Biomedical subjects
Publications and source records attributed to C A Romanowski.
Atlanto-occipital subluxation is a rare but recognized form of subluxation that occurs in rheumatoid arthritis (RA) at the cranio-cervical junction. Magnetic resonance imaging (MRI) clearly demonstrates the bony and soft tissue changes of RA in the cervical spine. We report a single case of atlanto-occipital subluxation in RA demonstrated by MRI.
We present a case of sarcoidosis in a 14-year-old girl who presented with a short history of visual disturbance. Computed tomography and magnetic resonance imaging (MRI) demonstrated enlargement of the optic chiasm and prechiasmic optic nerves. Post-contrast MRI showed marginal enhancement of the affected areas of the optic pathways. A diagnosis of optic nerve glioma and arachnoid gliomatosis was made; surgical confirmation was not sought due to the risk to vision associated with biopsy. A rapid clinical deterioration led to repeat MRI which demonstrated extensive enhancing soft tissue throughout the basal cisterns with extension into the brain. Biopsy confirmed a diagnosis of sarcoidosis.
Children with congenital bone dysplasias may benefit from leg lengthening procedures. Such procedures, by necessity, require frequent and regular imaging. It is necessary to minimize the total radiation dose to these patients, and particularly the dose to the gonads. In the present study the films of 13 patients who had completed leg lengthening procedures were reviewed. The number of films was assessed together with the use of appropriate gonad shielding. In a second part of the study, thermoluminescent dosemeter measurements of radiation doses to a phantom were made for both plain radiographs (with and without gonad protection) and computed tomography (CT) scanograms. The results show that audit plays an important role in assessing radiographic practice with respect to accurate placement of gonad protection and confirm that a significant dose reduction can be accomplished by careful use of this lead shielding. Dose reduction can also be achieved by using alternative radiographic techniques such as CT scanograms. Other techniques such as ultrasound or dual-energy X-ray absorptiometry are briefly discussed. These may play an important additional part in the reduction of total radiation dose to the patients.
The accessory navicular is a commonly occurring accessory ossicle of the foot. In most instances this is an incidental finding. In some patients, the accessory navicular is the direct cause of foot pain. We present 10 such cases. The typical clinical picture is of a young female patient who presents with chronic or acute on chronic medial foot pain centered over the medial side of the navicular. The patient is usually physically active on her feet and localizes the pain accurately. Plain radiography reveals an accessory navicular united to the navicular by a synchondrosis (Type II). The diagnosis can be confirmed by showing increased localized uptake of isotope on a technetium 99m MDP bone scan. In some cases, the accessory navicular is mistaken for a fracture. Awareness of this accessory ossicle causing such symptoms should lead to the correct diagnosis.
The early and long term outcomes of 25 subclavian and axillary angioplasties in a series of 19 patients treated at one centre over a period of 10 years were assessed. The eventual outcome was long lasting improvement in most cases. Two of 25 PTAs were technical failures as defined as > 30% residual stenosis. Twenty-three of 25 PTAs were technical successes: 17 of these were first procedures, one was a repeat after an initial failure, two were repeats for restenosis and three were for separate new lesions. Clinically, 13 of the 19 patients were asymptomatic at long term follow-up. Four had only occasional, mild symptoms (in one of those they were due to shoulder arthropathy). Two patients had technically successful dilatations but developed problems with arterial occlusion distally which in one patient required amputation of that limb.
Explore the source record for details and available documents.
The hypothesis that the six cytoarchitectonically distinct subdivisions of the zona incerta send efferent projections to different parts of the brain was tested using retrograde fluorescent tracing techniques. Injections of tracer in the superior colliculus, pontomesencephalic tegmentum, thalamus or spinal cord resulted in characteristic and distinctive patterns of labelling in the zona incerta, suggesting that the different subdivisions of the zona incerta give rise to different sets of efferent projections. Thus, injections into the deep layers of the superior colliculus resulted in retrogradely labelled neurons predominantly in the zona incerta pars ventralis, whereas injections into the pontomesencephalic tegmentum, avoiding the superior colliculus, labelled neurons mostly in the zona incerta pars dorsalis. Parafascicular thalamic injections resulted in labelled neurons in the zona incerta pars rostropolaris, pars dorsalis, pars caudalis and a few in the pars ventralis. The spinal cord injections labelled predominantly the magnocellular cells of the zona incerta. The results of the double labelling experiment also give support to the conclusion that different areas of the zona incerta give rise to largely individual sets of efferent projections. Combined injections of tracers into the superior colliculus and thalamus resulted in the labelling of two essentially independent cell groups, the tectal projecting cells being found mainly in the zona incerta pars ventralis and the thalamic projecting cells being found in the zona incerta pars rostropolaris, pars dorsalis and pars caudalis. However, a small number of double labelled cells was found. These cells, which presumably send collateral projections to both the tectum and the thalamus, were found mainly in the dorsal part of the zona incerta pars ventralis, immediately next to the pars dorsalis. In the light of these findings it would appear that the zona incerta may be organised into largely distinct subdivisions, each of which has its own set of cytoarchitectonic and efferent projection characteristics.
The skeletal remains of past populations provide an important source of information on the natural history of disease. Relatively few cases of bone tumours have been reported in archaeological material. This paper describes one of the oldest occurrences of osteochondroma to have been identified in a human skeleton.