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Biomedical subjects

R M Mendelson

Publications and source records attributed to R M Mendelson.

At least 19 recordsLinked to original sources
PubMed2001

Extracolonic findings at virtual colonoscopy: implications for screening programs.

OBJECTIVE: Virtual colonoscopy (VC) is an evolving technology proposed as a possible screening tool for colorectal cancer. In contrast to conventional colonoscopy, VC may detect extracolonic abdominal pathology. This may lead to unnecessary investigation of benign lesions, or may benefit the patient by identifying serious pathology at an early stage. The aim of this study was to assess the prevalence and characteristics of extracolonic pathology found in patients undergoing VC. METHODS: A total of 100 patients aged > or = 55 yr, referred for colonoscopy for bowel symptoms or family history of bowel cancer, underwent VC. Axial views of the abdomen were reviewed prospectively by a single radiologist for extracolonic pathology. Patients with extracolonic abnormalities were referred to their local doctor or to a specialist clinic when appropriate. Case records were reviewed and treating doctors contacted to document subsequent investigations and procedures generated. RESULTS: Fifteen patients (15%) had extracolonic abnormalities detected. In four patients, the pathology had been diagnosed previously (umbilical hernia, gallbladder and renal calculi, 3.5-cm aortic aneurysm, ovarian cyst). Eleven patients had new abnormalities detected: ovarian cysts (three), liver cysts (two), uterine fibroids (two), gallstones (one), splenic calcifications (one), aortic aneurysm (one), and renal tumor (one). Two patients with ovarian cysts underwent surgery, and histology showed benign cysts. CONCLUSIONS: Extracolonic abnormalities are common at VC. Most are benign, but may lead to investigative and procedural costs. These data should be carefully evaluated in feasibility and cost-effectiveness studies on colorectal cancer screening using VC.

Aged↗
PubMed2000

Virtual colonoscopy compared with conventional colonoscopy: a developing technology.

AIM: To determine the accuracy of computed tomography colography (virtual colonoscopy) in detecting colorectal polyps and colorectal cancer. DESIGN: Blinded comparison of virtual colonoscopy (initially supine-only scans and later supine plus prone scans) with the criterion standard of conventional colonoscopy. SUBJECTS AND SETTING: 100 patients aged 55 years or over referred to a public teaching hospital for colonoscopy, July 1997 to January 2000, because of colonic symptoms or a family history of bowel cancer. MAIN OUTCOME MEASURES: Presence and size of polyps and other lesions; certainty of polyp identification on virtual colonoscopy (on 100-point visual analogue scale); sensitivity and predictive values of virtual colonoscopy. RESULTS: Conventional colonoscopy identifed 121 polyps in 47 patients; 28 of these polyps, in 19 patients, were identified by virtual colonoscopy. Sensitivity of virtual colonoscopy for detecting polyps (using supine plus prone scans) was 73% for polyps with diameter > or = 10 mm (95% CI, 39%-94%) and 19% for smaller polyps (95% CI, 10%-31%) (P < 0.001); corresponding figures for supine-only scans were 57% (95% CI, 18%-90%) and 11% (95% CI, 4%-24%), respectively. Ten polyps identified at virtual colonoscopy were considered false-positive findings (8%). The value of finding a polyp on virtual colonoscopy (with thresholds of 5 mm for diameter and 30 points for certainty score) was assessed as a predictor of finding a polyp (diameter > 5 mm) on conventional colonoscopy. Positive and negative predictive values were 88% and 89%, respectively, for supine plus prone scans. CONCLUSION: Although virtual colonoscopy shows potential as a diagnostic tool for colorectal neoplasia, it is currently not sufficiently sensitive for widespread use.

Colon↗
PubMed1998

The role of the barium enema in the diagnosis of colorectal neoplasia.

The recent interest in guidelines for colorectal cancer diagnosis, management and in screening has important implications for radiologists. The present article reviews the role of the barium enema in colorectal neoplasia diagnosis in symptomatic patients, and in the context of screening programmes.

