Heavy cigarette smoking and alcohol consumption are the major contributing factors in the development of cancer of the upper aerodigestive tract. Other factors, such as chewing substances and chronic irritation, have been implicated. The purpose of this presentation is to draw attention to chronic inflammation as another likely etiologic factor in the pathogenesis of oral cavity cancer. During the past 4 years, we diagnosed squamous cell carcinoma of the oral cavity in six consecutive patients who had no history of cigarette smoking, alcohol intake, or substance abuse. Although this series is too small for significant analysis, it does suggest that chronic inflammatory processes such as lichen planus and chronic gingivitis can induce neoplastic metaplasia in the epithelium of the oral cavity.

Aged↗

PubMedDate not supplied

Diagnostic performance of CT, MPR and 3DCT imaging in maxillofacial trauma.

CT imaging of complex maxillofacial fractures is common practice now, but the relative diagnostic value of spiral computed tomography (CT), multiplanar reformations (MPR), and three-dimensional (3D) reconstructions in evaluating maxillofacial fractures is not established with independent validation of correct diagnosis. We studied these modalities and measured their diagnostic value in a carefully controlled observer based rated response experiment. Multiple fractures were created by blunt experimental trauma in nine adult cadaver heads (five males, four females). Spiral CT scans were performed on all specimens before (control) and after trauma. Axial slices (CT), sagittal and coronal multiplanar reconstructions (MPR), and 3D volumetric reconstructions views were generated. Truth was determined by defleshing the specimens and direct inspection of the traumatized skull. Three expert readers separately interpreted CT, MPR and 3D film hard copy images presented in random order blinded to patient identification or experimental conditions. We measured the time to diagnose each case as recorded by a monitor who was present while evaluations were performed. Twenty-eight facial regions were evaluated using rated response and free response illustrative formats. Each region was considered separately. Sensitivity and specificity were calculated to measure observer performance. We found that 3D and CT had a similar performance in fracture detection and both were markedly better than MPR. For free response illustrative data, CT correctly identified 10% more orbital fractures than 3D, and approximately 10% fewer zygomatic fractures. Fracture localization was best with 3D. Reader confidence was highest with CT, but assessment time was faster with 3D. We conclude that CT and 3D are comparable in detecting midfacial fractures and both are superior to MPR. 3D reconstructions are superior for localization of complex fractures involving multiple planes.

Aged↗

PubMedDate not supplied

Spiral CT in the evaluation of flank pain: overall accuracy and feature analysis.

PURPOSE: Our goal was to assess test reliability and identify those features that have the strongest positive and negative predictive values in the diagnosis of renal colic using spiral CT. METHOD: Fifty non-contrast-enhanced CT scans (5 mm slice thickness) obtained in patients presenting with flank pain were reviewed by three radiologists blinded to the final diagnoses. The sensitivity, specificity, and positive and negative predictive values for nine pertinent findings were determined as compared to clinical follow-up. RESULTS: Twenty-nine cases had findings of ureteral obstruction. Findings with the strongest positive predictive values (> 0.90) were ureteral stone, hydronephrosis, hydroureter, periureteral stranding, and ureterovesical junction edema. Findings with the strongest negative predictive values (> 0.89) were absence of hydronephrosis and hydroureter. The areas under the receiver operating curves for Readers 1, 2, and 3 were 0.970 +/- 0.030, 0.942 +/- 0.036, and 0.982 +/- 0.020. CONCLUSION: Absence of hydroureter and hydronephrosis on spiral CT images should prompt a search for a diagnosis other than an obstructing ureteral stone.

Adult↗

PubMedDate not supplied

Reengineering the documentation process.

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Documentation↗