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Biomedical subjects

C E Ravin

Publications and source records attributed to C E Ravin.

At least 109 records · Page 6Linked to original sources

Calcification in pulmonary metastases.

A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.

Adult↗

Thymoma detection by mediastinal CT: patient with myasthenia gravis.

The precise role of computed tomography (CT) in evaluating the mediastinum for thymomas in patients with myasthenia gravis is not defined. The only published CT accuracy assessment reports a false-positive rate of 90%. Mediastinal CT was performed in 23 consecutive unselected patients with myasthenia gravis who underwent thymectomy independent of their neurologic status or diagnostic imaging results. Four patients had discrete thymomas; all were detected by CT. Conventional chest radiography and tomography were positive in three and falsely negative in one. In the remaining 19 patients with a normal or atrophic thymus or microscopic hyperplasia, CT was falsely positive in two; conventional chest radiography and tomography were falsely positive in three. Mediastinal CT is an accurate technique for evaluation of thymoma in patients with myasthenia gravis.

Adolescent↗

Use of pulmonary angiography for suspected pulmonary embolism: influence of scintigraphic diagnosis.

The use of pulmonary angiography as related to ventilation-perfusion scintigraphy was studied at two teaching hospitals in 600 patients clinically suspected of having pulmonary embolism, using a combined prospective-retrospective approach. Sixty patients underwent angiography, 30 in each institution. A minority of patients in each scintigraphic diagnostic category underwent angiography, but the scintigraphic diagnosis had a major impact on the frequency of requests for angiography. Inconclusive scintigraphy was the principal reason for requesting angiography, although nearly half of patients in whom scintigraphic assessment was indecisive were managed without further diagnostic measures. Few patients in the low-probability and high-probability scintigraphic categories received angiography. This study also indicates that a substantial patient selection bias may exist in series that correlate scintigraphic and angiographic results.

Adult↗

Massive calcification of the mitral annulus in a 17-year-old patient with juvenile rheumatoid arthritis and systemic lupus erythematosis.

Mitral annulus calcification (MAC), while a relatively frequent autopsy finding in older patients, is rare in childhood. Such calcification has generally been regarded as a degenerative change and of no clinical significance. Recent studies have shown that MAC may be associated with hemodynamically significant lesions including mitral insufficiency, arrhythmias, heart block, and, rarely, mitral stenosis. We have studied a case of massive calcification in the mitral annulus in a 17-year-old girl with juvenile rheumatoid arthritis and systemic lupus erythematosis. In this case, the MAC was considered secondary to the rheumatoid disease. MAC in younger patients with no history of rheumatic fever or bacterial endocarditis suggests an associated connective tissue disorder.

Adolescent↗

Effect of vertical cassette holder design and construction on scatter-to-primary radiation ratios.

This paper analyzes the contribution to scattered radiation at the film plane by individual components of a conventional wall-mounted cassette holder. With grid technique, scatter from the front panel of the cassette holder is effectively reduced, but considerable scatter reaches the film plane from the automatic exposure control pickup interposed between the grid and the film cassette. With air-gap technique (grid removed), the front panel of the cassette holder and the automatic exposure control pickup contribute equally to increased scattered radiation at the film plane. The contribution to the total scatter from the air-gap positioning plate is less significant.

Humans↗

Coronary sinus atrial pacing: radiographic considerations.

Transvenous atrial pacing via an electrode placed in the coronary sinus has become an increasingly frequent procedure during the past 10 years for both diagnosis and therapy of cardiac arrhythmias. The coronary sinus has five major venous tributaries, any one of which can be entered by a pacing catheter. A catheter in the middle cardiac vein can mimic the usual ventricular pacemaker position, while an electrode in the coronary sinus or in a persistent left superior vena cava may be mistaken for myocardial perforation. A persistent left superior vena cava may also be catheterized. This anomaly is associated with a tenfold increased incidence of congenital atrioventricular conduction abnormalities and, therefore, is surprisingly common in patients having coronary sinus pacers placed because of cardiac arrhythmias.

Adult↗

Metastatic melanoma in the thorax: report of 130 patients.

Early detection of metastatic melanoma has become more important as newer and more effective therapeutic regimens are used. Between 1970 and 1980, 1,600 patients were treated at one institution for malignant melanoma. Of these, 260 (16.3%) developed thoracic metastasis. Satisfactory chest radiographs were available for analysis in 130 of 260 patients. The patterns of the intrathoracic metastasis include multiple pulmonary nodules (52 patients), solitary nodule (26), miliary pattern (two), mediastinal and/or hilar adenopathy (nine), pleural effusion (three), lytic bony lesions (one), extra-pleural mass (one), and combined lesions (36). Both the staging of melanoma and the radiographic pattern of thoracic metastasis seemed to prognosticate the survival rate of these patients. Miliary metastasis and bone destruction implied a grave prognosis. Patients with a solitary lung nodule had the best survival experience. Immunotherapy, chemotherapy, and surgery of selected distal metastases significantly improved the survival of most of these patients.

Adolescent↗

Pulmonary changes after primary irradiationfor early breast carcinoma.

The clinical records and radiographs of 37 patients with carcinoma of the breast (stages I and II) treated with primary radiation therapy without mastectomy were reviewed. In 10 patients, there was a radiographic pattern of increased radiopacity in the lung underlying the treated breast. The margins of the lesion corresponded to those of the tangential radiation ports with a well defined posterior border noted on the lateral chest radiograph. Apical fibrosis (secondary to supraclavicular irradiation) was demonstrated in six other patients. No patient had symptoms referable to the radiation injury. With the increasing use of radiation therapy as initial treatment for early stage carcinoma of the breast, it is important to recognize these radiation changes in the lungs and distinguish them from infection or recurrent tumor.

Breast Neoplasms↗

Detection of metastatic disease from carcinoma of the breast: limited value of full lung tomography.

Until now no large prospective study has been made to evaluate the efficacy of full lung tomography in detection of pulmonary metastases from carcinoma of the breast in the presence of a negative chest radiograph. In the current study, 144 patients with proven breast carcinoma and a negative chest radiograph underwent full lung tomography. Nodules were demonstrated in three patients and, in two of them, presumably reflected metastatic disease. Both patients had advanced extrapulmonary metastatic disease at the time of full lung tomography and in neither case did a change in therapy result. One presumed false-positive observation was also made. Because of the low propensity for carcinoma of the breast to metastasize to the lungs, full chest tomography does not appear warranted as a screening procedure in these patients.

Adult↗