Although frequently referred to as pulmonary abscess or necrotizing pneumonia, pulmonary gangrene is a distinct entity, requiring prompt medical and often surgical management. Radiographically, it begins as a lobar consolidation, usually in the upper lobes, develops lucencies, and coalesces to form a cavity. A "mass within a mass" or air crescent sign may be present. A vasculitis ensues, devitalizing parenchyma that must be drained surgically or expectorated through a patent bronchus. Serious complications of pulmonary gangrene that often lead to death are detected on computed tomography (CT) before these changes are apparent on chest radiographs. Specifically, a narrowed or obliterated bronchus impedes drainage of necrotic parenchyma and thrombosis of large vessels prevents the delivery of antimicrobial therapy. We review the literature and report this case to show the importance of CT in the early detection and management of pulmonary gangrene.

Fatal Outcome↗

PubMed1998

CT evaluation of mediastinal masses in children: spectrum of disease with pathologic correlation.

The mediastinum is the site of a variety of benign and malignant pathological processes in children. While the chest radiograph may be the initial imaging study to suggest an abnormality, spiral or helical CT provides detailed depiction of anatomic relationships and characteristics of the mass, and may increase the likelihood of a successful examination because of shorter scan times. This article will emphasize the important CT features in the evaluation of common and uncommon mediastinal masses in children. Pathologic correlation is presented for greater understanding. In many clinical settings, CT features such as attenuation, enhancement, calcification, anatomic relationships and extent of disease may suggest a specific diagnosis for a mediastinal mass in a child.

Adolescent↗

PubMed1997

Small bowel cancer. Imaging features and staging.

Small bowel neoplasms are relatively rare. This article presents the imaging features of the most frequently encountered small bowel masses, with emphasis on adenocarcinomas and carcinoid tumors. The CT scan findings and correlative barium and angiographic studies of various small bowel tumors are illustrated. The staging of adenocarcinoma of the small intestine is addressed, with attention to the role of CT scans for radiologic staging.

Humans↗

PubMed1996

Transitional cell carcinoma of the renal pelvis: a retrospective look at CT staging with pathologic correlation.

PURPOSE: To identify the reasons for the discrepancies between computed tomographic (CT) and pathologic staging of transitional cell carcinoma of the renal pelvis and to develop new criteria to increase the accuracy of CT in staging. MATERIALS AND METHODS: CT scans of 31 consecutive patients with renal pelvic transitional cell carcinoma were evaluated. CT and pathologic staging were compared. RESULTS: Pathologic staging revealed four stage 0 tumors, three stage I, five stage II, 10 stage III, and nine stage IV. The initial overall CT staging accuracy was 52% (16 of 31 patients). The sensitivity for minimal invasion was 17% (two of 12 patients). Two-thirds (10 of 15 patients) of the misinterpreted cases were overstaged as stage III. Proximal hydronephrosis was present in 80% of overstaged cases (eight of 10 patients). Reevaluation of the CT studies by using proximal hydronephrosis as a criterion for minimal invasion improved overall CT staging accuracy (77%). The revised staging yielded a sensitivity of 83% and specificity of 95% for minimal invasion and improved the specificity for deep invasion (17% to 92%). CONCLUSION: In a patient with transitional cell carcinoma of the renal pelvis, hydronephrosis proximal to the tumor may cause overstaging of stage 0-II disease and may not indicate more advanced disease.

Carcinoma in Situ↗

PubMed1995

Pulmonary nodules: effect of increased data sampling on detection with spiral CT and confidence in diagnosis.

PURPOSE: To compare spiral computed tomography (CT) with interscan spacing of 4-5 mm versus 8-10 mm for detection rate and level of confidence in diagnosis of pulmonary nodules. MATERIALS AND METHODS: Four radiologists (two junior and two senior faculty members) retrospectively reviewed 67 spiral CT studies with one to six nodules per study. Every second image was masked, which resulted in 8-mm sections every 8 or 10 mm; then all images reconstructed every 4 or 5 mm were reviewed. Lesions were classified as definite, probable, or possible. RESULTS: Narrow interscan spacing yielded more lesions overall (583 vs 566, P < .025) and more definite lesions and fewer equivocal lesions (482 vs 431 and 101 vs 135, respectively; P < .055). The greatest effects were in the reduction of possible lesions (50 vs 88, P < .001) and in the reduction of false-positive diagnoses made by less experienced radiologists. CONCLUSION: Increased reconstruction frequency of spiral CT volume data sets improves detection of pulmonary nodules and enhances confidence in the diagnosis.

False Positive Reactions↗

PubMed1995

Association of hepatic veno-occlusive disease with the acquired immunodeficiency syndrome.

