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Biomedical subjects

N T Wolfman

Publications and source records attributed to N T Wolfman.

At least 19 recordsLinked to original sources
PubMed1999

Radiographic anatomy: multimedia interactive instructional software on CD-ROM.

OBJECTIVE: We wanted to create a filmless radiographic anatomy curriculum, a didactic software with a digital image database on CD-ROM for first-year medical students. CONCLUSION: We created a CD-ROM that includes an introduction, radiographic anatomy tutorial, and interactive questions. Additional features include Boolean text searching, links to related images, and Internet accessibility. The software can be updated.

Anatomy↗
PubMed1998

Validity of CT classification on management of occult pneumothorax: a prospective study.

OBJECTIVE: In the setting of blunt trauma, abdominal CT, which routinely includes images of the lower thorax, frequently reveals pneumothoraces that have not been detected on routine supine chest radiographs. Proper management of these occult pneumothoraces remains controversial. The purpose of this study was to test the hypothesis that small (minuscule) to moderate (anterior) radiographically occult pneumothoraces can be safely managed without chest tube placement for patients in whom the need for positive pressure ventilation is not anticipated. SUBJECTS AND METHODS: We undertook a prospective study in which 44 occult pneumothoraces were classified into three groups, minuscule, anterior, or anterolateral, according to size and location on CT scans. Choice of initial management (tube thoracostomy versus close observation) was based in part on this classification system and in part on individual circumstances of a surgeon's decision. RESULTS: Of the 44 pneumothoraces found in 36 patients, 16 pneumothoraces were minuscule, 20 were anterior, and eight were anterolateral. Thirteen minuscule pneumothoraces and 11 anterior pneumothoraces initially managed with observation did not require subsequent tube thoracostomy. All eight patients with anterolateral pneumothoraces underwent tube thoracostomy. CONCLUSION: Most small (minuscule) occult pneumothoraces can successfully be managed with close observation. The risk that the pneumothorax will progress is slight. Moderate-sized (anterior) pneumothoraces may also be successfully managed without initial placement of a chest tube if the patient is not to undergo positive pressure ventilation.

Adolescent↗
PubMed1998

Acute pancreatitis: the role of diagnostic imaging.

In the U.S., acute pancreatitis is usually caused by excessive consumption of ethanol or by biliary stone disease. Major pathologic finding and complications include fluid collections within the organ or the adjacent peripancreatic tissues, pseudocysts, pancreatic necrosis, pseudoaneurysm, and abscess formation. Radiologic imaging, including endoscopic retrograde cholangiopancreatography (ERCP), sonography, and computed tomography (CT), are important in the evaluation of acute pancreatitis and its complications. CT in particular also aids in grading the severity of acute pancreatitis and in predicting complications and mortality; however, CT correlation with Ranson's clinical prognostic factors or with other classification systems is less clear. The imaging and therapeutic aspects of acute pancreatitis are discussed and illustrated and prognostic factors are correlated.

Acute Disease↗
PubMed1997

Assessment of rectal tumor infiltration utilizing endorectal MR imaging and comparison with endoscopic rectal sonography.

BACKGROUND: The preoperative assessment of depth of invasion of rectal carcinoma is increasingly important as new treatment methodologies are developed. Accuracy of preoperative endorectal MR imaging was therefore compared with that of the endoscopic rectal sonography in determining depth of invasion of rectal carcinomas. METHOD: From March 1993 to April 1994, 10 consecutive patients with biopsy-proven rectal carcinomas were imaged with both endorectal MR imaging and endoscopic rectal sonography. These two studies were performed an average of 2.7 days apart in each patient. All 10 patients had surgical resection of the rectal carcinoma within days of imaging studies. TNM staging of each malignant lesion was correlated with the imaging reports. RESULT: Staging accuracy was 80% for endorectal MR imaging and 70% for endoscopic rectal sonography. With MR imaging, one T2 lesion was overstaged and one T3 lesion was understaged. With sonography, two T2 lesions were overstaged and one T3 lesion was understaged. One MR error resulted from misinterpretation. All other staging errors occurred in patients with tumor spread into, but not through, the muscularis propria or with microscopic spread through this layer. CONCLUSIONS: Endorectal MR imaging and endoscopic rectal sonography have similar accuracy for assessing depth of invasion of rectal carcinoma.

