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Biomedical subjects

J Wittenberg

Publications and source records attributed to J Wittenberg.

At least 127 records · Page 7Linked to original sources
PubMed1980

A comprehensive approach for diagnosing pancreatic disease.

Diagnosis of a pancreatic disease should not be based primarily on angiographic or computed tomographic findings. The use of other modalities such as ultrasound, endoscopic retrograde cholangiopancreatography, transhepatic cholangiography and biliary drainage, and percutaneous needle biopsy should be considered based on the patient's clinical problem, risk and cost of the study, and the applicability of the information that may be gained from the study.

Angiography↗
PubMed1980

Significance of nonshadowing focal opacities at cholecystosonography.

Nonshadowing focal opacities within the gallbladder lumen are a frequent finding with cholecystosonography. This study describes a prospective analysis of 125 patients with this finding. In 36 patients surgical proof was obtained. It was found that nonshadowing echogenic foci in the gallbaldder can be separated into two distinct categories and that the incidence of gallstones can be determined for each. The categories are (a) nonshadowing echogenic foci less than 5 mm in size (incidence of gallstones is 81% for those patients coming to surgery) and (b) a fluid-fluid level or sludge (incidence of gallstones is less than 10% for those coming to surgery).

Cholelithiasis↗
PubMed1980

Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy.

Fine needle aspiration biopsy in 100 consecutive patients with suspected abdominal malignancy yielded a positive diagnosis in 69 (82%) of 84 patients in cases ultimately proven to have cancer in the area sampled. Of 21 pancreatic cancers, 18 (86%) were detected; 24 (83%) of 29 liver lesions, usually metastases, were identifed; and 16 (78%) of 22 retroperiteonal masses, most frequently metastatic lymph nodes, were correctly diagnosed. Overall success rate for epithelial malignancy was 67 (85%) of 79 and far exceeded the yield in lymphomatous masses where two (40%) of five cases were detected. Several radiologic guidance methods were used including computed body tomography in 41%, ultrasonography in 45%, and fluoroscopy with or without conventional contrast agents in 14%. Complications were negligible. In a subgroup of 20 patients in whom a positive diagnosis was obtained, separate analysis of the cytologic specimen revealed that the first needle pass contained definitive material in 15 (75%) of 20 cases. The results confirm the effectiveness, safety, and wide applicability of fine-needle aspiration biopsy for nonsurgical confirmation of advanced or unresectable intraabdominal malignancy.

Abdominal Neoplasms↗
PubMed1980

Clinical efficacy of computed body tomography, II.

The contribution to diagnostic understanding and therapeutic decision making by computed body tomography (CT) was measured in 623 patients using prospective and retrospective inquiry of referring physicians. CT improved diagnostic understanding in 52% of patients, reassured the physician about previously planned therapy in 43%, improved precision of previously planned treatment in 23%, and contributed to a change in therapy in 14%. There was a significant increase over time in reports of improved diagnostic understanding which was probably related to increasing clinical experience with the technique. However, this improvement in diagnostic understanding did not correspondingly increase the frequency of beneficially altered therapy. CT contributed to a substantial decrease in preplanned invasive imaging tests and a decision not to perform surgery in 19% of patients in whom an operation had been previously planned. The value of a CT examination to patient care varied considerably with the clinical problem; the most consistent contributions were observed in patients with diseases suspected in the mediastinum and retroperitoneum.

Attitude of Health Personnel↗
PubMed1980

Evaluating efficacy.

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Evaluation Studies as Topic↗
PubMed1980

Fallibility of exploratory laparotomy in detection of hepatic and retroperitoneal masses.

The recent wide availability of sonography and computed body tomography has added a new dimension to the diagnosis of abdominal masses. Recently in six patients exploratory laparotomy failed to reveal a mass demonstrated by preoperative cross-sectional imaging and subsequently confirmed in the postoperative period by reexamination with or without percutaneous needling. Three of the six patients had previous pancreatic inflammatory disease which may have limited the surgical evaluation of the retroperitoneum. Prior to the advent of cross-sectional imaging, there were few available direct means for discovering errors in intraabdominal surgical diagnosis. While exploratory laparotomy is obviously crucial for confirmation of abdominal masses, radiologists should be reminded that it is not infallible.

Adult↗
PubMed1980

Evaluation of computed tomography in pancreatic cancer.