AIMS: Observation of a patient with the acquired immunodeficiency syndrome and veno-occlusive disease (VOD) at autopsy prompted us to review the liver pathology of autopsied patients with human immunodeficiency virus seropositivity and/or acquired immunodeficiency syndrome (HIV/AIDS) to determine the frequency of occurrence of VOD and the circumstances in which it arose. METHODS: the patients studied had been autopsied at The Johns Hopkins Hospital, a referral center, between April 1981 and July 1993. We reviewed 275 adult HIV/AIDS patients autopsied with liver slides available for evaluation. Twenty cases fulfilled the pathologic criteria for VOD, central vein obliteration and sclerosis, sinusoidal congestion and fibrosis, and perivenular hepatocellular degeneration and necrosis. The autopsy cases were compared for age, race, gender, duration of HIV infection, and risk factor for the acquisition of HIV infection. The clinical and pathologic features of the 20 cases with VOD were reviewed. RESULTS: of the 275 HIV/AIDS patients, 20 (7.3%) had VOD. The average age was 41 yr (range 30-58) and most cases were black males (15 black, 5 white, and 18 male). The duration of HIV infection ranged from 6 mo to 8 yr (mean, 19 mo). The risk factor for acquiring HIV infection was primarily intravenous drug abuse (12 of 20, 60%). Six patients had homosexual or bisexual contacts, and two had other or unknown risk factors. In contrast, among the total of 275 HIV/AIDS autopsied patients reviewed, only 72 (26%) reported intravenous drug abuse whereas 157 (57%) individuals listed homosexual or bisexual contacts as a risk for developing HIV infection. Forty-six patients (17%) had other or unknown means of HIV infection. Statistical analysis by risk factor showed that intravenous drug abuse was statistically significant as a predictor for the development of VOD in an HIV/AIDS patient (P < 0.005). CONCLUSIONS: VOD of the liver can be seen in patients with HIV/AIDS and is associated with intravenous drug abuse.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Epidermal growth factor-mediated apoptosis of MDA-MB-468 human breast cancer cells.

MDA-MB-468 human breast cancer cells lack estrogen receptors, overexpress epidermal growth factor (EGF) receptors, and are growth inhibited by EGF. We show that treatment of MDA-MB-468 cells with EGF leads to inhibition of cell proliferation, fragmentation of DNA into nucleosomal oligomers, and the development of apoptotic morphology. This treatment is associated with increased expression of c-myc, c-fos, jun family members, and transforming growth factor beta 1 mRNA and with partial proteolytic cleavage of poly(ADP-ribose) polymerase and lamin B. The observation that EGF can mediate apoptosis in EGF receptor-overexpressing cells has important implications for clinical efforts directed at the EGF receptor.

Apoptosis↗

PubMed1992

Medical office design: Brigham West Medical Office Campus.

Explore the source record for details and available documents.

Ambulatory Care↗

PubMed1991

Development of a bone marrow culture for maintenance and growth of normal human B cell precursors.

The absence of long term bone marrow cultures for studying the growth and differentiation of human B cell precursors (BCP) has placed restrictions on the ability to analyze the early stages of human B cell ontogeny. We now describe a bone marrow-derived adherent cell microenvironment that maintains human BCP for several weeks in vitro. The adherent cells are maintained in a serum-free tissue culture medium, and consist of a predominant population of CD10+ fibroblast-like cells and a minor population of CD10+/nonspecific esterase+ macrophages. Adherent cell cultures seeded with fresh or cryopreserved fetal bone marrow, or purified CD10+/surface IgM- cells, provide a supportive microenvironment for lymphoid cells with a predominant phenotype of CD10+/CD19+/HLA-DR+/surface IgM-. Supplementation of the adherent cell cultures with human IL-7 induces active growth of BCP during the first 14 to 21 days of culture. However, the expansion of these cells does not continue past 21 days, and the cultures undergo a steady decline in BCP. Analysis of adherent cell conditioned medium revealed the presence of an unidentified soluble factor (or factors) that acts in concert with IL-7 to promote the growth of CD10+/surface IgM- cells. This culture system will be useful in elucidating the patterns of gene expression and growth factor requirements that characterize normal human B cell ontogeny, and perturbations of normal B cell ontogeny that lead to immunodeficiency and leukemia.

Antigens, CD↗

PubMed1985

Cefotaxime diffusion into cerebrospinal fluid of children with meningitis.

Cefotaxime diffused consistently and in therapeutic levels into the cerebrospinal fluid (CSF) of 13 children successfully treated for bacterial meningitis. CSF cefotaxime levels early (6.0 micrograms/ml) and late (1.2 micrograms/ml) in treatment were severalfold the MBCs for the infecting organisms. After a single 40-mg/kg dose to each of five infants with ventriculostomies, mean CSF levels of cefotaxime were 6.4, 5.7, and 4.5 micrograms/ml at 2, 4, and 6 h, respectively.

Cefotaxime↗

PubMed1984

A cupric ion-copper bioaccumulation relationship in coho salmon exposed to copper-containing treated sewage.

Exposure of coho salmon for 25 days to dilutions of sewage treatment plant effluent with river water containing added Cu (either 35 or 70 micrograms total Cu 1(-1) and an array of Cu2+ concentrations resulted in accumulations of Cu in gill and liver tissues that (a) correlated positively with the Cu2+ contents of the solutions; (b) reached a plateau coincident with onset of mortalities; and (c) correlated positively between these two tissues. Increases in hematocrit percentage and plasma albumin levels occurred in response to 7 micrograms Cu2+ 1(-1), indicating hemoconcentration. Treatment of blood in vitro under similar conditions resulted in association of Cu with the plasma rather than with the erythrocyte fraction.

Animals↗