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Biomedical subjects

W L Foster

Publications and source records attributed to W L Foster.

At least 19 recordsLinked to original sources
PubMed1991

Localization of occult bronchogenic carcinoma by bronchography.

Bronchography is seldom recommended today to localize radiographically and bronchoscopically occult bronchogenic carcinoma. We report a case in which bronchography promptly localized such a tumor that had been occult to multiple bronchoscopies and chest computed tomograms (CTs). The patient is free of recurrence 32 months after lobectomy. Bronchography should be considered when bronchoscopies and CT fail to reveal a radiographically occult carcinoma.

Bronchography↗
PubMed1988

Hepatic abscess: sensitivity of imaging tests and clinical findings.

The imaging studies of 63 patients with hepatic abscess were evaluated to determine the sensitivity of specific imaging tests and define causes of false-negative test results. Computed tomography (CT) detected 57 of 59 (97%) separate episodes of hepatic abscess. The two false-negative CT examinations were in patients with a diffuse low-density pattern throughout the liver. The radionuclide (RN) examination detected 16 of 20 (80%) cases, missing abscesses less than 2 cm in diameter. Ultrasound detected 33 of 42 (79%) cases, missing abscesses in the dome of the liver, small abscesses, and 2 large early abscesses. For all three imaging modalities, a specific diagnosis of abscess was possible only in those patients in whom CT scans demonstrated abscess gas (15%). The results of the imaging studies were correlated with the patients' clinical condition and laboratory findings. Thirty-one percent of patients were afebrile while 23% had normal white blood cell counts. Thirteen percent had totally normal liver function tests. We conclude that the clinical absence of fever, leukocytosis, or elevated liver function tests does not permit exclusion of the diagnosis of hepatic abscess. A CT scan is highly specific in excluding the diagnosis of hepatic abscess in the absence of diffuse liver disease. In this retrospective study CT was the most sensitive imaging modality available for the detection of hepatic abscess.

Adolescent↗
PubMed1988

Sonography of small renal masses with indeterminant density characteristics on computed tomography.

Nine small renal masses with attenuation coefficients greater than 20 HU on computed tomography (CT) were termed indeterminate for cyst or renal cell carcinoma. Correlative sonography identified the fluid-filled internal architecture in four of five cysts and correctly characterized as solid four small renal cell carcinomas. The sonogram was particularly valuable in assessing masses that were indeterminate on CT when enhancement was equivocal or when intravenous contrast could not be administered. We conclude that sonography is extremely useful as a noninvasive procedure in evaluating the occasional small renal mass with CT number greater than 20 HU.

Carcinoma, Renal Cell↗
PubMed1987

Scientific presentations. What to do and what not to do.

An effective scientific presentation requires skill, experience, and effort. In planning the presentation, a skilled speaker first forms clear conclusions through analysis of the data, then tailors the details of the proof of these conclusions to the interests and background of the audience. The facts and conclusions are presented in a practiced, specific, clear, and logical manner. It is not the topic or the data alone, but the sympathetic and strategic communication of the material to a particular audience that makes a meaningful presentation.

Audiovisual Aids↗
PubMed1987

Computed tomography of the rectum.

CT is an important diagnostic procedure in patients with suspected or known disease of the rectum. Knowledge of proper technique for CT of the rectum, as well as an understanding of normal pelvic anatomy, is essential to its effective use. CT can demonstrate the extent of perirectal and pararectal abnormalities detected on barium enema. While routine preoperative staging of rectal cancer is not justified, CT can be used to solve specific problems. Perhaps the most important role of rectal CT is in evaluating postoperative rectosigmoid cancer patients in an attempt to detect early asymptomatic recurrences and, thereby, prolong patient survival.

Abscess↗
PubMed1986

Centrilobular emphysema: CT-pathologic correlation.

Over a 5-year period, 25 patients who had undergone chest computed tomography (CT) died and were autopsied. Their lungs were fixed in the inflated state and were assessed for the presence and severity of centrilobular emphysema (CLE). Three radiologists independently evaluated the CT scans for nonperipheral low-attenuation areas, peripheral low-attenuation areas, pulmonary vascular pruning, pulmonary vascular distortion, and pulmonary density gradient. The CT criterion that best correlated with the presence and severity of CLE was the nonperipheral low-attenuation area. With this CT criterion, lung destruction was correctly identified in 13 of 15 cases. The absence of this criterion resulted in correct identification of eight of ten normal lungs. These preliminary data suggest that CLE can be reliably identified and quantified with current CT scanners.

Emphysema↗
PubMed1986

Esophageal cancer staging by CT: long-term follow-up study.

To evaluate the utility of computed tomographic (CT) staging in patients with esophageal cancer, the length of patient survival was compared with pretherapy CT findings in 89 patients. Regardless of therapy, patients with evidence of mediastinal invasion, liver metastases, or abdominal adenopathy had a statistically shortened survival (P less than .05). Specific CT criteria that predicted a shortened survival included evidence of tracheal, aortic, or pericardial invasion. Patients with evidence of both mediastinal invasion and abdominal metastases had a mean survival of 180.4 days; those with no evidence, 479.6 days. The presence of enlarged upper abdominal lymph nodes indicated the worst prognosis (mean survival, 90 days). The patients with squamous cell tumors were classified by the CT staging system, and survival data were compared according to surgical procedure. Patients who underwent attempted curative surgery did not have a statistically significant difference in survival by analysis of survival curves but demonstrated a longer mean survival than those who underwent palliative or no surgery.

