Biomedical subjects
Publications and source records attributed to P Goodman.
Primary malignant fibrous histiocytoma (MFH) is an unusual tumor which involves the deep fascia or skeletal muscles of the extremities or retroperitoneum. It rarely arises in the liver and, to our knowledge, the MRI appearance of primary MFH of the liver has never been reported. We present a patient with primary MFH of the liver and discuss the findings on MRI, CT, and angiography.
Operative cholangiography is an important adjunct to laparoscopic cholecystectomy, a recently developed surgical procedure in which cholecystectomy is performed through four abdominal ports under sustained pneumoperitoneum and the direct vision of a video laparoscope. Operative cholangiogram can effectively identify incidental choledocholithiasis or anatomic variation in the biliary system that may significantly influence the surgical approach or postoperative management of the patient. Unique features portrayed on operative cholangiogram in patients undergoing laparoscopic cholecystectomy include unusual displays of pneumoperitoneum, subcutaneous emphysema, visualization of the unresected gallbladder, and overlying surgical hardware that must remain in the operating field during film exposure.
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A variety of intraabdominal complications are associated with organ transplantation. These include inflammatory changes involving the bowel, liver, and pancreas and range from technical complications associated with the surgery to organ rejection, opportunistic infections, and an increased risk of de novo malignancy in transplantation patients.
The Southwest Oncology Group studied the response rate and toxicity of didemnin B (3.47 mg/m2 i.v. q 28 days) in patients with advanced renal cell carcinoma. There were no responses in 22 response evaluable patients. Toxicity was significant with 10 patients having grade 3 or 4 toxicity. Toxicity seen included nausea and vomiting, exacerbation of coronary artery disease, hyperglycemia, anorexia, diarrhea and hepatitis. Didemnin B was toxic but inactive in patients with renal cell treated at this dose.
Although it is not well recognized in the radiologic literature, gastric carcinoma has been reported to occur as a late complication of gastrojejunostomy for benign disease, even in the absence of partial gastrectomy. We present the radiographic findings in two patients with this complication and review clinical and experimental data supporting the role of gastrojejunostomy in the subsequent development of gastric carcinoma.
Beginning in 1981, 28 patients with advanced seminoma were treated with combination chemotherapy followed by irradiation to evaluate the possibility of improved survival using both modalities. The treatment protocol consisted of two courses of vincristine, actinomycin-D, and cyclophosphamide followed by reassessment. Those initially presenting with Stage B3 disease who achieved a complete response to two cycles of chemotherapy then underwent irradiation. All others were given a third course of chemotherapy before undergoing irradiation. The pre-radiation portion of this protocol produced a complete response rate of only 25 percent, substantially less than other, more recent, protocols. Radiation therapy produced a complete response in 69 percent of those who did not achieve a complete response from chemotherapy, increasing the complete response rate from 25 percent to 64 percent. Given this response rate to radiation therapy and the difficulty of dissection and associated morbidity with the surgical excision of postchemotherapy residual masses, the best option at this time may be observation with salvage chemotherapy and/or radiation reserved for those with disease progression.
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Penetrating missile or bullet wounds to the lung result in a number of abnormalities visible on chest radiographs. One finding that is unique to pulmonary parenchyma is the bullet track, which occurs along the course of a bullet as it traverses the lung. A bullet track may occur in the lung because of this organ's low specific gravity and high elasticity. In other tissues, such as liver and brain, that have higher specific gravities and lower elastic content, bullet tracks are rarely, if ever, noted because widespread destruction usually occurs. Bullet tracks may have a delayed appearance on chest radiographs, and thus may cause confusion in interpretation if a history of injury is not elicited. With the increase in violet confrontations in the United States, it is more and more likely that radiologists will be asked to interpret chest radiographs of patients who have had penetrating bullet injuries to the thorax. In this pictorial essay, we illustrate the appearance of bullet tracks in lung on chest radiographs.
Safe angioplasty of a portacaval shunt requires particular knowledge of the tissue characteristics of an anastomosis and the behavior of a balloon during inflation. The nature and true diameter of a portacaval shunt anastomosis are more difficult to evaluate than those of a peripheral arterial lesion, and complications are potentially more hazardous than those related to peripheral arterial angioplasty. We suggest that in some instances low pressure and incomplete balloon inflation are all that is necessary to yield safe and satisfactory results.
Computed tomography (CT) is a useful method for evaluating the abdominal wall. Pathology includes hernia, hematoma, infection and inflammation, tumor, and post-traumatic, post-operative, and miscellaneous conditions. The CT findings of these various abnormalities are presented.
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Adenocarcinoma of the pancreas is a highly lethal malignancy and chemotherapy has had little impact on the natural history of this disease. PALA, used to potentiate 5-fluorouracil (5-FU), has been shown to have synergy in vivo and in vitro. Twenty-seven patients were treated with an intravenous push dose of PALA (250 mg/m2) followed 24 hours later with a 24-hour infusion of 5-FU (2600 mg/m2). This regimen was repeated weekly. There was one partial response of 21 eligible patients with an estimated response rate of 5%. Toxicity was severe with one toxic death and four patients experiencing Grade 4 toxicity. 5-Fluorouracil and PALA, given in the schedule described, do not appear to be effective against adenocarcinoma of the pancreas.
Twenty four patients with advanced renal cell carcinoma were treated in a phase II trial with amonafide 300-450 mg/m2/day on days 1-5 every 21 days. There were no responders, 6 patients had stable disease, 14 experienced progressive disease and 4 were assumed to be non-responders as no evaluation was performed. There were no fatal toxicities although 8 patients had grade 3 or 4 granulocytopenia, 1 patient had grade 4 thrombocytopenia. Other toxicities included grade 3 diarrhea in 1 patient, grade 3 myopathy in 1 patient, severe nausea and vomiting in 1 patient and a facial rash, possibly a hypersensitivity reaction, in 1 patient. The median survival is 7.5 months. At this dosage and schedule, there is no evidence that amonafide has meaningful anti-tumor activity in patients with advanced renal cell carcinoma.
We present two cases of invasive squamous cell carcinoma of the anus complicating long-standing anal condyloma acuminatum. The computed tomographic (CT) findings are reviewed, and the increasing importance of malignant transformation of anal condylomas is discussed.
Percutaneous endoscopic gastrostomy (PEG) has become an accepted technique for providing long-term enteral feeding. We report two cases of extrusion of the PEG tube into a short fistulous tract that communicates with the stomach. Although this unusual complication led to difficulty with tube feedings, both patients were asymptomatic, and, in one case, it was possible to reposition another catheter in the stomach via the fistula.