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Biomedical subjects

S M Goldman

Publications and source records attributed to S M Goldman.

At least 73 records · Page 4Linked to original sources
PubMed1993

Renal cell carcinoma with situs inversus totalis.

A case of renal cell carcinoma in a patient with situs inversus totalis is reported. Only 8 cases of malignant neoplasms have been reported in situs inversus totalis, and our case represents the second case report of renal cell carcinoma in a patient with situs inversus totalis. The frequency of situs inversus totalis is between 1 in 8,000 and 1 in 20,000. Cardiac and pulmonary anomalies are common in patients with situs inversus totalis. Renal anomalies, including agenesis, dysplasia, hypoplasia, ectopia, polycystic kidney, and horseshoe kidney, have been reported. Because of the association between situs inversus and cardiac, pulmonary, renal, and vascular anomalies, management of the patient with situs inversus and urologic disease requires careful preoperative evaluation.

Aged↗
PubMed1993

The natural history of renal angiomyolipoma.

Of 35 patients with 48 angiomyolipomas 24 patients were followed clinically to determine the natural history of angiomyolipoma. Average patient age at presentation was 50 years (range 17 to 74) and of the patients 94% were women, 17% had tuberous sclerosis and 25% overall had bilateral disease. The patients could be divided into 2 distinct groups based on tumor size of 4 cm. or less and greater than 4 cm. Those with tumors less than 4 cm. were less likely to be symptomatic (24%) and patients with angiomyolipomas greater than 4 cm. were more often symptomatic (52%). No surgery was required for tumors less than 4 cm. but for 30% of the tumors greater than 4 cm. surgical intervention was necessary. Unlike any previously reported large series this study included radiological and historical followup available for 24 patients with angiomyolipoma with a mean followup time of 4 years (range 0.5 to 14). Moreover, to our knowledge we report for the first time documented growth during the study period of 27% of angiomyolipomas less than 4 cm. (4 of 15 tumors) and 46% of angiomyolipomas greater than 4 cm. (6 of 13 tumors). All patients with tumors less than 4 cm. were asymptomatic and only 1 required surgery. In contrast, tumors greater than 4 cm. were more frequently symptomatic (46%) and required surgery (54%). Patients with tuberous sclerosis and angiomyolipomas were distinctly different from patients with angiomyolipoma only, since they tended to present at a younger age, had a higher incidence of bilateral renal involvement, were more symptomatic, had larger tumors that were more likely to grow, and frequently required surgery. Based on this study, a modified approach to the current management of angiomyolipoma is recommended.

Angiomyolipoma↗
PubMed1993

Development of a computer-assisted instructional tool for evaluation and treatment of renal masses. An experiment in hypermedia.

RATIONALE AND OBJECTIVES: Using a personal computer and a commercially available "authoring" application, the authors constructed an interactive hypermedia teaching tool for the evaluation and management of renal masses. METHODS AND RESULTS: Through a series of questions, images, illustrations, hypertext, and graphical flow charts, the user reviews the spectrum of renal masses, including neoplasms, inflammatory disease, cysts, and "pseudomasses." The various imaging modalities (computed tomography [CT], ultrasound [US], magnetic resonance imaging [MRI], and angiography) are illustrated, with selective advantages and disadvantages to each technique highlighted. Selected algorithms for evaluation and treatment of masses are provided. Text, questions, a teaching file, and algorithms form the major sections of the program. Numerous links within and between the major sections of the program, a capacity unique to hypermedia, allow for nonlinear entry into the program, tailored to the individual user. CONCLUSIONS: Preliminarily, medical students and residents have responded positively to this hypermedia project. Furthermore, their comments and criticism have provided important feedback for future updates and enhancements.

Computer-Assisted Instruction↗
PubMed1993

Use of venous fistula technique for intraoperative cardiac hemorrhage.

