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S J Herman

Publications and source records attributed to S J Herman.

At least 19 recordsLinked to original sources
PubMed1992

Thin-walled cystic lesions in bronchioalveolar carcinoma.

In a retrospective study, thin-walled cystic lesions were identified in four patients with proved bronchioalveolar carcinoma (BAC). The radiographic appearances are described, and possible mechanisms of formation of the lesions are discussed. Although such appearances due to BAC have rarely been described in the literature, the authors believe that the differential diagnosis of thin-walled cystic lesions associated with consolidation should include BAC.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1991

Bronchiolitis obliterans after lung transplantation: findings at chest radiography and high-resolution CT. The Toronto Lung Transplant Group.

Although bronchiolitis obliterans (BO) is seen commonly after heart-lung transplantation, its occurrence after lung transplantation appears to be relatively infrequent. In the 55 single- and double-lung transplantations performed at Toronto General Hospital, 41 patients have survived longer than 3 months and four (10%) have developed pathologically proved BO. Chest radiographic findings in these four patients included slight to moderate decreased peripheral vascular markings (n = 3), slight to moderate volume loss (n = 2), subsegmental atelectasis (n = 2), and new, thin, linear, irregular areas of increased opacity (n = 2). High-resolution computed tomography (HRCT) demonstrated mild peripheral bronchiectasis (n = 4) and decreased peripheral vascular markings (n = 3). Although the radiographic and HRCT findings did not appear to be specific for posttransplantation BO, they may be of value in suggesting the diagnosis of BO within this patient population.

Adult↗
PubMed1991

Anterior mediastinal masses: utility of transthoracic needle biopsy.

The results of 143 transthoracic needle biopsies (TNBs) in 126 patients with anterior mediastinal masses were compared with the final diagnosis, which was proved with pathologic study (n = 95) or clinicoradiologic methods (n = 31). In the 26 patients with lymphoma, the sensitivity of TNB was 42%; the specificity, 96%. In the 15 patients with Hodgkin disease, the sensitivity was 20%. In the 28 patients with thymoma, the sensitivity was 71%; the specificity, 94%. In the 11 patients with germ cell tumors, the sensitivity was 91%; specificity, 98%. The sensitivity in the 33 patients with metastatic disease was 70%; specificity, 100%. The cytologic specimens were examined with light microscopy and the Papanicolaou method only, a limitation that explains the difficulty in differentiating lymphoma from thymoma and that can now be overcome with immunohistochemical study. TNB of anterior mediastinal masses is useful in metastatic disease and germ cell tumors. Lymphoma and thymoma are less reliably diagnosed unless immunohistochemical cytologic methods are applied.

Adolescent↗
PubMed1990

Pulmonary atelectasis after reconstruction with pectoralis major flaps.

Forty-four patients were reviewed to determine the incidence of atelectasis following pectoralis major myocutaneous flap reconstruction of head and neck defects. Patients underwent tumor resection with subsequent pectoralis major myocutaneous flap reconstruction (flap group, n = 24) or another major head and neck procedure (control group, n = 20). Chest roentgenograms taken on the first postoperative day were scored for atelectasis by preestablished criteria. Sixty-five percent of control and 70% of flap patients demonstrated postoperative atelectasis roentgenographically. The flap patients with skin paddles larger than 40 cm2 had a 60% incidence of major atelectasis compared with 5% in control patients. The skin island area was strongly correlated with the atelectasis score in the flap group. These results suggest that atelectasis is common following pectoralis major myocutaneous flap reconstruction of head and neck defects. As well, decreased chest wall compliance after primary closure of large donor defects may contribute to the atelectasis observed.

Carcinoma, Squamous Cell↗
PubMed1990

Radiologic correlation with early physiologic function of the transplanted canine lung.

There is no single reliable method for assessment of the transplanted lung. Multiple modes of assessment are therefore used. In a canine model designed to assess lung preservation, the reliability of information gained from chest radiographs performed in the early post-transplant period was examined. The function of 20 left lung allografts, stored for 12 hours after pulmonary artery flush preservation was studied. Radiographs graded according to disease severity were compared with physiologic function of the transplanted lung assessed immediately and at three days post-transplantation. This protocol enables study of acute preservation-related lung injury and the delayed manifestations of ischemic and reperfusion injury after a three day period of recovery, while avoiding confounding rejection and infectious episodes. The chest radiograph did not reliably reflect function of the flush-preserved transplanted lung. Thus, relying only on this modality may lead to erroneous conclusions. In this study, the progression of radiographic changes associated with the "reimplantation response" differed from previous descriptions, possibly reflecting differences in operative technique or improved lung preservation.

Animals↗
PubMed1990

Usefulness of the blood patch technique after transthoracic needle aspiration biopsy.

