Biomedical subjects
Publications and source records attributed to W H Knapper.
Twelve patients with subungual squamous cell carcinoma were treated at Memorial Sloan-Kettering Cancer Center during a 27-year period. To our knowledge, only 58 cases are reported in the literature. Trauma and chronic infection were predisposing factors in some of the cases, and radiation therapy was a substantive predisposing factor in our series. Disarticulation of the distal phalanx proved effective in most patients.
To study the efficacy of standard blood tests of liver function (LFTs) and technetium-99m liver scan followed by laparoscopy in the diagnosis of solid malignant tumors of the liver, 100 consecutive patients were evaluated who had these tests because of clinical suspicion of liver neoplasm. Malignant liver tumors were present in 65 of the 100 patients. Laparoscopy diagnosed 60 of the 65, and the neoplasms were documented pathologically by directed biopsy (92% sensitivity, 100% specificity). In 8 patients, hepatoma was diagnosed and staged for possible resection. A negative "blind" biopsy had been performed in 23 of the 60 patients with liver neoplasms diagnosed at laparoscopy. LFTs and liver scans together were good screening tests (95% sensitivity) but had low specificity (46%). Liver scans also provided information as to probable tumor location in the liver, guiding the insertion site for the laparoscope, and directing deep-needle biopsies if no surface lesions were seen.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Strongyloidiasis is usually a benign illness confined to the gastrointestinal tract. However, dissemination (hyperinfection syndrome) may occur, particularly in patients with impaired cell-mediated immunity. The diagnosis of hyperinfection syndrome is often made postmortem, and mortality is high, even when the disease is recognized during life. Central nervous system involvement with Strongyloides stercoralis has previously been recognized in only a few cases at postmortem examination, and in one case antemortem. We describe a patient with disseminated strongyloidiasis in whom central nervous system involvement was diagnosed antemortem. This patient developed multiple bacterial and fungal systemic and central nervous system infections as a complication of disseminated strongyloidiasis. The natural history of the disease in man, factors predisposing to dissemination, immunologic aspects of helminthic infection, and treatment modalities are discussed.
Conventional methods for measuring splenic sequestration of labeled cells rely on stationary probe counting over the liver and spleen. A quantitative spleen-scanning method is proposed as a means of performing a more accurate diagnosis of the degree of splenic sequestration. Improved methods for calibrating a rectilinear scanner employing "constant resolutions" collimators, designed for the in vivo measurement, are reported, Clinical evaluation of this method was performed by scanning several patients scheduled for splenectomy. Good correlation between in vivo and in vitro measurements of splenic radioactivity for 29 patients was obtained. A least-squares fit to the data yielded a coefficient of determination r2=0.93.