We describe an innovative technique to control hemorrhage after right atrial wall reconstruction in a patient with primary angiosarcoma. At the time of surgery, the tumor was found to involve all of the free wall of the right atrium and a superficial layer of the right ventricle. A pericardial patch was used to reconstruct the right atrial wall; however, there was diffuse coagulopathy with bleeding from the anastomoses and remaining tumor. To tamponade the bleeding, a Dacron patch was sewn to the right edge of the pericardium, around the right ventricle and right coronary artery, but with little improvement in the bleeding. A type of Cabrol fistula was then formed with a tube graft from the Dacron patch to the left innominate vein. This acted as a conduit back into the venous system, with the blood taking the path of least resistance. Hemostasis was then achieved, allowing the patient to be taken to the intensive care unit.

Adult↗
PubMed1993

CT evaluation of amyloidosis: spectrum of disease.

Amyloidosis is a rare systemic disease caused by extracellular deposition of an insoluble protein. Although it is usually seen in a systemic form, 10%-20% of cases can be localized. Systemic amyloidosis is subclassified into an idiopathic primary form and a secondary or reactive form. Patients with primary amyloidosis have no underlying condition or disease. Men are affected more than women, and the mean age at presentation is 55-60 years. Some causes of secondary amyloidosis are multiple myeloma (10%-15%), rheumatoid arthritis (20%-25%), tuberculosis (50%), or familial Mediterranean fever (26%-40%). Radiographic studies of 90 patients with biopsy-proved primary or secondary amyloidosis were reviewed. Computed tomographic (CT) scans demonstrated a wide spectrum of disease in the cardiothoracic, gastrointestinal, genitourinary, and musculoskeletal systems. Amyloid deposition simulated both inflammatory and neoplastic conditions. Amorphous or irregular calcifications were occasionally identified within the amyloid deposit. Definitive diagnosis requires biopsy confirmation, as CT findings are nonspecific.

Adult↗
PubMed1992

Combined cardiac operation and carotid endarterectomy during aortic cross-clamping.

We present a surgical technique that we believe provides superior cerebral protection for simultaneous correction of carotid and cardiac pathology with low operative mortality and stroke rate. Our study population consists of 23 consecutive patients undergoing cardiac operation between August 1989 and April 1991 who also had associated critical (greater than 85%) carotid artery stenosis. Using 20 degrees C systemic hypothermia for cerebral protection, we performed simultaneous correction of both lesions during the aortic cross-clamp period, using continuous retrograde blood cardioplegia for myocardial protection. Mean patient age was 69.4 years; 83% were 65 years or older. Eighty-seven percent had angina, 35% had recent myocardial infarctions (within 30 days), and 52% had congestive heart failure. Asymptomatic bruit was found in 39%, and 61% had previous strokes, neurologic symptoms, or both. All had 85% or greater luminal narrowing on cerebral angiography, with 65% having severe or critical contralateral disease as well. Sixty-one percent had associated other vascular pathology, including peripheral vascular occlusive disease, renal artery stenosis, or abdominal aortic aneurysm. There were no postoperative strokes or neurologic events. One early vein graft occlusion resulted in postoperative myocardial infarction and subsequent death (4.3%).

Aged↗
PubMed1991

Continuous retrograde blood cardioplegia.

We present a technique of myocardial protection using retrograde cold blood cardioplegia. This safe and simple method allows excellent continuous and homogeneous cooling of the heart during the ischemic period in all types of open heart operations.

Cardiac Surgical Procedures↗
PubMed1991

Pneumoscrotum after spontaneous pneumothorax with air leak.

A case of pneumoscrotum associated with a chest wall air leak following placement of a chest tube for spontaneous pneumothorax is reported. The patient recovered uneventfully once the air leak surrounding the tube was successfully closed at the entry wound. Two previous cases have described pneumoscrotum occurring after colonoscopy and after diagnostic peritoneoscopy. All 3 (previous and current) cases report the associated development of subcutaneous and retroperitoneal emphysema, which provides a possible etiological mechanism for this entity.

Chest Tubes↗
PubMed1991

Emphysematous pyelitis and emphysematous pyelonephritis characterized by computerized tomography.

