Biomedical subjects

H I Goldberg

Publications and source records attributed to H I Goldberg.

At least 19 recordsLinked to original sources

PubMed1992

Abdominal CT following liver transplantation.

Computed tomography (CT) is one of several imaging modalities employed in the evaluation of complications following orthotopic liver transplantation. Abdominal CT scans were performed in 92 (48%) of the first 190 liver transplant patients at our institution. These studies were retrospectively reviewed to determine the indications for CT in this population and to determine the incidences of the various CT findings. The major indication (70%) was detection of bile leakage, hemorrhage, or abscess. The role of CT was primarily to discover such abnormal fluid collections and guide their percutaneous drainage. This article describes a wide spectrum of common and uncommon findings following liver transplantation and illustrates their CT features.

Humans↗

PubMed1992

Cerebral vasculitis: MR imaging and angiographic correlation.

Cerebral vasculitis is an unusual disorder with numerous causes. One such entity, noninfectious granulomatous angiitis of the nervous system (GANS), is an extremely rare disease with a predilection for leptomeningeal and parenchymal arteries and veins. Isolated involvement of the central nervous system is characteristic of GANS, which has also been referred to as primary angiitis of the central nervous system (PACNS). The results of magnetic resonance (MR) imaging and angiography in seven patients with presumed PACNS were retrospectively analyzed and correlated. MR images were positive in every case. Characteristically, lesions were multiple, bilateral, and supratentorial. Both gray- and white-matter infarcts were identified in four of seven patients; infarcts were most common in the deep white matter. PACNS can also appear as primary parenchymal hemorrhage or simulate low-grade glioma. All lesions identified on MR images were associated with positive angiographic findings of cerebral vasculitis in the corresponding vascular distribution. However, for 12 of 33 vascular distributions with angiographic evidence of cerebral vasculitis, no lesions were identified on MR images. These correlative observations suggest that some patients with proved PACNS may have normal MR imaging results.

Adult↗

PubMed1992

Reversible arteriovenous malformation-induced venous hypertension as a cause of neurological deficits.

A case of a dural arteriovenous malformation with prominent localizing neurological deficits is reported. The venous drainage of the lesion and the lack of a significant pial supply implicate venous hypertension as the mechanism of neurological dysfunction. This mechanism is supported further by the angiographic changes and the prompt resolution of the deficits after endovascular treatment. This case illustrates the potential for this frequently postulated but rarely confirmed pathophysiological mechanism to cause reversible neurological dysfunction.

Cerebral Veins↗

PubMed1992

Imaging of the biliary tract.

Although endoscopic retrograde cholangiopancreatography is the technique of choice for examining the biliary tract when ultrasonography does not demonstrate dilated ducts, the transhepatic cholangiopancreatogram was shown to be useful when endoscopic retrograde cholangiopancreatography fails. On cholangiography, ultrasonography, and CT, clonorchiasis and cryptosporidiosis were found to have duct dilatation and contour irregularity, and in some patients, papillary stenosis. The value of cholangiography in determining the prognosis and appearance of primary sclerosing cholangitis and in diagnosing Klatskin tumor was examined. Patients with high-grade extrahepatic strictures, diffuse intrahepatic strictures, and marked intrahepatic dilatation had decreased survival. The preoperative cholangiogram diagnosis of Klatskin tumor was found to be accurate in only two-thirds of cases. In patients with liver transplantation who had dilatation of both donor and native extrahepatic bile ducts and abnormal liver function tests, but no evidence of anastomotic stricture, malfunction of the sphincter of Oddi was suggested as a possible cause. The sonographic features of acute gallbladder disease were evaluated and striations in the thickened gallbladder wall were shown not to be a specific sign for acute cholecystitis. Also, the ultrasonographic diagnosis of early gallbladder carcinoma was not accurate enough, but ultrasonography was reaching a sensitivity of 70% to 80% for advanced gallbladder cancer.

Bile Duct Diseases↗

PubMed1991

Thrombotic microangiopathy isolated to the central nervous system.

