Biomedical subjects

M Bohlman

Publications and source records attributed to M Bohlman.

10 recordsLinked to original sources

PubMed2002

Interdigitating dendritic cell sarcoma: a rare malignancy responsive to ABVD chemotherapy.

Interdigitating dendritic cell sarcoma (IDCS) is an aggressive neoplasm of which fewer than 25 cases have been reported in the world literature. This malignancy is difficult to diagnose because of its rarity, and because of the subtle histopathologic features that distinguish IDCS from similar tumors arising from reticular cells. To date, there exists no consensus on a standard chemotherapeutic regimen for IDCS. Patients with this malignancy have been treated with chemotherapy regimens used against non-Hodgkin's lymphomas. Responses to these regimens have been variable, but mostly unsuccessful. In this article we describe a case of IDCS occurring in a 44 year old female who presented with abdominal pain and inguinal adenopathy. Staging of the tumor with CT scan, PET scan, and bone marrow biopsy demonstrated inguinal and abdominal lymphadenopathies, a large mass encasing the small bowel, and extensive liver infiltration. Morphologic and cytochemical analysis of biopsies from the abdominal mass and inguinal node were consistent with a diagnosis of IDCS, and immunohistochemical stains of the lymph node were positive for CLA, Kp-1, S-100, while negative for CD1a, CD3, CD20, CKER, and HMB45. Treatment of this patient with ABVD chemotherapy resulted in rapid clinical improvement with a marked decrease in tumor burden after two cycles of ABVD, and a complete response after six cycles of therapy.

Adult↗

PubMed1999

Clinical decision making using teleradiology in urology.

OBJECTIVE: Using a personal computer-based teleradiology system, we compared accuracy, confidence, and diagnostic ability in the interpretation of digitized radiographs to determine if teleradiology-imported studies convey sufficient information to make relevant clinical decisions involving urology. Variables of diagnostic accuracy, confidence, image quality, interpretation, and the impact of clinical decisions made after viewing digitized radiographs were compared with those of original radiographs. MATERIALS AND METHODS: We evaluated 956 radiographs that included 94 IV pyelograms, four voiding cystourethrograms, and two nephrostograms. The radiographs were digitized and transferred over an Ethernet network to a remote personal computer-based viewing station. The digitized images were viewed by urologists and graded according to confidence in making a diagnosis, image quality, diagnostic difficulty, clinical management based on the image itself, and brief patient history. The hard-copy radiographs were then interpreted immediately afterward, and diagnostic decisions were reassessed. All analog radiographs were reviewed by an attending radiologist. RESULTS: Ninety-seven percent of the decisions made from the digitized radiographs did not change after reviewing conventional radiographs of the same case. When comparing the variables of clinical confidence, quality of the film on the teleradiology system versus analog films, and diagnostic difficulty, we found no statistical difference (p > .05) between the two techniques. Overall accuracy in interpreting the digitized images on the teleradiology system was 88% by urologists compared with that of the attending radiologist's interpretation of the analog radiographs. However, urologists detected findings on five (5%) analog radiographs that had been previously unreported by the radiologist. CONCLUSION: Viewing radiographs transmitted to a personal computer-based viewing station is an appropriate means of reviewing films with sufficient quality on which to base clinical decisions. Our focus was whether decisions made after viewing the transmitted radiographs would change after viewing the hard-copy images of the same case. In 97% of the cases, the decision did not change. In those cases in which management was altered, recommendation of further imaging studies was the most common factor.

Decision Making↗

PubMed1997

Perirenal MR high signal--a new and sensitive indicator of acute ureteric obstruction.

