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Biomedical subjects

E K Fishman

Publications and source records attributed to E K Fishman.

At least 415 records · Page 23Linked to original sources
PubMed1986

Pancreatitis or duodenal perforation after peri-Vaterian therapeutic endoscopic procedures: diagnosis, differentiation, and management.

The diagnosis, differentiation, and management of severe pancreaticoduodenal complications occurring after therapeutic endoscopic sphincterotomy and related procedures on the ampulla of Vater were reviewed for 254 patients. Five patients had duodenal (peri-Vaterian) perforation and six patients had clinically significant pancreatitis. Most patients were not suspected of having a significant complication the night of the procedure despite abdominal pain. Computer tomography proved to be the most accurate test for establishing the existence of a significant complication. A periduodenal collection of fluid (abscess) without significant pancreatic enlargement was the predominant complication in patients with duodenal perforation. In patients who had pancreatitis after peri-Vaterian procedures, generalized pancreatic enlargement and peripancreatic edema were most prominent. Four of the five patients with duodenal perforation required surgical drainage; all recovered. In contrast, four of the six patients with pancreatitis had medical therapy. One patient with pancreatitis died after multiple pancreatitic debridements were done. A second patient with pancreatitis who underwent exploration eventually recovered. Pancreaticoduodenal complications after therapeutic endoscopic sphincterotomy and related procedures are difficult to diagnose early; they should be suspected early and approached aggressively to limit morbidity and death.

Ampulla of Vater↗
PubMed1985

CT scanning for radiation therapy treatment planning of hepatoma.

One hundred forty-five patients with hepatoma had CT scanning for radiation therapy treatment planning. In order to demonstrate the anatomical distortions that occur with hepatoma and its effect on treatment planning, a control group of 50 colorectal cancer patients with normal livers was analyzed for comparison. The objectives of planning were to deliver as homogeneous a dose to the whole liver as possible and not to treat more than one of two functional kidneys or more than one-half of both functional kidneys. Conventional AP/PA portals were defined by physical examination, intravenous pyelogram, and bowel gas patterns at simulation and were found to be inadequate for the treatment of 76% of patients with hepatoma and 10% of patients with normal livers. Among the control group patients with no hepatoma, only 10% required oblique portals and 6% could not be treated because of left hydronephrosis or a solitary right kidney. Because the distortion of the liver in hepatoma in relationship to the kidneys required portal modification in 76% of hepatoma cases; 39% required oblique planning, 24% AP/PA, 20% PA and left lateral portals, and 17% required 4-field, 3-field or other plans in order to meet the treatment planning objectives. We concluded that all patients receiving radiation therapy to the liver for hepatoma require CT scanning for optimum radiation therapy treatment planning because of the hepatic distortion that occurs in hepatoma and the requirements of renal tolerance.

Carcinoma, Hepatocellular↗
PubMed1985

Computed tomography assisted volumetric analysis of primary liver tumor as a measure of response to therapy.

Serial computed tomography assisted volumetric analyses were made in 33 patients with hepatoma. Thirteen of 27 patients with tumor volumes less than 2,290 cc had a partial response to experimental therapy. However, only three of these patients also demonstrated a significant change in liver volume. Tumor volume determinations made by the method described are an accurate (+/- 10%) and reproducible way to measure response to therapy. In spite of small changes in total liver volume, there may be concomitantly substantial changes in tumor volume.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Solid and papillary epithelial neoplasm of the pancreas.

Solid and papillary epithelial neoplasm of the pancreas is an uncommon low grade malignant tumor histologically distinct from the usual ductal adenocarcinoma and amenable to cure by surgical excision. It tends to occur in black women in their second or third decade of life and has often been misclassified as nonfunctional islet cell tumor or as cystadenoma or cystadenocarcinoma. Twelve cases were reviewed. Sonography and CT of solid and papillary epithelial neoplasms depict a well-demarcated mass that can be solid, mixed cystic and solid, or largely cystic. The radiologic appearance is dependent on the maintenance of the integrity of the neoplasm versus the extent of retrogressive changes that have occurred.

Adolescent↗
PubMed1985

Fibrolamellar hepatocellular carcinoma.

