1001 S George St
York PA 17403
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: MD043271E
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Sonic hedgehog signals to multiple prostate stromal stem cells that replenish distinct stromal subtypes during regeneration. - Proceedings of the National Academy of Sciences of the United States of America
The adult mouse prostate has a seemingly endless capacity for regeneration, and sonic hedgehog (SHH) signaling has been implicated in this stem cell-driven process. However, it is not clear whether SHH acts on the epithelium or stromal cells that secrete factors required for epithelial expansion. Because little is known about stromal stem cells compared with their epithelial counterparts, we used in vivo mouse genetics tools to characterize four prostate stromal subtypes and their stem cells. Using knockin reporter alleles, we uncovered that SHH signals from prostate basal epithelial cells to adjacent stromal cells. Furthermore, the SHH target gene Gli1 is preferentially expressed in subepithelial fibroblast-like cells, one of four prostate stromal subtypes and the subtype closest to the epithelial source of SHH. Using Genetic Inducible Fate Mapping to mark adult Gli1- or Smooth muscle actin-expressing cells and follow their fate during regeneration, we uncovered that Gli1-expressing cells exhibit long-term self-renewal capacity during multiple rounds of androgen-mediated regeneration after castration-induced involution, and depleted smooth muscle cells are mainly replenished by preexisting smooth muscle cells. Based on our Genetic Inducible Fate Mapping studies, we propose a model where SHH signals to multiple stromal stem cells, which are largely unipotent in vivo.
Tumor lesion detection: when is integrated positron emission tomography/computed tomography more accurate than side-by-side interpretation of positron emission tomography and computed tomography? - Journal of computer assisted tomography
To determine if there is added value to oncology studies performed with a dedicated in-line positron emission tomography (PET)/computed tomography (CT) scanner as compared with PET read side by side with diagnostic CT (DCT).Forty-one consecutive oncology patients referred for PET/CT who had contemporary DCT scans for review were enrolled. Body regions assessed on a DCT scan were assessed on PET/CT and by side-by-side reading of PET and DCT (SBS PET/DCT). Lesions identified on DCT, the CT portion of PET/CT, SBS PET/DCT, and the reading of fused PET/CT images were scored as benign or malignant. The PET portion of the PET/CT study was read by 2 teams: the first read the SBS PET/DCT scan and the other read the complete fused PET/CT scan. For discordant lesions, the final diagnosis was determined by pathologic findings (n = 6) or imaging follow-up (n = 21).Twenty-seven (16.1%) of the 168 lesions were discordant when comparing analysis of fused PET/CT and SBS PET/DCT. Sixteen (9.5%) were fundamentally discordant, and 11(6.6%) were discordant in degree of confidence. For all discordant lesions only, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for PET/CT were 100%, 33%, 100%, 94%, and 78%, respectively, and for SBS PET/DCT, they were 38%, 50%, 19%, 73%, and 30%, respectively (P < 0.001 for sensitivity, P = not specific for specificity). The 2 main causes for misclassification on SBS PET/DCT were incorrect localization (n = 12) and changes occurring in the time gap between DCT and PET/CT (n = 4).In-line PET/CT offers better lesion localization in comparison to the visual fusion of PET and CT, especially for small lymph nodes, lesions adjacent to mobile organs, or lesions adjacent to the chest or abdominal wall.
Why we miss the diagnosis of appendicitis on abdominal CT: evaluation of imaging features of appendicitis incorrectly diagnosed on CT. - AJR. American journal of roentgenology
Our purpose was to retrospectively evaluate the cases of patients with surgically proven appendicitis that was misdiagnosed on abdominal CT to determine the causes of the missed diagnosis.Increased awareness of the underlying factors common to most cases of the missed diagnosis of appendicitis on CT and increased radiologic vigilance in cases of atypical abdominal pain may enable us to further improve our diagnostic accuracy.
The diagnostic accuracy of 18F-fluorodeoxyglucose PET/CT in patients with gynecological malignancies. - Gynecologic oncology
To evaluate the diagnostic accuracy of integrated positron emission tomography/computerized tomography (PET/CT) in patients with gynecological cancer.Fifty-three consecutive patients with gynecologic malignancies were included. The patients were referred to our tertiary center to undergo a PET/CT scan. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT were compared with the conventional imaging assessments [CT, magnetic resonance imaging (MRI) and ultrasonography (US)].All tested values were higher for PET/CT than those for the conventional modalities: sensitivity 0.97 vs. 0.40, specificity 0.94 vs. 0.65, PPV 0.97 vs. 0.70, and NPV 0.94 vs. 0.34, respectively.PET/CT is a reliable modality for assessing the extent of disease in patients with gynecologic malignancy.
Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. - Radiology
To assess diagnostic accuracy of combined positron emission tomography (PET) and computed tomography (CT) in detection of pelvic recurrence in patients with rectal cancer who underwent abdominoperineal or anterior resection.Sixty-two patients were enrolled; 37 were men, and 25 were women. Seventeen patients underwent abdominoperineal resection and 45 underwent anterior resection with an anastomosis in the pelvic region before referral for PET/CT. Pelvic sites of fluorine 18 ((18)F) fluorodeoxyglucose (FDG) uptake were rated separately on PET and PET/CT images as benign or malignant on the basis of shape, location, and intensity of (18)F FDG uptake (1-2 = benign and/or physiologic, 3 = equivocal, 4-5 = malignant). Two readers interpreted images in consensus. Altered pelvic anatomy and presence of presacral abnormalities were assessed with CT. Pelvic recurrence was confirmed with histologic analysis or clinical and imaging follow-up. Sensitivity, specificity, positive and negative predictive values, and accuracy of PET and PET/CT in the detection of pelvic recurrence were compared with lesion- and patient-based analyses by using the chi(2) test. Clinical relevance of PET/CT assessment was determined.Of 81 pelvic sites with increased (18)F FDG uptake, 44 were malignant. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for differentiating malignant from benign (18)F FDG uptake in the pelvis were 98%, 96%, 90%, 97%, and 93% for PET/CT and 82%, 65%, 73%, 75%, and 74% for PET, respectively. The most common cause for false-positive interpretation of PET findings was physiologic (18)F FDG uptake in displaced pelvic organs. Presacral CT abnormalities were present in 30 (48%) of 62 patients, and seven (23%) abnormalities were malignant. PET/CT was used to distinguish benign and malignant presacral abnormalities with a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 96%, 88%, and 100%, respectively. PET/CT findings were clinically relevant in 29 (47%) of 62 patients.PET/CT is an accurate technique in the detection of pelvic recurrence after surgical removal of rectal cancer.Copyright RSNA, 2004
[Left paraduodenal hernia: a report of a case and a review of clinical and diagnostic CT findings]. - Harefuah
Internal hernias are an uncommon cause of small bowel obstruction. Paraduodenal hernias have been considered until recently the most common sub-type. Due to non-specific and intermittent signs and symptoms the diagnosis of these hernias is notoriously difficult. We report a case of a paraduodenal hernia diagnosed correctly with abdominal computed tomography that was confirmed at surgery and review the clinical and imaging findings of these hernias.
Map & Directions
1001 S George St York, PA 17403
25 Monument Rd Suite 200
35 Monument Rd Suite 206
1001 S George St York Hospital