We report three cases of emphysematous pyelonephritis, all of them associated with perinephric emphysema, and one case of emphysematous pyelitis to demonstrate the value of computerized tomography (CT) in both diagnosis and patient management. The differentiation between air in the collecting system (emphysematous pyelitis), air within the parenchyma (emphysematous pyelonephritis), and air in the perinephric space (perinephric emphysema) may have significant prognostic (survival) and therapeutic (medical vs surgical) implications. Computerized tomography is currently the best method for demonstrating intrarenal air and for characterizing the location of that air (intracalyceal, intraparenchymal, perinephric, or pararenal).

Adult↗
PubMed1991

Upper urinary tract infection: the current role of CT, ultrasound, and MRI.

This article reviewed some of the fundamental concepts in renal inflammatory disease. The difficulties in present terminology were reviewed and our approach discussed. The pathological underpinning of the acute-subacute infections were contrasted with those seen in the granulomatous diseases. The importance of CT in separating emphysematous pyelonephritis from emphysematous pyelitis and perinephric emphysema was stressed. Although ultrasound has been used in the past and is still of value in select situations, we prefer CT for assessment of renal infection. CT examinations show whether the disease is focal or diffuse, whether air is present, whether there is perinephric or pararenal extension, whether an abscess is present, and when the ideal time is for intervention. In severe renal infection in the adult, CT has shown the development of renal scars, perinephric extension, and the spontaneous drainage of Staphylococcus abscesses into nearby calyces.

Bacterial Infections↗
PubMed1990

Mixed venous oximetry during automatic implantable cardioverter-defibrillator placement.

Mixed venous oxygen saturation (SvO2) monitoring was used to assess tissue and circulatory recovery following induced ventricular tachycardia or fibrillation in 17 patients undergoing surgery for automatic implantable cardioverter-defibrillator (AICD) placement. Return of systemic arterial pressure conventionally determines adequate recovery. The duration of circulatory arrest during defibrillator threshold (DFT) testing, measured from the moment of absent phasic pressure at the radial artery until its return, was 18 +/- 8 seconds (mean +/- SD, n = 118 episodes). The absolute decrease in SvO2 from baseline to nadir for these 118 episodes was 14% +/- 6% absolute, and correlated well with the duration of circulatory arrest (r = 0.757, P = 0.0001). The time from onset of phasic arterial blood pressure to the nadir of SvO2, available for 46 episodes, was 28 +/- 14 seconds, and did not correlate with the duration of arrest. The time from onset of phasic pressure to the return of SvO2 to within 1% (absolute) of baseline saturation, available for 84 episodes, was 52 +/- 32 seconds and, in the aggregate, correlated poorly (r = 0.401) with duration of arrest. Simultaneous recording of arterial pressure and SvO2 (n = 41) showed that arterial recovery (6 +/- 3 seconds) occurred long before SvO2 recovery (48 +/- 16 seconds, P = 0.0001). The authors interpret these data as showing that mixed venous oximetry, compared to arterial blood pressure, provides a more sensitive indicator of tissue recovery following periods of circulatory arrest during DFT testing of AICDs.

Arrhythmias, Cardiac↗
PubMed1990

Leiomyoma of the kidney: presentation of 4 new cases and the role of computerized tomography.

Renal leiomyoma is a challenging diagnostic and therapeutic condition. It is clinically similar in presentation and radiographic appearance to its malignant counterpart, leiomyosarcoma. We review 30 cases of clinically diagnosed leiomyoma of the kidney from the literature, including 4 new cases with emphasis on the computerized tomography findings. Computerized tomography may locate a renal leiomyoma serendipitously in an asymptomatic patient. If the lesion is peripheral or in the parapelvic area and a plane can be seen between the tumor and kidney a capsular tumor, such as a leiomyoma of the kidney, might be considered in addition to the more common renal cell carcinoma. Renal leiomyomas have a variable radiographic pattern from that of a pure cystic to a mixed solid/cystic to an entirely solid lesion. Renal leiomyomas usually are sharply demarcated from the surroundings. Although computerized tomography cannot distinguish a renal leiomyoma from other benign or malignant renal processes the presence of invasion can virtually eliminate this benign tumor as a diagnosis. Since a preoperative diagnosis cannot be made, management involves renal exploration and radical nephrectomy in the larger lesions with a renal-sparing operation possible in selected cases. After treatment patients have a uniformly excellent prognosis.

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