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Biomedical subjects

H P Forman

Publications and source records attributed to H P Forman.

26 records · Page 2Linked to original sources

Hyperechoic renal cell carcinomas: increase in detection at US.

Recent reports have indicated that hyperechoic renal cell carcinomas (RCCAs) are more frequent among small cancers and that small cancers are being detected more frequently. To determine whether these trends have resulted in a change in the frequency of detection of hyperechoic RCCA and, in particular, in the frequency of RCCA mimicking angiomyolipomas (AMLs), the sonographic features of 90 pathologically proved RCCAs in 82 patients were retrospectively reviewed and correlated with tumor size. Tumor echogenicity was compared with that of normal renal parenchyma and classified as hypoechoic, isoechoic, slightly hyperechoic, or markedly hyperechoic. Thirty-one tumors were 3 cm in diameter or less, and 59 were larger than 3 cm. Ten (32%) of the tumors 3 cm in diameter or less were markedly hyperechoic and mimicked AMLs, whereas only one (2%) of the tumors larger than 3 cm had this appearance (P < .001). Eleven of the 90 tumors (12%) were markedly hyperechoic. Twenty-four (77%) of the small tumors were either slightly or markedly hyperechoic, compared with 19 (32%) of the larger tumors (P < .001). Because of the increased detection of small RCCAs in recent years, the number of hyperechoic cancers and the number of cancers mimicking AMLs have increased.

Adult↗

A rational approach to the diagnosis of hypertrophic pyloric stenosis: do the results match the claims?

The currently accepted premise that the diagnosis of hypertrophic pyloric stenosis (HPS) should be made on clinical grounds, with ultrasound (US) and upper gastrointestinal series (UGIS) reserved for those with a negative clinical examination, was tested. Variable clinical skills of initial examiners, including pediatric surgeons, made abdominal palpation no more sensitive or specific than US or UGIS. For those with a negative clinical examination, proceeding directly to a UGIS will result in monetary savings, especially if good clinical performance decreases the probability of HPS among those without palpable pyloric "tumors." The benefits of a "US first" approach (no radiation, better patient and parent acceptance, no contrast medium) are less apparent but no less important and increase as clinical experience declines and performance of US improves. Criteria for the clinical or sonographic diagnosis of HPS should be kept strict to avoid false-positive results; false-negatives and other causes of vomiting should be identified by UGIS.

Diagnosis, Differential↗

Clinical activities of pediatric radiologists in the United States and Canada: 10-year follow-up.

The members of the Society for Pediatric Radiology were surveyed in 1989 about their involvement with newer imaging modalities. Results were compared with those obtained in a similar study performed 10 years earlier. The performance and monitoring of imaging studies increased dramatically, with most respondents now being involved with ultrasound (US) and computed tomography (CT), and almost one-half involved with magnetic resonance (MR) imaging. When equipment became available, pediatric radiologists were quicker to assume control of MR imaging than US and CT. In most large pediatric centers, imaging with all current modalities and of all organ systems has become the responsibility of pediatric radiologists. These findings are in contrast to those obtained in 1979, when pediatric imaging practices primarily consisted of conventional radiography and fluoroscopy.

Canada↗

Congenital neuroblastoma: evaluation with multimodality imaging.

The authors retrospectively evaluated 12 patients with congenital (neonatal) neuroblastoma to assess the utility of newer imaging modalities. Findings at prenatal ultrasound (US), performed in four patients, were nonspecific (hydramnios and hydrops fetalis) in two and consistent with a suprarenal mass (one solid, one cystic) in the other two. Postnatal US helped accurately detect adrenal tumors (solid or complex, with one exception) but was less accurate in the diagnosis of metastatic disease to the liver. Computed tomography accurately depicted all primary tumors and liver metastases. Magnetic resonance (MR) imaging helped establish the correct diagnosis in three patients. This study again confirmed the benign course of neonatal neuroblastoma, with 50% of the patients classified with stage IV-S disease and two deaths occurring in the series, both due to complications. Therefore, aggressive diagnostic imaging is less desirable, and US is therefore very useful, despite its limitations. The prenatal detection and solid appearance of a suprarenal mass makes the diagnosis of neuroblastoma very likely, as does the presence of liver lesions. In the absence of these characteristic findings, US should be repeated to exclude adrenal hemorrhage. MR imaging seems to be a good alternative in some instances.

Adrenal Gland Neoplasms↗

Cerebral vasculitis and hemorrhage in an adolescent taking diet pills containing phenylpropanolamine: case report and review of literature.

Phenylpropanolamine is consumed by millions of persons annually and is sold in varying dosages and combinations for different ailments. Adolescents are an especially susceptible group influenced by its action as an anorexiant. During the past 6 years, several cases have been reported of patients in whom intracerebral hemorrhage developed, with and without concomitant angiographic evidence of vasculitis, after taking phenylpropanolamine. In this report, the 11th documented case of phenylpropanolamine-associated intracerebral hemorrhage with vasculitis is described. This is the first case in an adolescent following the ingestion of an overdose of diet-aid pills. Cases of intracerebral hemorrhage with vasculitis have also been described in users and abusers of amphetamine, methamphetamine, and ephedrine, all sympathomimetics with chemical structures similar to that of phenylpropanolamine. This report should alert pediatricians to the potential use by their patients of nonprescription medications containing phenylpropanolamine whenever unexplained acute cerebral symptoms are present.

Adolescent↗