Fibrolamellar hepatocellular carcinoma (HCC) has recently been separated as a distinct clinicopathologic entity with a better prognosis than the usual HCC associated with cirrhosis. The mean age of our 17 patients was 20 years. Alpha fetoprotein levels were normal, and none of the risk factors for HCC was present. Distinctive histologic features included deeply eosinophilic polygonal hepatocytes and abundant fibrous stroma. Calcification was present on plain films of five of 13 cases. Sonography usually showed a homogeneous, echogenic mass. Computed tomography (CT) demonstrated small, central calcification in four of ten cases. A central echodensity, hypodense on CT scans, was seen in two cases and corresponded to a central scar. By combining clinical and laboratory data with radiologic tests, a correct diagnosis can often be suggested before biopsy is performed.

Adolescent↗
PubMed1985

Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis.

Invasive pulmonary aspergillosis (IPA) in immunocompromised patients is often difficult to diagnose. Many pathogens present initially with similar, nonspecific pulmonary findings. Air crescent formation has been reported to be highly suggestive of IPA in the appropriate clinical setting, but this is a late sign in an otherwise rapidly fatal infection. The authors reviewed the available chest computed tomography (CT) scans of nine patients with acute leukemia and documented IPA, including four patients with serial scans obtained during the course of infection. Typical CT findings of IPA were multiple inflammatory nodules, often with one large dominant mass, or a single peripheral masslike infiltrate. Cavitation or air crescent formation occurred late in the course of infection, usually at the time of bone marrow recovery from chemotherapy. CT scans obtained early in the course of infection in two patients demonstrated a distinctive feature of one or more pulmonary masslike infiltrates surrounded by a halo of low attenuation. These lesions subsequently progressed to cavitation or air crescent formation typical of IPA. While this CT halo sign may not be pathognomonic for Aspergillus, seen in the appropriate host, it may suggest early on the possibility of IPA.

Adult↗
PubMed1985

Femoral head avascular necrosis: CT assessment with multiplanar reconstruction.

Thirty-two patients with avascular necrosis (AVN) of the femoral head underwent imaging studies using computed tomography with multiplanar reconstructions (CT/MPR). Staging of the disease by means of CT/MPR images was compared with traditional staging by means of routine frontal and frog-leg lateral radiographs. CT/MPR examination upgraded staging in 30% of the hips studied and made significant contributions to patient management in 14 (54%) of 26 patients for whom both CT scans and plain-film radiographs were available for comparison. Asymptomatic and radiographically normal contralateral hips were found at CT study to have stage II or stage III AVN in four patients. Subtle alterations in trabecular patterns, joint spaces, femoral-head contours, and acetabula were well defined on CT/MPR studies in many cases; previously undetected or ill-defined abnormalities were frequently visualized. The major weight-bearing components of the hip (anterior and posterior acetabular columns, acetabular dome, and superior pole of the femur), which may be poorly defined on CT scans due to partial volume effects on the transaxial images, were best seen on the sagittal and coronal reconstructions. A new system for staging AVN is suggested.

Adolescent↗
PubMed1985

Iodine 131 antiferritin, a new treatment modality in hepatoma: a Radiation Therapy Oncology Group study.

One hundred five patients with hepatoma were treated with iodine 131 antiferritin in three sequential protocols in phase 1-2 trials. Therapy began in all trials with external beam irradiation and chemotherapy. The dosimetric results with 131I antiferritin indicated that 30 mCi (8 to 10 mCi/mg immunoglobulin G [IgG]) was sufficient to saturate the tumor. Tumor-effective half-life of the radioactive antibody was 3 to 5 days and was dependent on the species of animal from which the antibody was derived. This led to a 30 mCi on day 0 and 20 mCi on day 5 treatment schedule. Toxicity was predominantly thrombocytopenia. Due to clinical remission, cyclic therapy was next developed with antibodies from different species of animals. Rabbit, pig, monkey, and bovine antibodies were determined to produce the longest tumor-effective half-life and therefore the highest dose of radiation. Integration of 15 mg doxorubicin and 500 mg 5-fluorouracil (5-FU) with 131I antiferritin was accomplished next. Remission to external beam radiation was evaluated by computed tomography (CT) scan tumor volume computations that indicated that 22% of the patients had a partial remission (PR) from initial presentation to 1 month following external irradiation and chemotherapy. From the time of radioactive antibody administration, 48% of the patients (7% complete response [CR] and 41% PR) achieved remission to 131I antiferritin. Of 79 patients evaluated by CT scan tumor volumetrics 50% of the patients (7% CR and 43% PR) remitted to the entire treatment regimen. Patients not previously treated and without metastasis who were alpha fetoprotein positive (AFP+) had a 5-month median survival compared with AFP- median survival of 10 1/2 months. There were four CRs with one being 3 years and 6 months. The longest PR was 5 years and 8 months. These studies have demonstrated the toxicity and therapeutic activity of 131I antiferritin and the emerging role of radiolabelled antibody in cancer therapy.

