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Biomedical subjects

C F Mueller

Publications and source records attributed to C F Mueller.

17 recordsLinked to original sources

Alpha 1-antitrypsin deficiency: evaluation of bronchiectasis with CT.

PURPOSE: To assess bronchiectasis depicted with computed tomography (CT) in patients with alpha 1-antitrypsin deficiency and to examine associated clinical correlates. MATERIALS AND METHODS: CT scans in 14 patients with alpha 1-antitrypsin deficiency were evaluated by two thoracic radiologists for the presence and extent of bronchiectasis and emphysema. The findings were correlated with numeric infection scores on the basis of symptoms of sputum production and respiratory infection and with a history of conditions that may predispose to development of bronchiectasis. RESULTS: Six (43%) of 14 patients had CT evidence of bronchiectasis. Patients with bronchiectasis had significantly higher infection scores than did patients without bronchiectasis (P < .005). Two patients had diffuse cystic bronchiectasis, and neither reported a history of illness that may have predisposed them to this condition. CONCLUSION: Bronchiectasis may be more common in patients with alpha 1-antitrypsin deficiency than has been previously recognized. The diagnosis of alpha 1-antitrypsin deficiency should be considered in patients with emphysema and diffuse cystic bronchiectasis.

Bronchiectasis

Radiographic appearance of Chlamydia pneumoniae (TWAR strain) respiratory infections. CBPIS Study Group. Community-based Pneumonia Incidence Study.

PURPOSE: To report the spectrum of radiographic findings associated with a new respiratory pathogen: Chlamydia pneumoniae (TWAR strain). MATERIALS AND METHODS: Radiographs of 55 adult patients hospitalized with serologic evidence of C pneumoniae were retrospectively reviewed. RESULTS: On the basis of serologic criteria, two types of acute respiratory infection are possible: primary (first exposure) infections and recurrent, acute infection in a previously exposed individual. In the primary group, alveolar opacities (65%) with a unilateral distribution (71%) were most common at admission. Cavitary disease and hilar or mediastinal lymphadenopathy were uncommon. Small to medium-sized pleural effusions were common in both primary and recurrent groups during hospitalization. Also, both groups tended to progress to bilateral, mixed, interstitial and alveolar changes during the course of infection. CONCLUSION: Different radiographic patterns exist for the two types of acute C pneumoniae infection.

Acute Disease

The current status of faculty staffing and resident training in emergency radiology. Results of a survey.

The results of a survey of United States and Canadian radiology residency programs in hospitals maintaining major emergency departments indicate that (1) radiologic faculty assignment to emergency medicine may include "all faculty," "specific faculty," "specific and other faculty," "general," and "musculoskeletal" faculty; (2) a chief of emergency radiology section is designated in less than 35% of radiology departments providing emergency room services; (3) radiology resident rotation in emergency radiology occurs in less than 2/3 of the surveyed programs; and (4) radiology resident experience in emergency radiology ranges from two to 16 weeks in 40% of these programs, the remainder being "unspecified." The effect of this circumstance upon the emergency department patient care and resident teaching in emergency radiology is discussed and remedial suggestions presented.

Canada

Magnetic resonance imaging detection of early experimental periostitis. Comparison of magnetic resonance imaging, computed tomography, and plain radiography with histopathologic correlation.

This study characterizes the appearance of periosteal reaction by magnetic resonance imaging (MRI), and evaluates the efficacy of MRI versus computed tomography (CT), and plain film radiography (PF) in detecting early, experimentally induced periostitis. Acute Staphylococcus aureus osteomyelitis was induced in 30 legs of 20 New Zealand white rabbits. The rabbits were then imaged with MR, contrast-unenhanced CT, and PF 4 days after infection. Histologically, periosteal elevation was present in 27 cases. Periosteal ossification was seen in 23 cases, and cellular reaction without ossification in 4 cases. Periosteal reaction was demonstrated by PF in 21 (78%) and by CT in 20 (74%) cases. Evidence of periostitis was seen by MR in all 27% (100%) cases. MR resulted in two false-positive diagnoses. Multiple concentric, alternating high and low signal arcs demonstrated by MR in 19 (70%) cases represented periosteal ossification surrounded by fibrous or granulation tissue. These findings demonstrate the ability of MR to detect periostitis despite the absence of periosteal ossification. MR was more sensitive than CT (P less than .05) or PF (P less than .05) in the detection of experimentally induced periostitis.

