Richard S Lefleur, M.D.

Pancreaticoureteral fistula following penetrating abdominal trauma
Wolf, Joshua H; Miller, George; Ashinoff, Russell; Dave, Jasmine; Lefleur, Richard S; Frangos, Spiros G; Miglietta, Maurizio A
2007 ;8(5):613-616, JOP: journal of the pancreas
CONTEXT: The main pancreatic duct can form a fistulous communication with another epithelium in the setting of prolonged inflammation, operative manipulation, or direct trauma. We present a rare complication of a pancreaticoureteral fistula following a trauma nephrectomy. CASE REPORT: A 17-year-old male who sustained a gunshot wound to the back arrived to our Emergency Room hyopotensive, tachycardic, and with free intraperitoneal fluid on focused assessment sonography for trauma (FAST) exam. He was taken to the operating room for an exploratory laporatomy where a left nephrectomy was performed to control active bleeding from the left renal hilum. Significant bleeding was also encountered at the portal venous confluence. After packing and damage control laparotomy, the periportal/pancreatic bleeding was controlled during a second procedure 6 hours later. After one month in the Intensive Care Unit with an open abdomen, a computed tomography (CT) scan revealed a fluid collection in the splenic fossa which was drained by catheter. Persistent drainage revealed a high amylase concentration (greater than 50,000 U/L). A fistulogram revealed interruption of the main pancreatic duct, and a fluid collection by the tail of the pancreas that was in communication with the left ureter. The patient's urine amylase was also elevated. The patient was treated non-operatively given the healing open abdomen and controlled fistula. He had an otherwise uncomplicated recovery. CONCLUSIONS: This is the second report of a pancreaticoureteral fistula in the literature. Treatment of this communication should be similar to that of other pancreatic fistulae
— id: 74304, year: 2007, vol: 8, page: 613, stat: Journal Article,

Osler-Weber-Rendu disease. Diagnosis and management of spontaneous hemothorax during pregnancy [see comments]
Bevelaqua FA; Ordorica SA; Lefleur R; Young B
1992 Dec;92(12):551-552, New York state journal of medicine
— id: 13345, year: 1992, vol: 92, page: 551, stat: Journal Article,

Significance of an enlarged splenic artery in patients with splenic vein thrombosis
Dumont AE; Lefleur RS
1988 Oct;54(10):613-616, American surgeon
In an attempt to determine the relationship, if any, between the size of the splenic artery and various clinical aspects of splenic vein thrombosis, including splenomegaly, the clinical and angiographic findings in ten patients with this disorder were reviewed. The size of the splenic artery was found to be unrelated to the nature of the underlying disease, age of the patient, or history of variceal bleeding. An abnormally wide and tortuous splenic artery was identified only in those patients (five) in whom there was also radiographic evidence of splenic enlargement. Since the angiographic finding of an enlarged and tortuous splenic artery is known to correlate closely with increased flow in this vessel, this observation suggests that in patients with isolated splenic vein obstruction an increase in splenic artery flow accompanies splenic enlargement and is probably a critical component of the underlying derangement
— id: 10945, year: 1988, vol: 54, page: 613, stat: Journal Article,

CT evaluation of esophageal varices
Balthazar EJ; Naidich DP; Megibow AJ; Lefleur RS
1987 Jan;148(1):131-135, American journal of roentgenology
CT findings in 20 consecutive patients with proven esophageal varices are reviewed and analyzed. In 85% of patients, abnormalities were seen involving the esophageal wall and/or periesophageal region. In 65%, findings specific to varices were present: thickening of esophageal wall, a scalloped contour, and intraluminal protrusions enhancing after a contrast bolus injection. These findings were seen alone or in association with periesophageal varices, which were seen in 45% of patients; evidence of portal hypertension with varices in the lesser omentum was present in 95%. CT has a sensitivity similar to barium esophagram but evaluates better the presence and extent of periesophageal varices and portal hypertension. Normal CT does not rule out esophageal varices because small varices may escape detection, particularly in scans done without a contrast bolus injection
— id: 23441, year: 1987, vol: 148, page: 131, stat: Journal Article,

