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Biomedical subjects

H I Libshitz

Publications and source records attributed to H I Libshitz.

At least 91 records · Page 5Linked to original sources
PubMed1984

Malignant pleural mesothelioma: the role of computed tomography.

Computed tomography is believed to have a definite role in the evaluation of malignant pleural mesothelioma based on a review of computed tomography findings in 23 of our patients and previous reports. Twelve patients had a single computed tomography examination, and 11 had two or more studies. Computed tomography permits better appreciation of the extent of the tumor. This permits appropriate selection of therapy and may demonstrate that surgery or radiotherapy is not indicated. computed tomography often permits more accurate evaluation following chemotherapy and may be the only means by which to follow a patient after radical surgery. Computed tomography also has a role in differential diagnosis. It facilitates distinction of malignant pleural mesothelioma from rounded atelectasis, pleural changes of asbestosis, and pleural involvement with lymphoma and thymoma. It aids, but may not be diagnostic, in separating malignant pleural mesothelioma from metastases to the pleura.

Adult↗
PubMed1984

Radiation-induced pulmonary change: CT findings.

Four patterns of radiation change in the lung were identified in 53 computed tomographic studies of 41 patients at various times following completion of radiotherapy. (a) The homogeneous pattern shows slight increase in density uniformly involving irradiated portions of lung and is believed to represent a diffuse, minimal radiation pneumonitis. (b) Patchy consolidation is contained within irradiated lung but does not conform to the shape of the radiation field. It is analogous to radiation pneumonitis seen on chest radiographs. (c) Discrete consolidation that conforms to the radiation portal but does not uniformly involve it has several possible analogues. (d) Solid consolidation totally involves the irradiated lung and contains ectatic bronchi within it. This finding is analogous to radiation fibrosis. The temporal sequence and dose relationships of these appearances are discussed and related to those seen with conventional studies.

Adolescent↗
PubMed1984

Mediastinal evaluation in lung cancer.

Findings of mediastinal imaging were compared with pathologic findings following thoracotomy and full nodal sampling in 50 patients with bronchogenic carcinoma. All patients underwent full nodal sampling and chest radiography, conventional tomography, CT, and Ga-67 radionuclide scanning. The highest sensitivity for mediastinal metastases noted was 54%, considering nodes greater than or equal to 1.0 cm abnormal at CT. The small size of some involved nodes precluded sensitivity from reaching 100%. Using differing size criteria for nodal abnormality at CT (greater than or equal to 1.0 cm, greater than or equal to 1.5 cm, greater than or equal to 2.0 cm abnormal) sensitivity decreased as specificity increased. The highest specificity noted was 97% with CT, considering nodes greater than or equal to 2.0 cm abnormal. Ga-67 scanning did not offer additional information when compared with that of other studies. The predictive value of considering mediastinal lymph nodes greater than or equal to 1.0 cm abnormal at CT was 35%. Reasons for this include reactive nodes proximal to obstructions and prior granulomatous disease. In 13 peripheral T1N0 cancers (determined by chest radiography) no additional information was gained with any other imaging technique. The utility of CT in peripheral T2 cancers and central cancers is not clear.

Carcinoma, Bronchogenic↗
PubMed1984

Mediastinal lymph node size in lung cancer.

Using a size criterion of 1 cm or greater as evidence for abnormality, the size of mediastinal lymph nodes identified by computed tomography (CT) was a poor predictor of mediastinal lymph node metastases in a series of 86 patients who had surgery for bronchogenic carcinoma. The surgery included full nodal sampling in all patients. Of the 86 patients, 36 had nodes greater than or equal to 1 cm identified by CT. Of the 21 patients with mediastinal metastases proven at surgery, 14 had nodes greater than or equal to 1 cm (sensitivity = 67%). Of the 65 patients without mediastinal metastases, 22 had nodes greater than or equal to 1 cm. Specificity was 66% (43/65). Obstructive pneumonia and/or pulmonary collapse distal to the cancer was present in 39 patients (45%). Of these, 21 had mediastinal nodes greater than or equal to 1 cm; 10 harbored metastases and 11 did not. Obstructive pneumonia and/or pulmonary collapse is a common occurrence in bronchogenic carcinoma, but mediastinal nodes greater than or equal to 1 cm in this circumstance cannot be presumed to represent metastatic disease. Metastatic mediastinal lymph node involvement was related to nodal size also in patients with evidence of prior granulomatous disease and in patients with no putative benign cause for nodes greater than or equal to 1 cm. In both of these groups, metastatic nodal disease was found in only 25% of nodes greater than or equal to 1 cm.