Acute Disease

Acute experimental osteomyelitis and abscesses: detection with MR imaging versus CT.

Acute experimental osteomyelitis and abscesses were induced in the proximal tibia and surrounding soft tissues, respectively, in 67 New Zealand white rabbits. Fifty-three rabbits were injected with a Staphylococcus aureus solution and 26, with sterile saline in tibial medullae and/or surrounding soft tissues. Contrast material-enhanced computed tomography (CT) and magnetic resonance (MR) imaging were performed 7 days after inoculation. Immediately after imaging, the animals were killed and necropsy was performed. MR imaging was more sensitive than CT in the detection of osteomyelitis (94% vs 66%, P less than .025) and abscesses (97% vs 52%, P less than .001). MR imaging was equally specific as CT in the exclusion of osteomyelitis (93% vs 97%, chi 2 = 0) but less specific than CT in the exclusion of abscesses (77% vs 100%, P less than .025). The overall accuracy of MR imaging was somewhat, although not significantly, greater than that of CT in the detection of both osteomyelitis (93% vs 80%) and abscesses (87% vs 75%).

Abscess

Portable chest roentgenography and computed tomography in critically ill patients.

Computed tomography (CT) of the chest offers improved resolution and sensitivity for evaluating chest pathologic conditions compared with other imaging techniques. Intensive care unit patients with portable chest findings that diverge from the clinical course may actually have severe intrathoracic disease that can be detected with CT. Our three patients demonstrate chest CT can aid in the diagnosis of significant intrathoracic pathologic conditions which have been significantly underestimated by portable chest roentgenography. We discuss the reasons for this improved detectability by CT, as well as suggest alternative techniques that can be performed at the bedside in patients whose initial portable chest roentgenogram and clinical course do not correlate.

Adult

Aneurysmal bone cysts: MR imaging at 1.5 T.

Two patients with aneurysmal bone cysts of the pelvis were imaged using a 1.5-T magnetic resonance imaging device. Findings included multiple internal septations, cysts with fluid-fluid levels of varying intensity, and an intact rim of low-intensity signal completely surrounding the lesion. These findings allow a specific diagnosis of aneurysmal bone cyst to be made.

Adolescent

Asymptomatic esophageal perforation by a coin in a child.

Ingestion of coins by children is a common event that rarely causes serious complications. We present a case of asymptomatic esophageal perforation by a penny in a child who presented with wheezing six months after the ingestion. When esophagography and triple endoscopy failed to show the perforation, thoracotomy resulted in successful removal of the foreign body, which was encased in granulation tissue between the trachea and esophagus. Complications of foreign body ingestion are discussed.

Child, Preschool

Abnormal course of nasogastric tube in traumatic rupture of left hemidiaphragm.

In a review of 17 surgically proven cases of acute traumatic diaphragmatic hernia, a nasogastric tube had been inserted preoperatively in eight. In six of these patients the tube followed a characteristic course, indicating the diagnosis of gastric herniation into the left hemithorax. In four cases the passage of the tubing established the diagnosis; in the other two cases the diagnosis was suggested by plain films alone, but subsequent passage of the nasogastric tube provided confirmation.

Adult

Wandering spleen--the radiological and clinical spectrum.

Eight cases of wandering spleen demonstrate that this rare entity has a characteristic constellation of findings which, though nonspecific, are highly suggestive of the diagnosis. Angiography or isotopic imaging specific for the spleen confirms the diagnosis. Asymptomatic patients may be carefully observed, with the institution of splenectomy should signs of torsion develop.

Adult