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Biomedical subjects

E Atar

Publications and source records attributed to E Atar.

15 recordsLinked to original sources
PubMed2006

Nonradiologist utilization of American College of Radiology Appropriateness Criteria in a preauthorization center for MRI requests: applicability and effects.

OBJECTIVE: The purpose of this study was to evaluate the effects and applicability of use of the American College of Radiology (ACR) Appropriateness Criteria by nonradiologist physicians in an MRI preauthorization center. MATERIALS AND METHODS: All MRI requests received at our preauthorization center during a 19-month period were included in the study. The study period was divided into preintervention and postintervention phases, indicating before and after introduction of the ACR criteria to the general practitioners staffing our center. ACR appropriateness values were classified into three groups: appropriate, indeterminate, and inappropriate. Requests for which a matching ACR value could not be assigned were labeled ACR-noncodable. Multiple parameters evaluated and compared for the two phases included rate of request receipt, total approval and denial rates, and approval and denial rates according to the ACR Appropriateness Criteria and by anatomic region to be evaluated. RESULTS: There was no significant change in rate of request receipt and total approval and denial rates. However, there was an increase in the rate of approval of appropriate requests (phase 1, 71/96 [74%]; phase 2, 74/76 [97%]; p < 0.001) and the rate of denial of inappropriate requests (phase 1, 0/12 [0%]; phase 2, 9/13 [69%]; p < 0.001). More than 40% of requests were marked "ACR-noncodable" because of a lack of a matching clinical condition or variant. CONCLUSION: Introduction of the ACR Appropriateness Criteria resulted in an increase in the rate of performance of appropriate MRI examinations and a decrease in the rate of performance of inappropriate MRI examinations. ACR Appropriateness Criteria were applicable to approximately 50% of MRI requests.

Guideline Adherence↗
PubMed2001

Liver metastases from colorectal cancer: regional intra-arterial treatment following failure of systemic chemotherapy.

This study was designed to determine response rate, survival and toxicity associated with combination chemotherapy delivered intra-arterially to liver in patients with hepatic metastases of colorectal origin refractory to standard systemic treatment. A total of 28 patients who failed prior systemic treatment with fluoropyrimidines received a median of 5 cycles of intra-arterial treatment consisting of 5-fluorouracil 700 mg/m(2)/d, leucovorin 120 mg/m(2)/d, and cisplatin 20 mg/m(2)/d for 5 consecutive days. Cycles were repeated at intervals of 5-6 weeks. A major response was achieved in 48% of patients: complete response in 8% and partial response in 40%. The median duration of response was 11.5 months. Median survival was 12 months at a median follow up of 12 months. On multivariate analysis, the only variables with a significant impact on survival were response to treatment and performance status. Toxicity was moderate: grades III-IV neutropenia occurred in 29% of patients. Most of the patients complained of fatigue lasting for a few days following each cycle. There were no cases of hepatobiliary toxicity. These findings indicate that regional intra-arterial treatment should be considered in selected patients with predominantly liver disease following failure of standard treatment.

Adult↗
PubMed2001

CT findings in congenital anomalies of the spleen.

There is a wide range of congenital anomalies of the spleen. Some are common, such as splenic lobulation and accessory spleen. Other less common conditions, such as wandering spleen and polysplenia, have particular clinical significance. Radiologists need to be aware of the various congenital variants of the spleen in order to recognize clinically important anomalies and to avoid mistaking less significant ones for an abnormality. In this pictorial review, the embryology of congenital anomalies of the spleen as well as their appearance on CT are described, diagnostic pitfalls are identified and complications of the anomalies are discussed.

Choristoma↗
PubMed2001

Abdominal CT findings in nephropathic amyloidosis of familial Mediterranean fever.

To evaluate the abdominal CT features of reactive amyloidosis, abdominal CT scans of 20 patients with amyloidosis of familial Mediterranean fever (FMF) were reviewed and compared with abdominal CT scans of 2 control groups: 22 patients with chronic renal failure (CRF) due to non-amyloidotic kidney diseases and 40 patients with normal kidney function. The kidney size of patients with amyloidosis of FMF were found to vary during the course of the disease from normal or slightly larger than normal at the proteinuric phase, to smaller than normal and comparable to kidney size in CRF, at the uremic stage. Compared to kidney disease of other causes, more patients with FMF-amyloidosis had dense kidneys with coarse parenchymal calcification and calcification in other abdominal organs. Patients with FMF-amyloidosis had fewer aortic calcifications than patients with non-amyloidotic kidney disease. These findings suggest that kidney disease of reactive amyloidosis may have abdominal CT findings distinguishing it from other types of kidney diseases.

