Biomedical subjects
Publications and source records attributed to R A Bloom.
A fungating cutaneous tumor arising at the site of exit of a T-tube is described. The tube had been inserted to bypass an adenocarcinoma of the common bile duct. The tumor arose 30 months after operation and is the first such case recorded. Multiple percutaneous changes of the T-tube may be the causative factors.
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Increase in the soft-tissue thickness of the wrist is said to be a sensitive indicator of early oedema due to generalised or local arthritic disease. No normal values are available. Measurement of the soft-tissue thickness opposite the radial and ulnar styloid processes in a random population demonstrated a large normal range which was not related to obesity. This large normal variation calls into question the accuracy of radiological evaluation of early wrist oedema.
Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30, with back pain usually caused by disk degeneration; thus routine oblique views could be safely omitted in older patients.
During the past two years, floating stones within the gallbladder have been demonstrated in five patients, by both oral cholecystography and sonography. We suggest coupling administration of an oral cholecystographic contrast agent with ultrasound examination in cases of equivocal sonographic findings. The combined study--oral cholecystosonography--can facilitate the demonstration of small cholesterol stones by inducing the phenomenon of layering.
The prevalence of ankylosing hyperostosis in a Jewish hospital population is presented. In individuals over the age of 40 years the overall prevalence was 22.4% in males and 13.4% in females. The prevalence increased with age to a maximum of 46% in males and 30% in females over the age of 80 years. A method of grading the disease according to extent is described. The most extensive grade III is seen almost exclusively in males.
Sigmoid-appendiceal fistulae are unusual. A case in which such a fistula occurred secondary to diverticulitis is reported.
A case of bilateral symmetrical periosteal reactions of the lateral halves of the clavicles in a child with subacute sclerosing panencephalitis is presented. The appearances correspond with no previously recorded condition. The differential diagnosis most likely lies between aborted Salmonella osteomyelitis or a form fruste of subacute symmetrical osteomyelitis.
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Basal ganglion calcification is common in hypoparathyroid states. However, cerebral cortical calcification is rarely seen. Of the six cases previously recorded, five were in patients with idiopathic hypoparathyroidism and only one in a patient with pseudohypoparathyroidism. The present report is of a second case of pseudohypoparathyroidism with cerebral cortical calcification. It is stressed that cortical calcification occurs predominantly in the frontal lobes.
The precise estimation of osteoporosis is hampered by the lack of a generally accepted method of evaluation. Measurement of the combined cortical thickness (CCT) of the centre point of the second metacarpal has been widely used for this purpose, but the wide normal variation found in population studies has reduced its value in the diagnosis of this condition in the individual. The factors leading this normal variability are discussed and the three centre metacarpals are compared with each other. It is concluded that simple CCT measurement is preferable to any of the indices so far devised, but that a single measurement of a given metacarpal is too imprecise to be of real value. If a single metacarpal is to be chosen, three measurements of the third metacarpal gives a coefficient of variation lower than those of the second or fourth, and an average of nine measurements of the three centre metacarpals produces a further useful reduction in variability.
With the introduction of new imaging modalities the optimal protocol for the evaluation of renal tumors is under close review. Angiographers frequently are faced with the question of whether to proceed to inferior venacavography following a selective renal angiogram that demonstrates a patent renal vein. We report a case of renal cell carcinoma in which the main renal vein was shown by ultrasound to be unequivocally patent but at the same time there was considerable tumor extension into the inferior vena cava. The necessity of full examination of the inferior vena cava, either by venacavography or ultrasound, in all cases of renal cell carcinoma is stressed.
A 30 degrees cranial angulated view for the evaluation of spondylolysis demonstrates the pars interarticularis with minimal distortion and without being obscured by overlying bony structures. The degree of callous formation and bony union can be assessed.
The lumbar spine was examined radiologically for the presence of spondylolysis and spondylolisthesis in 936 asymptomatic soldiers prior to military placement and in 662 soldiers complaining of low back pain. The overall incidence of spondylolysis was 9.7% in both groups, but bilateral spondylolysis was more prone to be associated with symptoms than a unilateral defect. In the symptomatic group the incidence of spondylolisthesis was 5.3% but only 2.2% in the asymptomatic group. The defect was seen in the oblique views only in 18.7% of the cases of spondylolysis. The precise diagnosis is important for vocational counselling and military placement.
Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age is very similar. It is concluded that the known low incidence of femoral neck fracture in Bantu is not due to a lower incidence of generalised osteoporosis but to environmental factors. The chief environmental factor postulated is the greater amount of physical work performed by the Bantu. A more careful mode of walking is suggested as a subsidiary cause.
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A splenic abscess was erroneously diagnosed in a 65-year-old patient. The diagnosis was established on clinical, radiological and ultrasonographic data. At laparotomy the spleen was markedly enlarged by tumoral tissue and contained a large cystic lesion. The histological diagnosis was typical Hodgkin disease with lymphocytic depletion. Ultrasonography adds valuable information in the diagnosis of splenic lesions. Hodgkin disease should be included in the differential diagnosis of cystic lesions detected in the spleen by this method.