Intralobar pulmonary sequestration: MR evaluation
Naidich DP; Rumancik WM; Lefleur RS; Estioko MR; Brown SM
1987 May-Jun;11(3):531-533, Journal of computer assisted tomography
This report documents the use of magnetic resonance (MR) in evaluation of intralobar pulmonary sequestration. Because of its distinctive multiplanar capabilities and nonreliance on contrast media to visualize blood vessels, MR can be used to define and characterize the size and course of anomalous arterial feeding vessels. Furthermore, MR can be of value in detecting the presence of mucoid-impacted bronchi within abnormal segments of the lung. It is concluded that in select cases MR may obviate the need for more invasive procedures to establish the diagnosis of pulmonary sequestration
— id: 23440, year: 1987, vol: 11, page: 531, stat: Journal Article,

CT evaluation of pancreatic injury following splenectomy
Balthazar EJ; Megibow A; Rothberg M; Lefleur RS
1985 ;10(2):139-144, Gastrointestinal radiology
A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst
— id: 23442, year: 1985, vol: 10, page: 139, stat: Journal Article,

Auto-injection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence
Zorgniotti AW; Lefleur RS
1985 Jan;133(1):39-41, Journal of urology
Intracavernous injection of papaverine hydrochloride with phentolamine mesylate rapidly produces transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. Coital penetration was possible in 59 of 62 patients with impotence of divers etiologies (vascular, diabetic, iatrogenic and Peyronie's disease) who underwent injection and were sent home to attempt coitus. One patient had a prolonged erection that was treated successfully with aspiration of a corpus. When coitus was successful the patient was offered training in self-injection. With self-injection 18 patients have had satisfactory coitus without a noteworthy complication; 5 for more than 12 months. The long-term effects of intracavernous injections remain unknown. Intracavernous injection of vasoactive substances (chemical prosthesis) may become a useful alternative treatment. Administration should be restricted to urologists able to manage the possible complication of priapism
— id: 23443, year: 1985, vol: 133, page: 39, stat: Journal Article,

Computed tomographic recognition of gastric varices
Balthazar EJ; Megibow A; Naidich D; LeFleur RS
1984 Jun;142(6):1121-1125, American journal of roentgenology
The computed tomographic (CT) findings in 13 consecutive patients with proven gastric varices were analyzed and correlated with the radiographic, angiographic, and gastroscopic evaluations. In 11 patients, CT clearly identified large (five) or smaller (six) varices located mainly along the posteromedial wall of the gastric fundus and proximal body of the stomach. Well defined rounded or tubular densities that enhanced during intravenous administration of contrast material and could not be distinguished from the gastric wall were identified. Dense, enhancing, round or tubular, intraluminal filling defects were seen in the cases where the stomach was distended with water. In two patients, the CT diagnosis of gastric varices could not be confidently made. All patients had associated intraabdominal collateral circulation, situated medial to the stomach within the lesser omentum, along the distribution of the coronary venous system. In seven patients, the CT examination correctly diagnosed the pathogenesis of gastric varices by identifying hepatic cirrhosis, calcific pancreatitis, and carcinoma of the pancreas
— id: 23445, year: 1984, vol: 142, page: 1121, stat: Journal Article,

Solid and papillary epithelial neoplasm of the pancreas. Radiographic, CT, sonographic, and angiographic features
Balthazar EJ; Subramanyam BR; Lefleur RS; Barone CM
1984 Jan;150(1):39-40, Radiology
Solid and papillary epithelial neoplasm of the pancreas is a nonfunctioning tumor seen a slowly enlarging upper abdominal mass in young women. It is usually large, well encapsulated, and undergoing necrotic degeneration. On ultrasound, it is sharply defined, nonhomogeneous, and lacking central enhancement. On angiography, it can be avascular or hypovascular depending on the degree of necrosis. Calcification has not been reported, and metastatic deposits are rare. Excision leads to an excellent prognosis
— id: 23447, year: 1984, vol: 150, page: 39, stat: Journal Article,

