Pleural herniation in respiratory distress syndrome.
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Biomedical subjects
Publications and source records attributed to R Greene.
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The clinical records of 1,071 cases of extrathoracic malignant neoplasms seen over a 2 year period sere reviewed: 163 had abnormal chest films, and 25 of these showed evidence of mediastinal and/or hilar lymph node metastases. The primary malignancies which metastasized to intrathoracic lymph nodes included eight tumors of the head and neck, 12 genitourinary malignancies, three carcinomas of the breast, and two malignant melanomas. The chest films were analyzed to determine the distribution of lymph node groups involved. Unilateral lymph node enlargement occurred in eight. The most frequently detected lymph node group was the right paratracheal chain (60%), while the subcarinal and posterior mediastinal groups were rarely affected. Of the 25 cases, 10 had radiographic evidence of hematogenous or lymphangitic metastases in addition in the lungs. Metastatic disease from extrathoracic neoplasms should always be considered in the differential diagnosis of hilar and mediastinal adenopathy.
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A simple, single-stage, quasi-tomographic technique which is employable with ordinary C-arm fluoroscopes is presented as an alternative to small field chest tomography. Fluoroscopic axialography utilizes image intensifier filming during axial rotation to obtain sharp tomogram-like images of areas of interest. The technique incorporates preliminary fluoroscopic localization and has many applications in the chest. The use of axial rather than planar blurring and intensifier camera filming rather than radiography does not reduce the clinical usefulness of the method.
Data are presented from thirteen patients with marked coronal narrowing of the intrathoracic trachea associated with widening of the corresponding sagittal diameter. The term "saber-sheath" trachea describes this deformity which can simulate a mediastinal mass. The absence of mediastinal masses and the presence of obstructive pulmonary abnormalities in each patient, either as a clinical diagnosis (11 of 13), functional abnormality (10 of 11) or both (8 of 11), suggest that the "saber-sheath" trachea may be a useful sign of chronic obstructive pulmonary disease.
Methods currently used for determining total lung capacity are either simple but inaccurate in the presence of airways disease (gas dilution) or accurate but not generally available (body plethysmography). The manual radiographic method is accurate both in normals and in patients with airways disease but is very tedious to use. The authors have developed a semi-automatic radiographic method utilizing a position transducer and a small computer which reduces the time for each determination from approximately 20 min. to 1 min. Agreement with manual calculations in 80 controls and 80 patients with airways disease is excellent (average correlation coefficient, 0.9872; average residual error, 2.65% or 156 ml).
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