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Biomedical subjects

H S Shulman

Publications and source records attributed to H S Shulman.

13 recordsLinked to original sources
PubMed1987

Mediastinal lymph node metastases from bronchogenic carcinoma: detection with MR imaging and CT.

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in a prospective study of 48 patients for the detection of metastatic mediastinal lymphadenopathy from bronchogenic carcinoma. The images were interpreted by three experienced radiologists using a five-point rating scale, enabling receiver operating characteristic (ROC) analysis. Imaging results were evaluated against "truth" data based on analysis of surgical specimens from mediastinoscopy and thoracotomy. All MR images were cardiac gated to reduce cardiac motion artifacts in the mediastinum. MR and CT both performed well, as indicated by similar areas under the ROC curves of 0.779 +/- 0.039 for MR imaging and 0.781 +/- 0.038 for CT scanning. No strong correlation between nodal size and metastatic involvement could be found for either MR or CT results. As long as nodal size remains the sole criterion in the detection of metastatic mediastinal lymphadenopathy, MR imaging is unlikely to enable better interpretations than CT scanning.

Adult↗
PubMed1986

Elastofibroma: chest wall pseudotumor.

A 68-year-old man had a painless, nontender lump in the right infrascapular region. An unenhanced computed tomography (CT) scan showed a soft-tissue mass attached to the scapula, causing muscular displacement. A similar, smaller mass was found on the left side. The appearance of the masses on CT scans was suggestive of infiltrating malignancy, but pathologic examination disclosed findings typical of elastofibroma. Biopsy is recommended in similar cases to exclude sarcoma.

Aged↗
PubMed1983

Thyroid tumor imaging.

Clinical assessment of a patient with a focal or diffuse thyroid tumor is but the first step in diagnostic evaluation. The diagnostic imaging process augments information obtained by the inspecting eye and the palpating hand; it allows the qualification (for example, cystic v solid) and the quantification (for example, size, extension, and assessment of physiologic function) of the thyroid tumor mass. This diagnostic input allows the establishment of a more realistic provisional diagnosis and directs a rational treatment approach to the patient. This presentation reviews the major imaging modalities available for thyroid tumor evaluation: diagnostic ultrasound, radionuclide scans, and conventional radiology and computed tomography. The applications of these various modalities and their critical potentials and limitations are placed in a contemporary clinical setting. It is hoped that an increasing familiarity with these imaging modalities will give better direction to the specialist in otolaryngology--head and neck surgery and greater surgical benefit to his or her patients.

Adenocarcinoma↗
PubMed1983

The radiology of blunt chest trauma.

Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronchial rupture and diaphragmatic rupture.

Aortic Rupture↗
PubMed1982

Unnecessary diuretic therapy in the elderly.

The possible beneficial or adverse effects of long-term diuretic use in the elderly were evaluated in 60 males (mean age 80.0 years) and 17 females (mean age 84.3 years). All subjects were found to have no obvious need for diuretics when initially assessed and were not receiving concurrent digoxin therapy. Residents were randomly allocated to placebo or active groups with stratification for prior hypertension or congestive heart failure (CHF) and they were followed for one year in a double-blind design. Mean BP, heart rate and weight at one year were similar to baseline values in both groups. Six active and two placebo subjects developed CHF and two other placebo subjects had a return of BP to hypertensive levels. Serum creatinine, cholesterol, potassium and BUN were significantly improved at one year in the placebo group. Chronic diuretic use did not alter appreciably the occurrence of CHF or hypertension in this elderly population and may not be necessary.

Aged↗
PubMed1982

Controversies in the management of pulmonary contusion.

Most polytraumatized patients with lung contusion also have injury to the chest wall. Both are serious but the lung contusion is most important in contributing to respiratory failure. A small and localized injury to the lung leads to generalized edema in surrounding lung and even in the opposite lung. The permeability of capillaries is affected and there is an outpouring of the fluid through a leaking pulmonary membrane. Diagnosis is easy when the condition is straightforward and severe, but may be complicated in a confused or unconscious patient with or without head, abdominal and orthopedic injuries producing shock. Pulmonary aspiration and pneumonia may cloud the issue. Aggressive chest physiotherapy combined with the reduction of pain by local intercostal blockade or epidural anesthesia may obviate the need for mechanical ventilation.

Contusions↗
PubMed1982

CT of the larynx.

While conventional radiographic techniques are still of value in the radiologic work-up of the patient with laryngeal disease, computed tomography (CT) has assumed a dominant role, particularly in the pretreatment staging and post-treatment evaluation of the patient with cancer. Even prior to the present generation of high resolution, fast scan equipment, images were being generated that revealed information available in no other non-invasive way, offering two major advantages. Initially, CT's ability to depict cross-sectional (axial) anatomy allows the radiologist and surgeon to build a clear three dimensional image of the site and extent of disease. Secondly, CT discriminates small soft tissue density differences. Also, this latter capability allows a separation of lymph nodes and blood vessels if the study is done with intravenous contrast enhancement. These two outstanding imaging properties allow informed decisions to be made regarding the feasibility and/or extent of conservation or radical surgery in malignant disease and provide unique and critical information regarding cartilage and deep structures. Other advantages of varying importance include the speed of the examination, its noninvasive nature, and the comfort to the patient. This paper reviews normal CT anatomy and discusses, with illustrations, the major diagnostic applications of CT in laryngeal disease.

Carcinoma↗
PubMed1978

Variation in measurement of coronary lesions on 35 and 70 mm angiograms.

Inter- and intraobserver variability in the measurement of coronary artery stenosis using 35 mm cine and 70 mm spot film angiography was examined. Three experienced observers measured 52 lesions on two occasions. The 35 mm cine was evaluated visually, and a single 70 mm frame demonstrating the stenosis was assessed both visually and with a calibrated magnifying device (jeweler's eyepiece). Higher correlation coefficients within and between observers were obtained using the cine method compared to the 70 mm visual and eyepiece techniques. Observer variability was decreased further by using an average of several readings from the 35 mm cine to assess the degree of stenosis. The data suggest that neither higher resolution film (70 mm) nor calibrated magnifying devices diminish observer variability in the measurement of coronary artery lesions.

Angina Pectoris↗
PubMed1976

Thoracic manifestations of renal cell carcinoma.

Over 1/3 of patients with renal cell carcinoma will present with metastases with no symptoms referable to the kidney. Early metastatic disease is a result of the unique accessibility of the kidney to lymphohematogenous pathways. The thorax is particularly vulnerable. Several of the more unusual manifestations involving the thorax are illustrated, including 1 case with intra-alveolar metastases.

Adenocarcinoma↗