Ectopic duplicated ureter opening into ipsilateral vas deferens
Glasser J; Lefleur R; Subramanyam B; Al-Askari S
1984 Mar;23(3):309-312, Urology
A case of a duplicated collecting system with an ectopic ureter draining into the ipsilateral vas deferens is presented. The embryology of this entity is reviewed
— id: 23419, year: 1984, vol: 23, page: 309, stat: Journal Article,

Hepatocellular carcinoma with venous invasion. Sonographic-angiographic correlation
Subramanyam BR; Balthazar EJ; Hilton S; Lefleur RS; Horii SC; Raghavendra BN
1984 Mar;150(3):793-796, Radiology
Ultrasound was correlated with angiography for assessment of tumor extension to the intrahepatic inferior vena cava, hepatic veins, and portal vein branches in 15 cases of hepatocellular carcinoma (HCC) and 85 cases of hepatic metastases. Sonography revealed intraluminal tumor thrombus in 5 cases of HCC (33%), which were confirmed by angiography (sensitivity and specificity = 100%), and in 1 case of hepatic metastases (1%). Sonography was superior in depicting veins obscured or nonopacified on angiography, which in turn demonstrated arteriovenous shunting not appreciated on sonography. Used as the initial procedure for evaluation of venous extension of HCC, ultrasound can suggest the histology (though this must be confirmed by biopsy) and determine the feasibility of resection
— id: 23446, year: 1984, vol: 150, page: 793, stat: Journal Article,

Portal venous thrombosis: correlative analysis of sonography, CT and angiography
Subramanyam BR; Balthazar EJ; Lefleur RS; Horii SC; Hulnick DH
1984 Oct;79(10):773-776, American journal of gastroenterology
In 17 patients with portal venous thrombosis; nine due to venous invasion by liver tumors, and eight due to benign causes, sonograms and CT scans were reviewed, and the results were correlated with angiography. Sonography detected portal venous thrombosis in 94% and CT in 76%. Sonography was better than CT in the demonstration of the extent of thrombosis. By the detection of solid masses in the liver, and contiguous thrombosis of the segmental portal veins, both sonography and CT were accurate in the differentiation of venous invasion by tumor from benign thrombosis. Angiography was 91% accurate and was unique in the demonstration of arterioportal shunting and detailed vascular anatomy of the portal venous system
— id: 43900, year: 1984, vol: 79, page: 773, stat: Journal Article,

Ultrasonic features of cholangiocarcinoma
Subramanyam BR; Raghavendra BN; Balthazar EJ; Horii SC; LeFleur RS; Rosen RJ
1984 Sep;3(9):405-408, Journal of ultrasound in medicine
Sonographic features in 12 cases of proven cholangiocarcinoma were analyzed and correlated with findings on direct cholangiography. Proximal bile duct dilation was present in all cases of cholangiocarcinoma of the intrahepatic ducts except one. A neoplastic bile duct segment was detected in nine of the 12 cases. The neoplasms were seen as narrowed, normal-sized, or enlarged ducts, and contained intraluminal soft-tissue echoes or echogenic bands across the lumens. The sonographic accuracy was greater for lesions involving the bifurcation and the common hepatic duct than for common bile duct lesions. Cholangiography was superior to sonography in determining the length of the involved segment, whereas sonography was superior in detecting hepatic invasion and lymphadenopathy
— id: 23444, year: 1984, vol: 3, page: 405, stat: Journal Article,

Abdominal complications of drug addiction: radiologic features
Balthazar EJ; Lefleur R
1983 Jul;18(3):213-220, Seminars in roentgenology
— id: 43906, year: 1983, vol: 18, page: 213, stat: Journal Article,

Localization of impalpable testis by computed tomography
Glasser J; Naidich D; Lefleur R; Al-Askari S
1983 Aug;22(2):206-208, Urology
— id: 23420, year: 1983, vol: 22, page: 206, stat: Journal Article,

