Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 361 records · Page 20Linked to original sources

PubMed1987

CT abnormalities in right lower quadrant inflammatory disease: review of findings in 26 adults.

Abnormal abdominal computed tomographic (CT) examinations, performed on 26 adults who presented with clinical evidence of right lower quadrant inflammatory disease, were retrospectively studied. Final diagnoses, established surgically in each case, included complicated appendicitis (15 patients), diverticulitis of the ileum or right colon (4), previously undiagnosed Crohn's disease (3), perforated cecal neoplasm (2), right tuboovarian abscess (1), and paracolic abscess of unknown cause (1). The CT features in each diagnostic group are presented in detail. Solid or ring calcification within a pericecal inflammatory mass was specific for appendicitis, occurring in 40% of the 15 patients. Without calcification, the differentiation of complicated appendicitis from Crohn's disease or diverticulitis, based on CT features alone, may be difficult in some cases.

Adolescent↗

PubMed1987

The role of CT in the management of pelvic arteriovenous malformations.

Four cases of pelvic arteriovenous malformations (AVM) were diagnosed and managed by CT, angiography, and embolotherapy. CT was used to determine the size, extent, and vascularity of each AVM and the involvement of adjacent organs. Thus CT was pivotal in the choice between surgical extirpation or embolotherapy. CT was also useful in monitoring patients following therapy.

Adult↗

PubMed1987

Illustrative cases in pericardial effusion misdetection: correlation of echocardiography and CT.

Eight equivocal two-dimensional echocardiograms with concurrent CT scans were evaluated to identify potential pitfalls in pericardial effusion detection. By echocardiography, two pleural effusions were felt to be pericardial, two hemopericardiums were interpreted as normal myocardium, three loculated pericardial effusions were not seen or were misinterpreted as other mediastinal collections, and one epicardial lipoma was called a pericardial effusion. When the clinical suspicion for pericardial effusion does not correlate with echocardiographic findings, CT scanning may be the definitive arbiter of pericardial disease.

Adolescent↗

PubMed1987

Cystic renal melanoma: CT/ultrasound correlation.

A new computed tomographic and sonographic appearance of renal metastatic melanoma is described. Bilateral cystic masses with thick walls, many with mural nodules, were noted. Sonography also demonstrated complex echopenic masses with irregularly thickened walls and mural nodules.

Adolescent↗

PubMed1987

CT diagnosis of unsuspected von Hippel-Lindau disease.

Von Hippel-Lindau disease is a hereditary disorder with complex, multi-organ involvement including retinal, central nervous system, and abdominal manifestations. We report a case of clinically unsuspected von Hippel-Lindau disease identified during computed tomography (CT) evaluation of a renal mass. The CT demonstration of a coexisting pancreatic tumor and renal cell carcinoma suggested the correct diagnosis of von Hippel-Lindau disease, which was subsequently confirmed. This case reemphasizes the value of preoperative assessment of renal tumors by CT. The finding of coexisting renal and pancreatic tumors should stimulate the search for further evidence of von Hippel-Lindau disease.

Angiomatosis↗

PubMed1987

Multiplanar computed tomography: a multidimensional tool for evaluation and treatment of acetabular fractures.

Fractures of the acetabulum present a formidable diagnostic and therapeutic challenge. Improved management has decreased the mortality associated with these injuries. Prolonged survival of the severely injured has raised the associated morbidity. To improve diagnosis and treatment in these patients, computed tomography with multiplanar reconstructions has been utilized in the pre- and post-operative period in 30 patients. This refinement provides a precise, accurate, and reproducible method of establishing the diagnostic data base. Consequently it is possible to better define the pathoanatomy, make decisions as to the best technique for intervention, and facilitate execution of these techniques by improved preoperative planning and postintervention assessment. It is concluded that computed tomography with multiplanar reconstructions optimizes the ability to manage these injuries.

Acetabulum↗

PubMed1987

Fibrosarcoma in a patient with scleroderma.

Malignancies have been described in association with various connective tissue disorders. While such associations may be relatively common in some disorders, such as polymyositis, the relationship between scleroderma and malignancy is more controversial. A case of fibrosarcoma of the tibia in a patient with scleroderma is presented, with correlation of conventional radiography, computed tomography, and histopathology.

Adult↗

PubMed1987

Multi-modality treatment of primary nonresectable intrahepatic cholangiocarcinoma with 131I anti-CEA--a Radiation Therapy Oncology Group Study.