The authors investigated the effectiveness of the blood patch technique in reducing the pneumothorax and chest tube insertion rates after transthoracic needle lung biopsy. Biopsy of 100 pulmonary nodules was performed with a coaxial system. In this prospective, randomized study, patients either received a blood patch (group A, n = 46) or did not (group B, n = 47). Seven procedures were excluded: five for technical reasons and two because of lack of follow-up information. Comparison of the two groups by means of X2 analysis and the Student t test revealed no difference in the mean age, gender, smoking history, proportion of heavy smokers, nodule size, presence of cavitation, or number of needle passes. The pneumothorax rate was 24% (11 of 46 patients) in group A and 30% (14 of 47 patients) in group B. The chest tube insertion rate was 2.2% (one patient) in group A and 2.1% (one patient) in group B. The difference between the groups in either rate was not significant (P greater than .5). The blood patch technique did not lower the rate of pneumothorax or chest tube insertion.

Biopsy, Needle↗
PubMed1990

Radiologic assessment after lung transplantation.

Radiographic studies have a major role to play in patients undergoing lung transplantation. A review of the findings associated with the reimplantation response, acute rejection, bronchiolitis obliterans, ischemia-induced air-way complications, and cyclosporine-associated lymphoma, as well as the pulmonary and cardiac change following double lung transplantation, has been presented. It should also be kept in mind that this group of patients is also subject to all of the usual problems associated with thoracic surgery, such as infection, atelectasis, pleural effusion, and pneumothorax, conditions for which radiologic assessment is crucial.

Animals↗
PubMed1989

Single-lung transplantation: imaging features.

The imaging studies obtained after single-lung transplantation in 14 patients were reviewed. The reimplantation response occurred in 13 patients and was an early, transient process, which varied in its manifestations from a subtle perihilar haze to dense consolidation with air bronchograms. Nine episodes of acute rejection, an imprecise clinical diagnosis, occurred in eight of the patients. The associated chest radiographic changes were variable and included basal or diffuse reticular interstitial disease in three cases and basal and/or perihilar consolidation in three cases; no change was detected in three cases. On four occasions, the radiographic changes resolved within 24 hours of intravenous corticosteroid administration. The radiographic findings associated with the reimplantation response and rejection were nonspecific and could have been mistaken for those of fluid overload, atelectasis, mucous plugging, and pneumonia. Bronchial dehiscence was well demonstrated by the finding at computed tomography of extraluminal air adjacent to the bronchial anastomosis. One patient developed multiple pulmonary nodules due to cyclosporine-induced lymphoma.

Acute Disease↗
PubMed1989

Pulmonary lymphangioleiomyomatosis: high-resolution CT findings in four cases.

Lymphangioleiomyomatosis is a rare disease of unknown cause that affects women of reproductive age. It is characterized by progressive proliferation of smooth muscle in the lung. The patients present with progressive shortness of breath, pneumothorax, chylous effusion, and hemoptysis. Four patients with biopsy-proved lymphangioleiomyomatosis of the lung were evaluated using high-resolution CT. In all patients, the scan showed well-defined cystic air spaces, surrounded by uniformly thin walls, distributed diffusely throughout both lungs. The cystic air spaces ranged in size from a few millimeters to 5 cm. Pathologically, these cysts were predominantly bounded by normal-looking parenchymal components, with occasional patchy involvement by a smooth-muscle proliferative process. The CT appearance of lymphangioleiomyomatosis differs quite distinctly from that of other diseases that can cause cystic air spaces, such as fibrosing alveolitis, neurofibromatosis, and bronchiectasis, and less distinctly from pulmonary emphysema and eosinophilic granuloma. Our experience in these few cases suggests that the high-resolution CT findings in lymphangioleiomyomatosis are characteristic of the disease.

Adult↗
PubMed1989

Chest radiographic findings after bilateral lung transplantation.

We reviewed the postoperative chest radiographic and CT findings in the first 13 patients who underwent bilateral lung transplantation at our institution. Portable chest radiography was performed daily for about 10 days, after which upright posteroanterior studies were performed daily for about 10 days, and then as clinically required. CT was performed when a complication was suspected. The reimplantation response (noncardiogenic pulmonary edema due to ischemia, trauma, denervation, and lymphatic interruption) occurred in 12 patients and usually consisted of bilateral perihilar and basal consolidation. Twelve episodes of acute rejection, an imprecise clinical diagnosis, occurred in 10 patients. Radiographic changes consisted of bibasal (n = 2), right mid and lower (n = 2), or left basal consolidation (n = 1); there were no changes in seven episodes. Radiographic resolution occurred in four cases after administration of IV steroids. The radiographic findings associated with the reimplantation response and rejection were nonspecific and were mimicked by fluid overload and infection. Bronchial dehiscence and/or stricture formation occurred in seven patients; generally chest radiography was inaccurate and CT was very accurate in the assessment of these complications. Chest radiography was helpful but not definitive in sorting out the problems occurring in the postoperative period after bilateral lung transplantation. CT was excellent for use in demonstrating airway problems.

Adolescent↗
PubMed1989

The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis.