A man with plasma cell dyscrasia and bone marrow infiltration presented with rapidly progressive encephalopathy. Magnetic resonance imaging revealed multiple small areas of abnormal signal that correlated with the autopsy findings of thrombotic microangiopathy isolated to the central nervous system.

Caudate Nucleus↗

PubMed1991

Changes in contraceptive use and fertility: El Salvador, 1978-88.

In El Salvador from 1978 to 1988, contraceptive use among married women 15-44 years of age increased from 34% to 47%, and the total fertility rate declined from 6.3 to 4.6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception.

Adolescent↗

PubMed1991

The Health of the Public Program at the University of Washington: a new role for academic medical centers.

The University of Washington Health of the Public Program has convened a consortium composed of the region's academic medical center, the two largest managed care plans in Washington, and representatives of the state's major private and public purchasers of health care. The consortium's purpose is to test the feasibility of collaboratively collecting cross-system data, assessing variations in practice, and implementing site-specific interventions to improve the management of common illnesses and encourage preventive care. Changes under way in the ambulatory training environment and in the undergraduate curriculum as a result of the consortium's initial efforts are described. In today's climate of cost consciousness and concerns about quality, academic medical centers can play an important role in helping to improve community-wide outcomes of care.

Academic Medical Centers↗

PubMed1991

The ethics of ongoing randomization trials. Investigation among intimates.

Precisely because firm trials employ experimental designs, it is important that attention be paid to the rights and welfare of the human subjects of these evaluations. This report reviews how administrative firm trials, those that do not directly interfere in the practice of medicine, can be ethically conducted. However, because spiraling health costs are increasing pressures on managers to determine which medical practices are the most cost-effective, we also consider how clinical firm trials comparing accepted diagnostic or therapeutic modalities might be performed. Both of these types of trials require that patients agree to join clinical communities whose routine practice has been redefined to include some level of minimal-risk experimentation. Consequently, it may be appropriate for firm systems formally to adopt a new paradigm of investigation among intimates, one that encourages the participation of patients in all aspects of the research endeavor.

Ethics, Institutional↗

PubMed1991

Alcohol counseling in a general medicine clinic. A randomized controlled trial of strategies to improve referral and show rates.

We conducted a controlled trial of two interventions to increase the number of patients receiving alcohol counseling in an academic, general medicine clinic. Ongoing randomization yielded similar groups of patients and providers. By applying a two-item alcoholism-screening instrument incorporated into the routine intake process, nursing staff were successful in screening 90.4% of the 1,328 eligible patients seen during a 4-month study period. Of the patients screened, 428 (35.6%) were found to be positive. In those groups where nurses were allowed to refer directly on the basis of a positive screening result, over four times as many patients (10.8% versus. 2.3%) accepted appointments for counseling, as did patients seen by physicians providing standard care. Patients who were briefly introduced to the alcohol counselor at the time referral were no more likely to keep their first, formal appointments than were patients scheduled in the usual manner. Patients who did receive counseling had their diagnoses confirmed by the 25-item Michigan Alcoholism Screening Test. We conclude that the adoption of an alcohol screening program in our clinic increased the number of patients appropriately referred for counseling.

Alcoholism↗

PubMed1991

Diagnostic and interventional procedures for the biliary tract.

