms is discussed.

Computers↗
PubMed1983

Radiation-induced pneumothorax.

Pneumothorax is an uncommon complication of radiation therapy to the chest. The proposed pathogenesis is radiation-induced fibrosis promoting subpleural bleb formation that ruptures resulting in pneumothorax. We report on two young patients with primary sarcomas without pulmonary metastases who developed spontaneous pneumothorax after irradiation. Neither patient had antecedent radiographic evidence of pulmonary fibrosis.

Adolescent↗
PubMed1983

Lung disease caused by amiodarone, a new antiarrythmic agent.

Amiodarone hydrochloride, used for prophylaxis of recurrent ventricular tachyarrhythmias that are resistant to other agents, may cause toxic pulmonary reactions associated with abnormal chest radiographs. The authors review four new cases of amiodarone-induced toxicity and eight cases reported in the literature. Peripheral areas of consolidation, predominantly in the upper lobes and resembling chronic eosinophilic pneumonia or tuberculosis, and diffuse interstitial disease were seen. Clinical symptoms included dyspnea on exertion, weakness, and occasionally pleuritic pain. Radiographic abnormalities developed after a median latency period of six months on the drug (600 to 800 mg daily). Pathologic findings suggested a possible toxic effect of the drug on phospholipid metabolism in the lung. Amiodarone toxicity may lead to significant pulmonary insufficiency. The clinical symptoms and radiographic abnormalities were completely reversible upon cessation of drug use and institution of corticosteroid treatment. Resolution generally occurs within three months.

Adult↗
PubMed1983

Ventilator-induced subpleural air cysts: clinical, radiographic, and pathologic significance.

Alveolar rupture from the high airway pressures used in the treatment of adult respiratory distress syndrome may cause interstitial dissection of gas peripherally and the formation of "subpleural air cysts." These thin-walled, rounded air collections are easily detectable radiographically, and their recognition can provide an important early sign of pulmonary barotrauma. This report summarizes the clinical, radiographic, and pathologic features of this lesion in 5 adult patients. We found that tension pneumothorax rapidly occurs after the appearance of these cysts if airway pressures are not reduced or chest tubes are not in place. Secondary infection of the cysts was also common and added significant morbidity to this already compromised group of patients.

Adult↗
PubMed1983

NMR imaging of the chest at 0.12 T: initial clinical experience with a resistive magnet.

The chests of 40 subjects were imaged with an experimental nuclear magnetic resonance (NMR) imager operating at a magnetic field of 0.12 T. There were six normal volunteers and 34 patients with abnormalities affecting different areas, including the chest wall, pleura, hila, mediastinum, and lung parenchyma, and including benign and malignant processes. In this initial clinical experience, NMR imaging provided useful information on the presence and extent of disease by its ability to distinguish different tissues and by the excellent demonstration of vascular structures.

Humans↗
PubMed1982

Bronchopleural fistula complicating invasive pulmonary aspergillosis.

Pleural involvement has been notably absent in reviews of invasive pulmonary aspergillosis. This report describes the development of a bronchopleural fistula complicating invasive aspergillosis in a patient receiving chemotherapy for leukemia. The fungal hydropneumothorax occurred despite early diagnosis of the pulmonary infection and prompt treatment with amphotericin B. Closed pleural drainage and continued antifungal medication resulted in ultimate cure of the infection. The presumed pathophysiologic aspects of this event are discussed and the literature on pleural aspergillosis is reviewed.

Adult↗
PubMed1982

Pleural thickening: its significance and relationship to asbestos dust exposure.

The admission chest radiographs of 824 were screened for the presence of bilateral pleural thickening. Those patients with pleural thickening were scored according to the ILO classification of radiographs of the pneumoconioses. The prevalence of bilateral pleural thickening was high (6.2%) in these patients, of whom 67% had an environmental or occupational history suggestive of asbestos exposure. The predictive value of bilateral pleural thickening alone as an indicator of previous asbestos exposure was 67%. If one excludes known medical or surgical etiologies of pleural thickening then the predictive value increased to 81%. The radiographic detection of bilateral pleural thickening has a strong association with prior asbestos exposure.

Adult↗
PubMed1982

Lobar bronchioloalveolar cell carcinoma.

Bronchioloalveolar cell carcinoma has a variety of radiographic appearances. Usually it is a localized, well circumscribed nodule in the lung periphery. Nodules of various sizes that appear to coalesce in one or both lungs characterize a diffuse pattern of this disease. Occasionally, chronic lobar consolidation simulating a bacterial pneumonia may be seen. The clinical and radiographic course of eight patients whose bronchioloalveolar cell carcinoma appeared initially as lobar consolidation was analyzed. Four tumors rapidly progressed to involved the opposite lung. Attempts should be made by radiographic and other means to establish inoperability, since surgery is rarely useful in this type of lung cancer.

Adenocarcinoma, Bronchiolo-Alveolar↗