Barium Sulfate↗
PubMed1996

The whirl sign: a non-specific finding of mesenteric rotation.

The whirl sign has been described as a computed tomography (CT) finding of volvulus of the gut. Six cases are presented with a range of clinical diagnoses (a volvulus, adhesive obstruction with volvulus and previous left hemicolectomy, adhesions alone, transverse colectomy, and right hemicolectomy). All demonstrated a whirl sign. A further case simulating a whirl sign is also presented. We propose that the whirl sign, although a finding highly suggestive of volvulus, can occur in any situation that produces rotation or twisting of bowel and its mesenteric attachment.

Adult↗
PubMed1996

Liposarcoma of the hypopharynx.

A case of the unusual condition of liposarcoma of the hypopharynx extending submucosally down the oesophagus in a 64 year old male is reviewed. The clinical, radiological and pathological features are presented and the role of various radiological modalities is discussed.

Humans↗
PubMed1995

Retroperitoneal lymphangioma.

Five cases of retroperitoneal lymphangioma are presented. In three patients the lesions were symptomatic, with resolution of the symptoms following resection. In two elderly patients the lesions were asymptomatic. Ultrasound demonstrated masses that ranged from 4 to 15 cm in maximal extent, and which were predominantly anechoic. Two contained septations and two echogenic debris. Computed tomography demonstrated the masses to be of water density, and allowed better delineation of the lesions to adjacent structures within the anterior pararenal space. Fine needle aspiration (FNA) produces a characteristic cytology of abundant lymphocytes, which may be intermingled with macrophages. It is considered that retroperitoneal lymphangioma has characteristic imaging features that allows a presumptive diagnosis, which can be confirmed by FNA.

Adolescent↗
PubMed1995

Duodenal haemorrhage resulting from renal cell carcinoma metastases.

A case of duodenal haemorrhage resulting from renal cell carcinoma metastases is presented. This is an uncommon method of presentation and is often difficult to diagnose requiring multiple imaging regimes. This case demonstrates the problems that may be encountered in identifying the source of bleeding.

Carcinoma, Renal Cell↗
PubMed1995

Ultrasound and liver disease.

The widespread availability of ultrasound has revolutionised the investigation of hepatobiliary disease. Liver ultrasound should be the primary imaging modality in jaundice, suspected diffuse liver disease or focal liver disease and supplemented by other modalities where indicated. The advent of Duplex and Colour Doppler imaging has expanded the utility of ultrasound techniques in relation to the hepatic vasculature. This article presents an overview of the use of ultrasound in liver disease.

Humans↗
PubMed1994

Computed tomography in acute small bowel obstruction.

The abdominal computed tomograms of 28 patients with a clinical diagnosis of acute small bowel obstruction were reviewed. Computed tomography accurately identified the presence, severity and level of obstruction. Signs such as angulated bowel loops and adjacent streaks within the mesentery at points of luminal calibre change were recognized in 69% of cases with adhesive obstruction. Computed tomography may reveal non-adhesive causes and is the modality of choice for investigating patients with higher grades of bowel obstruction where early surgical intervention is contemplated.

Acute Disease↗
PubMed1991

A case of fibrolamellar hepatocellular carcinoma.

Fibrolamellar hepatocellular carcinoma is an uncommon histologic subtype of hepatocellular carcinoma, comprising 3.5% of all hepatocellular carcinomas in one large study (Brandt et al 1988). It usually occurs in young people, the average age being 18 years (Farhi et al 1983). It is not associated with cirrhosis and the serum alphafetoprotein is usually normal (Craig et al 1980). Fibrolamellar hepatocellular carcinoma has a more favourable prognosis than the usual hepatocellular carcinoma, with an average survival of 32 months from onset of symptoms, compared to 6 months for the usual type. The resectability rate and 5 year survival figures are also much better (Craig et al 1980). Hence distinguishing this histological subtype is important for surgical management and survival prognosis. This report describes a full radiological evaluation of such a case, covering the wide spectrum of relevant imaging modalities.

Adolescent↗