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Biomedical subjects

D H Frager

Publications and source records attributed to D H Frager.

13 recordsLinked to original sources
PubMed1997

Visceral fat and race-dependent health risks in obese nondiabetic premenopausal women.

Our previous finding that a waist-to-hip ratio (WHR) >0.85 was not associated with similar health risks in black, compared with white, obese premenopausal non-diabetic women of similar fatness is attributed to either 1) a different relationship between WHR and visceral adiposity or 2) differences in the relationship between visceral adiposity and the metabolic abnormalities of obesity. We measured visceral (VAT) and subcutaneous adipose tissue (SCAT) areas at midwaist in 25 black and 25 white obese nondiabetic pre-menopausal women with similar BMI, percentage body fat, and wide range of WHR (0.7-0.95 for black women and 0.7-0.9 for white women) and then compared insulin sensitivity index (SI), glucose and insulin areas under the 2-h curve (AUCs) during an oral glucose tolerance test (OGTT), and blood lipids in the two groups before and after adjustments for total body and visceral adiposity. After adjusting for total body fat mass (FM), obese black women had significantly less VAT (by 32 cm2) and lower VAT/SCAT for any given WHR. The regression equations predicting the SI the glucose and insulin AUCs, and the triglyceride and HDL cholesterol levels from regional adipose tissue measurements (VAT, SCAT, or VAT/SCAT) and from total body fat (FM or percentage body fat) had slopes that were not significantly different for black and white women. LDL cholesterol levels were independently related to VAT in black but not in white women. The black women had a similar SI insulin AUC, and triglyceride levels but significantly lower glucose AUC and higher HDL cholesterol levels (P < 0.001), after adjusting for VAT and FM. Regression analysis of the pooled data showed that high VAT and high VAT/SCAT, but not SCAT, predicted lower SI higher glucose and insulin AUCs during OGTT, and higher triglyceride levels, independent of total adiposity. We conclude that while increases in VAT and VAT/SCAT adversely affect metabolism in both black and white obese premenopausal women, similar levels of total body and visceral adiposity are associated with different metabolic risk factors in these groups.

Adipose Tissue↗
PubMed1996

Abdominal CT findings when the superior vena cava, brachiocephalic vein, or subclavian vein is obstructed.

OBJECTIVE: We evaluated findings on contrast-enhanced abdominal CT scans that suggest obstruction of the superior vena cava, brachiocephalic vein, or subclavian vein. SUBJECTS AND METHODS: We conducted a retrospective review of 22 patients with superior vena caval, brachiocephalic vein, or subclavian vein obstruction and analyzed the upper abdominal images on a chest CT scan or an abdominal CT scan. We assessed collateral vessels in the upper abdomen to answer the following question: Did enhancement approach undiluted IV contrast or were there other findings? In the second part of our study, we conducted a prospective review of abdominal CT scans of 200 patients without known mediastinal disease or known upper extremity venous occlusion to determine the frequency of abnormal enhancement of these vessels in a healthy population. RESULTS: The groups of collateral vessels revealed on abdominal CT scans were azygos or hemiazygos veins, internal mammary veins, lateral thoracic and superficial thoracoabdominal veins, vertebral venous plexus veins, and small mediastinal collateral veins. In the retrospective series, one patient had focal enhancement of the liver and early inferior vena caval enhancement due to collateral vessels. In the prospective series, abdominal CT scans of two patients (1%) revealed dense undiluted enhancement of one or more groups of collateral vessels: One patient had an ipsilateral pacemaker, and the other patient had an anterior neck phlegmon to the upper mediastinum. Both conditions may have been factors in the revealing of the collateral vessels. Two other patients (1%) in the prospective series had mild to moderate vessel enhancement that was less than that from undiluted contrast material. In one of these patients, the enhancement was related to abdominal wall hyperemia after surgery. In the other patient, enhancement may have been the result of ipsilateral axillary nodes. CONCLUSION: On upper abdominal CT scans, dense undiluted contrast material in the collateral vessel groups that we studied suggests possible obstruction of the superior vena cava, brachiocephalic vein, or subclavian vein.

