Biomedical subjects

Laurian Copel

Publications and source records attributed to Laurian Copel.

8 recordsLinked to original sources

PubMed2006

Computed tomography screening for lung cancer: applicability of an international protocol in a single-institution environment.

BACKGROUND: The purpose of this study was to assess the applicability of an annual low-dose computed tomography (CT) screening program for lung cancer in a single institution in Israel, which has a relatively lower prevalence of lung cancer compared with other Western countries, and to examine stage distribution of detected lung cancers. PATIENTS AND METHODS: A cohort of 842 former and current smokers underwent baseline low-dose CT screening and a total of 942 annual repeat screenings over a period of 68 months. The definition of positive results on baseline and repeat screening and their diagnostic workup were guided by the common International Early Lung Cancer Action Program protocol. Recommendations for biopsy of suspicious nodules were based on nodule size, nodule growth, non-resolution following antibiotic therapy, and positron emission tomography scan. RESULTS: The test result was positive in 102 of the 842 baseline screenings (12%) and in 45 of the 942 annual repeat screenings (5%), and biopsy was recommended in 12 baseline and 2 annual screenings. Twelve of the 14 cancers diagnosed (86%) were stage I tumors. CONCLUSION: Our study indicates that the adoption of a common international protocol is feasible, even in a very different clinical setting, yielding a high proportion of early-stage lung cancers.

Aged↗

PubMed2005

Clinical and duplex US assessment of effects of sildenafil on cavernosal arteries of the penis: comparison with intracavernosal injection of vasoactive agents--initial experience.

PURPOSE: To prospectively evaluate the clinical response and hemodynamic changes in cavernosal arteries after oral administration of sildenafil without and with audiovisual sexual stimulation and to compare those responses with responses from intracavernosal injections of vasoactive agents. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Thirteen consecutive patients (age range, 22-77 years; mean, 60.4 years) with erectile dysfunction were evaluated with clinical assessment and cavernosal duplex ultrasonography (US). The patients were examined at two sessions 3 weeks apart. First, each patient received 100 mg of sildenafil citrate orally and was examined 60 minutes later without any sexual stimulation. Each patient then underwent repeat clinical and duplex US assessment after audiovisual sexual stimulation. Three weeks later, the patients underwent identical clinical evaluation and duplex US after intracavernosal injection of a commercially available combination of papaverine, prostaglandin E1, and phentolamine. Clinical and duplex US data (ie, peak systolic velocity [PSV]) were examined by using the Wilcoxon signed rank test for matched pairs. RESULTS: At rest, the overall mean cavernosal artery PSV was 1.08 cm/sec and remained unchanged after intake of sildenafil without any audiovisual stimulation, with no clinical evidence of erection. With the addition of audiovisual sexual stimulation, eight (62%) of 13 patients had penile congestion or erection, and six (46%) had a PSV greater than 25 cm/sec. With intracavernosal injection of the combination of three drugs, all 13 patients achieved congestion or erection, and 10 (77%) had a PSV greater than 25 cm/sec. Both clinical and duplex US responses to intracavernosal injection were significantly greater than they were to sildenafil with audiovisual sexual stimulation (P = .04 and .003, respectively). CONCLUSION: Oral sildenafil with audiovisual sexual stimulation led to a significant clinical response and increment in blood flow in the cavernosal arteries. However, more patients responded to intracavernosal injection of the combination of three drugs than to sildenafil, and the clinical response was significantly better.

Administration, Oral↗

PubMed2005

Non-alcoholic Wernicke's encephalopathy - unusual clinical findings.

Wernicke's encephalopathy is a common complication of thiamine deficiency among alcoholics. However, there are few reports of this disorder in non-alcoholics. We present a case of Wernicke's encephalopathy in a non-alcoholic, 68-year-old patient with recurrent vomiting attributed to biliary colics. Establishing the diagnosis in this patient was complicated by our finding of positive 14-3-3 protein in the cerebrospinal fluid (CSF). This is typically elevated in prion disease, but it has not previously been reported to be elevated in this entity. Compatible clinical presentation in combination with typical magnetic resonance imaging (MRI) findings and exclusion of other possible causes finally established the diagnosis.

Journal Article↗

PubMed2004

US-guided percutaneous cholecystostomy: features predicting culture-positive bile and clinical outcome.

PURPOSE: To assess sonographic and clinical features that might be used to predict infected bile and/or patient outcome from ultrasonography (US)-guided percutaneous cholecystostomy. MATERIALS AND METHODS: Between February 1997 and August 2002 at one institution, 112 patients underwent US-guided percutaneous cholecystostomy (59 men, 53 women; average age, 69.3 years). All US images were scored on a defined semiquantitative scale according to preset parameters: (a) gallbladder distention, (b) sludge and/or stones, (c) wall appearance, (d) pericholecystic fluid, and (e) common bile duct size and/or choledocholithiasis. Separate and total scores were generated. Retrospective evaluation of (a) the bacteriologic growth of aspirated bile and its color and (b) clinical indices (fever, white blood cell count, bilirubin level, liver function test results) was conducted by reviewing medical records. For each patient, the clinical manifestation was classified into four groups: (a) localized right upper quadrant symptoms, (b) generalized abdominal symptoms, (c) unexplained sepsis, or (d) sepsis with other known infection. Logistic regression models, exact Wilcoxon-Mann-Whitney test, and the Kruskal-Wallis test were used. RESULTS: Forty-seven (44%) of 107 patients had infected bile. A logistic regression model showed that wall appearance, distention, bile color, and pericholecystic fluid were not individually significant predictors for culture-positive bile, leaving sludge and/or stones (P =.003, odds ratio = 1.647), common bile duct status (P =.02, odds ratio = 2.214), and total score (P =.007, odds ratio = 1.267). No US covariates or clinical indices predicted clinical outcome. Clinical manifestation was predictive of clinical outcome (P =.001) and aspirating culture-positive bile (P =.008); specifically, 30 (86%) of 35 patients with right upper quadrant symptoms had their condition improve, compared with one (7%) of 15 asymptomatic patients with other known causes of infection. CONCLUSION: US variables can be used to predict culture-positive bile but not patient outcome. Clinical manifestation is important because patients with right upper quadrant symptoms have the best clinical outcome.