PURPOSE: This study was carried out to determine the incidence of perirenal magnetic resonance (MR) high signal in acute ureteric obstruction as demonstrated by half-Fourier acquisition single shot turbo spin-echo (HASTE) MR. In addition, we evaluated the sensitivity of this perirenal MR high signal as a predictor of acute ureteric obstruction. MATERIALS AND METHODS: A prospective evaluation of 55 consecutive patients with suspected ureteric obstruction was carried out using the HASTE MR sequence. Images were compared to concurrent IV urography (IVU) or to computed tomography (CT) where these were available. Acute and chronic ureteric obstruction were differentiated by clinical evaluation. RESULTS: Forty-one patients had obstructed kidneys. HASTE MR accurately predicted the presence of acute ureteric obstruction in 20/23 (87%) based on presence of perirenal MR high signal. None of these showed evidence of contrast medium extravasation on the concurrent i.v. urogram. 15/18 (83%) chronically obstructed kidneys demonstrated no perirenal high signal on HASTE MR, and the remaining three showed only a trace of perirenal high signal. CT showed perirenal stranding in only 2/8 patients with acutely obstructed kidneys. CONCLUSION: In acute ureteric obstruction, HASTE MR shows perirenal high signal intensity much more commonly than IVU shows extravasation or CT showing perirenal stranding. The origin of this MR signal is uncertain but may represent oedema, lymphatic distension or free fluid from forniceal rupture. HASTE MR can accurately distinguish between acute and chronic ureteric obstruction based on the degree of perirenal high signal.

Acute Disease↗

PubMed1996

Choledocholithiasis: evaluation with MR cholangiography.

OBJECTIVE: We performed this study to evaluate the usefulness of a new T2-weighted MR sequence using a half-Fourier acquisition single-shot turbo spin-echo (HASTE) technique in the diagnosis of bile duct stones. SUBJECTS AND METHODS: We prospectively evaluated 23 patients with suspected bile duct calculi using HASTE MR cholangiography and compared that imaging technique with endoscopic retrograde cholangiography and sonography. The study group consisted of 15 women and eight men who were 42-89 years old. Patients were imaged in the axial, coronal, and sagittal planes with a 1.5-T MR scanner using a body coil. Acquisitions of 13 sec each allowed images to be obtained in a single breath-hold. All images were interpreted by two radiologists in a double-blinded fashion. The presence, number, and size of stones were noted, and common bile duct dilatation was assessed. RESULTS: Fifteen of the 23 patients were proven to have common bile duct stones. Stone size ranged from 3 mm to 35 mm (mean, 11 mm). HASTE MR cholangiography revealed stones in 14 (93%) of 15 patients; sonography revealed stones in nine (60%) of 15 patients. In 12 patients, the common bile duct was dilated, as shown by endoscopic retrograde cholangiography, HASTE MR cholangiography, and sonography. On HASTE MR cholangiograms, we measured the diameter of the bile duct in all patients. The mean diameter was 11 mm, which correlated well (r = .82) with a mean diameter of 13.5 mm as measured on endoscopic retrograde cholangiograms. CONCLUSION: HASTE MR cholangiography can noninvasively and rapidly reveal the presence of stones in the common bile duct and allows readers to assess the degree of biliary dilatation. The sequence should be considered as an alternative to endoscopic retrograde cholangiography in patients with clinical evidence of bile duct calculi and in those for whom endoscopic retrograde cholangiography is impossible.

Adult↗

PubMed1990

Diverticular disease in the elderly.

The prevalence of diverticular disease shows a striking correlation with advancing age. The spectrum of disease ranges from the entirely asymptomatic to a life-threatening surgical emergency. The diagnosis of acute diverticulitis is often particularly difficult to make in the elderly because of muted symptoms and signs. Current concepts of diagnosis and therapy are discussed.

Abdominal Pain↗

PubMed1985

Carpal tunnel syndrome: role of carpal canal size.

Carpal canal size was examined as a risk factor associated with carpal tunnel syndrome in the workplace. Seven of 14 electricians had symptomatic carpal tunnel syndrome. On measuring cross-sectional areas by CT, affected workers had a cross-sectional area of 1.75 +/- 0.21 cm2; control values were 2.53 +/- 0.15 cm2 (p less than 0.05). Individuals with a subclinical syndrome had an area of 1.83 +/- 0.22 cm2, similar to the symptomatic group. Wrist circumference was not a predictor of smallest carpal canal area. Unusual bony and soft tissue structures within the carpal canal were easily identified with CT.

