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Biomedical subjects

R H Daffner

Publications and source records attributed to R H Daffner.

At least 73 records · Page 4Linked to original sources
PubMed1989

CT diagnosis of renal artery injury caused by blunt abdominal trauma.

Controversy exists about the sensitivity of CT in the diagnosis of occlusion of the renal artery or one of its branches after blunt abdominal trauma. We report 10 cases in which contrast-enhanced CT was used to diagnose correctly either main (seven cases) or segmental (three cases) posttraumatic renal artery occlusion. The abnormality was proved angiographically and/or surgically in all cases. CT showed the absence of a nephrogram in the devascularized portion of the kidney in all 10 cases. A pyelogram was not shown on CT in the seven patients in whom the main renal artery was occluded, but was present in the three patients who had segmental arterial lesions. Termination of enhancement within the affected artery (renal artery cutoff sign) was observed in one patient, and a thin, peripheral rim of cortical enhancement in an otherwise unenhanced renal segment (rim sign) was observed in three patients. Retroperitoneal hematoma with renal displacement was present in nine patients. Our experience suggests that the absence of a nephrogram on contrast-enhanced CT scans is a useful sign of main or segmental renal arterial occlusion in patients with blunt abdominal trauma.

Adolescent↗
PubMed1988

The impact of magnetic resonance on the diagnostic evaluation of acute cervicothoracic spinal trauma.

From 1984 to 1987 magnetic resonance (MR) imaging was performed on 100 patients suffering acute spinal trauma. MR demonstrated one or more injuries to the cervicothoracic region in 31 patients. It displayed a spectrum of spinal cord injury ranging from mild compression and swelling to complete transection. MR was also useful in evaluating alignment at the cervicothoracic junction, in depicting ligamentous injury, in establishing the presence of disc herniation, and in identifying unsuspected levels of injury. We present a diagnostic algorithm that incorporates the role of MR in evaluating acute cervicothoracic spinal trauma and emphasizes the replacement of myelography by MR in the initial assessment of neurologic deficit.

Acute Disease↗
PubMed1988

Syringomyelia: myelography, computed tomography, and magnetic resonance imaging.

Seventeen patients with cervical spinal cord cavities were studied with myelography, postmyelographic computed tomography scanning, and magnetic resonance imaging. The three diagnostic techniques were compared for accuracy, patient comfort, and ease of procedure. Magnetic resonance imaging was the best diagnostic and most comfortable procedure. There is no need for myelography or postmyelographic computed tomography scanning for the evaluation of cervical syringomyelia.

Humans↗
PubMed1988

Occult occipital condyle fractures presenting as tumors.

Occipital condyle fractures can be easily overlooked on plain radiographic examinations of the head and cervical spine. This is especially true if such a fracture is not clinically suspected, since they are very rare fractures. Two patients presented with suspected tumors of the foramen magnum region. Both had old trauma and undiagnosed old fractures of the occipital condyle.

Adult↗
PubMed1988

Patterns of high-speed impact injuries in motor vehicle occupants.

Trauma from high-speed motor vehicle accidents is a leading cause of death and disability. Most of these injuries could be prevented if the driver and occupants of motor vehicles wore seatbelts or used other restraining devices. The injuries produced when an unrestrained occupant of a motor vehicle is ejected from that vehicle or impacts on a hostile surface at high speed occur in a reproducible pattern. The types of injuries sustained by drivers and front seat passengers are different and specific enough to allow one to identify drivers and passengers with confidence. Because of severe life-threatening injuries to the central nervous system, and thoracic and abdominal viscera, other serious injuries may be overlooked. Knowledge of the mechanism of injury and the role of the victim (i.e., driver or passenger) should lead to the prompt radiographic evaluation of all areas at risk. Our findings are based on a study of 250 drivers and 250 front seat passengers involved in motor vehicle accidents. We found distinct common injury patterns and radiographic findings in drivers and front seat passengers.

Abdominal Injuries↗
PubMed1988

Pylon fractures of the ankle: a distinct clinical and radiologic entity.

Pylon fractures are a distinct clinical and radiologic entity that should not be confused with trimalleolar fractures. Radiographic and clinical comparison of 20 surgically documented pylon and ten trimalleolar fractures revealed four major features of pylon fractures distinguishing them from trimalleolar fractures: (a) the presence of profound distal-tibial comminution, (b) intra-articular extension of tibial fractures through the dome of the plafond, (c) the presence of a fractured talus, and (d) anatomic relationship of the lateral malleolus to the talus at the level of the ankle mortise. With use of clinical history in addition to plain radiography, pluridirectional tomography, and computed tomography, these two fractures can be clearly separated. This distinction carries important surgical and prognostic implications.

