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Michael Patlas

Publications and source records attributed to Michael Patlas.

15 recordsLinked to original sources
PubMed2006

Type II endoleak after endoaortic graft implantation: diagnosis with helical CT arteriography.

PURPOSE: To retrospectively assess endoleak shapes and locations within aneurysms to differentiate type II from type I and type III endoleaks. MATERIALS AND METHODS: The institutional review board granted an exemption for this HIPAA-compliant study; patient informed consent was not required. A retrospective review of arterial phase helical computed tomographic (CT) studies and medical records was performed for 39 patients (29 men, 10 women; age range, 60-89 years; mean, 78.5 years) who had an endoleak after endoaortic graft implantation for treatment of abdominal aortic aneurysm and who subsequently underwent angiography (n = 25), surgery (n = 8), or long-term follow-up (n = 6) to classify their endoleak into a specific type. At CT, endoleak shape (tubular or nontubular) and location (central or peripheral) were recorded. An endoleak was classified as type II if it contained a peripheral tubular component (PTC) near the aortic wall, with or without an identifiable feeding vessel. Endoleaks without these features were classified as type I or III. The Fisher exact test was used to assess associations between CT findings and endoleak type. RESULTS: There were 22 type II and 17 type I or III endoleaks. CT enabled correct identification of 22 (100%) of 22 type II endoleaks, all of which contained a PTC. Of 17 type I or III endoleaks, only two (12%) contained a PTC and were misclassified as type II endoleaks; the remaining 15 (88%) were correctly classified. Overall, CT enabled correct identification of endoleaks as type II or type I or III in 37 (95%) of 39 patients. PTCs were significantly more common (P < .001) in type II than in type I or III endoleaks, with a sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of 100%, 88.2%, 94.9%, 100%, and 91.7%, respectively. CONCLUSION: A PTC is a statistically significant predictor of type II endoleak in most patients.

Aged↗
PubMed2006

Adenocarcinoma involving the uterine cervix: magnetic resonance imaging findings in tumours of endometrial, compared with cervical, origin.

PURPOSE: To determine the distinctive magnetic resonance imaging (MRI) features of cervical and endometrial adenocarcinoma that present clinically as a cervical mass. MATERIALS AND METHODS: From 1999 to 2002, 56 patients with adenocarcinoma on the initial biopsy of a cervical mass underwent MRI at our institution. Of these, 42 had a visible mass on MRI. Pathology review of all available tissue was the reference standard. A site of origin was determined by the pathologist in 38 of the 42 patients, and these were the cases evaluated; of these patients, 32 cases had adenocarcinoma and 6 had adenosquamous cancers. RESULTS: Findings were significantly more prevalent in patients with adenocarcinomas of endometrial, compared with cervical, origin for endometrial thickening (11 [73%] and 3 [13%], respectively; P = 0.0003), endometrial mass (11 [73%] and 1 [4%], respectively; P < 0.0001), endometrial cavity expansion by a mass (9 [60%] and 2 [9%], respectively; P = 0.001), and invasion of myometrium from endometrium (9 [60%] and 0, respectively; P < 0.0001). CONCLUSION: Adenocarcinomas of the endometrium that involve the cervix have MRI features that help distinguish them from primary adenocarcinomas of the cervix.

Adenocarcinoma↗
PubMed2005

The response to sex steroid hormones and vitamin D of cultured osteoblasts derived from ovariectomized mice with and without 17beta-estradiol pretreatment.

This study investigated whether 17beta-estradiol (E2) may have different effects on osteoblasts derived from estrogen-deficient ovariectomized (OVX) mice compared to sham-operated normal animals. We studied the specific effects of 17beta-estradiol on the differentiation and function of cultured osteoblasts derived from these groups of animals, with or without estrogen replacement treatment. One-month-old mice were ovariectomized or sham-operated, and treated (every second day) for 4 weeks with 0.5 mg/kg 17beta-estradiol or with vehicle alone. At the end of the experiment, bones were removed for primary osteoblast cultures or for morphological and chemical evaluation. In cells from untreated OVX animals, alkaline phosphatase (ALP) specific activity was reduced, while collagen production and mineralization were unchanged when compared to cells from controls. In vivo estrogen pretreatment of the OVX mice elevated ALP activity and mineralization of the cells, while collagen production was reduced. The addition of 17beta-estradiol to the culture medium increased ALP activity, collagen production, and mineralization by all cultured osteoblasts, except in those derived from sham-operated, estrogen-pretreated mice, where these features remained unchanged. Osteocalcin production was unchanged. Addition of testosterone or 1,25(OH)2D3 to the culture medium induced changes that differed among the groups depending on the source of the cultured cells. It seems that ovariectomy in mice prior to culture affected the phenotype of the cultured osteoblasts and their response to estradiol, testosterone, and 1,25(OH)2D3, depending on whether animals were pretreated with estradiol or not. These results imply that the animal's estrogen status prior to culture can influence the response to estrogens; this finding may have important implications for hormone replacement therapy (HRT) in postmenopausal women.