Sonography of portosystemic venous collaterals in portal hypertension
Subramanyam BR; Balthazar EJ; Madamba MR; Raghavendra BN; Horii SC; Lefleur RS
1983 Jan;146(1):161-166, Radiology
Portosystemic venous collaterals were studied with sonography in 40 patients with known portal hypertension. Eight patients had technically inadequate scans, while 32 had optimal scans. Sixty groups of venous collaterals were identified. At least one collateral pathway was seen in 28 patients, for a sensitivity of 88% for the 32 patients with optimal scans and 70% for the total group. The overall sensitivity for detection of coronary-gastroesophageal collaterals was 80% and 64%, respectively. The small size of the coronary-gastroesophageal varices in early portal hypertension seems to be the most important factor limiting detection in patients suitable for sonography
— id: 23126, year: 1983, vol: 146, page: 161, stat: Journal Article,

Sonographic evaluation of patients with portal hypertension
Subramanyam BR; Balthazar EJ; Raghavendra BN; Lefleur RS
1983 Jun;78(6):369-373, American journal of gastroenterology
The availability of real-time sonography has facilitated its use in the assessment of patients suspected of portal hypertension. Dilatation of the portal venous system may occur in portal hypertension, and a portal vein diameter greater than 13 mm is indicative of portal hypertension with a sensitivity of about 50%. Sonographic demonstration of lack of caliber variation of the portal system has a sensitivity of about 80%. The presence of venous collaterals can be demonstrated in about 90% of patients suitable for sonography. The coronary gastroesophageal varices can be seen in 90% when they are large sized, and in 65% when they are small sized. Other collaterals such as umbilical vein, duodenal varices, and gastrorenal and splenorenal varices can be detected. Sonography is a valuable screening procedure in the evaluation of portal hypertension and provides valuable information regarding the size and morphology of the liver and spleen, caliber and patency of the portal venous system, and the existence and location of the varices
— id: 23449, year: 1983, vol: 78, page: 369, stat: Journal Article,

Renal arteriovenous fistulas and aneurysm: sonographic findings
Subramanyam BR; Lefleur RS; Bosniak MA
1983 Oct;149(1):261-263, Radiology
Two cases of congenital renal arteriovenous fistula and one case of intrarenal arterial aneurysm that were prospectively evaluated by real-time sonography are presented. The cirsoid type arteriovenous fistula had a characteristic sonographic appearance and was seen as a cluster of tubular anechoic structures within the kidney; it was supplied by an enlarged renal artery and drained by a dilated renal vein. Both the fistula (aneurysmal type) and the renal artery aneurysm were associated with a peripheral thrombus in the wall of the aneurysm and a central tubular anechoic lumen. The arterial aneurysm was also associated with visible pulsations on real-time sonograms. When present, the sonographic features as seen in these cases should facilitate a correct diagnosis, or at least suggest a renal lesion of vascular origin to be confirmed by renal angiography
— id: 23448, year: 1983, vol: 149, page: 261, stat: Journal Article,

Sonography of pyonephrosis: a prospective study
Subramanyam BR; Raghavendra BN; Bosniak MA; Lefleur RS; Rosen RJ; Horii SC
1983 May;140(5):991-993, American journal of roentgenology
Sonograms of 73 patients with 92 hydronephrotic kidneys were prospectively reviewed in an attempt to differentiate hydronephrosis from pyonephrosis. Sonographic diagnosis of pyonephrosis was based on the presence of persistent internal echoes, dispersed or dependent, within the dilated pelvocaliceal system. In group 1, consisting of 38 patients without clinical evidence of renal infection, sonography revealed the collecting system distended by urine to be anechoic, for a specificity of 100%. In group 2, consisting of 34 patients with clinical suspicion of renal infection, sonography showed internal echoes within the fluid-filled collecting system in 10 cases; nine of these had pyonephrosis (sensitivity of 90%), and one had hemorrhagic debris without infection (false-positive rate 3%). In the other 24 patients, sonography correctly predicted the absence of infection in all but one case (specificity 97%, false-negative rate 10%). It is concluded that in patients with clinical suspicion of renal infection, sonography has a high degree of accuracy (96%) in the differentiation of pyonephrosis from hydronephrosis
— id: 23450, year: 1983, vol: 140, page: 991, stat: Journal Article,