Endosonography↗
PubMed1997

Esophageal cancer. Radiologic staging.

Multimodality therapy is used in patients with esophageal cancer because accurate tumor staging is essential to determine whether treatment should be directed toward cure or palliation. Imaging strategies must not only include tumor visualization but also incorporate pretreatment staging as the most important objective. This article reviews the use of CT scans, endoscopic ultrasound, and barium studies in the staging of esophageal cancer.

Endosonography↗
PubMed1996

Computed tomography evaluation of colorectal carcinoma.

Knowledge of the extent of primary colorectal carcinoma at initial diagnosis is critical for proper management of disease. Currently, CT does not have a role in screening for colorectal carcinoma, though promising work on virtual colonoscopy is on the horizon. In patients with proven colorectal carcinoma, accurate prospective noninvasive assessment can identify those who may benefit from preoperative local radiotherapy, hepatic resection or cryoablation, or intra-arterial chemotherapy. CT should be considered complementary to the clinical assessment of colorectal carcinoma and to other modalities, such as barium enema, endorectal ultrasonography, MRI, and immunoscintigraphy. Although limited in evaluation of the primary tumor and local spread, CT has proven useful in assessing patients thought to harbor extensive local or metastatic disease. CT is generally the modality of choice for imaging the postoperative patient. The cross-sectional display of CT clearly depicts the operative bed, particularly after abdominoperineal resection. Baseline examinations should be obtained 2 to 4 months after surgery, with follow-up examinations every 6 to 9 months for 2 years, and yearly studies thereafter. CT-guided biopsies should be performed when findings suggest recurrent carcinoma.

Colon↗
PubMed1994

Esophageal squamous carcinoma.

Squamous cell carcinoma of the esophagus is a tumor with poor prognosis; it is usually in an advanced state when first diagnosed. Because a multimodal treatment approach is currently used, proper tumor staging is essential to determine whether therapy should be directed toward cure or palliation. Important prognostic features of squamous cell carcinoma include the depth of tumor infiltration into or through the esophageal wall and the presence of distant metastases. Imaging strategies should not be limited to visualization of the tumor but also should be directed toward accurate pretreatment staging. In this article, the authors review the use of barium swallow, CT scans, and endoscopic ultrasonography both alone and in combination to visualize and stage esophageal carcinoma. The strengths and limitations of each modality are also discussed.

Barium↗
PubMed1992

Blunt upper abdominal trauma: evaluation by CT.

CT is the technique of choice for initial examination of hemodynamically stable patients after blunt abdominal trauma. It is highly sensitive, specific, and accurate for use in detecting the presence or absence of injury and defining its extent. Nonoperative management of many posttraumatic injuries, particularly in the liver, spleen, and kidney, is possible in part because of the diagnostic usefulness of CT. CT can be used effectively to visualize the progression of liver and spleen injuries in those patients chosen for conservative management. CT helps in treatment decisions in patients with renal injury by defining the character and extent and distinguishing minor from severe renal trauma. Posttraumatic injuries to the pancrease, bowel, and mesentery can be detected with CT. In these areas, however, signs may be subtle, and a significant injury may be missed on an initial examination.

Abdominal Injuries↗
PubMed1992

Evaluation of PACS in ultrasonography.

We review our experience with a picture archiving and communication system to replace film in the ultrasound section of a clinical radiology department. The system includes three ultrasound units connected by a fiberoptic network via acquisition nodes to a central data management system, workstation, and optical jukebox. The system handles 80% of sonographic studies in the department. Image production, interpretation, storage, and retrieval are evaluated. Despite limitations, a picture archiving and communication system can be integrated into a functioning ultrasound section of an active radiology department with minimal disruption and promising results.

Computer Systems↗
PubMed1990

Malignant papillary cystic tumor of the pancreas.

An example of the rare papillary cystic tumor of the pancreas was diagnosed cytologically by aspiration of the primary neoplasm. Subsequently, it metastasized, proving its low-grade malignant behavior. Diagnostic cytomorphologic features included abundant straight and branched papillary tissue fragments, and uniform, pale nuclei with folds or grooves. Although the primary tumor had a typical histologic appearance, metastases demonstrated increased nuclear pleomorphism and hyperchromasia, bizarre tumor giant cells, and an increased mitotic rate. Vimentin was diffusely positive, whereas neuron-specific enolase and somatostatin were focally and weakly reactive. Neurosecretory and zymogen granules were absent ultrastructurally. By flow cytometric study, the tumor was aneuploid (DNA Index = 1.3).