Alkaline Phosphatase↗
PubMed2004

Orthopedic considerations in Gaucher disease since the advent of enzyme replacement therapy.

Gaucher disease, the most prevalent lysosomal storage disorder, is characterized by hepatosplenomegaly, hypersplenism, and rarely, neurological involvement. The most variable symptoms relate to skeletal disease, and both onset and progression are difficult to predict on the basis of genotype. This review describes findings from a large referral clinic (> 500 patients) and from the literature in the decade since the advent of specific enzyme replacement therapy. Such therapy is effective in reducing visceral and hematological involvement, but its greatest advantage as regards the skeleton is prevention of irreversible damage. Avascular necrosis of the joints-particularly the hips but also the knees and shoulders-and pathological fractures of the long bones including the ribs, as well as episodic "crises' of bone pain in children and young adults, are common manifestations. Various imaging modalities should be performed at baseline for life-long monitoring, and then as required because of specific complaints. Surgical interventions such as joint arthroplasties are important adjuvant treatments in this population; presurgical hematological profiling plus antibiotic cover and postoperative pain control are equally critical. Opportunities for orthopedic consultations with senior surgeons are not abused by our patients. These reflect disease-related morbidity, with greater numbers of requests being made by patients requiring enzyme therapy, who by definition have more severe disease characteristics.

Adolescent↗
PubMed2004

Increased prevalence of cholelithiasis in Gaucher disease: association with splenectomy but not with gilbert syndrome.

GOALS: The purpose of this study is to ascertain the incidence of gallstones among adult patients with type 1 Gaucher disease and whether the presence of the UDPGT1 polymorphism (Gilbert syndrome), increases the incidence of gallstones. BACKGROUND: Cholelithiasis was been observed among patients with type I Gaucher disease with variable frequency. Too, studies have addressed the possibility of an association between Gilbert syndrome and formation of bilirubinate gallstones in hereditary spherocytosis wherein, like Gaucher disease, there is hemolysis of blood cell membranes. METHODS: Medical records of all adult patients with type 1 disease in a referral clinic were reviewed for evidence of gallstones or cholecystectomy. Blood samples were collected for molecular analysis for Gilbert syndrome. RESULTS: Of 323 adult patients, 82 patients (25.4%), 54 women (65.9%) and 28 men (34.1%), had evidence of gallbladder disease (P < 0.001 relative to normal white controls). There was a statistically significant increase (P < 0.001) for all groups above the ages of 20 years other than for men aged 40 to 49 years. There was a statistically significant association between splenectomy and both cholelithiasis (P = 0.022) and Gilbert syndrome (P = 0.002). CONCLUSIONS: This study highlights an increase incidence of cholelithiasis but not Gilbert syndrome among patients with Gaucher disease. Storage of glycolipid per se or an immune reaction to storage, may explain these findings.

Adult↗
PubMed2004

Sonographic diagnosis of primary malignant tumors of the fallopian tube.

The purpose of this study is to illustrate the sonographic features of primary malignant tumors of the fallopian tube and to heighten awareness of their existence. This is a retrospective review of the imaging and clinical files of 7 patients with a primary malignant tumor of the fallopian tube found in the medical records of 4500 patients with primary gynecologic malignancies seen during the last 6 years at the authors' institution. All patients had transvaginal sonography before surgery. Images were reviewed to determine common features of this rarely encountered pathology. Transvaginal sonography showed normal ovaries in 5 patients in association with a discrete solid adnexal mass in 4. The fallopian tube origin of the mass was shown directly in 2 of these 4 patients and was inferred in the other 2 on the basis of a mass in the expected location of the fallopian tube. In the 3 patients without a discrete adnexal mass, there were more extensive changes, including large, solid adnexal masses of unknown origin (n = 2) and gross peritoneal carcinomatosis (n = 1). Fallopian tube malignancies should be considered when unexplained solid masses corresponding with the expected location of the fallopian tubes are seen in association with normal ovaries. Disease dissemination may show carcinomatosis or more extensive pelvic disease.

