Biomedical subjects

R Chisin

Publications and source records attributed to R Chisin.

104 records · Page 6Linked to original sources

PubMedDate not supplied

Synovial sarcoma of the hypopharynx.

Primary synovial sarcoma of the hypopharynx is an extremely rare neoplasm. Only 16 cases could be traced in the literature so far. An additional case, in a 29-year-old male patient, is presented. Progressive disturbance of deglutition and speech, chocking sensation, and mild respiratory distress were his original complaints. Our case differs from those previously reported in that a) the tumor was pedunculated, and the site of its attachment could be very well-defined, and b) unusual intratumoral destructive hemorrhage turned the case into an emergency. The pedicle was radically excised together with part of the grossly uninvolved underlying tissue, and the tumor was removed in toto. The histological findings are described. The patient is under observation. No recurrence has been noticed 11 months after surgery, and there are no signs of metastasis. The origin of the tumor and its treatment are discussed.

Adult↗

PubMedDate not supplied

Cochlear and brain stem responses in hearing loss following neonatal hyperbilirubinemia.

The site of lesion in hearing loss following neonatal hyperbilirubinemia is unclear. Histopathological studies have implicated the brain stem auditory nuclei while other investigations have hinted at a lesion in the cochlea. In order to clarify this issue, attempts were made to record responses from the auditory pathway in 13 patients with hearing loss following neonatal hyperbilirubinemia. The neural response from the auditory nerve was absent in 11 of the 13 patients and present only in response to high intensity stimuli in 2 patients. However, the response of the cochlear hair cells (cochlear microphonic potential) was present in 9 of the 13 patients. In most other cases of sensorineural hearing loss, with no history of hyperbilirubinemia, the hair cell response was absent. This is functional evidence for auditory nerve damage in cases of hearing loss following neonatal hyperbilirubinemia while the hair cells are spared.

Adult↗

PubMedDate not supplied

Primary presentation of malignant lymphoma in middle ear cleft.

An unusual case of histiocytic type malignant lymphoma with primary presentation in the middle ear cleft in a 32-year-old female patient is reported. Despite combined surgical, radiological and chemotherapeutic treatment, the patient expired from a fulminant spread of the lymphoma 14 months after the first clinical manifestation of the disease in the right ear.

Adult↗

PubMedDate not supplied

Irrigation of the maxillary sinus by canine fossa puncture. Experience with 202 patients.

Maxillary sinus lavage through the canine fossa was performed on 202 patients. This procedure is relatively safe, easily learned and quickly performed, has minimal side effects and a very low percentage of failures, and is more acceptable to most patients. It should be used by otolaryngologists, at least as a useful alternative to the classical method.

Adult↗

PubMedDate not supplied

Negative bone scans in impending tibial stress fractures. A report of three cases.

Three highly motivated military recruits who presented with tibial pain on exertion are reported. Their initial bone scan assessments to rule out stress fracture were normal, and the recruits were returned to demanding training. One month later, because of persistent and increasing tibial pain, they were rescanned and focal activity representative of tibial stress fractures was found in each case. Until now it has been assumed that a negative bone scan ruled out a stress fracture unequivocally. Our reported cases show that bone pain may in fact precede scintigraphic evidence of a stress fracture. Persistent and increasing bone pain during demanding physical activity, even in the presence of a prior normal bone scan, may represent stress fracture and repeat bone scan may be indicated.

Humans↗

PubMedDate not supplied

The long-term followup of soldiers with stress fractures.

A group of 295 Israeli infantry recruits was evaluated in a prospective study of stress fractures which began in basic training. On the basis of scintigraphy, 91 of the recruits (31%) were found to have sustained stress fractures during basic training. Sixty-six of the 91 recruits with stress fractures (72%) were followed for a minimum of 1 year after basic training to determine the natural history of a soldier who sustains a stress fracture and resumes training after a period of rest. Five clinical patterns were observed: (1) uneventful recovery (47%); (2) protracted recovery (13.6%); (3) symptoms consistent with recurrent stress fractures in new sites (19.6%); (4) intermittent nonstress fracture bone pain (16.7%); and (5) chronic stress fractures (3%). The incidence of recurrent stress fractures was 10.6%. A control group of 60 recruits who sustained no stress fractures in basic training had a 1.7% incidence of stress fractures after basic training. Recruits who sustained stress fractures in basic training continued to be a higher risk for stress fractures during subsequent training.

Follow-Up Studies↗

PubMedDate not supplied

Scintigraphic techniques in pre-operative localization of parathyroid adenoma.

Solitary parathyroid adenoma is the most common cause of primary hyperparathyroidism. It can be removed surgically with a 92-96% success rate without any pre-operative imaging procedures. However, imaging procedures may be of help in localization, thereby reducing operative morbidity, and in the detection of ectopic adenomas. The decision to undertake surgical exploration should not be based on these procedures because of their low sensitivity and limited specificity when used alone, but rather on an established biochemical diagnosis of hyperparathyroidism.

Adenoma↗

PubMedDate not supplied

Contribution of nuclear medicine to the diagnosis and management of extracranial head and neck diseases (excluding thyroid and parathyroid).

Nuclear medicine contributes to the diagnosis and management of extracranial head and neck diseases through the physiological information it provides. In addition to thyroid and parathyroid indications, radionuclide studies, i.e., bone and 67Gallium citrate scans are helpful in diagnosing and treating head and neck malignancies. Positron emission tomography with 18F-fluorodeoxy-glucose evaluates tumor glucose metabolism before and after treatment. Triphase bone scintigraphy enables early detection of osteomyelitis of the skull base, and its management requires 67Gallium-citrate or 111Indium-WBC scintigraphies. Salivary gland scintigraphy is the only functional imaging test of salivary tissue and should be utilized more in the diagnosis of submandibular duct obstruction and in the evaluation of preserved parenchymal function after recurrent infections.

