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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 19 recordsLinked to original sources
PubMed1992

Computed tomography appearance of bone metastases of leiomyosarcoma.

Bone lesions in leiomyosarcoma are uncommon. When encountered, they are usually a late manifestation of disease seen in the setting of widespread systemic metastases. We present five cases of metastatic leiomyosarcoma, including one in which a bone lesion predated detection of a primary gastric leiomyosarcoma and one in which bone metastases signaled disease recurrence. Computed tomography in 14 of 16 osseous leiomyosarcomas demonstrated a lytic, non-expansile pattern.

Adult↗
PubMed1992

Eosinophilic granuloma simulating an aggressive rib neoplasm: CT evaluation.

Eosinophilic granuloma of bone can pose difficulties in diagnosis. We report a case of eosinophilic granuloma of rib origin in a child presenting with an enlarging chest mass whose appearance on computed tomography suggested Ewing sarcoma. Eosinophilic granuloma should be included in the differential diagnosis of an aggressive rib mass on CT in the pediatric patient.

Bone Neoplasms↗
PubMed1992

Three-dimensional display of hepatic venous anatomy generated from spiral computed tomography data: preliminary results.

A new method is presented for generating three-dimensional images of the hepatic venous anatomy from helical computed tomography (CT) scans using volumetric rendering. The helical CT scans were obtained using peripheral injection of intravenous contrast via a power injector. Five patients with suspected liver tumors were studied from which one sample case was selected for illustration. Surgical planning of hepatic resection from three-dimensional images will soon become a practical part of patient care.

Adult↗
PubMed1992

Sequential chemotherapy and immunotherapy for the treatment of metastatic melanoma.

Interferon (IFN) has numerous biological properties, and more recently a new role for interferon has emerged, as a modulator of cytotoxic chemotherapeutic agents. This is based upon preclinical data that demonstrate additive and/or synergistic effects of IFN with a number of anticancer drugs including cisplatin against human cancer cell lines. Therefore, we evaluated the outpatient use of recombinant alpha 2a-interferon, 3-15 MU/m2 given on 3 consecutive days, subcutaneously, followed by intravenously administered cisplatin, 25-60 mg/m2, every 21 days. In this phase I clinical study, 23 patients with advanced malignant melanoma were treated. Dose-limiting toxicities included decline in performance status, fatigue, and anorexia. No synergistic or unpredictable toxicities were seen. Of the 20 patients who completed two cycles of therapy, there were three partial responses, for an overall response rate of 15%. Interestingly, responses occurred at the intermediate dose levels.

Adult↗
PubMed1992

Examination of the pathologic anatomy of ankle fractures.

A prospective study of the translational and rotational displacement of the lateral malleolus in ankle fractures was carried out utilizing roentgenographic techniques. Twenty-six ankle fractures in 25 patients were studied using both routine plain films and CT scanning with two- and three-dimensional multiplanar reconstruction. Eighty-one percent were Lauge-Hansen supination-external rotation type injuries. Overall, 21 fractures did not involve the medial malleolus. Initial talar shift was less than or equal to 2 mm in 15 fractures. Although all patients exhibited external rotation deformities of the lateral malleolus on plain films, only one fracture was found to possess any degree of external rotation relative to the talus. The proximal fibula was seen on CT scans to have increased internal rotation with respect to the tibia in 19 cases. One patient had a slightly externally rotated proximal fibula; the remainder appeared normally aligned. The displacements measured by the CT scans at the talofibular articulation were compared with the standard plain film measurements. The displacements at the distal lateral malleolus were consistently overestimated by the plain roentgenograms, presumably because the capsular and ligamentous attachments to the distal fibula limit malleolar displacement. The talocrural angle, determined on both plain films and CT scans, was also not found to be a sensitive measure of fibular shortening nor of the severity of the fracture. The results of this study suggest that, in an isolated lateral malleolar ankle fracture, the apparent external rotation of the fracture fragment is relative only to the proximal fibula and is not associated with derangement of the talofibular articulation. Based on these mechanical considerations, surgical intervention for such fractures may not be necessary. This hypothesis is consistent with previous long-term clinical studies.