Abdomen↗
PubMed2001

[Metallic stents for acute colonic obstruction].

The traditional treatment of acute colonic obstruction, usually caused by malignant tumor, is a 2-stage surgical procedure. The first operation is emergent and includes primary tumor resection and end colostomy followed by scheduled colostomy closure. These operations are associated with high mortality and morbidity. Recently, insertion of self-expanding metallic stents for temporary colonic decompression has been was introduced. With this new technique colostomy can be avoided in the acute phase. In advanced colonic cancer stent-insertion is the only palliative treatment. It is done in the radiology department under fluoroscopic guidance. We present 2 cases of malignant colonic obstruction treated successfully by stent insertion.

Acute Disease↗
PubMed1999

Infarct volume, neurological severity and PAF binding to platelets of patients with acute cerebral ischemic stroke.

Studies show that Platelet Activating Factor (PAF) is involved in the cerebrovascular response to ischemia, and that its binding to platelets may change in stroke victims. The purpose of this study was to determine whether binding of PAF to platelets of stroke patients could serve as an index for determining the volume of ischemic strokes and severity of neurological presentation. Thirteen stroke patients and 21 healthy controls were studied. The neurological severity of these stroke patients was evaluated by the Scandinavian Stroke Scale. Infarct volume was assessed by planimetric measures of brain CT. PAF binding to platelets was determined by use of radiolabelled PAF. (3H)PAF binding to platelets of stroke patients was lower than in controls (149.58 +/- 46.11 and 212.1 +/- 10.3 receptors cell-1, respectively, p < 0.001) and was significantly correlated with infarct volume (r = -0.606, p = 0.014) and with neurological score (r = 0.527, p = 0.032). No correlation was observed between neurological score and infarct volume. The study confirms the involvement of PAF in the pathogenesis of brain ischemia and neuronal damage. It shows that PAF binding to platelets of stroke patients correlates both with the extent of neuronal damage and the associated neurological impairment, and may serve as an additional index in the assessment of stroke severity and clinical outcome of stroke victims.

Aged↗
PubMed1997

[Angioplasty and stenting of the carotid artery].

Percutaneous endovascular techniques are well established procedures in the management of peripheral vascular disease and visceral arterial stenosis. They are now being adapted for use in the carotid artery as well. 8 patients with 9 extracranial carotid artery stenoses were successfully treated by percutaneous angioplasty, following which in 4 of them 5 stents were inserted. The stenotic lesions were situated in the proximal internal carotid artery and in its bifurcation and also in the common carotid artery. The indications for angioplasty in these patients were the same as for surgery. There were no major complications. 1 patient had transient hemiparesis lasting a few hours, and another had bradycardia following balloon dilation in the region of the carotid body. Percutaneous endovascular treatment of carotid artery stenosis is becoming a safe, feasible alternative to surgery.

Angioplasty, Balloon↗
PubMed1997

[Buschke-Ollendorf syndrome].

Buschke-Ollendorf syndrome is a rare condition characterized by uneven sclerotic, osseous formations seen on X-ray (osteopoikilosis) and fibrous skin papules (dermatofibrosis lenticularis disseminata). We report an 82-year-old man with this syndrome. Awareness of the condition is important to avoid misdiagnosis and hazardous management designed for other disorders, such as prostatic metastases.

Aged↗
PubMed1996

[Ultrasound-guided aspiration of pleural fluid].

We review the outcome of guided, percutaneous, catheter drainage of pleural collections in 102 patients over a 2-year period. In 87% diagnostic aspiration of small or loculated collections was performed. Drainage of malignant and nonmalignant effusions in high-risk patients, or after failure of drainage without imaging guidance, was performed in 13%. All aspirations were successful and the only complication was a small pneumothorax in a single patient. If the collection was a small pneumothorax in a single patient. If the collections were large and easy to aspirate, we marked the best location for aspiration on the skin and sent the patient back to the ward for aspiration. We conclude that the use of sonography increases the proportion of successful drainage of small pleural collections and results in few complications.

Catheterization↗
PubMed1996

Mefloquine versus doxycycline for malaria prophylaxis in intermittent exposure of Israeli Air Force aircrew in Rwanda.