Adolescent↗

PubMedDate not supplied

Indications for gadolinium-DTPA in magnetic resonance evaluation of extracranial head and neck mass lesions: review of experience with 27 patients examined with a 2 tesla imager.

The authors review their experience with 27 patients who underwent gadolinium-enhanced magnetic resonance imaging (MRI) at 2 tesla. The contribution of the contrast agent was evaluated with respect to three properties--lesion conspicuity, margins and characterization. Gadolinium enhancement contributed most to the characterization of the lesion and helped to better define lesion margins in relationship to nonfatty tissues. It is concluded that gadolinium-enhanced MR images frequently give significant additional information in the evaluation of head and neck mass lesions.

Contrast Media↗

PubMedDate not supplied

Nonoperative management of blunt splenic trauma in adults.

Forty-five adult patients with traumatic splenic injuries were treated during a 6-year period between 1980-1986 at Hadassah Hospital. The diagnosis was confirmed by splenic scintigraphy with 99mTc Tin-colloid. Fifteen patients (33%) who were stable on admission or after initial resuscitation were treated non-operatively and selected for this study. Treatment consisted of careful hemodynamic monitoring, strict bed rest, nasogastric suction, and i.v. fluids. In no case was emergency laparotomy necessary for deterioration of clinical condition or late complications. Splenic scans were repeated in 11 of the patients to assess resolution. In six of the patients, minimal residual defects were detected with no further complications. It is concluded that nonoperative treatment of splenic injuries in carefully selected patients is both safe and effective.

Adolescent↗

PubMedDate not supplied

Phase-contrast imaging of the parotid region.

Standard T1- and T2-weighted spin-echo acquisitions were compared with T1- and T2-weighted phase-contrast techniques in a series of 10 consecutive patients with parotid masses to assess the role of phase-contrast methods in the evaluation of lesions in the parotid fossa. Greater tissue-lesion contrast was obtained with phase-contrast methods in nine of 10 cases, allowing improved lesion visualization; however, an increase in lesion detectability was not observed in this series. Standard MR imaging methods are sufficient for imaging the parotid region in most cases, but can be quite time-consuming. Recommended screening of the parotid fossa that optimizes tissue-lesion contrast, lesion detectability, and imaging time is performed by combining a standard T1-weighted acquisition with a T1- or T2-weighted phase-contrast acquisition. Selection of a T1- or T2-weighted phase-contrast acquisition is determined by the T1 characteristics of the lesion.

Humans↗

PubMedDate not supplied

Preliminary clinical results with low flip angle spin-echo MR imaging of the head and neck.

A new approach for producing primarily T2- and proton-density-weighted MR images in less time than the conventional long TR, long TE imaging is to reduce the TR of a double spin-echo pulse sequence and to also reduce the RF excitation flip angle to minimize the resulting T1 sensitivity. In preliminary studies with a human volunteer and five patients with various diseases of the head and neck, conventional long TR, long TE and short TR, short TE images were compared with short TR, long TE images with reduced flip angles (45 degrees, 30 degrees), which required only 40% of the imaging time of the long TR images. The latter images showed a similar contrast pattern to the conventional T2-weighted image, and contrast-to-noise measurements indicated an increase in contrast between the lesion and nearby tissue when the flip angle was reduced. Furthermore, the maximum contrast/noise per unit imaging time on the short TR, long TE image was comparable to that on the long TR, long TE image. Optimization of the flip angle with short TR allows a substantial reduction in imaging time but with a reduction in multislice capability. This technique will be most useful in areas of complex anatomy where two or more orthogonal imaging planes are required, such as the head and neck.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Treatment of primary and metastatic liver cancer using an implantable chemoinfusion pump.

Twenty evaluable patients with primary or secondary neoplastic liver involvement received FUDR (0.2 to 0.3 mg/kg per day) by continuous infusion to the hepatic artery for 14 days, every 4 weeks, through a surgically implanted Infusaid (USA) pump. In addition to FUDR, MMC (15 mg/m2 every 6 to 8 weeks) was given to 14 patients with colorectal cancer and one patient with breast cancer, and ADR, (40 mg/m2 every 4 to 6 weeks) was given to 5 patients with hepatocellular carcinoma. MMC and ADR were given as a bolus injection, through the pump sideport. Radiation therapy to the liver (2,000 rads in fractions of 180 to 200 rads each) was given to eight patients with colorectal carcinoma. In total, the 20 patients received 218 months of treatment and 580 injections. The overall remission rate (complete, partial and minor response) was 55%; one patient with a colorectal carcinoma achieved a CR and seven patients (35%) a PR; three patients (15%) had a MR, and in eight patients (40%) stabilization of disease was observed. Overall median survival was 12 months: 15.5 months for colorectal cancer patients and 7.5 months for patients with hepatocellular carcinoma. Toxicity consisted mainly of chemical hepatitis, mild to severe peptic disease and sclerosing cholangitis. Hematological toxicity was not observed. These data suggest that chemotherapy through the hepatic artery, while still experimental, may be considered for selected patients with tumor confined to the liver.

Adult↗

PubMedDate not supplied

Multiple stress fractures. A longitudinal study of a soldier with 13 lesions.

A highly motivated 18-year-old man continued vigorous military training in spite of the presence of 11 stress fractures and subsequently developed two additional stress fractures. Scintigraphy over 27 weeks illustrated simultaneous regression and progression in his individual multiple foci. When stress fracture foci were not in anatomic locations prone to evolve to gross fractures, healing occurred despite vigorous activities and pain.

Adolescent↗