Computed tomography of ureteral obstruction
Bosniak MA; Megibow AJ; Ambos MA; Mitnick JS; Lefleur RS; Gordon R
1982 Jun;138(6):1107-1113, American journal of roentgenology
Although hydronephrosis can usually be diagnosed by urography and/or pyelography, the etiology of the obstruction may not be apparent. Computed tomography (CT) is usually helpful in evaluation of these cases. In 36 cases in which CT was performed solely to determine the cause of ureteral obstruction of uncertain etiology, it proved to be of value in 33 instances (91.7%). The disease processes encountered in this series included metastatic carcinoma to the ureter or periureteral tissues(22), lymphoma (one), primary ureteral tumor (two), radiolucent ureteral stone (four), adjacent ileocolitis (two), aortic or iliac artery aneurysm (two), fibrous band(one), urinoma (one), and radiation fibrosis (one). In three cases (8.3%) an etiologic diagnosis could not be made by CT. These patients had radiation therapy to treat malignant disease, and recurrent tumor responsible for ureteral obstruction could not be distinguished from radiation fibrosis
— id: 23451, year: 1982, vol: 138, page: 1107, stat: Journal Article,

Adrenal adenoma associated with renal cell carcinoma
Ambos MA; Bosniak MA; Lefleur RS; Mitty HA
1981 Jan;136(1):81-84, American journal of roentgenology
Four cases of nonfunctioning adrenal adenomas associated with renal cell carcinoma are reported. The adenomas were found incidentally during angiographic examination of the renal carcinoma, and originally were thought to be metastases to the adrenal gland. Reports in the pathologic literature indicate an increased incidence of adrenal adenomas in patients with renal cell carcinoma. Adrenal adenomas occur in 12%-15% of patients with renal cell carcinoma as compared to 2%-3% of the general population. Since a vascular metastasis to the adrenal gland and an adrenal adenoma may appear identical angiographically, awareness of this association is important to avoid overdiagnosis of metastatic disease
— id: 23453, year: 1981, vol: 136, page: 81, stat: Journal Article,

ANALYSIS OF 56 PARENCHYMA NEOPLASMS OF THE RENAL PARENCHYMA STUDIED BY CT AND ANGIOGRAPHY
BOSNIAK, MA; AMBOS, MA; MEGIBOW, AJ; LEFLEUR, RS
1981 JAN 20 ;137(1):199-199, American journal of roentgenology
— id: 98636, year: 1981, vol: 137, page: 199, stat: Journal Article,

The role of Chiba-needle cholangiography in the diagnosis of possible acute pancreatitis with cholelithiasis
Coppa, G F; LeFleur, R; Ranson, J H
1981 Apr;193(4):393-398, Annals of surgery
In patients with suspected severe acute pancreatitis and known or suspected cholelithiasis, it may be extremely difficult to exclude the diagnosis of gangrenous cholecystitis or obstructive cholangitis by nonoperative means. Since early intra-abdominal surgery has, in our experience, led to markedly increased morbidity in patients with gallstone pancreatitis, non-operative visualization of the biliary tree by percutaneous transhepatic Chiba-needle cholangiography (PTCNC) has been evaluated in 14 patients with suspected acute pancreatitis in whom life-threatening acute biliary disease could not be excluded by other nonoperative means. The final diagnosis was acute pancreatitis in nine patients (Group A) (mean serum amylase 3242 SU%) and acute biliary disease with hyperamylasemia in five patients (Group B) (mean serum amylase 2084 SU%). PTCNC made visualization of the biliary system possible in all patients and excluded the diagnosis of cystic duct or common duct obstruction in each case. Following PTCNC, potentially hazardous early laparotomy was avoided in eight of nine Group A patients. Biliary surgery was undertaken on day 3 to 13 in four Group B patients. When early laparotomy may be needed to evaluate or treat possible life-threatening acute biliary disease but is considered undesirable because of possible acute pancreatitis. PTCNC appears to be a safe and effective nonoperative method of obtaining precise anatomical delineation of the biliary tree
— id: 92885, year: 1981, vol: 193, page: 393, stat: Journal Article,