BACKGROUND: The issue of the best chemoprophylaxis agent for aircrew to use against malaria is still not settled. METHOD: We studied the patterns of use of both doxycycline and mefloquine in aviators and other aircrew for 2 mo during biweekly flights from Israel to Rwanda with a few hours' visits. Some 28 aviators and 15 non-aviator aircrew were treated with doxycycline and mefloquine, respectively, less than 12 h before the first flight and up to 4 wk after the last return. RESULTS: No case of malaria occurred within or after the operational period. Compliance was better for mefloquine than for doxycyline for the full period of the operation (100% vs. 75%, respectively). The rate of side effects, mostly gastrointestinal, was higher for doxycycline (39% vs. 13%, respectively) and was related mainly to the frequency of administration (daily vs. weekly). CONCLUSION: In situations involving frequent intermittent short-term visits to areas with substantial risk of acquiring malaria, we conclude that aircrew can safely take weekly mefloquine as prophylaxis.

Aerospace Medicine↗
PubMed1989

Ovarian carcinoma during pregnancy: a study of 23 cases in Israel between the years 1960 and 1984.

Data from a study on malignant ovarian tumors in pregnancy in Israel are presented. During the 25-year period of the survey, 23 new cases of malignant ovarian tumors during pregnancy were diagnosed, representing an incidence of 0.12/100,000 females over the age of 14; over half of the patients were in their third decade of life at the time of diagnosis of the tumor. Ovarian malignant tumors during pregnancy are more prevalent in Jewish women of European-American origin than in those of Asian-African descent. Borderline carcinomas were found in 35% of our patients; epithelial invasive tumors were found in 30%; the other tumors were dysgerminoma (17%), granulosa cell tumor (13%), and undifferentiated carcinoma (5%). Most of the patients (74%) were diagnosed in stage I. In three cases, ovarian cancer was diagnosed during surgery for tubal pregnancy, and in two during cesarean section at term. In early-stage disease and low-potential-malignancy tumors, surgery can be conservative; thus, 14 of 23 bore a live child. In advanced disease, aggressive surgery, chemotherapy, and/or radiotherapy should be instituted. Factors affecting prognosis were age of patient, histologic type of tumor, and clinical stage of disease. Overall, the survival is much better than that for ovarian tumors in general, because most of the tumors are of low potential malignancy and are diagnosed at an early stage.

Adult↗
PubMed1986

Inverting papilloma of the nose and paranasal sinuses.

A series of 30 patients with inverted papillomas of the nose and/or the paranasal sinuses is presented. The inverted papilloma is a rare tumor with an overall incidence varying from 0.5% to 4% of all primary nasal tumors. The incidence of inverted papilloma is much more common in the fifth to seventh decades. An association between inverted papilloma and carcinoma is well established. In the large series of patients, the incidence of malignancy associated with inverted papilloma ranges from 1% to 13%, and in our series 10%. Treatment of inverted papilloma is always surgical. The incidence of recurrence is directly related to the method of surgical treatment. Among our 20 patients who were treated by limited surgery, there was recurrence in 14 cases (70%). By contrast, medial maxillectomy and ethmoidectomy via lateral rhinotomy reduced the recurrence rate dramatically. In our opinion this approach is the surgery of choice in the treatment of inverted papilloma.

Adolescent↗
PubMedDate not supplied

Use of a collagen-based device for closure of low brachial artery punctures.

PURPOSE: To report our experience with the Angioseal vascular closure device for hemostasis of distal brachial artery puncture. METHODS: Between September 2003 and August 2005, 64 Angioseal vascular closure devices were inserted in 64 patients (40 men, 24 women; mean age 65 years) immediately after diagnostic or therapeutic arterial angiographies performed through a 5 Fr to 7 Fr sheath via the distal brachial artery. Ultrasound examination of the brachial artery preceded the angiography in all cases and only arteries wider than 4 mm were closed by the Angioseal. In cases of a sonographically evident thin subcutaneous space of the cubital fossa, tissue tumescence, using 1% Lidocaine, was performed prior to the arterial closure. RESULTS: The deployment success rate was 100%. No major complications were encountered; only 2 patients developed puncture site hematoma, and these were followed conservatively. CONCLUSIONS: Closure of low brachial artery punctures with the Angioseal is simple and safe. No additional manual compression is required. We recommend its use after brachial artery access interventions, through appropriately wide arteries, to improve early patient ambulation and potentially reduce possible puncture site complications.

Adult↗