The role of "hospitalists" in the health care system.
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Biomedical subjects
Publications and source records attributed to W Rubenstein.
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The classical approach for the fine-needle aspiration biopsy of deep pelvic masses has been through the lower anterior abdominal wall. With this approach, and using either CT or sonographic guidance, bowel or bladder may be unavoidably traversed to reach the mass. We have been using a posterior approach through the sciatic notch, which is a safe and simple procedure, with good results. The biopsy is done with the patient in a prone position, using a 22-gauge biopsy needle. With this technique we have successfully biopsied various neoplastic pelvic entities.
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The first case report of magnetic resonance imaging of splenic vein thrombosis is presented together with CT and ultrasound correlation.
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Deep inspiration preceding Valsalva maneuver and rapid expiration immediately following it (DIVE) enhance venous blood flow on color Doppler flow imaging (CDI). The effect of DIVE was assessed in 115 consecutive lower extremity examinations. Of these, 95 or 115 (83%) had negative CDI sonograms, and 20 of 115 (17%) had partially (six of 115) or completely (14 of 115) occluding deep vein thrombosis. DIVE enhanced venous blood flow in 68% of the negative cases, resulting in transient venous distention, and/or more complete color filling, and/or greater spectral flow velocities. The 14 cases with completely occluding thrombi showed no response to DIVE. Six cases with partially occluding thrombi showed moderate to mild response to DIVE, with improved color delineation of the residual patent lumen around the thrombus. The authors conclude that DIVE facilitates deep venous CDI, especially when compression cannot be used to augment venous flow.
Late recurrence of renal cell carcinoma (RCC), arbitrarily defined as > 10 years post nephrectomy, is rare. The longest known clinical disease-free interval of 36 years was reported by Walter and Gellespie in 1960. We report a case of recurrent RCC presenting 45 years after nephrectomy.