Abdominal Neoplasms↗
PubMed1990

CT features of renal cell carcinoma with emphasis on relation to tumor size.

Computed tomography (CT) is the current standard for diagnosing and staging renal cell carcinoma (RCC). Although general diagnostic guidelines exist, no large studies to date have delineated the CT features of RCC. We reviewed the CT appearances of 78 pathologically proven RCCs. Of the 61 RCCs larger than 50 mm (78%) there was imaging evidence of extrarenal spread (87%), intratumoral necrosis (61%) and differential growth rates within the tumor (64%). Tumors 50 mm or smaller often had a "benign" appearance with sharp, rounded margins (88%), homogeneous density (65%), and distinct interface with the kidney (82%). The significance of these lesions should not be underestimated. Although RCCs often showed transient marked enhancement after bolus contrast material injection (41%), during the infusion phase 97% were hypodense compared with the kidney regardless of tumor size. Calcifications were visible in 31% of RCCs. Although 22% of RCCs were predominantly cystic, none fulfilled all CT criteria of simple renal cysts.

Adult↗
PubMed1990

Computed tomography versus chest radiography: impact on management of patients with lymphoma.

To assess the influence of computed tomography of the thorax (CTT) in management of patients with lymphoma, we compared results of CTT and chest radiography (CXR) for 42 patients (65 examinations) with Hodgkin's disease (HD) with 48 patients (57 examinations) with non-Hodgkin lymphoma (NHL). Six percent (7/122) of all CTs resulted in major changes in patient management (95% confidence interval = 2-12%). In four patients with HD, influential findings included of additional sites of lymphoma and clarification of x-ray results. In three patients with NHL (5%), management was altered as a result of identification of additional sites of lymphoma on CTT. Eleven percent of CTT examinations clarified equivocal CXR findings in NHL, and management was affected in two of these cases. Our findings suggest that CTT is valuable in clarifying equivocal CXR findings, and in staging or restaging patients for whom the detection of mediastinal adenopathy affect patient treatment.

Hodgkin Disease↗
PubMed1990

Radiology in the diagnosis and staging of renal cell carcinoma.

Renal cell carcinoma (RCC), a potentially curable lesion, is the most common primary renal malignancy. Due to the importance of early diagnosis and the lack of specific clinical features of RCC, imaging plays a vital role in the diagnosis and management of RCC. Newer imaging modalities have superseded plain-film radiography in the diagnosis of RCC by offering greater sensitivity and specificity in both diagnosis and staging. RCC can be diagnosed with computed tomography (CT) with greater than 95% accuracy. Once an RCC is detected, tumor staging becomes paramount for treatment planning. Greater than 90% staging accuracy can be accomplished with CT alone using techniques described in this article. Magnetic resonance imaging (MRI) can be used to achieve staging accuracy similar to CT. MRI and ultrasonography (US) should be used to aid the diagnosis and staging of RCC in equivocal CT cases. The appropriate use of additional staging adjuncts including arteriography, phlebography, skeletal and thoracic imaging is described in this article.

Carcinoma, Renal Cell↗
PubMed1988

Oral cholecystography vs gallbladder sonography: a prospective, blinded reappraisal.

In a prospective, blinded study of 205 patients, oral cholecystography (OCG) and sonography were compared in terms of how well each screened patients for gallbladder diseases. Among 23 patients who had pathologic confirmation of the diagnosis at cholecystectomy, OCG correctly diagnosed 20 cases (87%) while sonography diagnosed 18 (78%). Among 54 patients with an abnormal OCG and/or sonogram, OCG detected 47 (87%) while sonography detected 44 (81%). These small differences in detection rates were not statistically significant. On the basis of these results, we cannot conclude that either sonography or OCG has a diagnostic advantage in screening patients for gallbladder disease. The large numbers of false-negative examinations found on both sonography and OCG suggest that in a patient with persistent symptoms, the alternative study should be performed if the first examination is negative.

Administration, Oral↗