Adult↗

PubMed1984

Radiographic findings in neonatal pneumonia.

The chest films of 30 infants with autopsy-proved pulmonary infections were reviewed to assess the radiographic changes in neonatal pneumonia. The most common abnormality identified was bilateral alveolar densities, noted in 77% of cases. One-third of patients had characteristically extensive, dense alveolar changes with numerous air bronchograms. A pattern of radiographic abnormalities consistent with transient tachypnea of the newborn was found in 17% of cases, and a second pattern resembling hyaline membrane disease was found in 13%. Recognition of the spectrum of expected radiographic changes can aid in the diagnosis of neonatal pneumonia, particularly if this information is correlated with the clinical features.

Bronchography↗

PubMed1983

Fatal barium embolization due to incorrect vaginal rather than colonic insertion. An ultrastructural and x-ray microanalysis study.

Fatal generalized barium sulfate (BaSO4) embolization followed erroneous vaginal insertion of the enema tip intended for colon examination. Light microscopy revealed the presence of swollen, granular reticuloendothelial cells in most visceral organs such as lung, liver, spleen, bone marrow, kidney, and brain. Transmission electron microscopy showed the reticuloendothelial cells loaded with uniformly electron-dense granules of various sizes. Scanning electron microscopy equipped with an energy-dispersive x-ray analyzer confirmed the BaSO4 composition of these granules when unstained paraffin sections of different organs mounted on glass slides without coverslips were examined. The use of the technique of x-ray microanalysis is recommended when absolute identification of inorganic material in human organs is needed. The technique can be used directly on routine paraffin-embedded material mounted on glass slides as well as with material expressly prepared.

Age Factors↗

PubMed1981

Computed tomography for localization of parathyroid adenomas.

Fourteen consecutive patients with the clinical diagnosis of primary hyperparathyroidism had computed tomography (CT) preoperatively to evaluate the use of CT in localizing parathyroid adenomas. The patients were scanned from above the level of the thyroid cartilage to the bifurcation of the trachea. Computed tomography correctly identified, prospectively, the site of the adenoma in 7 of 14 patients, including one adenoma that was ectopic in location. Nine of these patients also had barium esophagrams, and this study was accurate in only three of the nine. Our study suggests that CT may be beneficial in the preoperative localization of parathyroid adenomas, particularly those in ectopic locations.

Adenoma↗

PubMedDate not supplied

MR cholangiography in biliary obstruction using half-Fourier acquisition.

PURPOSE: Our goal was to evaluate biliary obstruction using a T2-weighted, turbo, SE MR sequence with half-Fourier acquisition (HASTE). METHOD: A prospective evaluation of 21 consecutive patients with clinical evidence of obstructive jaundice was carried out comparing HASTE MR cholangiography (MRC) to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. A control group of five normal volunteers was also evaluated. The study group was imaged with a 1.5 T MR scanner using a body coil. The HASTE sequence was applied in axial, coronal, and oblique sagittal planes. Ultrafast acquisition scanning times allowed the use of a single breath hold. Bile duct dilatation, level of obstruction, and cause of obstruction were assessed on both imaging modalities by two radiologists blinded to the clinical diagnosis and to each other's results. RESULTS: All studies were interpretable with anatomy well seen in 82% of the cases. MRCs of a normal control group were correctly interpreted. The presence of biliary dilatation was accurately depicted by HASTE MRC in 100% of patients with complete interobserver agreement. The level of obstruction was depicted correctly in 87% of patients with 93% interobserver agreement. The right main duct was seen by MRC in 80% of obstructed systems. The left main duct was seen in all obstructed patients. The gallbladder was identified in 88% of patients by MRC. Common bile duct stricture and stones could be differentiated as a cause of obstruction in all cases. CONCLUSION: MRC using the HASTE imaging sequence can safely and accurately depict the presence and level of biliary obstruction. The fast acquisition time of 13 s/scan makes the technique suitable for uncooperative and ill patients. HASTE MRC should be considered an alternative procedure to direct cholangiography in selected patients.

Aged↗