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Biomedical subjects

M A Feldberg

Publications and source records attributed to M A Feldberg.

52 records · Page 3Linked to original sources
PubMed1984

Preoperative staging of rectal cancer with computerized tomography. Accuracy, efficacy, and effect on patient management.

Twenty-three consecutive patients with rectal cancer were evaluated by pelvic computerized tomography (CT). The study was designed to assess the accuracy of preoperative CT staging. The results showed that the CT and surgical and/or pathologic staging agreed in 18 patients. In two patients, the pelvic extent was correctly assessed, but small liver implants were not recognized. In three patients, CT over-estimated the extent of disease. The authors also studied whether or not CT yielded significant new information, which was not obtainable by other diagnostic methods. In most patients this was the case. Finally, the authors wanted to know the extent to which this knowledge influenced the decision about how to treat the patient. Computerized tomography findings influenced the treatment in less than 50% of the patients. It is concluded that the accuracy in staging, and the addition of new and unique information justified the routine use of CT prior to surgical intervention in all patients with known invasive rectal cancer.

Adult↗
PubMed1984

Computed tomographic diagnosis of superior mesenteric artery embolic thrombosis associated with renal and splenic infarction.

We describe a case of apparent embolic thrombosis of the superior mesenteric artery that on computed tomography (CT) was noted unexpectedly, making the diagnosis of ischemic bowel disease straightforward. It occurred together with the typical CT findings of renal and splenic infarction. This diagnosis was verified by angiography that provided more information and was confirmed at surgery.

Angiography↗
PubMed1984

Direct multiplanar CT findings in cystic teratoma of the ovary.

The CT findings in cystic teratomas of the ovary are reviewed and our findings in four patients discussed. We analyzed those teratomas with standard CT, augmented by direct nonreconstructed coronal and sagittal views, to establish the true extent of the process and to define the characteristic heterogeneous contents. Computed tomography was successful in predicting or excluding malignant degeneration.

Adult↗
PubMed1983

Perianeurysmal fibrosis and its response to corticosteroid treatment: a computerized tomography followup in 1 case.

We report a case of bilateral hydronephrosis due to perianeurysmal fibrosis in which surgical ureterolysis could not be established due to inflammatory mass involvement of the ureteral wall. The right ureter was transected and continuity could not be restored. Therefore, the patient was treated with a high dose regimen of corticosteroids. Followup computerized tomography studies demonstrated resolution of obstruction of the left ureter and a decrease in the size of the perianeurysmal mass. The size of the mass stabilized and did not decrease any further.

Aorta, Abdominal↗
PubMed1983

Management of loculated abscesses that are difficult to drain: a new approach.

Fourteen critically ill patients underwent percutaneous drainage of abdominal abscesses. All 14 had one or more relative contraindications to external drainage procedure: (a) multiloculated abscesses; (b) multiple abscesses; (c) abscesses that form fistulae to surrounding organs; (d) abscesses containing viscous fluid, debris, or necrotic material. A total of 32 cavities was drained, usually using a multiple trocar/catheter system. Biplane computed tomography demonstrated a safe drainage route in all patients. In those patients in whom the contents of the abscess were too viscous to permit drainage, the contents were liquefied with acetylcysteine. Nine of the 14 patients (64%) recovered completely following the drainage procedure.

Abdomen↗
PubMed1983

Psoas compartment disease studied by computed tomography. Analysis of 50 cases and subject review.

Fifty patients with disease involving the psoas compartment were analyzed. There were 27 patients with inflammation, 17 with tumor, and 6 with hemorrhage. In all but 3 cases the disease did not originate in the psoas but spread there from neighboring structures. Disease processes followed the fascial planes in patients with abscesses and hemorrhage but were less predictable with tumors. All three types of lesions were similar radiographically and were often indistinguishable. Asymmetry of the muscle mass, regions of decreased density, and opacification of fat in the peri- and pararenal compartments were the most frequent signs of disease. Computed tomography is recommended as the diagnostic procedure of choice.

Abscess↗
PubMed1983

Management of rectal carcinoma: impact of computed tomography.

Twenty-one patients with rectal carcinoma were examined preoperatively in order to assess the accuracy of CT in recognizing the extraluminal extension of the tumor and its effect on treatment planning. Evaluation was done by barium enema, endoscopy, and standard CT augmented by nonreconstructed coronal and sagittal sections. The information was compared with the operative and pathologic findings. Correct staging was achieved in 19 out of 21 patients. In two patients, CT overestimated the extent of the disease. In two patients, small distant metastases detected at surgery were not appreciated; however, the extent of pelvic disease was accurately assessed. In 17 patients, CT added new important information unobtainable by standard techniques. This new information affected treatment planning in 10 patients.

Adult↗
PubMed1980

An infected renal cyst.