Adolescent↗
PubMed1992

Nephrotoxicity of high-osmolality versus low-osmolality contrast media: randomized clinical trial.

The comparative frequency of and risk factors for nephrotoxicity with low-osmolality contrast medium (LOM) versus high-osmolality contrast medium (HOM) were investigated. A randomized, double-blind clinical trial was conducted in patients undergoing diagnostic angiocardiography (n = 430) or contrast material-enhanced body computed tomography (CT) (n = 499). Nephrotoxicity was defined as an increase in serum creatinine level that was greater than both 33% and 0.4 mg/dL (40 mumols/L) above the baseline level within 48 hours after the radiologic procedure. The frequency of nephrotoxicity was similar in patients who received LOM versus those who received HOM: 13 of 479 (2.7%) versus 13 of 450 (2.9%), respectively (P = .87), overall; 4.4% versus 4.0% in angiocardiography patients (P = .84); and 1.2% versus 2.0% in body CT patients (P = .35). Factors associated (P less than .05) with increased risk of nephrotoxicity were insulin-dependent diabetes, baseline serum creatinine level greater than 1.5 mg/dL (130 mumols/L), concurrent use of furosemide, and angiocardiographic examination. Patients who have preexisting renal insufficiency may be at higher risk for nephrotoxicity with HOM than with LOM.

Angiocardiography↗
PubMed1992

Comparison of helical and serial CT with regard to three-dimensional imaging of musculoskeletal anatomy.

To test the hypothesis that helical computed tomographic (CT) scans provide three-dimensional images as good as or better than those provided by serial CT, two objects were used to study the effects of helical CT: an angled cylindrical bone phantom and a human cadaveric femur specimen with a simulated fracture 1 mm wide. Both objects were immersed in a water bath, and a series of helical and serial CT scans were obtained with various parameters. Volumetric rendering was applied to the resultant data sets to create three-dimensional images, which three radiologists reviewed in a blinded manner to rate their fidelity, accuracy, and diagnostic usefulness. As expected, the images obtained with thin collimation and small intersection spacing or slow table movement were considered superior. Helical and serial CT data acquired with similar parameters were similar in quality, but helical CT is approximately five times faster than serial CT; hence, it is possible to use thinner collimation and obtain more sectional data with helical CT.

Femur↗
PubMed1992

Hepatic masses in infants and children: CT evaluation.

Hepatic masses are uncommon in children. Although some lesions may have overlapping appearances on CT, a careful analysis of the CT characteristics of the lesion, in combination with the age of the patient and the clinical and laboratory data, can lead to a specific diagnosis in many cases [1-5]. In this pictorial essay, the spectrum of hepatic masses in children is reviewed, with emphasis on the key CT findings that help in differentiating the various lesions.

Adolescent↗
PubMed1992

Musculoskeletal infections in patients with AIDS: CT findings.

The CT appearances of various musculoskeletal infections found in patients with AIDS are illustrated. Recognition of these infections is important for management of patients, but conventional laboratory tests may be inadequate in screening for infection or confirming the response of the host to therapy. As a screening examination for patients with AIDS, CT can suggest or confirm the presence of musculoskeletal infections even when infection has not been suspected.

Abscess↗
PubMed1992

Comparison of iohexol 300 and diatrizoate meglumine 60 for body CT: image quality, adverse reactions, and aborted/repeated examinations.