Carcinoma, Bronchogenic↗
PubMed1983

Bone involvement in hairy cell leukemia.

Four patients with a diagnosis of hairy cell leukemia complicated by bone involvement are described. This is an uncommon complication of the disease. Manifestations included osteolytic lesions, severe osteoporosis, and aseptic necrosis of the femoral head. The osseous complications do not seem to bear on the prognoses for these patients. Radiotherapy or chemotherapy provides symptomatic relief and may prevent further morbidity from the bone lesions.

Adult↗
PubMed1983

Radiation-induced injury of the esophagus.

Forty patients with functional or morphologic esophageal abnormalities following radiotherapy were identified. Abnormalities included abnormal motility with and without mucosal edema, stricture, ulceration and pseudodiverticulum, and fistula. Abnormal motility occurred 4 to 12 weeks following radiotherapy alone and as early as 1 week after therapy when concomitant chemotherapy had been given. Strictures developed 4 to 8 months following completion of radiotherapy. Ulceration, pseudodiverticulum, and fistula formation did not develop in a uniform time frame. Radiation-induced esophageal injury is more frequent when radiotherapy and chemotherapy are combined than it is with radiotherapy alone.

Adolescent↗
PubMed1983

Sterilized metastases: a diagnostic and therapeutic dilemma.

The usual indication of improvement in metastatic cancer is diminution of the mass. When a mass persists after treatment, it is presumed the lesion either does not respond or has stopped responding to the therapy. Two patients with brain metastases, one biopsy proven, from breast cancer and eight patients with presumed metastatic testicular cancer to the lung, liver, or retroperitoneum have been identified in whom surgery or autopsy revealed only necrosis and/or fibrosis in the persistent mass; the mass had been "sterilized." Although this phenomenon is not frequent, it is not uncommon in testicular cancer. Our observations are offered to make others aware that persistent mass need not indicate viable tumor. When sufficient examples are accumulated, some clues to predicting this phenomenon may help resolve the therapeutic dilemma it presents.

Adolescent↗
PubMed1983

Treated Ewing sarcoma: radiographic appearance in response, recurrence, and new primaries.

Healing of Ewing sarcoma after therapy has a predictable radiographic appearance, eventually stabilizing and remaining constant in appearance. This study is based on 35 patients in whom adequate follow-up radiographs were available. The expected sequence was evident in 21 patients. Complete healing was evident in about 1 year. Failure to heal as expected or lytic change in healed bone indicated recurrent or refractory disease in 11 patients who developed distant metastases or clinical signs of recrudescence at the primary site. This complication was evident within months to 2 years of the initial treatment. In three patients, development of a new, primary, osteogenic sarcoma was heralded by disorganized tumor new bone in an osteoid matrix, evident only after several years of stability. These new osseous malignancies are probably treatment-related.

Adolescent↗
PubMed1983

Diazepam prophylaxis of contrast media-induced seizures during computed tomography of patients with brain metastases.

The effect of 5 mg of intravenous diazepam (Valium) on contrast media-associated seizure incidence was studied in a randomized controlled trial involving 284 patients with known or suspected brain metastases undergoing cerebral computed tomography. Of these patients, 188 were found to have brain metastases, and it is estimated that for this subgroup prophylactic diazepam reduces the risk of contrast-associated seizure by a factor of 0.26. Seizures occurred in three of 96 patients with metastases on diazepam and in 14 of 92 patients with metastases but without diazepam. Factors related to increased risk of contrast media-associated seizures are: (1) prior seizure history due to brain metastases and/or prior contrast, (2) progressive cerebral metastases, and (3) prior or concurrent brain antineoplastic therapy. Factors not related to an increased risk of these seizures are: (1) contrast media dosage, chemical composition, or osmolarity, (2) computed tomographic appearance of metastases, and (3) type of primary malignancy. Concomitant therapeutic levels of diphenylhydantoin (Dilantin) do not protect completely against contrast media-associated seizures. Pathophysiology of contrast media-associated seizures is discussed in view of the risk factors determined by this study.