Various diagnostic imaging studies have been employed in the past year to evaluate the normal and abnormal biliary ductal system. Variations in the normal ductal drainage of the left lobe of the liver, in which the right lateral hepatic duct drained into the left hepatic duct, were studied because of the implications for the surgical resection of the left lobe. Choledochal cysts have been studied in adults using endoscopic retrograde cholangiopancreatography to evaluate the abnormal junction between the common bile duct and pancreatic duct and the long dilated common channel. An ultrasound study indicated that children with choledochal cysts also may have intrahepatic duct dilatation. An increased incidence of malignancy has been noted in adults with choledochal cysts, and their appearance on ultrasound, CT, and cholangiography were described. Cystic fibrosis produces abnormalities of the biliary tree, extrahepatic strictures, and more interestingly, intrahepatic ductal dilatation and abnormal contour without strictures. The usefulness of the preoperative ultrasonographic evaluation of the biliary tract in Oriental cholangiohepatitis was stressed. Bile duct abnormalities in fascioliasis were also noted on CT scans. Patterns of abnormality in the CT appearance of the thickened, contrast-enhanced, extrahepatic bile ducts were elucidated. Focal concentric, focal excentric, diffuse concentric, and diffuse excentric ducts were seen with various forms of pancreatic disease, choledocholithiasis, and various forms of cholangitis. An enhanced, thick-walled duct indicates disease, but is a nonspecific finding. Chronic cholecystitis was found to produce false-positive cholescintigram results in patients with suspected acute cholecystitis, but only in those with severe degrees of chronic cholecystitis. The results of multicenter trials using extracorporeal biliary lithotripsy in the United States have been published. They are somewhat disappointing and do not confirm the original excellent results reported in Germany for treatment of gallbladder stones. Much interest has been focused on the use of expandable metallic stents for the treatment of benign and malignant biliary obstruction. Preliminary data suggest good patency rates for benign lesions. Patency rates for malignant lesions are similar to those of previously available plastic stents.

Biliary Tract Diseases↗

PubMed1990

Rhinocerebral mucormycosis: management and survival after carotid occlusion.

Rhinocerebral mucormycosis is a rare but often fatal fungal infection. We present 2 patients with mucormycosis complicated by internal carotid artery thrombosis. Magnetic resonance imaging was superior to computed tomography in localizing the pathological process. Subtotal resection of devitalized tissue and intravenous amphotericin B therapy resulted in a successful outcome for both patients. Prompt recognition of this disorder by using modern diagnostic and therapeutic modalities promises to improve survival rates.

Adult↗

PubMed1990

Pediatric brainstem glioma. Post-radiation clinical and MR follow-up.

Thirty-four pediatric patients, twenty with presumed and fourteen with biopsy or autopsy proven brainstem gliomas were imaged by CT and MR before radiation therapy. Twenty-eight patients received radiotherapy. Of these, eighteen fit the protocol for combined clinical and MR post-treatment evaluation. No cases of radionecrosis were seen at autopsy. This study shows that MR can demonstrate tumor response to radiation therapy, tumor progression prior to clinical deterioration, post-treatment cyst formation and hemorrhage. Although MR clinical correlation was not optimal on six week post-treatment evaluation, 4-10 month post-treatment MR scanning correlated well with clinical evaluation. MR appears useful in post-therapeutic monitoring of tumor response.

Adolescent↗

PubMed1990

Comparison of computed tomography and magnetic resonance imaging in the evaluation of focal hepatic lesions.

Two combined magnetic resonance (MR) spin-echo pulse sequences at 0.35 T were compared with dynamic bolus contrast-enhanced computed tomography (CT) in the evaluation of focal hepatic lesions. Each combined MR sequence was performed in a separate group of patients. The first group consisted of 76 patients in whom a moderately T1-weighted sequence (spin echo [SE] 500/30 [repetition time/echo time]) was combined with a T2-weighted sequence (SE 2000/60). In the second group, consisting of 68 patients, a more heavily T1-weighted sequence (SE 250/15) was combined with the T2-weighted sequence. All studies were evaluated in a retrospective blinded fashion, with construction of receiver operating characteristic curves. We conclude that, in detection of patients with one or more focal hepatic lesions, either combined MR sequence was comparable to CT. In the detection of individual hepatic lesions, the sensitivity of the combined MR sequence with a moderately T1-weighted sequence (SE 500/30 and 2000/60) was essentially equivalent to CT (79 vs 77%, respectively). Additionally, a combined MR sequence with a heavily T1-weighted pulse sequence (SE 250/15 and 2000/60) was not statistically different than CT (86 vs 80%, respectively). These findings were supported by the receiver operating characteristic analysis.

Adolescent↗

PubMed1990

CT detection of asymptomatic pancreatitis following ERCP.

