Biomedical subjects
Publications and source records attributed to J Stines.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
MRI is now the method of choice for bone marrow imaging. The MR appearance of bone marrow is influenced by the relative amounts of its fatty or hematopoietic components. In the following study, we report different patterns in changes consistent with reconversion into hematopoietic tissue of fatty marrow that were observed in 3 patients who received hematopoietic growth factors in combination with their chemotherapy for musculo-skeletal tumors of lower limbs.
Until recently, the film has remained the only medium of information in mammography. The film is used to record, to exploit, to store and to transmit the image. Computerization of images allows to dissociate and to optimize these different functions. Among classical factors of image quality (spatial resolution, contrast, noise), new factors should be added like the detective quantum efficiency and the conversion factor. Radioluminescent screens, then digital sensors for breast stereotactic imaging have been marketed. Manufacturers are now testing full field digital mammographs. Digital imaging allows many applications (computed-aided diagnostic, 3D imaging.) and permits the easy transfer of images for diagnosis and teaching. Three parts are presented in this chapter. The first one describes the different imaging modalities and gives a reminder of the different elements related to image quality. The second one is related to the practical aspects of full field mammography, the reading of mammograms on a review station, ergonomy in full field mammography and to possible changes for screening mammography. The third part is devoted to computed aided diagnosis and its possible application in screening.
Explore the source record for details and available documents.
Lipomatous tumors of the upper and lower extremities in adults are frequent and lipoma is the most common soft tissue tumor. Most have a typical appearance at imaging but presentation and management may vary based on the exact histological subtype. The purpose of this paper is to review the main clinical, radiological and histological features of the different benign and malignant lipomatous tumors.
Explore the source record for details and available documents.
PURPOSE: A characterization of the geometrical or morphological aspect of microcalcifications is not sufficient to confirm a diagnosis of cancer. On the other hand, it seems that the shape of the cluster is a pertinent and helpful criterion for diagnosis. The aim of our study is to work out a method for 3D reconstructions of clusters of microcalcifications. MATERIALS AND METHODS: After having tested different algorithms for extracting microcalcifications, we have developed a method of 3D reconstructions of the shape of the cluster from three radiographs. The technique, available using a standard mammography unit, consists of three principal steps RESULTS: The technique has been tested with two simple tridimensional phantoms and has given results with sufficient precision for possible clinical use. CONCLUSION: We plan now to apply the method in vivo with adaptation on a dedicated mammographic stereotactic unit with digital acquisition.
Several postoperative complications associated with pain may develop in the stump of an amputated lower limb. Clinical findings are often nonspecific; however, radiologic evaluation, especially with magnetic resonance (MR) imaging, is useful in the early diagnosis of these complications, thereby helping minimize physical disability with its psychologic and socioeconomic implications. Conventional radiography can demonstrate evidence of osseous origins of pain (eg, aggressive bone edge, heterotopic ossification, osteomyelitis) and should be the first imaging study performed after clinical examination. Videofluoroscopy can help evaluate improper prosthetic fit by demonstrating abnormal residual limb motion, piston action, rolling of soft tissues, and abnormal angle between the limb axis and the prosthesis during gait. Ultrasonography can demonstrate inflammatory changes in the stump as well as soft-tissue fluid collections. However, MR imaging is the modality of choice when clinical and other imaging findings are indeterminate. Because of its high spatial and contrast resolution, MR imaging can demonstrate subtle inflammatory changes, fluid collections, cancers, neuromas, and subtle traumatic bone lesions. Knowledge of various surgical and rehabilitation techniques is required for accurate diagnosis of complications associated with stump pain. Correct diagnosis allows choice of the most appropriate therapy, which may involve treating the stump, remodeling the prosthesis, or both.
Explore the source record for details and available documents.
Medical decision making, especially in oncology, is more and more assisted by pre-established therapeutic protocols. But applying these protocols for particular cases is sometimes difficult; then, local expertise intervenes. For solving these difficult cases, Alexis-Vautrin like other centers, organizes committees for therapeutic decisions. This paper aims to describe, from a field study, the tools for medical decision making and the difficulties of using them. These result of the analysis of decision committee for breast cancers in a center using of protocols, which the first were established twenty years ago. This analysis was carried out by a team of oncologists and ergonomists; it stresses on collective decision making as a mean for adapting rules and exchanging knowledge. Furthermore, these findings lead to discuss using of decision committee for advancement and particularization of protocols themselves.