Adolescent↗
PubMed1985

Transdiaphragmatic extension of invasive thymoma.

The initial and follow-up computed tomographic (CT) examinations of 19 patients with surgically proven invasive thymoma were reviewed; 10 have been previously reported. Transdiaphragmatic extension of tumor was observed in six (31.5%) of the 19 patients. Sites of infradiaphragmatic invasion included the right lateral liver surface, posterior pararenal space, left paraaortic region, perigastric soft tissue, and spinal canal. In the patient with known or suspected invasive thymoma, transdiaphragmatic extension is a common occurrence that requires routine CT imaging of the upper abdomen to avoid underestimating the extent of disease.

Adult↗
PubMed1985

CT in the diagnosis of enterovesical fistulae.

Enterovesical fistulae are difficult to demonstrate by conventional radiographic methods. Computed tomography (CT), a sensitive, noninvasive method of documenting the presence of such fistulae, is unique in its ability to outline the extravesical component of the primary disease process. Twenty enterovesical fistulae identified by CT were caused by diverticulitis (nine), carcinoma of the rectosigmoid (two), Crohn disease (three), gynecologic tumors (two), bladder cancer (one), cecal carcinoma (one), prostatic neoplasia (one), and appendiceal abscess (one). The CT findings included intravesical air (90%), passage of orally or rectally administered contrast medium into the bladder (20%), focal bladder-wall thickening (90%), thickening of adjacent bowel wall (85%), and an extraluminal mass that often contained air (75%). The fistulae secondary to diverticulitis, rectosigmoid neoplasms, carcinoma of the bladder, and uterine tumors involved the left and/or posterior aspects of the bladder. Those form Crohn disease of the terminal ileum or cecal and appendiceal lesions implicated the right lateral or anterior aspects of the bladder. CT proved to be an important new method in the diagnosis of enterovesical fistulae.

Adult↗
PubMed1985

The evaluation of mesoatrial shunt patency with computed tomography.

The mesoatrial shunt is performed in patients with the Budd-Chiari syndrome when the inferior vena cava is occluded and not available for a conventional portosystemic shunt. Computed tomography (CT), with injection of contrast media, was used to evaluate mesoatrial shunt patency with five examinations in four patients. Shunt patency was demonstrated by CT and confirmed by angiography in two studies. Total shunt occlusion diagnosed by CT in two additional cases was confirmed by angiography or operation. Partial graft occlusion diagnosed by CT in a fifth study was verified by both angiography and operation. CT is recommended instead of angiography in the evaluation of mesoatrial shunts because it is less invasive, it may be performed on an outpatient basis, and it yields additional useful information related to shunt patency, such as the volume of ascites, collateral vascularity, and the size of the spleen.

Adult↗
PubMed1984

Anticoagulants and abdominal pain. The role of computed tomography.

The development of abdominal pain in the patient receiving anticoagulants, especially with a documented drop in hematocrit levels, almost certainly indicates a major hemorrhage. If loss of blood from the GI tract is not documented, some form of internal bleeding must have occurred. Unfortunately, the site of the bleeding is frequently unclear. Even small hemorrhages in critical locations (eg, the adrenal gland) can have serious consequences. In the obese patient, a rectus sheath hematoma may remain hidden at the time of repeated physical examinations. Generally, the cause of a mass palpated or perhaps demonstrated by conventional radiological studies cannot be diagnosed accurately. Computed tomography can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. By careful evaluation of the attenuation coefficient, it is possible to establish the definitive diagnosis of hemorrhage. Should the attenuation value of a mass be insufficiently high to diagnose hemorrhage conclusively on the initial scan, serial scans demonstrating a decrease in size and/or attenuation of the mass confirm the diagnosis of hemorrhage. In our opinion a negative CT examination is a reliable indicator that such a bleeding complication has not occurred.

Acute Disease↗
PubMed1984

Computed tomographic diagnosis of radiation ileitis.

Two patients were studied by CT after resection of colon carcinoma followed by abdominal radiation therapy. Based upon the findings of a localized, mass-like confluence of shortened loops of bowel with thickening of bowel wall, adherence of adjoining loops, thickening of the adjacent mesentery, and increased density of mesenteric fat the patients were considered to have radiation ileitis. Recurrent tumor was excluded by autopsy and confirmed by a 1-year asymptomatic follow-up period.

Adenocarcinoma↗