Biomedical subjects
Publications and source records attributed to H M Goldstein.
One hundred and eight ultrasonographic examinations of the abdomen and pelvis in 89 patients with malignant melanoma were reviewed. Forty of these patients were found to have metastatic disease demonstrated by this new diagnostic modality. The varied ultrasonographic manifestations of melanoma are illustrated. Its use in staging and evaluating therapy is stressed.
Ultrasonographic findings in 13 right adrenal gland neoplasms were reviewed. Primary malignancy was the etiology in four patients and metastatic malignancy in nine. Anterior displacement and/or indentation of the posterior aspect of the inferior vena cava was present in nine patients. This sign, although nonspecific, helpful in the localization and diagnosis of right adrenal lesions.
Percutaneous fine-needle aspiration biopsy of pancreatic masses was performed in 34 patients. Biopsies were performed with a 22 or 23-gage, spinal-type needle under fluoroscopic guidance. Correct results were obtained in 73% of the patients including 21 patients with pancreatic carcinoma. No complications occurred. The primary indication for aspiration biopsy was to document the presence of malignancy and avoid a diagnostic laparotomy in patients considered to be unresectable.
Transcatheter therapy for arteriocapillary gastrointestinal bleeding is often an effective form of treatment. The choice of transcatheter therapy (ie, vasoconstrictor or occlusive) often is dependent on the etiology and location of bleeding. Vasopressin is a generally safe form of treatment which is often successful in treating bleeding secondary to gastritis, Mallory-Weiss mucosal tears, and diverticular disease. It is less effective in treating bleeding peptic ulcers, neoplastic bleeding, or bleeding when clotting abnormalities exist. Occlusive therapy is an effective alternate form of therapy in selected circumstances. Ischemic complications from vasoconstrictor and embolic therapy may occur and require appropriate caution and discretion with their use.
In a study of 62 musculoskeletal neoplasms, computed tomography contributed little to establishing tissue diagnosis. Its primary value lay in the assessment of intraosseous and/or extraosseous extent of disease. CT also established the presence or absence of disease in a small number of cases with clinically questionable findings. In most cases, conventional radiographic methods were superior in diagnosing musculoskeletal neoplasms.
Twelve patients with sonolucent hepatic metastases studied with gray scale ultrasonography are presented. Extensive necrosis presumably accounts for the sonolucent appearance of the hepatic lesions. The spectrum of ultrasonographic features and correlations, particularly with computed tomography, are presented. The similarity between anechoic hepatic metastases and benign conditions of the liver is emphasized.
The role of ultrasonography in the evaluation of 12 patients who had previously undergone nephrectomy for renal carcinoma is discussed. Ultrasonography is a useful, noninvasive means of evaluating such patients for recurrence of disease. The ultrasonographic features of retroperitoneal recurrence and a potential diagnostic pitfall of bowel loops in the renal bed are emphasized.
Ultrasonic characteristics of 21 adrenal neoplasms (19 patients) examined by gray scale ultrasonography are reviewed. The significance of the adrenal-renal cleavage plane is discussed. In our experience the cleavage plane only has definite localization value when it separates the adrenal gland from the kidney on all ultrasonographic sections. Compression of the posterior wall and/or anterior displacement of the inferior vena cava was seen in about two-thirds of the right adrenal tumors. The difficulty in examining left adrenal masses is emphasized. Ultrasonography has proved to be an excellent screening procedure for adrenal tumors.
Eight patients with various forms of hepatic cystic disease studied with gray scale ultrasonography are described. Four had solitary cysts, two had multiple simple liver cysts, and two had congenital polycystic liver and kidney disease. The spectrum of ultrasonographic features in benign cystic disease of the liver is discussed. All eight patients were felt to have malignant disease in the liver prior to ultrasonographic evaluation. The value of gray scale ultrasound as a noninvasive means of differentiating cystic disease from suspected metastatic disease is emphasized.
Five cases of extension of renal carcinoma into the inferior vena cava were detected using gray scale ultrasonography. Two different ultrasonographic appearances reflecting the intracaval tumor were observed. Four patients had one or two intraluminal echogenic nodules or thrombi, and the fifth case manifested generalized caval dilatation with innumerable diffuse low amplitude echoes emanating from the lumen. The role of ultrasonography in the complete evaluation of the patient with renal carcinoma is discussed, and the ultrasonographic features of intracaval tumor are demonstrated.
Ultrasonography was performed in the prone and supine positions in six patients with neoplasms in the tail of the pancreas. The masses were either not apparent (three cases) or less well visualized on the supine scans. The value and indications of the prone position in the ultrasonic evaluation of masses in this portion of the pancreas are documented. Prone scanning is particularly useful when malignant ascites interferes with pancreatic visualization in the supine position.
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Seven patients with necrotic liver metastases were evaluated by computed tomography. The metastases demonstrated low attenuation areas varying from a small central portion to the entire lesion. Other findings included mural nodules and fluid-fluid levels. Possible etiologies for necrotic metastases are presented and their differential diagnosis is discussed.
Radiation injury of the gastrointestinal tract requires a minimum dose of 4200 to 4500 rads. The symptoms and signs of radiation injury usually appear within 6 to 24 months following therapy. The radiation induced changes include mucosal atrophy and ulceration associated with an obliterative endarteritis in the supportive vasculo-connective tissue. The roentgen manifestations are those of an ischemic process but may also mimic those of recurrent malignant disease. Obstruction, hemorrhage, and fistula formation are common complications. Surgery is frequently required. The morbidity and mortality is considerable.
Marginal spiculations and punctate collection of barium may occasionally be identified on barium examination in patients with a normal colon. These may be due either to filling of the crypts of Lieberkuhn with barium or retention of barium in the innominate grooves of the colon. Perhaps both combine to produce the radiographic findings. This normal variant must be carefully distinguished from actual ulcers associated with inflammatory bowel disease in order to avoid making a major error in diagnosis.
Percutaneous aspiration biopsies of opacified retroperitoneal lymph nodes, and retroperitoneal, intraperitoneal and paraspinal masses were successfully accomplished in 14 of 17 patients. A 23-guage needle was utilized for the procedure which is performed under fluoroscopic guidance. Metastatic carcinoma, sarcoma and melanoma were readily identified by aspiration biopsy while the diagnosis of lymphoma, especially as to type, was more difficult. No significant complications have resulted from the passage of the needle through the peritoneal cavity.
Percutaneous fine needle aspiration biopsy of 18 patients with pancreatic masses, and 19 with other intra-abdominal tumors, showed it to be a safe, accurate procedure. A diagnostic biopsy yield was obtained in over 85% of the cases without clinical complications. Indications for fine needle biopsy are: (a) to avoid surgery by obtaining a histologic diagnosis; (b) to determine the staging of a neoplastic disease process; and (c) to facilitate treatment planning. The technique of "skinny needle" biopsy is discussed.
Ninety malignant hepatic neoplasms were studied by gray scale ultrasound. Four different ultrasonic patterns were observed: (a) discrete, relatively echo-free masses; (b) discrete, relatively echogenic masses; (c) totally echo-free masses; and (d) a diffuse alteration of echo architecture without discrete masses. There has been no apparent association of ultrasonic pattern with either the histologic type of neoplasm or the angiographic vascularity. Corresponding isotopic data is discussed.