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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 289 records · Page 16Linked to original sources
PubMed1990

Hepatic infarction in preeclampsia.

Two cases of hepatic infarction in toxemia of pregnancy are described. Both patients had associated laboratory findings of the HELLP syndrome (hemolytic anemia, elevated liver enzyme levels, and low platelet levels). Computed tomography (CT) showed nonenhancing low-attenuation areas varying in configuration from peripheral, well-defined, wedge-shaped lesions to larger abnormalities. Magnetic resonance imaging showed a corresponding area of low signal intensity on T1-weighted images with high signal intensity on T2-weighted images. Ultrasound showed several well-defined peripheral hypoechoic areas. The low attenuation and lack of enhancement on CT scans and the absence of mass effect are the key distinguishing features.

Adult↗
PubMed1990

Adult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans.

Thirteen patients with 15 ankle fractures potentially requiring surgical reduction according to plain film criteria were studied with transaxial CT, from which static and animated interactive two-dimensional (2-D) images and animated volumetric three-dimensional (3-D) images were generated. CT criteria believed to parallel well-accepted plain film criteria for triage of ankle fractures were developed and applied. The tibiofibular, talofibular, and tibiotalar articulations were characterized and, where possible (nine cases), compared with the (presumably normal) contralateral ankle. Talocrural angle measurements were made on interactive coronal measurements and compared with standard plain film measurements. Fracture fragment displacement, rotation, and impaction were noted. Posterior tibial lip disruption was quantified. Information derived from the 2-D/3-D CT study led to cancellation of proposed surgery in three of the distal fibular fractures and in two distal tibial fractures. There was far less variation than anticipated between the talocrural angles of the injured and normal ankles, and both injured and normal ankles deviated significantly from the accepted standard of 84 degrees. Displacement at the level of the fibular fracture was a poor predictor of more distal disruption. Two-dimensional CT was found to provide anatomic detail and information superior to either plain film or 3-D CT; 3-D CT was preferred by the surgeons for final surgical planning and for integration of the 2-D data. CT altered management in five of the 13 patients studied, supporting our belief that 2-D/3-D CT can be of significant value in assessing ankle fractures.

Adolescent↗
PubMed1990

Cloacal exstrophy: radiologic findings in 13 patients.

Cloacal exstrophy is a complex, multisystem malformation that has not received much attention in the radiologic literature. The clinical histories and imaging studies of 13 cases of cloacal exstrophy proved surgically or at autopsy were reviewed. Radiologic observations were based on skeletal plain films (13), contrast-enhanced examinations of the genitourinary system (12), abdominopelvic sonograms (nine), gastrointestinal studies (seven), CT scans of the pelvis and CNS (seven), MR images of the pelvis and CNS (six), renal nuclear medicine scans (three), myelography (three), and three-dimensional scans of the pelvis (two). Genitourinary and gastrointestinal abnormalities identified in our 13 patients included bladder malformations (13), hindgut anomalies (13), undescended testes (five), malrotation (five), duplicated müllerian structures (four), and renal ectopia (four). Skeletal abnormalities included symphysis pubis diastasis (13), posterior element dysraphism (12), vertebral segmentation anomalies (12), clubfeet (six), and hip dislocations (five). CNS anomalies included meningocele (nine) and Chiari malformation (one). Immediate surgical closure of the defect with maximal bowel preservation and diverting colostomy offers optimal chances for survival. Appropriate preoperative gastrointestinal and genitourinary evaluation is essential.

Abnormalities, Multiple↗
PubMed1990

Computer-based learning in radiology: a hypermedia application in CT.

Multimedia is a form of computer data presentation that uses multiple formats (text, illustration, sound, and animation) to enhance attention to and retention of presented information. Hypermedia is a nonlinear, branched access version of this that allows the user to pursue information more freely and variably than a linear format does. We used the hypermedia format to create an interactive medical teaching program that we believe holds the user's interest and attention better than a straight-text style does.

Computer-Assisted Instruction↗
PubMed1990

The natural history of pancreatic pseudocysts documented by computed tomography.