Explore the source record for details and available documents.
The risk of relapse of colorectal cancer depends on tumor characteristics such as location and Dukes' stage. Recurrences may be metastatic only (70%), locoregional only (20%) or both (10%). The main objective of postoperative follow-up is to detect recurrent disease as early as possible, in order to allow curative resection. Most relapses are now diagnosed when still asymptomatic. Different imaging methods help to diagnose these recurrences. The CT scan allows to examine the liver, lymph nodes, anastomosis and the pelvic cavity. MRI can bring complementary information in some selected cases. Lastly, percutaneous needle biopsies will be useful to prove the diagnosis. For the detection of distant metastases, chest X-ray, hepatic echography and CT scan examination can be used.
Cat-scratch disease is usually a self-limiting illness but it can initially present as a tumor. A case of a lesion of the arm is described, with CT and MR findings. The radiologic appearance is not characteristic but the diagnosis can be suggested in a predisposing clinical setting.
The study bears on 672 infiltrating carcinomas of the cervix treated from 1977 until the end of 1991, by a radiosurgical combination (311 patients) or by exclusive irradiation (361 patients). The radiosurgical series includes mostly stages IB and II and patients under 50 years because of the therapeutic protocol. Most of the patients aged over 50 years and all stages III were treated by exclusive irradiation. External beam irradiation was most often performed in 4 fields by linear accelerator of 12 and 25 MeV. Uterovaginal brachytherapy used the technique of molds. In 55 cases, a complementary interstitial brachytherapy was applied on residual node. A computer dosimetry was made for each patient with calculation of the doses delivered to organs at risk and to node areas (points of calculation ICRU n degrees 38). The results at 5 years are as follows for the total series: locoregional control (LRC) 79%, specific survival (SS) 73%, overall survival 70%. For stage I, the LRC of the radiosurgical series is 92%, that of the series of exclusive irradiation 87% (no significant difference, neither for SS if we consider the tumoral size); For stage II, the LRC is 70% in the radiosurgical series and 79% in the series of exclusive irradiation. There is no difference if proximal stage II is compared. Conversely, for distal stage II, the difference is very significant in favour of exclusive irradiation (LRC 31%/77%, SS 26%/70%, p < 0.006). If we consider the results according to age, the difference for distal stage II comes mostly from patients under 50 years and especially those aged 40 years or under. For stage III, the LRC is 61% for patients over 50 years and 34% for those aged 50 years or under (p = 0.006). As the nodes, the results of surgical pieces and lymphadenectomy are studied. The patients under 40 years in stages II and III present more metastases than others (p = 0.003). Among the therapeutic factors, the dose rate and the treatment duration were particularly studied. A detailed study of the complications is made for the radiosurgical series as for the series of exclusive irradiation according to the French Italian glossary of complications as well as a study of the factors inducing them.
Spiral CT allows the exploration of the whole larynx and hypopharynx in 30 seconds. This is a good adjustment between the technique and the organ. Performed on 15 patients during a 30 seconds' Valsalva maneuver, the exploration yields results from good to excellent. In two cases, conventional and helical CT are compared. The limitation of mA is not a drawback in such a thin region and there is no shift of organ or lesion between two scans, because the whole range is scanned in a single breathhold. 3D display of larynx and pharynx can be performed with some advantage, especially easiness of presentation for surgeon. They help topographic analysis and make correlation between endoscopic views and axial scans. They could be useful for surgical simulation and 3D photon treatment plannings.
Explore the source record for details and available documents.
Early colorectal cancer produces no symptom, thus justifying efforts at detection in screening programs. Symptoms are usually secondary to obstruction, local invasion, perforation or bleeding. Any fecal bleeding must be investigated to rule out a colorectal cancer. The initial imaging study to identify a colorectal cancer is often colonoscopy, which is frequently supplemented with a double contrast barium enema. Once the presence of cancer is histologically proven, the preoperative evaluation includes detection of hepatic and extrahepatic spread, especially with ultrasound and CT scan. Endorectal ultrasonography has been shown to be a significant advance for staging rectal cancer. It provides the best staging in selecting patients for preservation of sphincter function and for adjuvant therapies. The most useful prognostic factors in tumors without distant metastases are the depth of tumor extension, the number of positive lymph nodes and the histologic grade. Preoperative CEA level, vascular invasion and ploidy are also important prognostic factors.