Sonography of the inverted right hemidiaphragm
Subramanyam BR; Raghavendra BN; Lefleur RS
1981 May;136(5):1004-1006, American journal of roentgenology
— id: 23452, year: 1981, vol: 136, page: 1004, stat: Journal Article,

Renal emphysema secondary to traumatic renal infarction
Subramanyam BR; Lefleur RS; Van Natta FC
1980 ;2(1):53-54, Urologic radiology
Renal emphysema is most often due to emphysematous pyelonephritis in diabetics. The emphysema is the result of infection by gas-forming organisms. Intrarenal gas can also be seen under noninfective conditions. The report is a case of renal emphysema following traumatic renal infarction
— id: 23454, year: 1980, vol: 2, page: 53, stat: Journal Article,

Blood flow to the kidney via the gonadal-renal capsular artery
Ambos MA; Bosniak MA; Lefleur RS
1979 ;1(1):11-16, Urologic radiology
The gonadal artery is an important collateral pathway of blood flow to the kidney. Collateral routes may be from the gonadal artery to the inferior capsular artery (gonadal-renal capsular artery) or to the periureteric arteries. These pathways develop in cases of renal artery stenosis, or when a vascular renal tumor increases the kidneys need for blood. We present five cases in which the gonadal artery served as a source of blood supply to the kidney
— id: 23458, year: 1979, vol: 1, page: 11, stat: Journal Article,

Unsuspected aortic dissection: the chronic "healed" dissection
Ambos MA; Rothberg M; Lefleur RS; Weiner S; McCauley DI
1979 Feb;132(2):221-225, American journal of roentgenology
Of all aortic dissections, 10% are chronic. Typically they arise distal to the left subclavian artery and have reentry points into the true lumen. Pain may be minimal or absent and patients often present with cardiac failure. Chronic dissections are more likely to appear radiographically as atherosclerotic aneurysms on a chest film than are acute dissections. Four cases of chronic dissections found incidentally during angiography are presented
— id: 23456, year: 1979, vol: 132, page: 221, stat: Journal Article,

ANGIOGRAPHIC PATTERNS IN RENAL ONCOCYTOMAS
Ambos, MA; Bosniak, MA; Valensi, QJ; Madayag, MA; Lefleur, RS
1979 ;132(6):1031-1031, American journal of roentgenology
— id: 30105, year: 1979, vol: 132, page: 1031, stat: Journal Article,

An unusual vascular impression on the renal pelvis
Lefleur RS; Ambos MA; Rothberg M
1979 ;1(2):117-118, Urologic radiology
In a female patient who presented with the complaint of dysuria, angiography was required to distinguish a vascular impression on the renal pelvis from a possible tumor or calculus. Neither intravenous urography nor retrograde pyelogram clarified the smooth filling defect sufficiently to rule out the possibility of a urothelial tumor
— id: 23457, year: 1979, vol: 1, page: 117, stat: Journal Article,

Involvement of the inferior vena cava in patients with renal cell carcinoma
Madayag MA; Ambos MA; Lefleur RS; Bosniak MA
1979 Nov;133(2):321-326, Radiology
Inferior vena cavography plays an important role in the staging of renal cell carcinoma. The renal angiograms and inferior vena cavograms in a series of patients with renal cell carcinoma were reviewed to determine which patients require cavography. Our findings show that renal angiography is of great value in suggesting tumor involvement of the renal vein or vena cava, and that the decision to do cavography can be made from the angiographic findings. In the series of 172 patients with renal carcinoma, 15 or 9% had inferior vena cava involvement
— id: 23455, year: 1979, vol: 133, page: 321, stat: Journal Article,

