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Biomedical subjects

S M Goldman

Publications and source records attributed to S M Goldman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Renal inflammatory disease: the current role of CT.

Computed tomography (CT) plays a significant role in establishing the diagnosis in clinically equivocal cases of renal infection, determining the extent of the disease process, and assessing its complications. Gas, calculi, renal parenchymal calcifications, hemorrhage, and masses can be revealed with unenhanced CT. A subsequent study with contrast enhancement is crucial for the complete evaluation of patients with renal infection in order to demonstrate the areas of altered nephrogram that occur as a result of the inflammatory process and to identify complications. In this article we review a spectrum of renal inflammatory disease, with illustrations of the CT findings in representative cases. We also review the role and potential pitfalls of fast scanning techniques that can image a particular phase of the nephrogram in a renal infection. In acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal hypodense areas with obliteration of the corticomedullary differentiation. Delayed images obtained during the excretory phase are frequently more helpful in defining the extent of the disease process, identifying the complications such as renal abscess, and confirming the presence of urinary obstruction than are early images.

Acute Disease↗
PubMed1996

Radiologic management of abdominal trauma in pregnancy.

Radiologic management of the pregnant female who has sustained blunt abdominal trauma must be individualized and based on the pathophysiology and medical status of the mother and of the conceptus. The potential effects of ionizing radiation and their dependence on the age and size of the conceptus are all considerations in a rational approach to patient management but must not overshadow any exigent need for a diagnostic study.

Abdominal Injuries↗
PubMed1996

The indeterminate renal mass.

Ultrasound and CT scan play complimentary roles for the evaluation of indeterminate renal masses. Fast MR imaging with and without gadolinium is performed for characterization of renal masses when patients have a contraindication to iodinated contrast material. Radiologists have a primary role in detecting and managing indeterminate renal masses.

Humans↗
PubMed1996

Epidemiology of Parkinson's disease.

The epidemiologic studies reviewed here have provided insights into the etiology of PD. Evidence increasingly suggests that, like many other chronic age-related diseases, PD is a multifactorial disorder, with both genes and environment contributing to risk. As the elderly population of the world grows, incidence and prevalence of PD will continue to increase, underscoring the importance of further delineating risk factors. The introduction of levodopa and other pharmacologic therapies over the last 2 decades has postponed disease morbidity and mortality, but morbidity and mortality still are increased markedly relative to unaffected individuals. The development of therapies that may slow disease progression makes early identification and treatment of PD particularly important. Investigations of early markers of PD, or markers of disease susceptibility, are critical areas for future research. These efforts all will be aided by careful collaboration between epidemiologists and laboratory scientists.

Age Distribution↗
PubMed1995

Does routine use of aortic ultrasonography decrease the stroke rate in coronary artery bypass surgery?

PURPOSE: The purpose of this study is to determine whether the routine use of intraoperative surface aortic ultrasonography decreases the stroke rate in coronary artery bypass graft surgery (CABG). METHODS: One hundred ninety-five consecutive patients undergoing CABG between July 1, 1992, and June 30, 1993 (study group), were evaluated by intraoperative surface aortic ultrasonography. Based on information obtained, changes in the operative technique were made in an effort to decrease the incidence of embolic stroke from unsuspected atherosclerotic disease of the ascending aorta. The outcome of these patients was compared with that of 164 consecutive patients who underwent CABG between July 1, 1991, and June 30, 1992 (control group), in whom the ascending aorta was assessed by inspection and palpation only. RESULTS: Significant disease was detected in three (2.0%) of 164 patients in the control group. Modifications in their operative technique consisted of hypothermic fibrillatory arrest with no cross-clamping of the aorta and left ventricular venting in two patients and single cross-clamping in one patient. There were five strokes overall in this group (3.0%), and six patients died (3.6%), one in whom the stroke contributed directly to the cause of death. In the study group the ultrasonic findings were normal to mild in 168 patients, moderate in 20 patients, and severe in seven patients. These results led to a modification of the technique in 19 patients, (10%): hypothermic fibrillatory arrest with no cross-clamping of the aorta and left ventricular venting in 14 patients, modification in the aortic cannulation site or single cross-clamping in three patients, and modification in placement of proximal anastomoses or all arterial grafts in two patients. No strokes occurred in this group (p < 0.02, Fisher's exact test). Five patients died, for an operative mortality rate of 2.6%. CONCLUSION: These data indicate that intraoperative ultrasonography of the ascending aorta with simple modifications in operative technique reduces the stroke rate in CABG.

Adult↗
PubMed1994

Acute pyelonephritis: can we agree on terminology?

There is no general agreement on which terms to use to report abnormalities on imaging studies in patients with kidney infection. The Society of Uroradiology recommends a simplified nomenclature that is based on the traditional and widely understood term acute pyelonephritis. To provide a framework for the simplified terminology, the authors review the relevant pathophysiology with its imaging correlates and offer a historic perspective on the terminology issues.