Abdomen↗
PubMed1995

Role of CT in evaluating patients with small-bowel obstruction.

The accurate and rapid diagnosis of acute small-bowel obstruction has troubled surgeons and radiologists for more than a century. With the advent of CT, solving the problem is now a possibility. CT can accurately diagnose obstruction, determine the likely cause and location, and even suggest whether there is associated bowel ischemia or strangulation.

Colonic Neoplasms↗
PubMed1995

Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings.

OBJECTIVE: The expeditious diagnosis of complete and partial mechanical small-bowel obstruction, as opposed to paralytic ileus, during the immediate postoperative period may be difficult on the basis of clinical and plain film radiographic findings. For this reason, we prospectively evaluated the use of CT in this setting and compared it with the clinical and plain film evaluations as well as with various contrast examinations. SUBJECTS AND METHODS: Thirty-six postoperative patients with signs and symptoms of paralytic ileus or mechanical small-bowel obstruction were examined clinically and had plain abdominal radiographs. Based on the findings of these examinations, the surgeon assigned patients to one of the following categories: (1) paralytic ileus, (2) indeterminate, (3) partial mechanical obstruction, or (4) complete mechanical obstruction. CT scans were obtained within 24 hr of the initial diagnostic studies, and patients were then recategorized according to the above classification solely based on CT findings. Initial examination results were then compared with the CT results. In addition, the results of contrast studies, namely, enteroclysis and barium enema, performed after CT small-bowel series, were evaluated. The gold standard for diagnosis was laparotomy in 20 patients, clinical course and follow-up in 13 patients, and clinical course and contrast studies in the other three patients. RESULTS: CT was effective (sensitivity and specificity, 100%) in distinguishing between postoperative ileus and complete mechanical small-bowel obstruction. The combined clinical and plain film findings were often confusing and nondiagnostic (sensitivity, 19%). CT was also valuable in diagnosing and distinguishing partial mechanical small-bowel obstruction from paralytic ileus. Contrast studies (enteroclysis) in four patients with partial mechanical small-bowel obstruction were useful in grading the degree and severity of the obstruction. CONCLUSION: Our results suggest that in the immediate postoperative period, CT is the method of choice for diagnosing mechanical small-bowel obstruction and distinguishing it from paralytic ileus. Contrast studies are useful in further evaluating partial mechanical small-bowel obstruction.

Adolescent↗
PubMed1988

Squamous cell carcinoma of the esophagus in patients with acquired immunodeficiency syndrome.

Two patients with Acquired Immunodeficiency Syndrome (AIDS) and infectious esophagitis developed squamous cell carcinoma of the esophagus. The clinical, radiographic, and endoscopic presentations in both cases were atypical. One patient developed a focal flat lesion that imitated segmental esophagitis, and the other patient developed a superficially spreading carcinoma that mimicked diffuse esophagitis. In the setting of AIDS, a changing radiographic or endoscopic mucosal pattern requires biopsy to exclude the possibility of a superimposed squamous cell carcinoma.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Computed tomography guidance for skeletal biopsy.

Computed tomographic (CT) guided biopsy and abscess drainage of multiple organ systems have been well described. Reports of spinal and skeletal applications have been less common. This study describes the use of CT guidance in the biopsy of various skeletal lesions in 46 patients. Forty-one patients had skinny needle aspirations (18 or 22 gauge) and 23 patients had trephine core biopsies. Sites of the lesions included: thoracic spine-15 patients, lumbosacral spine-17 patients, bony pelvis-6 patients, rib-2 patients, and long bones-6 patients. Fast scanners capable of rapid image reconstruction have overcome many constraints. With CT guidance, the physician who performs the procedure receives virtually no ionizing radiation. The exact location of the needle tip is accurately visualized in relation to the lesion being biopsied and to the vital organs.