Thirty-seven patients with primary nonresectable intrahepatic cholangiocarcinoma (57% with prior treatment and/or metastasis) were prospectively treated with external radiation, chemotherapy, and 131I labelled anti-CEA. Therapy began in all trials with whole liver irradiation (21.0 Gy, 3.0 Gy/Fx, 4 days/week, 10 MV photons) with alternate treatment day chemotherapy (Adriamycin, 15 mg + 5-FU, 500 mg). One month after external beam therapy, chemotherapy was given (Adriamycin, 15 mg + 5-FU, 500 mg) followed the next day by the first administration of 131I anti-CEA. The treatment schedule used was 20 mCi day 0; 10 mCi day 5 as an outpatient. This schedule was derived from tumor dose estimates which indicated that 20 mCi (8-10 mCi/mg IgG) was sufficient to achieve tumor saturation with a tumor effective half-life of 3 to 5 days, depending upon the species of animal from which the antibody was obtained. The median tumor dose for the 20 mCi + 10 mCi regimen was 6.2 Gy. Antibody therapy was delivered in 2-month cycles using antibody generated in different species of animals; rabbit, pig, monkey, and bovine. Toxicity was limited to hematologic toxicity and was manifested as thrombocytopenia and leukocytopenia (3.2% Grade IV for each according to RTOG toxicity criteria). Tumor remission evaluated by CT scan digitized tumor volume analysis indicated a 26.6% partial response (PR). Tumor remission by physical examination indicated a 33.3% remission rate (25.9% PR and 7.4% complete remission (CR]. The median survival for patients who responded was 15.2 months. The actuarial median survival for the entire group of patients (metastases and previous treatment) was 6.5 months. The longest partial remission is presently more than 4 years.

Adenoma, Bile Duct↗

PubMed1987

Diagnosis and management of massive gastrointestinal bleeding owing to duodenal metastasis from renal cell carcinoma.

We report 3 cases in which duodenal metastases from renal cell carcinoma caused massive upper gastrointestinal bleeding. In 2 patients the initial symptom was melena and 1 experienced hematobilia. In 2 patients the diagnosis was not suspected until a hypervascular mass was seen on arteriography and the bleeding was controlled by embolization of the gastroduodenal artery. In the third patient an aorto-enteric fistula was suspected on contrast-enhanced computerized tomography but arteriography showed hypervascular metastases in the duodenum.

Adolescent↗

PubMed1987

Three-dimensional imaging of acetabular trauma.

Computed tomography (CT) scanning is widely used in evaluation of acetabular fractures. Three-dimensional (3D) images of the pelvis can be created from CT scan data. This article reports two studies, each employing one type of 3D imaging in acetabular trauma cases. The first was a study of 21 patients utilizing surface-rendered 3D images, the second, a study of 19 patients using volume-rendered 3D images. Both types of 3D images were clinically helpful and can be used in lieu of conventional plain films as a supplement to CT examination. Advantages of volume-rendered images are described.

Acetabulum↗

PubMed1987

Abdominal pain in sickle cell disease: the role of CT.

Patients with either homozygous or heterozygous sickle cell disease may have frequent episodes of abdominal pain and/or fever of uncertain cause. While many of these episodes represent a so-called sterile crisis, the possibility of gross organ infarction and rupture, infection, or other complication cannot be ignored. Computed tomography (CT) was used to evaluate 30 such patients. Virtually all patients had splenic abnormalities, which could be considered clinically significant (rupture, hemorrhage) or insignificant (calcified spleen). In four patients hepatic abnormalities were found, including one case of multiple liver infarction, one of hepatic abscess, and two of retained intrahepatic gallstones after cholecystectomy. Two patients had significant acute renal abnormalities, including one case of interstitial nephritis and one of renal vein thrombosis. One patient had a ruptured periappendiceal abscess and one a pericolonic abscess. One patient had an abscess around a total hip replacement. CT was found to be an excellent and relatively noninvasive means of both initial investigation and subsequent follow-up.

Abscess↗

PubMed1987

Volumetric rendering techniques: applications for three-dimensional imaging of the hip.

Volumetric rendering is a new approach to three-dimensional (3D) imaging that overcomes many of the drawbacks of currently available surface-rendering systems. Its application on the Pixar Imaging System in two cases of acetabular fracture was assessed to illustrate the features of the technique. The fast-computing architecture and large memory of this system allow rapid generation of a series of high-quality 3D images in each plane of rotation (x or spinal axis, z or somersaulting axis) that can be viewed as independent static images or as an animated real-time video loop. Editing to remove the normal contralateral hemipelvis enhances appreciation of acetabular abnormalities. Every pixel of computed tomographic data is preserved, allowing representation of both soft tissue and bone as translucent overlap. The presentation of data also allows detection of subtle abnormalities and features and minimizes the artifact generation common in surface-rendered images.

Computers↗

PubMed1987

Hepatoblastoma: radiologic-pathologic correlation in 50 cases.

