Biomedical subjects
Publications and source records attributed to J H Hirsch.
A papillary adenoma of the gall bladder was demonstrated by gray scale echography. The pathology of the tumor was described and the ultrasonic characteristics which distinguish it from a calculus were discussed.
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The nature of pleural based radiographic opacities in the chest can be uncertain; however, ultrasonic examination provides a reliable means of distinguishing solid from fluid-containing lesions. It is superior to both fluoroscopy and radiography in accurately localizing loculated fluid collections for thoracentesis and can be performed with commercially available gray scale contact scanning equipment. Cases representing a spectrum of clinical applications are discussed.
Five cases of hemochromatosis arthropathy are presented and the distinctive radiological features of the disease are described. Although the condition is typically degenerative, showing subchondral cyst formation, sclerosis, and thinning of cartilage, its distribution is characteristic. Selective degenerative changes of the second and third metacarpophalangeal joints are striking, particularly in the hands, while abnormalities in the intercarpal joints are variable and the interphalangeal joints are spared. Chondrocalcinosis involving both fibrous and hyaline cartilage is frequently seen as well, particularly in the large joints. The calcification is due to deposition of calcium pyrophosphate crystals, perhaps resulting from iron inhibition of pyrophosphatase.
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One hundred twenty eight cervical carotid arteriograms were twice viewed by three readers for the evaluation of atherosclerotic disease at the carotid bifurcation. Stenoses were estimated using calipers to the nearest 5% and lesions were qualitatively characterized as smooth, irregular, or ulcerated. The intraobserver correlation coefficient between estimates of percent stenosis was .94 overall and .98 for the internal carotid artery. The average intraobserver variability in estimating percent stenosis was 5.23% for all vessels and 6.04% with a standard deviation of 8.09% for the internal carotid artery. The intraobserver percent agreement at a fixed stenosis is defined as the percent of the time one reader on two readings would read at least the fixed percent stenosis among cases that might be read as having the fixed percent stenosis. The intraobserver percent agreement rate for the internal carotid artery was 95.9% at greater than 0% stenosis, 90.4% for 50% or greater stenosis, and 96.8% for 100% stenosis (total occlusion). The interobserver correlation coefficient between readers was .92 overall and .97 for the internal carotid artery. The absolute difference in percent stenosis between readers was 7.21% for all vessels and 8.64% for the internal carotid artery with a standard deviation of 9.5%. The interobserver agreement rate for the internal carotid artery at greater than 0% stenosis was 93.0%, 85.4% for 50% or greater stenosis and 96.8% at 100% stenosis. The addition of oblique views had no statistical effect on estimates of percent stenosis but increased the frequency with which irregularity and ulceration were diagnosed in the internal carotid artery.
Intraoperative neurosonography was performed in 44 patients with contact transdural or transgyral scanning technique. Localization of intracranial pathology included primary brain tumors (24), metastatic tumors (11), aneurysms (two), abscesses (two), arteriovenous malformation (one), thrombosed arteriovenous malformations (two), and plasmacytoma (one). Sonographic guidance was used in transdural decompression of three cystic lesions, therapeutic and diagnostic aspiration of two abscesses, and biopsy of three solid lesions. The expertise of the physician-sonographer with sonographic equipment facilitates accurate and expedient intraoperative neurosurgical localization of pathology.