Biomedical subjects
Publications and source records attributed to J D Swartz.
High resolution computed tomography (CT) has been of extraordinary value in all areas of the head and neck. Previous communications have indicated its effectiveness in the evaluation of the temporal bone and soft tissues of the neck. This current communication illustrates and discusses the anatomy and pathology of the salivary glands and oral cavity as seen on CT.
High-resolution computed tomography with intravenous contrast enhancement is the initial procedure performed on individuals who present with signs and symptoms of a paraganglioma of the head and neck. Clinical information about these entities is reviewed and technical considerations are discussed.
Thirty-five consecutive patients with the clinical diagnosis of fenestral otosclerosis were evaluated with high-resolution computed tomography (CT). Twenty-six were diagnosed as having this disorder by CT evidence of abnormal bony excrescences at or adjacent to the oval window. The diagnosis was made upon examination of 1.5-mm-thick targeted sections obtained at 0.5-mm intervals in the axial projection. Coronal sections were also included. Sections were also evaluated for evidence of plaque formation elsewhere in the lateral wall of the labyrinth and for surgical obstacles such as an abnormally wide cochlear aqueduct, a high jugular vein, and a dehiscent facial nerve. It is concluded that fenestral otosclerosis may be accurately diagnosed with proper CT techniques.
While conventional angiography has been used to demonstrate cerebrovascular occlusive disease in the past, digital subtraction angiography (DSA) is capable of showing progressive vascular involvement with ease, simplicity, and extremely low morbidity, making it particularly well suited for children and outpatients either alone or coordinated with computed tomography. The authors discuss the usefulness and advantages of DSA as demonstrated in 7 infants and children with hemiplegia, 4 of whom had sickle-cell disease.
The development and subsequent course of the facial nerve canal are complex. High resolution computed tomography (HRCT) provides an opportunity for the study of this often perplexing structure. Normal anatomy and normal variations of the facial nerve canal must be considered when examining patients who have facial nerve palsy referrable to the temporal bone. The author recommends direct axial and coronal imaging supplemented by sagittal and possibly oblique reformations.
Cholesteatomas of the middle ear may be either congenital or acquired. Acquired lesions arise from either the pars flaccida or the pars tensa of the tympanic membrane. Etiology, modes of extension, and consequent complications are described.
Two cases of vertical fractures through the anterior arch of C-1 vertebrae are described. One was associated with an additional fracture through the posterior arch on the opposite side in the region of the vertebral artery sulcus, and the other with an additional horizontal fracture through the anterior arch. Both patients were neurologically asymptomatic. Diagnosis was made by computed tomography.
Neurological abnormalities are a major cause of the morbidity associated with renal failure. Substantial elevations in parathormone levels have been found to accompany significant increases in brain content of calcium. Two cases of cerebral subcortical calcifications are demonstrated by computed tomography in patients with severe chronic renal failure. To our knowledge this finding has not been described previously.
Our experience with high-resolution computed tomography has indicated that the accepted norms for appearance and size of the pituitary gland may not be entirely valid for women of childbearing age. Fifty women with normal menstrual histories and who were not taking oral contraceptives were studied. The study consisted of overlapping 1.5-mm sections through the pituitary fossa in the coronal position only, using a bolus of contrast material followed by a continuous drip during the study. The results indicate that the top of the normal range of gland height is well over the accepted 7 mm and that focal defects within the gland are common. Other variables such as gland shape, width, and overall density were also evaluated.
The use of high-resolution computed tomography (CT) to examine the middle ear and mastoid is discussed. Exceptional detail of the viscera of the middle ear was attained in almost all cooperative patients with proper technique. Important anatomical structures are illustrated and discussed, and the appropriate projection for depicting specific structures is emphasized. Normal variations, preoperative knowledge of which is important to the otologic surgeon, are also illustrated.
Of more than 200 patients who underwent high-resolution computed tomography (CT) of the middle ear, the vast majority had tubotympanic disease in one of its forms: middle ear effusion, tympanosclerosis, granulation tissue, tympanic membrane retractions, or acquired cholesteatoma. The CT appearance of each of these conditions is discussed and illustrated. Emphasis is placed on the differential diagnosis of tubotympanic disease by determining dependent from nondependent soft-tissue opacity using two CT projections.
High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear and mastoid is recommended at approximately 3 months following the surgical procedure.
The Holtzman Inkblot Technique (HIT) was administered to 83 male juvenile delinquents, ranging in age from 13 to 16 years (mean age: 15.2 years), who were being detained at the Texas Youth Council Reception Center. Scores from 22 HIT variables scored were factor-analyzed and then compared with Megargee's pioneering normative HIT study of juvenile delinquents published in 1965. Results of the two investigations were strikingly similar, reinforcing Megargee's finding that norms for nondelinquent adolescents are not appropriate for use with a confined delinquent group. Important differences were discovered, however, and these are discussed.
It appears reasonable to suggest a histological diagnosis of ependymoma when CT shows an isodense tumor expanding the fourth ventricle or lying within its outlets; when the tumor contains small, round calcifications; and when presentation occurs early in life. An isodense mass occurring in the cerebral white matter, containing a cyst, exhibiting small, round calcifications, and developing early in life should also suggest the diagnosis. Unfortunately, despite a high accuracy of detection (95%) and the use or modern therapeutic modalities, the outcome remains poor.
The Holtzman Inkblot Technique was administered to all 269 adult males admitted as forensic patients in the state of Texas during a 12-mo. period. Normative data presented suggest that these forensic patients differ from other criterion groups in their responses to this psychometrically rigorous projective technique. Factor analysis of the scores indicated a factorial structure similar to that reported for several of the Holtzman standardization samples but with at least one factor which seems to be unique to these forensic patients.
A previous article by Lockwood, Roll, and Matthews (1981) reported dramatic differences between the Movement scores obtained by 6-year-old children on the Holtzman Inkblot Technique (HIT) and previously reported normative data for this variable. The Lockwood et al. data were rescored by experienced HIT scorers; their findings-and other possible reasons for the high HIT Movement scores reported by Lockwood et al.-are described and discussed. Finally, the practice of using the HIT in the manner of the Rorschach is criticized.
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