A study of the clinical efficacy of computed body tomography (CBT) is ongoing at the Massachusetts General Hospital. This study attempts to measure the contribution of CBT to diagnostic understanding, the use of other diagnostic tests, and the choice of therapy. During the first nineteen months of the study, 185 patients were examined on the pancreas protocol, a number approximating 30 per cent of all patients in the study. Physicians have some suspicion of pancreatic cancer in nearly all patients examined on the pancreas protocol. CBT improved the physician's diagnostic understanding in 54 per cent of patients examined on the pancreas protocol and contributed to a change in therapy in 18 per cent. CBT also contributed to a net reduction of 54 per cent in the number of angiograms performed compared to the number planned prior to CBT examination. In a subset of seventy-three patients, a definitive diagnosis of pancreatic cancer, inflammation, or normal pancreas was reached in each case. For patients with inflammation, CBT was 1.5 times as likely to increase as to decrease the physician's estimate of the correct diagnosis; for cancer patients CBT was 3.5 times as likely to aid as to mislead the physician; for patients with a normal pancreas, CBT was 6 times as likely to help as to hinder correct diagnosis. CBT can be a valuable aid to the diagnosis and treatment of patients suspected of having pancreatic cancer, but the physician should interpret its results in the light of all available clinical information.

Evaluation Studies as Topic↗
PubMed1979

Gray scale ultrasound in adnexal thickening: correlation with laparoscopy.

A retrospective comparison between ultrasound and subsequent laparoscopy was made in 70 female patients to evaluate the sonographic features of minimal pelvic disease (in particular, adnexal thickening). The overall accuracy of sonography as compared with laparoscopy was 75 percent (53 of 70), with a true positive rate of 72 percent (40 of 51) and a true negative rate of 68 percent (13 of 19). In this study the concept of clinical or sonographic adnexal thickening did not correlate with observations at laparoscopy. Of the 7 patients diagnosed by ultrasound as having adnexal thickening, only 1 had pelvic inflammatory disease, whereas the other 6 showed no abnormalities at laparoscopy.

Adnexa Uteri↗
PubMed1979

Assessment of drug intervention on the ischemic myocardium: serial imaging and measurement with computerized tomography.

Computerized tomography was evaluated as a technique for imaging and measuring the effect of an intervention on acutely ischemic myocardium. Because cell edema occurs with acute myocardial ischemia and decreases the X-ray attenuation coefficients (tissue density) of myocardium, computerized tomographic images were used to quantitate the effect of hyperosmotic mannitol on ischemia-induced edema. Canine hearts were arrested and scanned after (1) temporary occlusion of the proximal circumflex artery followed by reflow of blood, or (2) continued occlusion of the distal left anterior descending coronary artery. X-ray attenuation values (Hounsfield units) were linearly related to tissue wet/dry weight ratios (r = 0.87, P less than 0.001). After 2 hours of occlusion of the left anterior descending coronary artery the hearts that received mannitol manifested a significant reduction (P less than 0.05) in the volume of left ventricular wall involved with edema. Although the area of edema measured with computerized tomography tended to be smaller in the hearts treated with mannitol than in untreated hearts subjected to a 6 hour occlusion of the left anterior descending coronary artery, the size of the lesion was variable and did not differ significantly from that in untreated hearts. With either short periods of circumflex arterial occlusion followed by blood reflow or with 2 or 6 hours of prolonged occlusion of the left anterior descending coronary artery, the difference in mean attenuation coefficients between the ischemic and nonischemic areas of myocardium in mannitol-treated and untreated hearts was significantly less. These results indicate that computerized tomography in the arrested heart can detect and quantitate the lesion of early acute myocardial ischemia and can quantitate the effect of drug intervention.

Animals↗
PubMed1979

Computed tomography of the thorax and standard radiographic evaluation of the chest: a comparative study.

Comparison of standard radiographic evaluation of the chest with computed tomography (CT) was carried out in 109 patients who were examined on a prototype EMI CT5000 scanner. Forty-eight patients had lung problems, and 61 were evaluated because of a mediastinal mass or widening, or for the detection of an occult thymoma in myasthenia gravis. Computed tomography was of value in the staging of bronchogenic carcinoma, particularly in the detection of direct mediastinal and pleural extension, and in evaluating patients with solitary or multiple nodules by detecting additional lesions and calcification. Thymomas not detected on conventional imaging modalities were visualized in 4 of 33 patients with myasthenia gravis or red cell aplasia. One of these was a false positive. In 28 patients with a mediastinal mass or widening on the chest roentgenogram, incremental information was noted on CT in 22. These included a definitive diagnosis of lesions composed of fat, evaluation of the isolated esophagus after colon by bypass surgery,and identification of the cause of paraspinal widening.

Anemia, Aplastic↗
PubMed1979

Radiographically guided needle biopsy of abdominal neoplasms--who, how, where, why?