Traumatic injuries of the portal vein. The role of acute ligation
Pachter HL; Drager S; Godfrey N; LeFleur R
1979 Apr;189(4):383-385, Annals of surgery
Injuries to the portal vein are rare but have a high risk with a mortality of 50--70% secondary to exsanguinating hemorrhage. When managing injuries to the portal vein, lateral venorrhaphy, end to end anastomosis, or an interposition graft should be attempted whenever possible. However, in a hemodynamically unstable patient or when confronted with a nonreconstructable injury, acute portal vein ligation may be the procedure of choice as it is safely tolerated in some 80% of patients. Of eleven reported patients in whom the portal vein was ligated acutely for traumatic injury, six survived. Four of the nonsurvivors died of massive associated injuries. Of the six surviving patients, five tolerated acute ligation of the portal vein without complication. Should portal vein ligation be performed a 'second look' operation is essential in 24 hours to examine the bowel for viability. A portosystemic shunt with its inherent complications should not be done as a primary procedure when attempts at reconstruction of the portal vein have failed. Shunting should be reserved for those few patients who develop stigmata of portal hypertension or impending infarction of the bowel
— id: 60004, year: 1979, vol: 189, page: 383, stat: Journal Article,

Angiographic patterns in renal oncocytomas
Ambos MA; Bosniak MA; Valensi QJ; Madayag MA; Lefleur RS
1978 Dec;129(3):615-622, Radiology
Renal oncocytomas are benign tumors arising from proximal tubular epithelial cells. They appear radiographically as solid masses which are vascular on angiography. Angiograms of 13 cases of renal oncocytomas were reviewed, as well as those of 155 renal-cell carcinomas. The classic angiographic findings for the oncocytoma include a spoke-wheel pattern, a homogeneous nephrogram, and a sharp, smooth rim. The finding of a homogenous blush and/or a spoke-wheel pattern greatly increases the possibility of an oncocytoma, though a renal-cell carcinoma may have any or all of the classical findings described for an oncocytoma
— id: 23459, year: 1978, vol: 129, page: 615, stat: Journal Article,

Angiographic demonstration of gas and thrombus in the portal vein
Lefleur RS; Ambos MA; Rothberg M; Benjamin J
1978 Jun;130(6):1171-1173, American journal of roentgenology
— id: 23460, year: 1978, vol: 130, page: 1171, stat: Journal Article,

The pear-shaped bladder
Ambos MA; Bosniak MA; Lefleur RS; Madayag MA
1977 Jan;122(1):85-88, Radiology
The tear-drop or pear-shaped bladder was originally described in cases of pelvic hematoma. It may also be seen, however, with a variety of other entities, including pelvic lipomatosis, inferior vena cava occlusion, lymphocysts, and enlarged pelvic lymph nodes. Pertinent radiographic findings of these conditions are reviewed
— id: 23464, year: 1977, vol: 122, page: 85, stat: Journal Article,

Infiltrating neoplasms of the kidney
Ambos MA; Bosniak MA; Madayag MA; Lefleur RS
1977 Nov;129(5):859-864, American journal of roentgenology
Some neoplastic processes which involve the kidney develop not as a distinct localized mass, but rather as an infiltrating process which replaces the renal parenchyma, causes little or no mass effect, and contains little if any neovascularity. These neoplasms include (1) carcinoma of the renal pelvis when it invades the parenchyma (transitional cell and squamous cell); (2) blood-borne metastatic squamous cell carcinoma to the kidney (most frequently from the lung): (3) renal lymphoma of the infiltrating variety; and (4) infiltrating sarcomatous type of hypernephroma. While the urographic and angiographic appearance of these infiltrating lesions can be similar, clinical aspects are usually sufficient to differentiate them. Radiographic findings include amputation of portions of the collecting system on urography and encasement of vessels with a loss of nephrogram on angiography
— id: 23462, year: 1977, vol: 129, page: 859, stat: Journal Article,