The clinical courses of 75 patients with pancreatic pseudocysts documented by computed tomography (CT) were retrospectively reviewed. History, physical examination, laboratory findings and CT scan data were analyzed. The treatment regimen followed during the period spanning the review dictated nonoperative management for those patients with asymptomatic pseudocysts who were able to tolerate oral intake. Operative management was used only for patients with persistent abdominal pain or enlargement or complications of pseudocyst. Approximately one-half of the patients (n = 36, 48 per cent) were managed nonoperatively, and the remainder (n = 39, 52 per cent) were treated operatively. In the group managed nonoperatively, with a mean follow-up period of one year, 60 per cent had complete resolution of the pseudocyst documented roentgenographically, and 40 per cent had pseudocysts that remained stable or decreased in size. Only one pseudocyst-related complication developed in the nonoperative group. No pseudocyst-related mortality occurred in either group. The size of the pseudocyst was a significant predictor of the need for operative drainage. Pseudocysts greater than 6 centimeters in diameter required surgical treatment in 67 per cent, significantly more frequently (p less than 0.05) than the 40 per cent of patients who required operative treatment for pseudocysts less than 6 centimeters in diameter. We conclude that a large proportion of patients with pancreatic pseudocysts, without specific indications for operative treatment, can be safely managed nonoperatively, with careful clinical and roentgenographic follow-up study.

Acute Disease↗
PubMed1989

Complications of endoscopic retrograde sphincterotomy: computed tomographic evaluation.

Although the reported complication rate of endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is low, patients often experience abdominal pain postprocedure. When pain persists, or fever and leukocytosis develop, a procedure-related complication should be suspected. The authors reviewed a series of 36 patients referred to computed tomography (CT) for evaluation of possible complications following ERCP with sphincterotomy. Initial CT scans were obtained within 24 h in 19 patients, and during the second to seventh day in the remainder. Complications detected by CT included acute pancreatitis (23), duodenal perforation (11), retroperitoneal dissection of air (4), pneumoperitoneum (4), and development of retroperitoneal abscess (4). Eight patients had normal CT scans except for air and contrast material in the biliary tree. The severity and extent of injury were readily assessed by CT, and response to therapy effectively monitored by serial CT examinations. Thirty-one cases (31 of 36) were successfully managed conservatively with antibiotics, intravenous hydration, and restriction of oral intake. Four patients required surgical intervention for drainage of a retroperitoneal abscess (3) or a pseudocyst (1). A fifth patient required intensive care resuscitation for septic shock. We conclude that CT is the study of choice for evaluating the patient with suspected complication following ERCP and sphincterotomy.

Acute Disease↗
PubMed1989

Seminal vesicle abscesses: spectrum of computed tomographic findings.

The computed tomographic (CT) findings in four cases of seminal vesicle abscess are presented. The predominant infectious organism in two cases was Escherichia coli, one case was probably caused by Mycobacterium tuberculosis, and another by atypical mycobacterium. The CT findings included unilateral (three cases) or bilateral involvement (one case), seminal vesicle enlargement with hypodense areas within the gland (three cases), adjacent perivesicle inflammation (three cases), and associated bladder wall thickening (three cases). Although the diagnosis of seminal vesicle abscess is often overlooked clinically, CT may help suggest the correct diagnosis early thereby helping to initiate therapy.

Abscess↗
PubMed1989

Computerized tomography in diagnosis of bladder rupture.

Patients with significant pelvic fractures and hematuria must be carefully evaluated for concomitant urinary tract injuries. Computerized tomography may be a useful adjunct to retrograde cystography for diagnosing bladder rupture in those patients with either equivocal or unexpectedly negative findings on cystograms.

Accidents, Traffic↗
PubMed1989

194 hepatocellular cancers treated by radiation and chemotherapy combinations: toxicity and response: a Radiation Therapy Oncology Group Study.