Aged↗
PubMed1983

Study of the natural history of immunoblastic lymphadenopathy and atypical immunoproliferative disorders.

Twenty-three patients, 9 with immunoblastic lymphadenopathy and 14 with atypical immunoproliferative disorders (AIPD), were studied in order to determine their clinical, radiographic, and pathologic features. Diffuse lymphadenopathy was present in all patients. Patients with immunoblastic lymphadenopathy (ILA) had an increased incidence of constitutional signs and symptoms. Radiographic findings in both groups were indistinguishable from those of malignant lymphomas. Of all the clinical characteristics examined to establish a prognostic significance, a positive history of allergies and the presence of polyclonal gammopathy were associated with a worse prognosis. Of the 22 patients treated, 15 initially received single agents and seven combination chemotherapy. The median survival of patients who received combination chemotherapy has not been reached at 38 months, while that of the patients on single agents is 10 months. Of 9 patients who achieved complete remission, 7 remain alive, while all 14 patients who failed to achieve a complete remission have already expired. Patients initially treated with combination chemotherapy tolerated treatment well and had a more favorable outcome with only three deaths (mostly secondary to tumor recurrence) in seven patients. Even though these entities are not considered malignant morphologically, their clinical behavior frequently resembles that of a lymphomatous disorder as confirmed by the short median survival of 22 months for AIPD and 24 months for ILA. Once progressive disease is documented, we recommend combination chemotherapy as initial therapy.

Hodgkin Disease↗
PubMed1982

Slipped proximal humeral epiphysis: a complication of radiotherapy to the shoulder in children.

Slipped proximal humeral epiphyses as a sequela of radiotherapy were identified in two children treated for Ewing's sarcoma in whom the shoulder was included in the field of treatment. The radiation doses were slightly greater than those in children developing slipped capital femoral epiphyses following radiotherapy. The lesser stress about the shoulder compared to the hip is believed to be the reason this is an infrequent complication of radiotherapy.

Bone Neoplasms↗
PubMed1982

Antiinflammatory agents protect opossum esophagus during radiotherapy.

Eighteen opossums received 2250 rad 60Co to the entire esophagus and lower esophageal sphincter. Animals received treatment with 600 mg aspirin, 25 mg/kg hydrocortisone, or saline before irradiation and twice daily for 1 week after irradiation. At 10 days postirradiation, animals were evaluated for signs of acute esophagitis by esophagoscopy and barium esophagram. Each animal was then killed and the esophagus removed and evaluated histologically. Animals treated with either aspirin or hydrocortisone had significantly milder esophagitis than control irradiated animals.

Animals↗
PubMed1982

Cranial computed tomography of breast carcinoma.

Cranial computed tomographic (CCT) manifestations of brain metastases were reviewed in 304 patients with carcinoma of the breast. Metastases were demonstrated in 103 patients; 13 had other significant abnormalities. Single lesions were found in 55 (54%) patients (cerebral hemisphere, 48; cerebellar hemisphere, 4; pineal, 1; pituitary and optic chiasm, 1; vermis, 1) and multiple metastases were found in 48 patients. Continuity with bony metastases was seen in 4 patients. Prior to contrast infusion, 13 (12.5%) patients with metastases had a normal CCT, and 13 (12.5%) showed lesions of increased attenuation. All metastases demonstrated enhancement following contrast infusion; 74 (72%) had a zone of surrounding "edema." Histopathologic-CCT correlation was available in 54 patients. Precontrast, increased attenuation of metastases was associated with hemorrhage or calcification, or both. Calcification accompanied by necrosis was the result of previous treatment. Following therapy, 3 patients demonstrated lesions that were impossible to differentiate from metastases by CCT, but proved histologically to have no viable tumor cells present.

Adult↗