Epinephrine-enhanced renal angiography in renal mass lesions: is it worth performing?
Bosniak MA; Ambos MA; Madayag MA; Lefleur RS; Casarella WJ
1977 Oct;129(4):647-652, American journal of roentgenology
In our experience, properly performed epinephrine-enhanced angiography is a useful technique to improve accuracy in the angiographic diagnosis of renal masses. This pharmacologic enhancement is helpful in establishing the benignity of some lesions, clearly establishing malignancy in those questionable by routine angiography, and actually detecting malignant lesions not seen at all on unenhanced angiograms. Six examples of these situations are illustrated. The basic principles and pitfalls in the performance of the technique as well as its limitations are discussed
— id: 23463, year: 1977, vol: 129, page: 647, stat: Journal Article,

EPINEPHRINE ENHANCED RENAL ANGIOGRAPHY IN RENAL MASS LESIONS - IS IT WORTH PERFORMING
BOSNIAK, MA; MADAYAG, MA; AMBOS, MA; LEFLEUR, RS; CASARELLA, WJ
1977 ;128(3):523-523, American journal of roentgenology
— id: 39993, year: 1977, vol: 128, page: 523, stat: Journal Article,

Spontaneous mediastinal hemorrhage associated with renovascular hypertension
Culliford AT; Ginsberg GD; Lefleur RS; Acinapura AJ
1977 Dec;112(12):1500-1501, Archives of Surgery (Chicago)
We report on a patient with severe renovascular hypertension associated with massive spontaneous mediastinal hemorrhage. Differentiation of this entity from aortic dissection, as well as establishing the cause of the severe hypertension, was possible only through the aid of angiography. Following exploratory thoracotomy, renal artery revascularization was carried out, with resolution of the hypertension. To our knowledge, this complication of renovascular hypertension has not been reported. Prompt recognition and appropriate therapy were possible only after angiographic evaluation
— id: 23461, year: 1977, vol: 112, page: 1500, stat: Journal Article,

Diagnosis if dissecting aortic aneurysm by left atrial angiography
Kronzon I; Deutsch PG; Lefleur R; Glassman E
1975 Jul;124(3):458-460, American journal of roentgenology
— id: 21653, year: 1975, vol: 124, page: 458, stat: Journal Article,

Radiology of hepatic abscess
Madayag MA; Lefleur RS; Braunstein P; Beranbaum E; Bosniak M
1975 Aug;75(9):1417-1423, New York state journal of medicine
— id: 23466, year: 1975, vol: 75, page: 1417, stat: Journal Article,

The osseous and angiographic features of vertebral chordomas
Pinto RS; Lin JP; Firooznia H; Lefleur RS
1975 Sep 15;9(5):231-241, Neuroradiology
Eight cases of vertebral chordoma, exclusive of the sacrococcygeus, are presented. The conventional radiographic signs in descending order of importance in differential diagnosis are: destruction of multiple adjacent vertebral bodies; a paravertebral or precervical soft tissue mass; osteosclerosis, seen mainly at the periphery of the destructive lesion; and involvement of the intervening intervertebral disc space. All eight patients had a demonstrable intraspinal extension of chordoma on myelography. Four patients had complete blocks, two epidural in configuration, and two intradural in appearance - indicative of dural invasion by the neoplasm. Four patients had angiographic evaluation. Two demonstrated angiographic features usually associated with soft tissue malignant tumors. Angiography in all four cases was helpful in determining the full extent of the lesion, more so than either conventional radiography or myelography
— id: 23465, year: 1975, vol: 9, page: 231, stat: Journal Article,

Angiographic demonstration of bleeding site following late rare complication of aorto-coronary by-pass
Abrams, R M; LeFleur, R; Madayag, M; Rothberg, M
1972 Nov;45(539):862-863, British journal of radiology
— id: 131180, year: 1972, vol: 45, page: 862, stat: Journal Article,