Adult↗
PubMed1986

Optimal cholangiographic technique for detecting bile duct stones.

Twenty-eight patients with proven bile duct stones were evaluated during either operative or T-tube cholangiography. Two radiographs were obtained for each patient without changing patient position between films. The first was performed with low peak kilovoltage (75-80 kVp) and 15% iodinated contrast medium and the second with high kVp (110) and 38% iodinated contrast. Seven radiologists evaluated the radiographs individually and in matched pairs for ductal filling, ductal penetration, motion unsharpness, overall quality, and stone detectability. The high-kVp radiographs were rated significantly better overall than the low-kVp studies (p less than 0.001) for all five criteria. In the second evaluation, which compared the pairs from the same patients, the 28 high-kVp radiographs were considered superior to the 28 low-kVp studies by the radiologists in almost two-thirds of the comparisons (ductal filling, 68%; penetration, 59%; less motion unsharpness, 65%; overall quality, 77%; stone detection, 62%). On the basis of the results of this study, high-kVp technique with full-strength contrast medium for operative and T-tube cholangiography is recommended.

Cholangiography↗
PubMed1986

Preoperative and postoperative CT staging of rectosigmoid carcinoma.

This study reports a 4 year experience using CT for preoperative staging and for evaluation of patients with rectal and sigmoid carcinoma after surgery. All patients were evaluated on a GE 8800 scanner using 1 cm contiguous slices. Only 15 of the 25 preoperative patients were staged correctly. The other 10 patients were understaged by CT. The accuracy of detecting local invasion was 70%, but only seven (35%) of 20 patients had accurate assessment of lymph nodes. The overall accuracy of CT staging in the 46 postoperative patients was 87%, with a sensitivity of 91% and a specificity of 72%. Most recurrences were found in the pelvis; 16 patients had liver metastases, and metastatic disease obstructing the ureters was detected in eight patients. On the basis of these results, it was concluded that CT should not be used routinely to preoperatively stage patients with rectosigmoid carcinoma. However, all patients who have undergone resection for rectal or sigmoid carcinoma should have aggressive CT evaluation including a baseline study at 2-4 months and then follow-up studies at every 6 months for at least 2 years. All new or enlarging masses should have CT-guided biopsies. This approach may prolong survival by detecting early asymptomatic recurrences.

Adult↗
PubMed1985

Esophageal lesions after total laryngectomy.

Clinical and endoscopic evaluation of the post-total laryngectomy patient with dysphagia may be limited by postoperative fibrosis or strictures. The barium esophagogram is a valuable adjunctive tool in further assessing these patients, as both functional and anatomic abnormalities can be evaluated. A 10-year retrospective review yielded 204 patients who had had total laryngectomies for squamous cell carcinoma of the larynx; 85 of these patients had postoperative barium esophagograms. Dysphagia was the chief complaint in 73 of these 85 patients. The studies were reviewed for anatomic abnormalities of the surgically deformed pharynx (neopharynx) and the esophagus distal to it. While most patients (51%) with dysphagia had abnormalities in the neopharynx, 17 (23%) had abnormalities distal to the neopharynx; these included four esophageal carcinomas and 13 benign esophageal strictures. These results emphasize the importance of evaluating the entire esophagus and maintaining a high index of suspicion for distal esophageal disease in the total laryngectomy patient with dysphagia.

Aged↗
PubMed1985

The radiologic evaluation of gross cecal distension: emphasis on cecal ileus.

A retrospective review of plain abdominal radiographs in 46 patients with gross cecal distension (greater than 10 cm) was performed. In 25 (54%) of 46 patients, the cecum was dilated out of proportion to the rest of the colon and was rotated anteromedially. The term cecal ileus is used to describe this situation. Five (20%) of 25 patients with cecal ileus developed perforation. Four of these patients died as a result of the perforation. The risk of perforation was related more to duration of cecal distension than to absolute cecal size. Aggressive decompressive measures, including consideration of cecostomy, appear warranted in patients with gross cecal distension, especially when it is dilated out of proportion to the rest of the colon and has persisted for several days.

Adult↗
PubMed1985

Carcinoma of the lung with osseous stromal metaplasia.

Calcification has long been a determinant in the radiologic distinction of a benign pulmonary mass. However, rare examples of calcification without ossification in pulmonary adenocarcinoma and ossification in the bronchial carcinoid have led some investigators to warn against this approach. A case of pulmonary adenocarcinoma with stromal ossification is reported herein. The literature is reviewed for neoplasms that exhibit pulmonary ossification either by primary or metastatic lesions. To our knowledge, this case represents the first report of benign osseous stromal metaplasia in the primary lesion of a pulmonary adenocarcinoma.

Adenocarcinoma↗