Biopsy, Needle↗
PubMed1987

Problems in the colonoscopic localization of tumors: continued value of the barium enema.

Six patients in whom errors of diagnosis and therapy occurred because of reliance on colonoscopic tumor localization are presented. Three of the patients required a second laparotomy for surgical resection of a tumor that was missed at the first exploration. While endoscopy is regarded as the diagnostic gold standard, there are problems in its use for colonoscopic localization. Reliance on distance measurements may be misleading. Anatomical variants can be confusing. For this reason, a preoperative barium enema for precise delineation and localization of tumors is recommended. When a barium enema is not feasible, such as when a malignant polyp has been removed endoscopically, preoperative endoscopic localization with injection of India ink or intraoperative colonoscopy must be performed.

Adult↗
PubMed1986

Extraspinal abnormalities identified on lumbar spine CT.

Retrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patient's symptomatology is suggestive of spinal abnormalities.

Adult↗
PubMed1986

Cytomegalovirus colitis in acquired immune deficiency syndrome: radiologic spectrum.

Six cases of cytomegalovirus (CMV) colitis are described. The radiographic manifestations of this colitis are nonspecific and usually mimic the findings of ulcerative colitis with diffuse mucosal ulceration or granulomatous colitis with aphthous ulceration and skip areas. Terminal ileal involvement was noted in 1 patient. Nonspecific edema was present in 2 other cases. One patient demonstrated unusual cecal and ascending colonic nodularity due to pseudomembranes and, in another, large, flat discrete ulcerations were identified. Angiography, in 1 case, demonstrated marked hypervascularity and identified a site of hemorrhage in the ascending colon. With the radiographic identification of colitis in an immunocompromised patient, particularly a patient with acquired immunodeficiency syndrome (AIDS), CMV colitis must be strongly considered in the differential diagnosis. Endoscopic biopsy is the most effective method of establishing the diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Gastrointestinal complications of AIDS: radiologic features.

The radiologic features were examined in a retrospective review of 25 patients with gastrointestinal complications of acquired immunodeficiency syndrome (AIDS). Factors of risk for AIDS present in these patients included homosexuality (n = 10), intravenous drug abuse (n = 7), multiple blood transfusions (n = 1), and unconfirmed or unknown factors (n = 7). Gastrointestinal abnormalities identified on radiologic studies (including upper gastrointestinal, small bowel, and barium enema studies) were correlated with histopathologic specimens and the results of bacteriologic, viral, fungal, and parasitologic studies. The most common disorders (88%) were candidal esophagitis and cytomegaloviral colitis; neoplastic involvement of the gastrointestinal tract was far less common (12%), with only two patients (8%) having Kaposi sarcoma. Gastrointestinal studies, which can provide useful if not always definitive diagnostic information, are recommended to precede more invasive diagnostic studies in evaluating patients with suspected AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Radiographic appearance of the esophagus and stomach after laser treatment of obstructing carcinoma.

Nd:YAG laser therapy is an attractive palliative treatment for carcinoma of the esophagus and gastric cardia. Twenty-five patients with these tumors underwent laser therapy over a 2-year period, receiving a total of 52 courses of therapy with 189 treatments. Treatments per course averaged 3.6, with a mean of two courses per patient. Luminal diameter is increased with this method; symptomatic improvement in dysphagia occurred in all patients after one course of therapy. Radiographic improvement also is seen. The complication rate in this series was four (2.1%) of 189 procedures, consisting of one perforation, one tracheoesophageal fistula, one pneumopericardium, and one pneumoperitoneum without leak.

Aged↗
PubMed1983

Computed tomography in Crohn disease.

Twelve patients with Crohn disease were studied by computed tomography. Characteristic findings of small intestinal involvement include symmetrical bowel wall thickening, a "double halo" appearance on cross section of the diseased bowel segment, and an associated mesenteric fat mass. Computed tomography provided crucial diagnostic information in the management of some of the intestinal and extraintestinal complications of the disease.

Barium Sulfate↗