Biomedical subjects
Publications and source records attributed to M M Figley.
Metastatic pulmonary calcification occurs in a chronic form in patients with malignancy, chronic renal failure, and primary hyperparathyroidism. A rapidly progressive form is associated with renal transplant failure. This case report describes chronic progressive pulmonary calcification after successful transplant with no obvious underlying cause.
The highlights are reported from the fourth international symposium on the impact of new imaging technology on health care, research, and teaching held in San Francisco, October 23-25, 1986. Ninety representatives of academic radiology and industry from 23 nations discussed modern radiology from differing perspectives dependent on the political structure of their governments and the economic status of their peoples. Keynote addresses by leading health-care administrators from government, universities, industry, and hospitals provided insightful overviews of current health service, teaching, and research issues in the United States. Three recommendations were derived from the symposium: (1) more complete and objective documentation of the impact of new technologies on the cost and outcomes of health services is urgently needed, (2) technical specifications for imaging instruments need better definition in terms of the medical problems to which they are applied, and (3) radiologists and radiologic societies in industrialized countries should support more generously the local training in radiology in underdeveloped countries.
Publications in radiology have become vastly proliferated and highly differentiated compared with the past. They have developed in response to several factors: accelerating scientific progress, clinical subspecialization, industrialization of practice, and growth of academic and clinical practitioners. New peer-reviewed journals, controlled periodicals heavily subsidized by advertising, newspapers, and newsletters of various forms have arisen. The command the traditional journals, Radiology and the American Journal of Roentgenology, once had upon reader attention has been challenged. But with rigorous editing, broad content, and pleasing format, these have grown with the competition to retain their positions. Electronic publishing is another challenge they face and which they have begun to incorporate in their production. At this point, it appears the printed page will survive and that the traditional journals will continue to serve our specialty along with newcomers for which there are more specialized roles.
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In 32 patients, 58 angiographically proven pulmonary infarcts were followed for 3 months or longer by serial chest radiography. Complete clearing was seen in 29 (50%) of the infarcts on chest radiography. In the other 29 infarcts that left residual findings, linear scars were identified in 14, pleural diaphragmatic adhesions in nine, and localized pleural thickening in six; in all cases the features were diminutive when compared with the original abnormality. Follow-up perfusion lung images at similar time intervals to the chest films were available for 44 infarcts. Seven of these showed complete resolution and the other 37 showed a residual but much smaller perfusion defect. None of the patients had known preexisting pulmonary disease. The frequency of permanent radiographic scarring seemed to be the same at all ages.
In 76 adult males quantitative angiographic measurements of left ventricular size were compared to 12 plain chest film measurements of heart size and shape. Of the 18 normal cases, only Rigler's B measurement correlated with left ventricular volume (r = .64). However, this correlation was not statistically significant. Of the 58 patients with isolated aortic valve disease, 19 had increased left ventricular mass (hypertrophy) and 39 had both increased left ventricular end-diastolic volume and mass (hypertrophy and dilatation). In the hypertrophy group, plain film heart volume was the most sensitive detector of an enlarged left ventricle (21% false negative rate) and correlated with left ventricular end-diastolic volume (r = .62). Using stepwise discriminant analysis, the combination of heart volume, leftness of the heart, apex position, and roundness of the left ventricle decreased the false negative rate to 5%. In the hypertrophy and dilatation group, plain film heart volume had the highest correlation with left ventricular volume and mass (r = .66) and a false negative rate of 8%. No single variable or combination of variables could usefully discriminate between the hypertrophy and hypertrophy and dilatation groups. These data support the conclusion that plain film heart volume is the best single measurement for detecting left ventricular enlargement.
Ten radiologists at three levels of training visually assessed total heart and individual chamber size in 95 adults of both sexes with well defined cardiac diagnoses. Overall accuracy was highest for total heart size (82.2% correct), followed by left ventricular size, left atrial size and right heart size 79.6%, 75.0%, and 72.8%, respectively. Right heart and left atrial enlargement had a statistically significant negative effect on visual assessment of other chambers (P less than .05). Attempts to subclassify left ventricular enlargement into hypertrophy and hypertrophy and dilatation groups proved unsuccessful. While 63% of the hypertrophy group was detected as abnormal, only 24.3% were correctly subclassified as hypertrophy. For the hypertrophy and dilatation group, the corresponding values were 82% and 70%, respectively. Oblique views were useful in assessing left ventricular size only when inexperienced observers were included in the group of evaluators (P less than .05). A statistically significant improvement in assessment of normal left ventricular size and overall left atrial size was noted with experience (P less than .01 and P less than .05, respectively).
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