Diagnosis, Differential↗
PubMed2004

Spectrum of imaging findings in abdominal extraosseous myeloma.

OBJECTIVE: Extraosseous multiple myeloma is rare (< 5%) and has not been systematically documented in the abdomen. Our aim is to catalogue and describe the manifestations of multiple myeloma affecting abdominal organs. CONCLUSION: Extraosseous myeloma may involve multiple abdominal organs and may mimic other malignancies. Clinicians and radiologists should be aware of the potential for myeloma to involve extraosseous sites to avoid unnecessary interventions when this occurs.

Abdominal Neoplasms↗
PubMed2003

Detection of endoleaks after endovascular repair of abdominal aortic aneurysm: value of unenhanced and delayed helical CT acquisitions.

PURPOSE: To assess unenhanced and delayed phase computed tomographic (CT) images combined with arterial phase images for detecting endoleaks after endovascular treatment for abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: CT scans were retrospectively evaluated for the presence of endoleaks after endovascular treatment of AAAs in 33 patients with endoleak (positive group) and 40 patients without evidence of endoleak or aneurysm enlargement (negative group). All patients underwent unenhanced and biphasic contrast material-enhanced CT. The CT scans were reviewed in the following combinations: (a) arterial phase and unenhanced scans (uniphasic/unenhanced set), (b) arterial and delayed phase scans only (biphasic set), and (c) arterial and delayed phase scans with unenhanced scans (complete set). Each set was reviewed by two radiologists blinded to the diagnosis of endoleak. Findings were recorded as positive, negative, or indeterminate for endoleak. RESULTS: Within the positive group, endoleaks were diagnosed with the uniphasic/unenhanced, biphasic, and complete image sets in 30 (91%), 32 (97%), and 33 (100%) patients, respectively. With the uniphasic/unenhanced set, three (9%) endoleaks (seen only on delayed phase images) were missed. With the biphasic set, one (3%) endoleak was interpreted as indeterminate. Within the negative group, uniphasic/unenhanced, biphasic, and complete image sets were negative for endoleaks in 100%, 80%, and 100% of patients, respectively. With the biphasic set, results were indeterminate in 20% of cases. CONCLUSION: A delayed CT acquisition enables detection of additional endoleaks, while an unenhanced acquisition helps eliminate indeterminate results. Thus, both acquisitions contribute to accurate diagnosis of endoleaks when combined with an arterial phase acquisition.

Aged↗
PubMed2003

Does mammography hurt?

The documented incidence of pain associated with screening mammography varies from 1% to 62%. Some researchers suggest that pain may undermine compliance with screening mammography. As a part of a quality improvement project, we have surveyed women undergoing mammography in 2 centers in Jerusalem to identify the prevalence, severity, and duration of mammography-associated pain, demographic risk factors, and the degree that this may undermine compliance with breast cancer screening. A 23-item questionnaire was administered to 399 women (32% at the Shaare Zedek Medical Center [SZMC] and 68% at the Rachel Nash Comprehensive Breast Clinic [HALA]). Of the total, 77% of the women reported that the procedure was painful. Of those reporting pain, 60% described pain intensity as moderate or severe. In 67%, the pain resolved within 10 minutes. By univariate analysis, the only significant predictor for pain during mammography was cyclic breast pain (P = 0.053). No significant correlation was identified for age, breast size, pre-mammography counseling, and examination center (SZMC vs. HALA). The prevalence of pre-mammography counseling or explanation was low (51%). Despite that, 61% of the respondents expected that mammography would be painful. Indeed, most of those who anticipated pain reported that the actual severity was not greater than the anticipated severity. Even among women who reported pain of moderate or greater severity, less than 5% expressed preference to receive pre-emptive analgesia prior to their next mammogram. A substantial minority of women acknowledged that the experience of their mammography invoked reactions that may impend future compliance; 26% reported anxiety and 12% reported pain as factors that may interfere with ongoing compliance with regular mammographic screening. These data serve to emphasize the need for appropriate pre-test counseling and suggest a possible role for post-test debriefing to address those factors which may interfere with future test compliance.

