Search PubMed⌕ Search

Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 397 records · Page 22Linked to original sources
PubMed1986

The feasibility of surgical enucleation for renal cell carcinoma.

Although partial nephrectomy for renal cell carcinoma has been recommended for tumors in solitary kidneys, surgical enucleation has been suggested as an alternative form of surgical management in highly selected patients. To verify the efficacy of surgical enucleation the surgical specimens from 16 standard radical nephrectomies were dissected carefully. The tumors were enucleated ex vivo and carefully investigated pathologically. It was possible to enucleate successfully some well circumscribed, low grade tumors but venous invasion, tumor heterogeneity, occult metastatic disease in lymph nodes, satellite tumor nodules in the kidney and extrinsic spread through the renal capsule were features that may not have been appreciated fully in the operating room. Computerized tomography could not always predict which patients were possible enucleation candidates. Partial nephrectomy remains the preferred surgical treatment in a parenchymal-sparing operation rather than simple enucleation.

Carcinoma, Renal Cell↗
PubMed1986

Candida of the bladder wall: computerized tomography demonstration.

We describe a patient with a history of vulvar cancer, aplastic anemia and diabetes who was found to have a bladder wall lesion on a computerized tomography scan, which was compatible with malignancy. Pathological examination of the biopsy specimen revealed the lesion to be Candida. The differential diagnosis of filling defects in the bladder as seen on computerized tomography is discussed.

Adult↗
PubMed1986

Multiplanar (MPR) imaging of the hip.

Multiplanar CT expands the ability of the radiologist to define the extent of disease, to suggest appropriate surgery, and to offer a probable prognosis.

Acetabulum↗
PubMed1986

Lipomatous tumors of the liver: evaluation with CT and US.

Seven cases of lipomatous masses within the liver parenchyma were demonstrated with computed tomography (CT). Five of these cases were obtained from a retrospective review of 50 cases of renal angiomyolipoma in which the liver was adequately demonstrated. The other two cases were from the files of the Armed Forces Institute of Pathology and had no associated renal lesions. Three of the five cases were associated with tuberous sclerosis. In all seven cases, the fatty tumors appeared on CT scans as a well-defined, 0.8-13-cm mass, with attenuation coefficients of less than -30 HU. On ultrasound studies, the lesions were well circumscribed, highly echogenic, and similar to hemangiomas. While distinctly rare lesions, these lipomatous masses are not as unusual as the literature would indicate. One may anticipate such masses in patients with renal angiomyolipomas and in a relatively high percentage of those with tuberous sclerosis.

Adult↗
PubMed1986

Renal vein thrombosis in patients with nephrotic syndrome: CT diagnosis.

A retrospective evaluation of the computed tomography (CT) findings in 50 patients with the nephrotic syndrome was undertaken. In four patients with clinical manifestations of acute renal vein thrombosis (RVT) on initial examination, the diagnosis was confirmed by CT findings. Three patients had left RVT, one had right RVT, and all four had thrombus in the inferior vena cava (IVC) at the level of the renal veins. Of the remaining 46, otherwise asymptomatic patients, one had bilateral RVT, two had left RVT, and five had isolated IVC thrombus. The abnormalities noted on CT scans were widened renal vein(s) containing thrombus, thrombus in the IVC, renal enlargement, thickened Gerota fascia and formation of pericapsular venous collaterals, and an abnormal renal parenchymal enhancement pattern consisting of prolonged corticomedullary discrimination, delayed and/or persistent paraenchymal opacification, and delayed or absent pyelocalyceal visualization.

Adult↗
PubMed1986

Cryptosporidiosis of the gastric antrum: detection using CT.

We describe a patient who had cryptosporidiosis and cytomegalovirus infection of the gastric antrum that was initially detected on computed tomography (CT) scans. CT may be useful in the evaluation of immunocompromised patients with diarrheal illness, as well as in the assessment of the gastrointestinal tract.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Skeletal metastases from hepatoma: frequency, distribution, and radiographic features.

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.

Adult↗
PubMed1986

Solitary pulmonary nodules: CT assessment.

Computed tomography (CT) was used to examine 634 solitary pulmonary nodules (SPNs). Each lesion was assessed as benign or indeterminate on the basis of CT criteria. Benign nodules made up 44% of all SPNs and 58% of the 431 that were 2 cm or less in diameter. All malignant SPNs were assessed as indeterminate, and adenocarcinoma (42%) was the most common primary malignancy. A total of 176 (63% of benign SPNs) were correctly assessed as benign by CT. Ninety SPNs assessed as diffusely calcified were not so identified by conventional tomography at outside institutions. An SPN can be reliably assessed by CT as benign if it exhibits high attenuation values, exceeding a critical level and distributed diffusely throughout a CT section through the center of the lesion and a well-defined edge. Although 38 of 283 (13.4%) primary lung cancers contained localized calcification, there was no significant overlap with the diffuse calcification of benign lesions. Central carcinoid tumors may contain focal ossification, but such lesions may be recognized by noting the proximity of larger bronchi. Assessment of SPNs by CT is most effective for lesions 2.0 cm or less in diameter. For larger lesions, the frequency of benign disease was decreased (14.3% of 203), as was the percentage of benign SPNs correctly assessed as benign by CT (37.9%).

Calcinosis↗
PubMed1986

Pulmonary hamartoma: CT findings.

Forty-seven patients with a proved (n = 31) or presumed (n = 16) diagnosis of pulmonary hamartoma were studied prospectively by thin-section computed tomography (CT). CT criteria for hamartoma included a diameter of 2.5 cm or less, a smooth edge, and focal collections of fat or fat alternating with areas of calcification. No case of cancer (n = 283) or metastatic disease (n = 72) fulfilled these criteria. Seventeen hamartomas with no detectable calcium or fat were not diagnosed by means of CT. Two other lesions contained diffuse calcium deposits. In 28 lesions, a CT diagnosis of hamartoma was based on the detection of fat (n = 18) or calcium plus fat (n = 10). Twelve such cases were proved histologically by means of thoracotomy or needle biopsy; the remainder, including eight in asymptomatic patients aged 65 years or older, were managed with conservative follow-up.