Fifty cases of hepatoblastoma were reviewed. Virtually all patients were infants or young children with hepatomegaly or a mass. Calcification seen on 11 of 20 radiographs was often in a pattern of small chunks, and eight of these correlated with osteoid formation in histologically mixed hepatoblastomas. Angiography generally showed tumor vascularity, sometimes with a spoke-wheel pattern. Suggestion of tumor nodularity or lobulation on sonography or computed tomography (CT) correlated with the gross appearance. The tumor was usually echogenic and occasionally had small hypoechoic or anechoic areas representing necrosis or hemorrhage. On CT it was usually hypodense, with minimal if any enhancement. The calcification pattern and demonstration of tumor lobulation with septation may help differentiate hepatoblastoma from other liver neoplasms in infants and children under 5 years of age.

Angiography↗

PubMed1987

Acetabular protrusion in the Marfan syndrome.

The Marfan syndrome is a genetic disorder of connective tissues resulting in ocular, cardiovascular, and musculoskeletal deformities. The authors reviewed 22 cases of Marfan syndrome. Forty-five percent (ten of 22) of the patients had acetabular protrusion, with one-half of these being unilateral and one-half bilateral. Scoliosis was associated with acetabular protrusion in 90% of cases (nine of ten). The authors conclude that acetabular protrusion is a common skeletal finding in the Marfan syndrome.

Acetabulum↗

PubMed1987

Acetabular fractures: optimal imaging.

In 19 cases of acetabular fracture, computed tomography (CT) with volumetric three-dimensional (3D) reconstructions displayed as video loops about horizontal and vertical axes of rotation replaced the traditional imaging combination of CT and multiple plain radiographs, while offering significant advantages. Overlying bowel content or foreign matter obscured detail in 36 of 45 plain radiographic views, and positioning or radiographic technique was suboptimal in 21. Three-dimensional reconstructions completely eliminated these problems. These 3D reconstructions accurately simulated oblique, inlet, and tangential views in all cases. In ten of 19 cases a nonconventional oblique view, and in 13 of 19 cases a cephalocaudal angulation other than the inlet, tangential, or anteroposterior view, best demonstrated the fracture. Elimination of five plain radiographs resulted in a skin radiation dose savings of 5 rad (50 mGy). No difficult or painful patient positioning was required beyond that necessary for the standard CT examination.

Acetabulum↗

PubMed1987

Marfan syndrome: evaluation with MR imaging versus CT.

Twenty-five patients with Marfan syndrome underwent computed tomography (CT) and magnetic resonance (MR) imaging. MR images were interpreted in blinded fashion and then the results were compared with findings from CT scans. MR imaging was found to be equivalent to CT in the depiction of aortic, dural, and hip abnormalities in patients who had not undergone surgery. MR imaging was superior to CT in evaluation of postoperative patients because the artifact produced by Bjork-Shiley or St. Jude valves precludes adequate evaluation of the aortic root on CT scans, while producing only a small inferior field distortion, a "pseudo-ventricular septal defect," on MR images. The absence of radiation exposure is another significant advantage for the relatively young Marfan syndrome population, who require serial studies. MR imaging is the modality of choice for evaluation and follow-up of patients with Marfan syndrome and offers an appropriate means of screening their kindred.

Adolescent↗

PubMed1987

High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema.

Centrilobular emphysema (CLE) is a disease defined pathologically. Assessment of the accuracy of high resolution computed tomography (CT) in the diagnosis of centrilobular emphysema has been hampered by a lack of pathologic correlation. We applied high resolution computed tomography to 20 postmortem lung specimens fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. The degree of centrilobular emphysema was assessed radiologically on a visual grading system based on nonperipheral low-attenuation areas. The lungs were then sectioned along the plane of the CT image, and the degree of centrilobular emphysema was graded pathologically by scoring against a panel of standards. A significant correlation (r = 0.91, p less than 0.005) was found between the pathologic grade and the in vitro CT score.

Histological Techniques↗

PubMed1987

Conversion by new treatment modalities of nonresectable to resectable hepatocellular cancer.

Eleven patients with hepatocellular cancer had nonresectable lesions, ten as determined by laparotomy and one by computed tomographic (CT) evidence of inferior vena caval invasion. These patients were treated with a variety of new modalities, particularly radiolabeled antiferritin antibodies. Following treatment, seven of the 11 patients were considered to have converted their lesions to possible resectability. Six patients had complete resections, and one patient was partially resected. All patients had the common features of either nodular massive or nodular multifocal hepatocellular cancer. Relative to the patient's initial status, the quality of life remains high, and a new approach in the treatment of the nodular form of nonresectable hepatoma has been demonstrated. The present rate of such conversion to resectability is unknown. However, with further advances in radiolabeled antibody therapy, these results offer a new opportunity in the management of hepatocellular cancer.

Antibodies, Monoclonal↗