Hepatocellular carcinoma is known to have a doubling time of approximately 41 days. This rapid cell division suggested that hyperfractionated radiation and chemotherapy might add an advantage in gaining remission of this malignancy. One hundred and thirty-five patients (70% with metastasis and/or previous treatment) were prospectively treated with single daily fractions to the liver (3.0 Gy external beam radiation, total dose 21.0 Gy), and chemotherapy for hepatocellular carcinoma. The low dose chemotherapy used in conjunction with the radiation was 2 hr before treatment on days 1, 3, 5, and 7 and consisted of Adriamycin, 15 mg IV and 5-FU, 500 mg IV. These patients were compared to a second group of 59 patients (80% with metastases and/or previous treatment) treated using the same chemotherapy regimen but using hyperfractionated whole liver external beam irradiation (1.2 Gy twice daily, 4 hr between treatments, 5 days per week to 24.0 Gy, 10 MV photons). Response was determined by CT scan tumor volumetric analysis. The response rate for the single daily fraction patient group was 22% and for the new hyperfractionated group, 18% (p = 0.68). Toxicity was evaluated by RTOG criteria. The grade 4 hematologic toxicity noted in the daily fraction patient group was 6%. Among 59 patients treated with the hyperfractionated liver irradiation, 2% experienced grade 4 hematologic toxicity. Esophagitis occurred in 1% of patients in the standard fractionation group and 19% in the hyperfractionated group (p = 0.0001). Grade 1-4 thrombocytopenia occurred in 49% of patients in the conventional group and 68% in the hyperfractionated group (p = 0.03). Normal liver volume changes with treatment were measured with CT scan tumor volumetric analysis. The hyperfractionated group experienced a median of 11 cc increase in liver volume and the conventional group a 46 cc decrease, but the difference was not significant. Hyperfractionated radiation did not demonstrate a significant benefit over standard daily radiation, but acute toxicity appeared to be higher.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Treated invasive cervical carcinoma. Utility of computed tomography in distinguishing between skeletal metastases and radiation necrosis.

The bony pelvis should be carefully evaluated on computed tomography (CT) scans of the lower abdomen and pelvis performed for staging cervical cancer or for evaluating suspected recurrence. CT provides optimal imaging of the spine and pelvis, frequently providing a clinically relevant supplement to bone scan or plain film information. In a study of eight patients with skeletal metastases from cervical carcinoma and three cases of radiation osteitis, overlap existed in their imaging characteristics. Metastases were always lytic but nearby sclerotic areas from radiation were often present. Radiation osteitis may be lytic, sclerotic, or mixed, and both may avidly accumulate bone-scanning radiotracers. The absence of a soft tissue mass, slow progression, blastic elements, and sharply defined borders on CT suggest radiation necrosis. However, in some lesions within a radiation portal, biopsy or MRI may be required for final diagnosis.

Bone Diseases↗
PubMed1989

Enlargement of the pancreatic head in patients with pancreas divisum.

Pancreas divisum (PD) is a congenital anomaly present in 6-10% of the population. Computed tomography (CT) examinations in eight of 15 patients (53%) with endoscopic retrograde pancreatography (ERCP)-proven PD were interpreted as showing enlargement of the pancreatic head. Two of these had carcinoma, three had pancreatitis limited to the ventral pancreas, and three were normal. Criteria to distinguish nonpathologic enlargement of the pancreatic head due to PD alone from pathologic causes may include homogeneous parenchyma and an absence of other abnormal signs on CT. Because PD may simulate a pancreatic head mass, the radiologist should be familiar with this variant, and ERCP should precede biopsy unless other evidence of malignancy is present.

Adolescent↗
PubMed1989

The changing spectrum of splenic abscess.

Thirteen cases of splenic abscess were reviewed retrospectively from pathologic and medical records from 1978 through 1986. Splenic abscess is uncommon, but the diagnosis has been made more frequently in recent years due to the increasing number of living immunosuppressed patients and to the use of more sophisticated radiologic diagnostic techniques. Five patients had a solitary abscess (SA) and eight had multiple abscesses (MA). Seventy-five percent of the patients with MA were immunosuppressed, most had no symptoms from the splenic abscess, and none died. Only one patient (with SA) died, a mortality of 10% overall. Previously the mortality has been 40 to 70%. The decreased mortality may in part be attributable to the more rapid diagnosis (3.8 days for SA, 1.8 days for MA) of the splenic abscess, prompting early treatment. Improved radiologic studies reduce the time to diagnosis and thereby improve the prognosis. Computed tomography (CT) was diagnostic for splenic abscess in 4 of 7 patients and suggestive of abscess in the other 3. Computed tomography was the diagnostic modality of choice in suspected splenic abscess, as it provided more information than the other radiologic studies used.

Abscess↗
PubMed1989

Computed tomography of uterine sarcomas.

Uterine sarcomas are rare tumors, comprising only 2% of uterine malignancies. Abdominal and pelvic computed tomography (CT) of 14 patients with pathologically proven uterine sarcomas were reviewed. The average age of patients in our series was 64 years. The primary tumor measured between 4 and 30 cm. CT characteristics of uterine sarcomas included a low density mass within the uterine cavity in 12 of 14 cases. In two cases the mass was nearly isodense with uterus. Tumor necrosis was present in eight cases. Two patients presented with sarcomatosis, two demonstrated nodal spread, and one had liver metastases. Hydronephrosis was seen in three cases.

Aged↗