Adult↗
PubMed1986

Metallic hip implants: CT with multiplanar reconstruction.

Thirty consecutive patients with metallic implants in the hip were evaluated with both standard transaxial computed tomography (CT) and multiplanar reconstruction (MPR) to assess the contribution of MPR. The metallic devices included total hip replacements (n = 6), one or more surgical plates with screws (n = 9), acetabular pins or screws (n = 9), and Knowles pins (n = 6). The metallic implants were on the side of interest in 25 hips and in the contralateral hip in five cases. One patient had bilateral hardware. MPR reformats axially acquired data into other planes. The reconstruction program weights the true signal over the randomly distributed artifacts by integrating adjacent axial images. Examination using standard transaxial imaging was graded as excellent in five cases, adequate in 15 cases, and inadequate in ten cases. After MPR, 19 studies were classified as excellent, 11 were classified as adequate, and none were classified as inadequate. It is concluded that MPR significantly reduced artifacts caused by metal present in transaxial images.

Acetabulum↗
PubMed1986

Low-attenuation thoracic metastases in testicular malignancy.

Low-density abdominal and pelvic lymph nodes are seen in nearly half of patients with testicular cancers. Thoracic low-attenuation metastases are much less common. Three cases of low-density metastases to lung parenchyma and mediastinal nodes are presented. In a man of appropriate age, a low-attenuation pulmonary or mediastinal mass should prompt a search for a primary testicular neoplasm.

Adult↗
PubMed1986

Computed tomography of gastrointestinal inflammation after bone marrow transplantation.

Overwhelming secretory diarrhea can be a major complication after bone marrow transplantation, associated usually with acute graft-versus-host disease (AGVHD). Radiographic evaluation may be hampered by nausea, vomiting, or debilitation. Computed tomography (CT) in seven such patients demonstrated diffuse wall thickening in the small intestine, colon, and/or mesentery. In two cases, prolonged adherence of oral contrast material to the luminal surface resulted in bizarre patterns of coating. In two others, a layer of low attenuation within the thickened wall produced a target appearance consistent with submucosal edema or hemorrhage. Small bowel dilatation and fold enlargement was the only finding in one patient. The role that superinfection of the gastrointestinal tract with opportunistic organisms can play in this immunocompromised group of patients is less well established. In this group of patients, the findings were due to AGVHD in two, AGVHD and viral enteritis in two, and viral enteritis alone in three. CT may be an alternative to routine contrast studies in assessing the extent of gastrointestinal tract involvement after bone marrow transplantation. Neither contrast studies nor CT were able to differentiate between AGVHD and viral enteritis.

Adolescent↗
PubMed1986

Thorotrast-induced hepatosplenic neoplasia: CT identification.

Despite discontinuation of its use in the 1950s, the consequences of Thorotrast usage continue to be recognized. In a review of plain film and CT findings of 20 cases of Thorotrast exposure, 15 of 17 patients demonstrated Thorotrast accumulation in the liver and spleen on plain films. Typically, this appeared as regions of trabeculated increased density within the liver. The spleen was of normal or decreased size and often demonstrated a finely punctate pattern of opacification. Only two malignancies could be suggested on plain film alone: one hepatic and one splenic. Five patients with hepatic malignancies underwent CT examinations: three with cholangiocarcinoma, one with angiosarcoma, and one with hepatocellular carcinoma. No specific criteria could be established to distinguish among these lesions, as each neoplasm appeared as relatively low-density mass(es). Two cases of splenic angiosarcoma appeared as low-density filling defect(s) in the otherwise opaque spleen, one case primary and the other metastatic from the liver. CT was superior to plain radiography in detecting and characterizing Thorotrast distribution and any superimposed malignancy. In addition to periodic liver function tests, screening CT of patients exposed to Thorotrast might detect hepatic neoplasms at an operable stage.

Adenoma, Bile Duct↗
PubMed1986

MRI of hemorrhagic renal cysts in polycystic kidney disease.

Nine patients with polycystic kidney disease were examined by MRI, CT, and sonography. MRI distinguished among simple cysts, cysts complicated by prior hemorrhage, and coexistent renal cell carcinoma. On T1-weighted spin-echo images, simple renal cysts appeared as round, homogeneous, low-signal regions with smooth outer margins and a distinct interface with remaining normal renal parenchyma or adjacent cysts. Hemorrhagic cysts were seen as homogeneous medium- to high-signal intensity regions, and about half of them correlated with hyperdense cysts by CT. In five cases, fluid-iron levels were evident by dependent high-intensity layering within the cysts. Renal cell carcinomas occasionally show high intensity because of hemorrhage, but intratumoral fluid-iron levels have not yet been described. These results suggest that MRI is useful in differentiating between simple cysts, hemorrhagic cysts, and neoplasms when CT and sonography are indeterminate.

Adult↗
PubMed1986

Small-bowel diverticulitis: CT findings.

Three patients with subsequently proven small-bowel diverticulitis were studied with preoperative CT. In all three cases, an inflammatory mass was present, two involving the terminal ileum and cecum and one involving the jejunum. While the findings in the two cases of ileal diverticulitis simulated appendicitis, in the case of jejunal diverticulitis the diagnosis was suggested on the basis of CT findings. Small-bowel diverticulitis should be included in the differential diagnosis if an inflammatory mass involving the small bowel is demonstrated on CT.

Aged↗