A randomized, placebo-controlled, double-blind clinical trial was performed to test the hypothesis that a 2-g single dose of metronidazole for male partners of women with bacterial vaginosis was more effective than placebo in improving cure rate and decreasing recurrence rate. In addition, the effectiveness of a 2-g single dose of metronidazole was compared with a seven-day course of 500 mg of metronidazole twice a day in patients with bacterial vaginosis. Statistically significant benefits of partner treatment were noted in the initial cure rate by Gram-stained smear criteria (P less than .01) and in percentage of women with symptoms eight weeks after initiating therapy (P less than .05). The seven-day course of metronidazole was superior to the single-dose regimen in the percentage of patients with clue cells and the percentage of patients with a positive "sniff" test at the first follow-up visit; however, differences in the initial cure rate assessed by clinical criteria and Gram-stained smear criteria were not statistically significant between the two patient treatment regimens. Recurrence rates by Gram-stained smear criteria between patient and partner treatment groups at five and eight weeks after initiation of treatment were also not significantly different between the two patient regimens. Single-dose metronidazole treatment of the sexual partner of women with bacterial vaginosis improves initial bacterial vaginosis cure rates. The seven-day course of metronidazole was not found by statistical analysis to be significantly superior to single-dose therapy when considering initial cure rates by clinical or Gram-stained smear criteria or recurrence rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Cyclosporine-induced lymphoma following a unilateral lung transplant. The Toronto Lung Transplant Group.

Lymphomas are a well-known complication of therapy following organ transplantation. To date we have seen one lymphoma develop in a group of 24 patients who have undergone single or double lung transplantation. We report a 16-year-old man who developed multiple, rapidly appearing pulmonary nodules four months following transplantation. The Epstein-Barr virus and immunosuppressant drugs such as cyclosporine A have been implicated in the pathogenesis of this patient's rapidly progressive and fatal course.

Adolescent↗
PubMed1988

Computed tomography and pathologic correlations of thymic lesions.

Computed tomographic and pathologic correlations of the thymus gland were assessed in 69 patients. The sensitivity of computed tomography (CT) for undifferentiated thymic pathology is 87.1%; the specificity is 85.7%. The sensitivity of CT for neoplasm or mass is 97.1%, the specificity is 97.1%. The sensitivity of CT for lymphoid follicular hyperplasia (LFH) is 71.4%, the specificity is 97.6%. Therefore, a normal-sized thymus gland on CT does not exclude LFH. Completely preserved fat planes between thymic mass and adjacent structures on CT usually indicate a benign (noninvasive) neoplasm; completely absent fat planes usually indicate a malignant (invasive) neoplasm; partially preserved fat planes are indeterminate in assessing invasiveness. CT is also useful in showing recurrence or remnants of thymic tissue in patients who have had a previous thymectomy.

Adolescent↗
PubMed1988

A randomized, controlled trial to determine the effectiveness of fascial infiltration of bupivacaine in preventing respiratory complications after elective abdominal surgery.

A randomized, controlled trial was performed to determine whether infiltration of fascia with bupivacaine, a long-acting local anesthetic, at the time of closure after elective laparotomy, is effective in preventing postoperative respiratory complications. At the Toronto General Hospital 415 patients undergoing elective laparotomy were randomly allocated to receive bupivacaine 0.25% (2 ml/cm incision), infiltrated into the fascia evenly along both sides of the incision before wound closure (202 patients), or to have closure without infiltration (213 patients). Chest x-ray (CXR) films of all patients were obtained preoperatively and on the second postoperative day. Pulmonary function studies were performed preoperatively and for the first two consecutive days postoperatively. CXR films were scored by a blinded observer. Postoperatively, 64% of the treatment group and 56% of the control group had evidence of atelectasis on CXR films (p = NS, chi 2 test). Both groups had similar decrements in vital capacity and expiratory reserve volume on the first and second postoperative days. There was no significant difference in the amount of analgesic taken in the first 24 hours, although the time to first analgesic was significantly longer in the treatment group (2.2 vs 1.3 hours, p less than 0.055). We conclude that infiltration of the fascia with 0.25% bupivacaine at a dose of 2 ml/cm of incision is not effective in preventing postoperative atelectasis. It does not reduce use of an analgesic although it may delay its initial requirement.

Adult↗
PubMed1988

Lymphomatoid granulomatosis: a review of 12 cases.

We retrospectively studied 12 patients with lymphomatoid granulomatosis (LYG), a form of angiitis and granulomatosis first described in 1972, with emphasis on radiographic findings and clinical presentation. Ten patients had bilateral disease, with middle and lower lung predominance of ill-defined nodular densities being the commonest radiographic presentation. In two patients, chest radiography showed mixed alveolar and interstitial disease. Symptoms of cough, dyspnea, and cutaneous disorders with or without neurologic complications, in a patient with an abnormal chest radiograph, are suggestive of the diagnosis of LYG.

Adult↗