Radiographically guided percutaneous needle biopsy is a safe, accurate, well-tolerated alternative to laparotomy for confirmation of advanced abdominal malignancy. Here we describe the indications and methodology for its performance. Eighty-two percent of 66 patients with proven abdominal neoplasms were successfully biopsied with a fine-caliber needle using a variety of guidance methods. Cross-sectional techniques, such as ultrasound and computed body tomography (CBT), provide the preferred monitoring techniques because of their excellent soft-tissue resolution and the capacity to determine tumor depth accurately. The ability of CBT to define the exact position of the biopsy needle tip in a mass makes it the preferable guide for biopsing of small, solid lesions.

Abdominal Neoplasms↗
PubMed1979

Computed body tomography in chronic pancreatitis.

CT of the pancrease permitted correct positive diagnosis in 28/50 or 56% of patients with chronic pancreatitis proved by laparotomy or retrograde ductography. Diagnoses were based on CT identification of one or more specific hallmarks of chronic pancreatitis including calcifications (18/50 or 36%), parenchymal atrophy (7/50 or 14%) and pancreatic duct dilatation (2/50 or 4%), as well as the principal surgical complications, pseudocyst and abscess (15/50 or 30%). In 9 patients, CT disclosed pancreatic calcifications not visible on conventional radiographs. In 32 patients, ultrasound was less informative than CT giving a correct diagnosis in 8 pseudocycts (25%). In the patient with unexplained upper abdominal complaints, a positive CT diagnosis of chronic pancreatitis permits more confident patient management than a negative, or "no tumor" diagnosis rendered by other noninvasive examinations.

Chronic Disease↗
PubMed1979

Malignant seeding of the tract after thin-needle aspiration biopsy.

Fine-needle aspiration biopsy is an established technique for cytodiagnosis of malignant neoplasms, yielding a high rate of positive tissue with negligible local sequelae. The authors report the first instance known to them of needle tract seeding following this biopsy technique in a patient with an unresectable pancreatic carcinoma. Because of the rarity of this occurrence, the procedural indications remain unaltered.

Aged↗
PubMed1979

Nonvisualized gallbladder by cholecystosonography.

To further define the significance of gallbladder nonvisualization by cholecystosonography, we studied follow-up data on 25 consecutive patients in whom the gallbladder could not be identified despite adequate fasting. In one patient, intravenous cholangiography demonstrated a large gallbladder but no gallstones. In the 24 cases for which a pathoanatomic diagnosis was established, all but two had diseased gallbladders with obliteration of the lumen. This 88% accuracy for positive prediction confirms results of previous sonographic studies and matches the diagnostic significance of nonvisualization at oral cholecystography. We recommend oral cholecystography for all ultrasonic nonvisualized gallbladders for greater diagnostic accuracy when surgery is contemplated.

Cholangiography↗
PubMed1979

Acoustic contrast enhancement: value of several system gain variations in gray scale ultrasonography.

Because of the broad spectrum of echogenicity inherent in the heterogeneous composition of the abdominal viscera, system gain variations may be useful in gray scale ultrasound imaging to improve lesion definition. In general, Anechoic or hypoechoic processes may be accentuated by scanning in the higher gain ranges, while hyperechoic lesions may be better delineated at lower gain levels. Thus adjustments in "acoustic contrast" may supplement and reinforce information derived from an initial standard medium gain scan. Although the liver serves as a model in this report, careful selection of a variety of system gain levels can be helpful in evaluating focal lesions in any organ.

Humans↗
PubMed1978

Computed tomographic diagnosis of pseudoascites (floating viscera syndrome).

Two cases of excessive fat deposition in the abdomen, confused clinically as massive ascites, are reported. Computed tomography (CT) has proven useful in making a definitive diagnosis of fat deposition in the abdominal and retroperitoneal space and has made further clinical studies unnecessary. No prior cases of pseudoascites (floating viscera syndrome) have been reported in the radiologic literature despite the specificity of CT diagnosis.

Abdomen↗
PubMed1978

CT biopsy of abdominal tumors: aids for lesion localization.

Computed tomographic guided fine needle aspiration biopsy of 25 consecutive patients with a variety of confirmed malignant abdominal and plevic neoplasms resulted in a 100% yield of positive tissue diagnosed, without significant complications. The principal advantage of CT guidance is the continuous direct observation of the needle tip position in relation to the target volume. Simultaneous insertion of 2 fine caliber biopsy needles (tandem needle maneuver) is a new technique developed for rapid, accurate needle repositioning for repeated aspiration attempts. CT guidance, multiple aspirates with the fine needle, and the tandem needle maneuver for precise localization all contribute to a high rate of tissue diagnoses. Because CT guidance permits more precise sampling of smaller, deeper tumors than other procedures, including ultrasonic biopsy transducer systems, it is preferred for percutaneous tissue sampling of abdominal neoplasms. Preliminary experience suggests that a large proportion of symptomatic abdominal malignancies which can be diagnosed by CT are amenable to successful percutaneous biopsy by this technique.

Abdominal Neoplasms↗