Presence or absence of pancreatitis without symptoms attributable to pancreatitis was assessed by computed tomography (CT) in 31 patients who underwent CT following endoscopic retrograde cholangiopancreatography (ERCP) within a time interval of 0-9 days. Presence or absence of pancreatitis was proven by elevated or normal amylase, and/or surgery, and by symptoms related to pancreatitis. Twenty-five of the patients underwent ERCP without and six with sphincterotomies. Among the six patients, additional procedures included two stent placements, two balloon dilatations, and one basket retrieval. Eleven of 31 patients developed pancreatitis following ERCP. The incidence of pancreatitis was higher in the group with maneuvers (four of six patients or 66.7%) than that without maneuvers (seven of 25 or 28%). Asymptomatic pancreatitis was present in five of 31 patients or 16.1%, and three of these had CT evidence of severe pancreatitis. CT demonstration of pancreatitis following ERCP with or without maneuvers may not always indicate clinically relevant disease.

Acute Disease↗

PubMed1990

Microembolization and resection of a highly vascular pyogenic granuloma.

An unusual case is reported of a hypervascular pyogenic granuloma arising from the mandible which continued to grow postpartum in a person with an associated port-wine nevus. Microembolization of the lesions permitted complete surgical removal with minimal blood loss. This case supports the theory of arteriovenous anastomosis being associated with the pathogenesis of pyogenic granulomas.

Adult↗

PubMed1990

A computer-assisted, interactive radiology learning program.

A computer-assisted adjunct to traditional radiology teaching files is described. The student is presented with an image and questions with multiple choice answers. The student's choice leads to additional presentations that reinforce correct responses and provide a critique of incorrect answers. The process is under the control of a teaching script. Requirements for the system included the ability to present high-resolution radiology images along with text; high capacity for storing teaching scripts and images; ease of use by students and authors of teaching scripts; and reasonable cost. A prototype program was written in C-language and run on an IBM PS/2 (IBM Corp., Armonk, NY) with DOS. The hardware also included a 30 megabyte disk drive, an IBM Image Adapter/A and a 14 inch IBM 8514 monitor operating at a 1024 X 768 X 8 bit resolution. Image acquisition was accomplished with a high resolution Pulnix video camera (Pulnix Corp., Tokyo, Japan), with an Imaging Technology (Imaging Technology Corp., Weston, MA) frame grabber, attached to an IBM PC/AT. All hardware is available commercially. A sample teaching file was constructed using a case of ischemic colon after a cecal volvulus. Students used the system and provided a critique. Results indicate that computer-assisted teaching programs can be a valuable addition to traditional teaching methods in radiology.

Computer-Assisted Instruction↗

PubMed1990

Magnetic resonance imaging of implanted melanomas before and after chemotherapy. Relation to 31P magnetic resonance spectroscopy and tumor histology.

The early effects of in vivo platinum-rhodamine (PtR) chemotherapy on tumor high-energy phosphorous metabolism was investigated using phosphorus-31 (31P) magnetic resonance spectroscopy (MRS), magnetic resonance imaging (MRI), and histologic examination in a subcutaneously implanted hamster melanoma model. PtR was chosen because of its potential antimitochondrial and antineoplastic properties. All melanomas were clearly observed on both T1- and T2-weighted images (T1WI and T2WI), with viable tumor regions generally characterized by low to intermediate intensity on T1WI and high intensity on T2WI. Necrotic regions were more variable in appearance, depending on the amount of cystic fluid and hemorrhage. No changes were detected on either T1WI or T2WI within 90 minutes of a tumoristatic dose of PtR (40 mg/kg) by visual examination, but slight differences were seen on calculations of relative signal intensities. However, this same dose of PtR caused a 50% drop in tumor ATP and phosphocreatine content (relative to Pi) measured by 31P MRS within 90 minutes of drug injection. Magnetic resonance spectroscopy appears to offer a sensitive means of detecting the earliest biochemical effects of chemotherapeutic agents that are known to affect tumor bioenergetics.

Animals↗

PubMed1990

Biliary tract.

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Biliary Tract↗