A patient with a large renal cyst that became infected, after puncture, is reported. A very high LDH of the aspirate was highly suggestive of infection. CT showed air bubbles, a thick wall with little contrast enhancement, and low density content. CT alone cannot differentiate an infected cyst from an abscess necrotic tumor.

Aged↗
PubMed1978

Hippel-Lindau disease. A case history of one family.

This article describes the results of a prospective study in the 4 asymptomatic members of a family affected with Hippel-Lindau disease after the death of 2 patients and the surgical findings of the third. It stresses the multicentric and bilateral origin of renal cell carcinoma in Hippel-Lindau disease, usually combined with renal cortical cysts. The walls of these cysts often contain carcinoma cells. It is important that all relatives of a patient with the Hippel-Lindau disease are adequately screened.

Adult↗
PubMedDate not supplied

CT prediction of irresectability in esophageal carcinoma: value of additional patient positions and relation to patient outcome.

BACKGROUND: To improve computed tomographic (CT) prediction of local irresectability and to correlate preoperative CT findings with patient outcome. METHODS: Eighty-five patients with esophageal carcinoma underwent CT in supine, left lateral decubitus, and prone positions. CT signs that were indicative of local irresectability included (1) an angle of contact >45 degrees with the aorta; (2) obliteration of triangular fat pad between the tumor, aorta, and spine; (3) tumor contiguous with the aorta in all three positions; and (4) indentation of the airway in all three positions. RESULTS: All CT signs indicative for local irresectability concerning the aorta had comparable percentages of false-positive scans (75%) when correlated with surgical findings. When correlated with pathologic findings, >45 degrees angle of contact with the aorta yielded the fewest false-positive cases (9%). Concerning the airway, additional positions changed the staging correctly in 1 of 18 cases. Median survival was 21 and 8 months, respectively, for tumors considered CT resectable or irresectable. CONCLUSION: Additional patient positions do not improve the CT prediction of aortic invasion. Predicted resectability correlates with a significant longer life expectancy.

Adenocarcinoma↗
PubMedDate not supplied

Added value of CT criteria compared to the clinical SAP score in patients with acute pancreatitis.

BACKGROUND: To assess the added value of established computed tomography (CT) scores versus the Simplified Acute Physiology (SAP) score in predicting outcome in patients with acute pancreatitis. METHODS: Contrast-enhanced CT was performed in 45 patients with acute pancreatitis. The Balthazar score, CT severity index (CTSI), and Schröder score were assessed, and the SAP score was calculated. The predictive values of CT score and SAP score for mortality, need for one or more interventions, and length of hospital stay were compared. The added value of the SAP score to the CT scores was assessed by using ROC (receiver operating curve) analysis. RESULTS: The positive predictive values of the higher Balthazar, CTSI, Schröder, and SAP scores, reflecting severe disease, were 50%, 41%, 41%, and 48%, respectively, for mortality, 85%, 84%, 84%, and 83%, respectively, for need for one or more interventions, and 55%, 66%, 66%, and 65%, respectively, for longer hospital stay. The negative predictive values of the lower Balthazar, CTSI, Schröder and SAP scores were 84%, 92%, 92%, and 42%, respectively, for mortality, 44%, 69%, 69%, and 45%, respectively, for need for one or more interventions, and 44%, 69%, 69%, and 55%, respectively, for longer hospital stay. When CT scores were added to the SAP score, there was no improvement in discriminating power for mortality. CONCLUSION: To identify patients with severe outcome, there is no clear benefit using established CT scores as opposed to the SAP score. However, the Balthazar score and CTSI are better than the SAP score in predicting a favorable outcome.

Adult↗
PubMedDate not supplied

Planning of liver surgery using three dimensional imaging techniques.

In the simplified Couinaud classification, in which the liver is divided into eight segments, each supplied by a central vasculo-biliary sheath, little attention is given to the high prevalence of anatomical variations which occur, especially in the right hemiliver. Using volumetric acquisition techniques, such as magnetic resonance imaging or spiral computed tomography scanning, detailed insight into the individual segmental anatomy can now be obtained in a non-invasive manner. The significance of this anatomical insight lies in the planning of anatomical resections, whereby the relationship between tumour and individual segmental anatomy can be depicted in a three-dimensional format. As such, three dimensional (3D) liver imaging helps to design an individualised resection, tailored to the topographical relationship between individual segmental anatomy and tumour tissue present. Three dimensional liver imaging is of most practical value if a resection of one or more segments or sectors is considered, especially in the right hemiliver. In these cases, 3D liver imaging can demonstrate the precise location of the scissuras to the surgeon pre-operatively.

Colorectal Neoplasms↗
PubMedDate not supplied

Computed tomography of pseudocysts in retroperitoneal fibrosis.

Two cases of pseudocysts associated with retroperitoneal fibrosis and ureteral obstruction are described. Chemical analysis in the first case identified the retroperitoneal cyst as chylous in origin. In the second case the cystic area within the retroperitoneal fibrosis disappeared following treatment with steroids.

Aged↗