Acute Disease↗
PubMed1994

CT of intraabdominal desmoid tumors: is the tumor different in patients with Gardner's disease?

OBJECTIVE: A retrospective study of abdominal CT scans of patients with proved intraabdominal desmoid tumors was done to determine if any objective characteristics exist to differentiate desmoids related to Gardner's syndrome from isolated desmoids. Because the desmoid tumors of Gardner's syndrome can predate the diagnosis of Gardner's syndrome, it would be helpful to know which patients with desmoids need careful follow-up studies as well as initial workup for Gardner's syndrome and all its ramifications. Also, it would be important to differentiate benign from malignant desmoids associated with Gardner's syndrome. It was hoped that the location, enhancement characteristics, and/or the presence or absence of infiltration might be of value. We were interested in noting if, over time, the growth characteristics of desmoids found in Gardner's syndrome were different from those of isolated desmoids. MATERIALS AND METHODS: We reviewed 101 abdominal CT scans obtained in 23 patients during a 13-year period. Forty desmoid tumors were intraabdominal, including 30 lesions associated with Gardner's syndrome in 13 patients and 10 desmoids of the idiopathic form in 10 patients. These tumors were studied to define location; whether they were single or multiple; and whether they had any specific CT characteristics regarding margins, attenuation numbers, or contrast enhancement. RESULTS: Desmoid tumors associated with Gardner's syndrome were more likely to be multiple (38%, five of 13 patients) and to involve the mesentery (60%, 18 of 30 tumors) and the abdominal wall (40%, 12 of 30 tumors), whereas isolated desmoid tumors were singular (all 10 patients) and were located in the retroperitoneum (six cases), pelvis (three), and anterior wall (one). Desmoids related to Gardner's syndrome also tended to be smaller (mean diameter, 4.8 cm) than idiopathic desmoids (mean diameter, 13.8 cm). No differentiating CT characteristics regarding margins, attenuation numbers, or response to contrast material were ascertained. Ten new lesions (seven intraabdominal, three mesenteric) developed in three patients with Gardner's syndrome, whereas no new intraabdominal lesions developed in patients with idiopathic desmoids. Follow-up data on 16 surgically resected desmoids in nine patients (seven with Gardner's syndrome and two with isolated desmoids) revealed seven local recurrences (two in the two patients with isolated desmoids and five in two patients with Gardner's syndrome). CONCLUSION: No CT characteristics, such as attenuation values, margins, and response to the contrast material, were found that would enable differentiation between isolated intraabdominal desmoids and those associated with Gardner's disease. Desmoid tumors associated with Gardner's syndrome tend to occur in the mesentery and abdominal wall, whereas isolated desmoids involve the retroperitoneum and pelvis. When studying CT scans obtained over time, new lesions were noted to develop in a few of the patients with Gardner's syndrome (three of 13), whereas no new lesions were found in patients with isolated desmoids.

Adult↗
PubMed1994

Renal cell carcinoma in pregnancy: report of three cases and review of the literature.

BACKGROUND: Renal cell carcinoma is a potentially fatal tumor that occasionally presents during pregnancy. Based on our experience with three patients and a review of the recent cases in the literature, we believe there has been a change in presentation of this lesion over that described in previous reviews. CASES: Two of three women with renal cell carcinoma found during pregnancy had symptoms suggesting recurrent urinary tract infection. The renal tumors were all discovered by ultrasound. In addition, magnetic resonance imaging was used for preoperative, intragestational staging of one patient. CONCLUSION: Renal cell carcinoma should be considered in women of childbearing age who present with recurrent or refractory urinary tract symptoms, flank pain, or a palpable flank mass. Ultrasound appears to be the imaging procedure of choice for evaluating the urinary system in pregnant women.

Adult↗
PubMed1993

Augmented femoral venous return.

We present a technique of femoral cardiopulmonary bypass that allows excellent venous drainage. This is accomplished by augmenting the venous return with a centrifugal pump.

Blood Circulation↗
PubMed1993

Prevention of retrograde cardioplegia catheter displacement.

The most frequent catheter-related complication of retrograde cardioplegia, in our experience, has been catheter displacement. An easily placed coronary sinus snare that maintains proper retrograde catheter position is described.

Cardiac Catheterization↗
PubMed1993

Extragonadal germ cell tumor originating in iliac fossa.

Extragonadal germ cell tumors usually originate in midline body structures. We describe the first case of an extragonadal germ cell tumor that arose atypically in the right iliac fossa, a nonmidline pelvic region. Based on this case report and a review of the literature, we suggest a modification of Abell's criteria for the diagnosis of retroperitoneal extragonadal germ cell tumors.

Humans↗