Biomedical subjects
Publications and source records attributed to R H Daffner.
The radiographic and pathologic findings of a Zenker's-type diverticulum containing multiple ulcers are described. This rare complication probably represented peptic ulceration of the diverticular mucosa resulting from reflux of the gastric content.
Mach bands are an optical phenomenon in which dark and light lines appear at the borders of structures of different radiodensity on radiographs. In most instances they do not cause a diagnostic dilemma. However, in a patient who has sustained trauma to the cervical spine, the commonly occuring negative Mach band across the base of the dens may be mistaken for a fracture. Failure to recognize this optical illusion may result in unnecessary treatment by skeletal traction. The production of Mach bands, methods of proving their illusory nature, and several illustrative cases are presented.
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Over a 28 month period, 19 patients underwent esophageal reconstruction using the Beck tube fashioned from the greater curvature of the stomach. Eighteen had unresectable carcinoma of the esophagus and one had a benign stricture secondary to reflux esophagitis. The degree of palliation was considered good in 13 cases. The surgical aspects of the Beck gastric tube are described and radiologic features in both uncomplicated and complicated cases are illustrated. Early experience with the procedure is encouraging.
A compilation of injuires sustained in an amateur ice hockey program over a tw0-year period revealed that the majority of those injuires were facial lacerations. The number of injuries increased with the level of players' skill and with the intensity of the games. Youth players who were required to wear head and total face protection had fewer injuries than either the adult league or semi-professional players. Injuries were greatest to the semi-professional players who wore little or not head protection, and no facial protection. Physicians have a duty to urge all hockey players to wear adequate head and face protection to prevent such injuries. Equipment which is currently available is illustrated.
Epidural venography is a simple and safe procedure for the diagnosis of herniated intervertebral disc and other disease of the epidural space. It is especially useful in symptomatic patients with normal or equivocal myelographic findings. The accuracy rate of positive venograms is 88.2% in this series of 58 patients. Five illustrative cases are presented.
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The human body is a complex of tissues of different radiographic densities. Overlapping shadows, differences in background density, subjective contour formation, and the parallax effect often produce a variety of optical illusions that exist only in the "mind's eye" and may be mistaken for significant pathology. Most of these phenomena are produced by the Mach effect, a consequence of the physiological process of lateral inhibition. Subjective contour formation is a "psychophysiological" phenomenon in which complete "structures" appear from minimal outlines. A parallax effect occurs if real structures contribute to the radiographic image. This review discusses the basic physiology involved in image reception and the formation of false images. Clinical consequences of the presence of Mach bands, background density effect, subjective contours, and real or physical phenomena are illustrated.
Computed tomography (CT) is a simple, rapid, and safe method of evaluating patients with severe facial trauma. It has its greatest value in defining the extent of soft tissue damage as well as in assessing the skeletal disruption. In a group of 32 patients with severe facial trauma, CT outlined the degree of soft tissue and skeletal fracture. In 13 of these patients who also underwent conventional pleuri-directional tomography CT was determined to be just as effective in identifying all fractures. CT was also shown to be useful for follow up evaluation of patients with previous severe facial trauma.
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Severe facial fractures produce a variety of radiographic and CT abnormalities. Careful evaluation of plain films and any CT images should allow rapid and accurate diagnosis of the extent of injury. Table 3 summarizes the radiographic findings seen in the severe mid facial fractures.
Radiologic findings in 20 patients with splenic abscesses were reviewed. Chest roentgenograms frequently showed abnormalities which were nonspecific and nondiagnostic. Results of barium sulfate studies were normal in 66.7% of patients tested. Gas beneath the left side of the diaphragm or within the splenic shadow was revealed by abdominal plain film or barium sulfate study in three patients. Focal splenic abnormalities were present in 50% of the patients who underwent 99mTc sulfur colloid scans; in 71.4% of patients who underwent 67Ga scans, increased uptake of isotope was seen in the left upper quadrant of the abdomen. In only one of six patients who underwent both 99mTc and 67Ga scans did results show corresponding abnormalities. Pathologic findings in the left upper quadrant of the abdomen were detected by ultrasonography in three of five patients. Angiography confirmed splenic abscess in one patient. Abnormal splenic lucencies were seen on computed tomography in four patients, although one repeat scan was interpreted as normal. Although no one technique consistently detected splenic abscesses and data from several studies are combined, computed tomography appears the best modality. The diagnosis of splenic abscess and the decision for surgical intervention should be based on clinical impressions, even in the absence of unequivocal radiologic findings.
Blunt injury to the abdominal aorta has been previously reported. Due to the severity of the lesion, radiologic studies other than aortography are rarely undertaken prior to emergency surgery. We report a case in which CT initially demonstrated an angiographically and surgically proven rupture of the infrarenal abdominal aorta due to blunt trauma.