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Enigma of primary aortoduodenal fistula

World Journal of Gastroenterology 2009年第25期15卷 3191-3193页

作者： Miklosh Bala jacob sosna Liat Appelbaum Eran Israeli Avraham I Rivkind Department of General Surgery and Trauma Unit Hadassah-Hebrew University Medical Center Department of Radiology Hadassah-Hebrew University Medical Center Department of Gastroenterology Hadassah-Hebrew University Medical Center

A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.

关键词：消化道出血动脉粥样硬化腹主动脉老年病年轻人疾病

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Factors associated with surgery in patients with intra-abdominal fistulizing Crohn's disease

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World Journal of Gastroenterology 2016年第47期22卷 10380-10387页

作者： Shaul Yaari Ariel Benson Eyal Aviran Naama Lev Cohain Ran Oren jacob sosna Eran Israeli IBD Unit Institute of Gastroenterology and Liver Diseases Hadassah-Hebrew University Medical Center Department of Radiology and Medical Imaging Hadassah-Hebrew University Medical Center

AIM To characterize radiological and clinical factors associated with subsequent surgical intervention in Crohn's disease(CD) patients with intra-abdominal *** From a cohort of 1244 CD patients seen over an eight year period(2006 to 2014), 126 patients were identified as having intra-abdominal fistulae, and included in the study. Baseline patient information was collected from the medical records. Imaging studies were assessed for: anatomic type and number of fistulae; diameter of the inflammatory conglomerate; length of diseased bowel; presence of a stricture with pre-stenotic dilatation; presence of an abscess; lymphadenopathy; and the degree of bowel enhancement. Multivariate analysis for the prediction of abdominal surgery was calculated via Generalized Linear *** In total, there were 193 fistulae in 132 patients, the majority(52%) being entero-enteric. Fifty-nine(47%) patients underwent surgery within one year of the imaging study, of which 36(29%) underwent surgery within one month. Radiologic features that were associated with subsequent surgery included: multiple fistulae(P = 0.009), presence of stricture(P = 0.02), and an entero-vesical fistula(P = 0.01). Evidence of an abscess, lymphadenopathy, or intense bowel enhancement as well as C-reactive protein levels was not associated with an increased rate of surgery. Patients who were treated after the imaging study with combination immunomodulatory and anti-TNF therapy had significantly lower rates of surgery(P = 0.01). In the multivariate analysis, presence of a stricture [RR 4.5(1.23-16.3), P = 0.02] was the only factor that increased surgery *** A bowel stricture is the only factor predicting an increased rate of surgery. Radiological parameters may guide in selecting treatment options in patients with fistulizing CD.

关键词： Crohn’ s 疾病管代表性的成像 Intra 腹的外科磁性的回声成像计算断层摄影术扫描

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Accessory spleen-like masses in oncology patients:Are they always benign?

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World Journal of Radiology 2010年第9期2卷 368-373页

作者： David Groshar Hanna Bernstine Natalia Goldberg Dorit Stern jacob sosna Department of Nuclear Medicine Rabin Medical Center Department of Nuclear Medicine Assuta Medical Center Department of Radiology Hadassah Hebrew University Medical Center Department of Radiology Beth Israel Deaconess Medical CenterHarvard Medical School