Ankle Injuries↗
PubMed1988

Trauma radiology: an integrated approach.

A program at Allegheny General Hospital, Pittsburgh, integrated active radiologic participation with the services of the trauma team and emergency department. Two target areas served as objective criteria for the program's effectiveness: the time patients spent in the emergency department and the number of patients in whom vital diagnostic information was immediately obtained because of direct radiologic participation. This report outlines how the services were integrated and details our results in the two target areas studied.

Emergency Service, Hospital↗
PubMed1987

Pseudofractures due to Nec-Loc cervical immobilization collar.

The plastic rivets attached to the commonly used Nec-Loc cervical immobilization collar produce linear lucencies which often traverse the cervical vertebrae. Linear lucencies in this location often simulate a fracture. In most instances, the complete outline of the object causing the artifact may be identified. However, identification may not be possible in all cases. Radiologists should familiarize themselves with the appearance of the artifact produced by this particular immobilization device so as to avoid the erroneous diagnosis of a cervical fracture. Whenever the diagnosis is in doubt, the collar should be removed and a repeat radiograph should be obtained.

Adult↗
PubMed1987

Thoracic fractures and dislocations in motorcyclists.

Motorcyclists who are involved in accidents generally suffer severe multiple injuries, some of which are not readily apparent on initial examination. One such subtle injury is fracture, with or without dislocation, in the upper thoracic spine. The severe spinal cord damage produced by the injury is often overshadowed by cerebral or cervical injury. Proper diagnosis is further hampered by the fact that the upper thoracic region is difficult to examine radiographically on plain films, particularly when using portable equipment. Of a group of 14 motorcyclists having 26 fractures and/or dislocations in the thoracic region, 12 had 24 injuries between T3 and T8. These 24 injuries represented 56% of the fractures and/or dislocations encountered in a larger study of trauma to the thoracic vertebral column. All of these were flexion injuries, suffered when the individual was thrown from the motorcycle and struck a large, solid object. In three cases, the diagnosis was delayed as much as 48 h because proper films were not obtained initially. Because of the serious consequences of delayed treatment, we recommend that all motorcyclists who have sustained severe trauma be examined by overpenetrated film of the upper thoracic region.

Accidents, Traffic↗
PubMed1987

Torsion of the lung causing refractory hypoxemia.

Torsion of the lung is an unusual and potentially fatal cause of hypoxemia following blunt chest trauma. It must be considered in the differential diagnosis of any trauma patient whose pulmonary picture does not improve following intubation, chest tube placement, and/or bronchoscopy. Immediate thoracotomy is the definitive treatment.

Accidents, Traffic↗
PubMed1987

The posterior vertebral body line: importance in the detection of burst fractures.

A review of the lateral radiographs and CT studies of 114 patients with burst fractures, 46 patients with combined injuries in whom bursting was a major component, and 82 patients with simple anterior compression fractures was performed to evaluate the integrity of the posterior vertebral body margin. This structure normally produces a single or bifid vertical line on the lateral radiograph. Disruption, displacement, or rotation of this line was found in all 114 patients with "pure" burst fractures. These abnormalities were also present in 36 of the 46 patients with combined burst injuries. In all patients with simple compression fracture, flexion, distraction or dislocation, and extension injuries, the line was normal. CT studies showed these abnormalities to be the result of retropulsion of one or more bone fragments from the posterior margin of the vertebral body. Disruptive abnormalities of the posterior vertebral body line are reliable plain-film signs that a burst fracture has occurred and that compromise of the vertebral canal and subarachnoid space is present.

Cervical Vertebrae↗
PubMed1987

Trauma oblique radiographs of the knee.

Special trauma oblique radiographs of the knee were designed for the purpose of demonstrating the patella radiographically in a manner that would free it from the shadow of the distal end of the femur. These radiographs are made by directing the x-ray tube at an angle of 45 degrees and making two exposures, with the film placed first on the lateral and then on the medial side of the injured knee. These two radiographs have been found to be useful for delineating the extent of fractures of the patella as well as abnormalities of the tibial plateau.

Fractures, Bone↗
PubMed1986

Pseudofractures of the cervical vertebral body.

A lucency traversing obliquely across the inferior-posterior aspect of cervical vertebral bodies may be a normal variant due to osteophytes of the uncinate processes or transverse processes with a resultant Mach band phenomenon. This could be misinterpreted as a fracture of the vertebral body in a patient with a history of cervical injury. A review of normal lateral cervical vertebral films obtained on patients with no traumatic history showed this phenomenon to occur in 27% of adults. It was not observed in children. The proper interpretation is easily made when one considers the location and the fact that a cervical fracture does not occur in such a location as an isolated event.

Adolescent↗