Adult↗

PubMed2003

Use of three-dimensional CT in the abdomen: a useful preoperative planning tool.

Multidetector computer tomography (CT) scanners permit large volumes of the body to be scanned during a single breath-hold. Post-processing of the acquired data permits thin-section anatomic reconstructions to be created. Software improvements also currently permit high-resolution reformations to be depicted in multiple planes, along with volume-rendered anatomic depiction and measurements, and fine detail of small vessels. For preoperative surgical planning in the abdomen, these technical advances permit the surgeon to make crucial decisions during the planning phases, by facilitating anatomic and, in particular, vascular depiction, tumor staging, and volumetric determinations of solid organs. This article describes the current state of CT scanning for performing image processing, and illustrates the spectrum of available imaging tools that can be used to facilitate surgical planning. Using the abdomen as a paradigm, practical uses of image processing are demonstrated for pancreas tumor staging, segmental liver resection planning, assessment and planning of liver transplantation, renal transplant donor, and renal cancer evaluation.

Abdomen↗

PubMed2003

Computed tomography colonography (virtual colonoscopy): update on technique, applications, and future developments.

Computed topography colonography (CTC) was first described in 1994 as a rapid, non-invasive imaging method to investigate the colon and rectum. Since the advent of CTC, it has been regarded as a potential alternative technique to conventional colonoscopy for detection of colorectal polyps and cancers. Patients undergo standard bowel preparation 24 to 48 hours before the procedure, using either a standard barium enema preparation or balanced polyethylene glycol (PEG) solution. This rapid examination, without the use of sedation or intervention, is well-tolerated by patients. The potential for limited bowel preparation can reduce discomfort associated with traditional purging techniques significantly, and result in an improved perception of the screening study. CTC is performed using a single or multislice CT scanner, with acquisition of volumetric data from the entire colon. Multislice technology enables fast scanning with high resolution. To minimize the radiation dose, efforts have been made to adapt the tube current to the minimum accepted dose while not diminishing study performance. Acquired CT data are transferred onto a dedicated workstation equipped with navigator software, which permits the radiologist to obtain multiplanar reformations as well as construct an endoluminal model of the air-distended colon. Currently, the most widely accepted application for CTC is following incomplete colonoscopy. Other indications that await further clinical validation include colorectal screening. The collective experience of published studies shows CTC to be an accurate tool for detection of clinically significant colorectal polyps. Specificity and sensitivity of CTC are excellent for polyps larger than 10 mm.

Colectomy↗

PubMed2003

Ultrasound-guided percutaneous cholecystostomy: update on technique and clinical applications.

Acute cholecystitis is one of the most frequent causes for emergency admissions to General Surgery Departments. Due to the increased morbidity and high-risk of mortality, patients with severe underlying disease or a debilitated general condition are initially treated conservatively by administration of antibiotics, decompression, and drainage of the gallbladder. Percutaneous cholecystostomy (PC) is a minimally invasive method of percutaneous placement of a catheter, under ultrasound guidance, in the gallbladder lumen. PC can be performed at the bed-side and help the patient as well as physicians searching for a site and cause of sepsis. Dynamic ultrasound visualization of the puncture needle and gallbladder is crucial to avoid complications. PC cholecystectomy is an efficacious procedure with reported clinical response rates of 56%-100%. Clinical response is considered when a decrease in white blood cell count, defervescence, and decrease in the need for vasopressors are present. Patients with gallstones and symptoms and signs localized to the right upper quadrant are more likely to respond. Mortality is associated mainly with the underlying medical conditions. Ultrasound-guided PC can be followed by elective cholecystectomy at a later stage if the patient's condition permits, or by expectant or conservative management in those with acalculous cholecystitis.

Acute Disease↗

PubMed2003

Ultrasound-guided percutaneous liver biopsy: indications, risks, and technique.

Percutaneous biopsy of the liver is the most specific test available currently to assess the nature and severity of liver diseases. Image-guidance either before or during the procedure has allowed this technique to be performed on a routine basis. The purpose of this article was to review the indications and contraindications for performing liver biopsy, and describe the spectrum of major and minor complications that can occur following biopsy. Equipment and biopsy needles available currently were compared, and the individual steps involved in ultrasound-guided biopsies described. Blinded versus ultrasound-guided biopsies were compared, and techniques used for selecting the most appropriate site for biopsy, reducing the passes through the liver, and reducing complications were discussed.

Biopsy, Needle↗