AIM:To assess retrospectively the significance of accessory spleen-like mass(ASLM) in oncology patients undergoing positron emission tomography/computed tomography(PET/CT).METHODS:The results of PET/CT of 913 patients(278 lymphoma;635 solid tumors) were *** number,size,location and attenuation of all ASLMs,and spleen attenuation,were *** fluorodeoxyglucose uptake was graded as normal(less than or equal to that in the liver) or representative of malignancy(more than in the liver).Follow-up PET/CT in patients with ASLM was reviewed when *** size and attenuation for spleen and ASLM were compared by unpaired Student's t *** χ2 and Fisher's exact tests were used to compare ASLM frequency and uptake for lymphomatous and solid tumors,***:ASLM frequency was 14.8,with 152 ASLMs found in 135 *** attenuation was lower in ASLM compared with spleen by enhanced and nonenhanced CT(80.7 ± 20.4 HU vs 92.0 ± 14.4 HU,P < 0.0011 and 42.3 ± 9.0 HU vs 51.5 ± 6.3 HU,P < 0.0001,respectively).ASLM incidence was higher in lymphoma patients(56/278,20.1) than in those with solid tumors(56/278,20.1 vs 79/635,12.4,P = 0.0036).Pathological uptake was found in four(7.1) lymphoma patients but not in any patients with a solid tumor(P = 0.028) and it upstaged one patient with ***-up PET/CT within 3-16 mo was available in 54 of patients with *** regression was noted in all four pathological ASLMs on follow-up PET/CT after ***:In patients with lymphoma,ASLM can represent malignancy,and thus further characterization with PET/CT might be *** with neoplasia other than ASLM can be confidently diagnosed with accessory spleen.

关键词： Positron emission tomography/computed tomography Lymphoma Oncology Accessory-Spleen

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虚拟 nonenhanced 腹的双精力的 MDCT : 图象特征的分析

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世界放射学杂志：英文版（电子版） 2012年第4期4卷 167-173页

作者： jacob sosna Shmuel Mahgerefteh Liran Goshen Galit Kafri Galit Aviram Arye Blachar Department of Radiology Hadassah-Hebrew University Medical CenterJerusalem 91120Israel Department of Radiology Beth Israel Deaconess Medical CenterBostonMA 02215United States Philips Healthcare Haifa 31004Israel Department of Radiology Tel Aviv Sourasky Medical CenterSackler School of MedicineTel Aviv UniversityTel Aviv 64239Israel

AIM:To evaluate abdominal and pelvic image characteristics and artifacts on virtual nonenhanced(VNE) images generated from contrast-enhanced dual-energy multidetector computed tomography(MDCT)***:Hadassah-Hebrew University Medical Institutional Review Board approval was obtained;22 patients underwent clinically-indicated abdominal and pelvic single-source dual-energy MDCT(Philips Healthcare,Cleveland,OH,USA),pre-and post-IV administration of Omnipaque 300 contrast(100 cc).Various solid and vascular structures were *** images were generated from the portal contrast-enhanced phase using probabilistic ***-enhanced-,regular nonenhanced(RNE)-,and VNE images were evaluated with a total of 1494 density *** ratio of iodine contrast deletion was *** of calcifications,urinary tract stones,and image artifacts in VNE images were ***:VNE images were successfully generated in all *** portal-phase iodine contrast deletion was seen in the kidney(61.7%),adrenal gland(55.3%),iliac artery(55.0%),aorta(51.6%),and spleen(34.5%).Contrast deletion was also significant in the right atrium(RA)(51.5%)and portal vein(39.3%),but insignificant in the iliac vein and inferior vena cava(IVC).Average post contrast-to-VNE HU differences were significant(P<0.05)in the:RA-135.3(SD 121.8),aorta-114.1(SD 48.5),iliac artery-104.6(SD 53.7),kidney-30.3(SD 34.9),spleen-9.2(SD 8.8),and portal vein-7.7(SD 13.2).Average VNE-toRNE HU differences were significant in all organs but the prostate and subcutaneous fat:aorta 38.0(SD 9.3),RA 37.8(SD 16.1),portal vein 21.8(SD 12.0),IVC 12.2(SD 11.6),muscle 3.3(SD 4.9),liver 5.7(SD 6.4),spleen 22.3(SD 9.8),kidney 40.5(SD 6.8),and adrenal 20.7(SD 13.5).On VNE images,196/213 calcifications(92%)and 5/6 renal stones(84%)were ***-like artifacts in the vertebral bodies were seen in all ***:Iodine deletion in VNE images is most significant in art

关键词： Abdominal computed tomography Dualenergy computed tomography Pelvic computed tomography Virtual nonenhanced computed tomography

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