Female↗
PubMed2003

Percutaneous cholecystostomy in the management of acute cholecystitis.

BACKGROUND: The mainstay of therapy for acute cholecystitis is cholecystectomy, which has a mortality of 14-30% in high risk patients. An alternative approach in patients suffering from acute cholecystitis with contraindications to emergency surgery is percutaneous cholecystostomy. OBJECTIVE: To evaluate the efficacy and safety of percutaneous cholecystostomy as the initial treatment of acute cholecystitis in high risk patients. METHODS: Eighty consecutive patients (42 men, 38 women) underwent ultrasound-guided percutaneous cholecystostomy over a 5 year period. Sixty-five patients suffered from acute calculous cholecystitis, 4 patients had acalculous cholecystitis, and 11 patients had sepsis of unknown origin. RESULTS: Sixty-eight patients improved after the percutaneous gallbladder drainage, 10 patients died from co-morbid disease and 2 patients died from biliary peritonitis. During a 1 year follow-up, 32 of the patients underwent interval cholecystectomy, 4 additional patients died from a co-morbid disease, 18 patients did not suffer from any gallbladder symptoms, and 14 were lost to follow-up. CONCLUSIONS: Percutaneous cholecystostomy is an effective contribution to the treatment of acute cholecystitis in high risk patients.

Acute Disease↗
PubMed2002

Repeat abdominal ultrasound evaluation of 100 patients with type I Gaucher disease treated with enzyme replacement therapy for up to 7 years.

With the advent of enzyme replacement therapy for Gaucher disease, there was a need to assess response to treatment repeatedly over relatively short periods of time; hence abdominal ultrasound was used in our referral clinic because it was convenient, safe and inexpensive. In 100 treated patients monitored for 2-7 years, nearly all had reduction in hepatosplenomegaly. The per cent reduction was more dramatic in patients who started treatment when older than 16 years. This effect may be explained by a correlation between per cent reduction and degree of baseline organomegaly. Because children often initiate therapy sufficiently early to preclude developing massive organomegaly, the observed per cent reduction is commensurately less. For all patients treated for more than five years, plateau-ing in response was seen after the first three years of treatment. This study permits us to reconsider less frequent evaluations of organ volumes. Our findings also underscore the efficacy of enzyme replacement, but raise the question of the need for dose reduction as nearly normal organ volumes are achieved.

Abdomen↗
PubMed2002

Multiple hypoechoic hepatic lesions in a patient with Gaucher disease.

The most common symptoms of Gaucher disease include hepatosplenomegaly and anemia and thrombocytopenia due to hypersplenism. We describe the case of a patient with Gaucher disease who had cachexia, massive hepatomegaly, and multiple focal hepatic lesions. The clinical and radiologic findings suggested malignancy. A biopsy specimen was taken from a hepatic lesion and revealed infiltration by Gaucher cells. We discuss our findings in light of the putative increased incidence of hematologic malignancies in patients with Gaucher disease.

Adult↗
PubMed2001

Spectrum of abdominal sonographic findings in 103 pediatric patients with Gaucher disease.

The purpose of this study was to catalogue spleen and liver features by US in a cohort of 103 pediatric patients with Gaucher disease, and to document response to enzyme replacement therapy by serial US examination. There were 42 boys and 61 girls, 2 were splenectomized. Forty-eight patients received enzyme replacement therapy (ERT). At presentation all patients evinced organomegaly and 4.9% had focal (splenic or hepatic) lesions (hypo- and hyper-echoic or mixed). Fifteen patients began ERT before 11 years of age. There was a mean liver volume reduction from 230 to 137% after 2 years of ERT, with further reduction of 91% up to 6 years later. Mean spleen volume reduction was 38.4% at 2 years of ERT and a further reduction to 40.8% at last evaluation. Fourteen children began ERT between ages 11 and 16 years. Mean liver reduction was from 230 to 124% at 2 years and further reduction to mean of 104% recently. Mean splenic reduction was 37.7% after 2 years of ERT, with a mean of 43.8% recently (mean 4.5 years later). Organ volume changes in untreated and treated children were documented by US which is the modality of choice for repeat measures in this population. Our results highlight the initial dramatic and then continued response to ERT in pediatric patients with Gaucher disease.

Adolescent↗