Six hundred patients were prospectively randomized and given either diatrizoate meglumine 60 or iohexol 300 during dynamic contrast-enhanced body CT in order to compare image quality, contrast reactions, and the number of aborted studies or studies in which images had to be repeated. Three hundred two patients received iohexol 300, and 298 patients received diatrizoate meglumine 60. Thirty-nine percent (119/302) of the patients given iohexol 300 and 63% (188/298) of the patients given diatrizoate meglumine 60 had at least one adverse reaction thought to be related to contrast material during, or within 24 hr of, the body CT scan. When reactions of discomfort (heat or warmth, flushing, bad taste) were excluded, 16% (48/302) of the patients who received iohexol and 33% (99/298) of the patients who were given diatrizoate meglumine 60 had at least one adverse reaction. The differences in both types of reactions between the two agents were significant (p less than .001). Among scans evaluated for study quality, 71% (214/302) of the iohexol 300 group and 62% (184/298) of the diatrizoate meglumine 60 group had optimal enhancement (p = .02). However, when the optimal and adequate categories were combined, 301 of 302 patients given iohexol 300 and 292 of 298 patients given diatrizoate meglumine 60 had diagnostic-quality studies (no statistical difference). Studies were not terminated nor were images repeated in 97% (292/302) of the patients given iohexol 300 and in 94% (280/298) of those given diatrizoate meglumine 60. The CT study was repeated because of movement during the contrast injection or aborted because of contrast-related reactions in 0.7% of the patients given iohexol 300 and in 3.0% of the patients given diatrizoate meglumine 60. This difference was statistically significant (p = .04). Our results suggest that the difference in image quality, number of adverse reactions, and number of aborted/repeated CT scans performed with iohexol 300 or diatrizoate meglumine 60 are not sufficiently different to warrant conversion to nonionic agents for body CT scans.

Diatrizoate Meglumine↗
PubMed1992

Lymphoma of bone, muscle, and skin: CT findings.

Lymphoma can involve any part of the musculoskeletal system. Primary musculoskeletal lymphoma is rare but can occur in bone (reticulum cell sarcoma) or in the skin and subcutaneous tissues (mycosis fungoides). Secondary involvement in the musculoskeletal system is more common and can have a variety of radiologic findings. The definitive diagnosis of musculoskeletal lymphoma, however, is difficult to make by using imaging criteria alone. Any part of the musculoskeletal system can be involved and, therefore, a wide variety of primary and secondary neoplasms or inflammatory processes may have similar radiologic findings. The main differential diagnostic considerations, depending on the age of the patient and the clinical presentation, include osteosarcoma, Ewing's tumor, metastatic disease (from breast, lung, thyroid, or renal primary lesions), as well as chronic osteomyelitis or myositis. Primary and secondary bone lymphoma can be indistinguishable radiologically and histologically, but modern imaging techniques allow more accurate differentiation of primary from secondary bone involvement. This pictorial essay illustrates the CT findings of primary and secondary lymphoma involving bone, muscle, and skin and subcutaneous tissues.

Bone Neoplasms↗
PubMed1992

Spiral CT of the pancreas with multiplanar display.

This essay illustrates the findings obtained with spiral CT imaging in pancreatic disease. Features of spiral CT--fast scanning, dynamic injection of contrast material allowing optimal vessel opacification, and supplemental multiplanar imaging--promise to provide increased accuracy in the diagnosis and staging of pancreatic disease. With further development of continuous (spiral/helical) scanning technology, this technology should expand to cover a wider range of applications.

Adolescent↗
PubMed1992

Computer-based radiological teaching programs: the challenge and trauma of development and implementation.

Computers are becoming an invaluable part of the radiologist's environment whether they are used as a source of the patient's clinical or laboratory information, to store x-ray or pathologic reports or as a viewing station for films. The use of computers in the educational environment is but a natural extension of the increased computerization of the radiologic department. This article reviews the use of personal computers in a teaching environment via the construction of the computed tomography teaching program entitled "CT: The Game." The decisions that must be made in terms of hardware and software prior to program development as well as the actual development are discussed. The potential of computers in terms of continuing education as well as in residency training programs is discussed with the potential for the future addressed.

Computer Systems↗
PubMed1991

Pulmonary Aspergillus chest wall involvement in chronic granulomatous disease: CT and MRI findings.

Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. One patient underwent both CT and MRI, one, CT only, and one, MRI only. In all three, both CT and MRI demonstrated pulmonary consolidations with direct extension to the adjacent chest wall. In both patients who were examined by CT, scans revealed permeative osteolytic changes of adjacent rib or spine compatible with osteomyelitis. In both patients who were examined by MRI, adjacent chest wall involvement was depicted on T1-weighted images and showed increased signal intensity on T2-weighted images. In one of these patients, the chest wall lesion was well defined on T2-weighted images, an appearance compatible with abscess. Epidural extension was demonstrated on MRI in the other patient, who later developed paraparesis. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease.

Adolescent↗