Biomedical subjects
Publications and source records attributed to T L Pope.
Rupture of the silicone prosthesis can occur following external closed compression capsulotomy for fibrous capsules that develop after augmentation mammaplasty. The forces needed to rupture the fibrous capsule can cause silicone gel from the prosthesis to be pressure injected into the breast tissue and surrounding musculature. Film-screen mammography can be utilized to diagnose prosthetic rupture.
Computed tomography (CT) is far superior to plain radiography or xeroradiography in the detection of orbital foreign bodies and in defining altered anatomic relationships in this region. We present a case in which CT was instrumental in the management of orbital cellulitis in a patient who had forgotten that an eye prosthesis had been inserted in the past. We stress the importance of CT in our case and discuss its usefulness in other reported clinical situations involving the orbit.
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A 25-year-old woman had a giant cell reparative granuloma (GCRG) in the nasal fossa during the fifth month of pregnancy. This was treated with a partial excision, but the lesion recurred three months later. By this time, there was extension into the anterior fossa. Because of rapidly decreasing visual acuity, headache, and facial pain, a combined craniofacial approach was undertaken. The lesion encroached on the optic chiasm and a piecemeal, but incomplete, removal of the lesion was performed. The patient spontaneously gave birth to a normal child while in the recovery room. She received no additional therapy and her symptoms disappeared. She remains well 11 years later. The course of disease in this patient is compared with eight other patients from the literature who had GCRG during pregnancy.
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Reported are ten instances of major bronchial obstruction by mucous plugs in eight patients during which the clinical features resembled pulmonary embolism. Perfusion lung studies showed significantly diminished perfusion of the involved portions of the lungs. The chest radiographs generally did not, however, reflect the severity of the airway obstruction and in some instances were completely normal. The ventilation studies indicated the extent and severity of the obstruction and matched with the perfusion scans. Pulmonary arteriograms were performed in three patients and gave direct evidence of focally diminished lung perfusion without embolism. The physiologic mechanisms underlying the condition are discussed.
Earlier reports implicated the association of adenosis and adenocarcinoma of the vagina in offspring exposed in utero to diethylstilbestrol (DES). Subsequently attention was directed to the structural abnormalities of the müllerian system in the same females. In this report, the hysterosalpingographic findings in 11 DES-exposed women are presented. The external cervical os was stenotic in two patients. Multiple uterine cavity aberrations were noted: T-shaped configuration, hypoplasia, constriction deformities, and nodular or other filling defects. Tubal patency was demonstrated consistently. If structural abnormalities of the vagina and/or cervix are present, then upper reproductive tract alterations should be considered.
We measured breast skin thickness on the film-screen mammograms of 250 asymptomatic women and found a normal range of 0.7-2.3 mm in the superior quadrant and 0.7-2.7 mm in the inferior quadrant as measured on the mediolateral view and 0.6-2.4 mm in the medial quadrant and 0.5-2.1 mm in the lateral quadrant as measured on the craniocaudad view. In our experience a skin thickness of greater than 2.5 mm suggests the presence of disease. Causes of skin thickening in our series of 44 patients included carcinoma, metastases, post radiation therapy, post surgery, infection, and anasarca. Other reported causes are trauma, fat necrosis, dermatologic conditions, and lymphoma.
Pittsburgh Pneumonia Agent, Legionella micdadei, is a recently recognized source of pulmonary infection in immunocompromised hosts. A literature review suggests a typical pattern of clinical and radiologic presentation, of which the following case is representative. Eighteen of twenty-one infections have occurred in recipients of cadaveric renal transplants, defining a population at risk. The onset often occurred within days to weeks of bolus doses of corticosteroids. Fever, often accompanied by mild pulmonary symptoms usually developed, coupled with nodular or segmental chest infiltrates which were often well defined or rapidly expansile. Recognition of this pattern followed by prompt open lung biopsy may lead to increased survival.
Women have a 7 percent natural lifetime risk of developing breast cancer, which is the leading cause of death in women aged 40 to 50 years. Most data suggest that the earlier the disease is diagnosed, the better the chance for cure. Women with "minimal breast cancer" have an actuarial 20-year survival rate of 93.2 percent. The majority of these breast cancers are diagnosed by mammography. The radiation doses from this technique have been dramatically decreased over the last ten years to about 0.1 to 0.6 rads per study. The two largest breast cancer screening studies, the Health Insurance Plan of Greater New York and the Breast Cancer Detection Demonstration Project, have shown conclusively that women over 50 years old can benefit from annual mammography and that certain groups can benefit from mammography at close intervals before the age of 50 years. This article describes the development of mammography and outlines current perspectives on its indications and limitations.
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Pittsburgh pneumonia agent, Legionella micdadei, is a Gram-negative, weakly acid-fast bacillus, recently recognized as a cause of pulmonary infection in the immunocompromised host. The chest radiographic findings in seven patients with this disease are reported. These consist of single or multiple nodules and segmental infiltrates involving part of all of one or more lobes. A striking feature in this series was the rapid growth of the pulmonary densities.
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Candida albicans arthritis in the pediatric patient is rarely reported. In each instance, the patient has had one of the factors that predispose to fungal sepsis: broad spectrum antibiotic therapy, hyperalimentation, prematurity, abdominal surgery, corticosteroid or immunosuppressive therapy, malnutrition, maternal vaginal candidiasis, or lymphoproliferative disorders. To avoid the potentially fatal consequences of delayed treatment, early recognition of the disease is imperative. The patient usually refuses to use the affected joint and plain radiography shows a joint effusion with soft tissue swelling. Osteomyelitis develops in approximately half of the cases. Arthrocentesis with fungal cultures is the best method to make the diagnosis. Treatment is primarily chemotherapeutic and the drug of choice is the membrane inhibitor amphotericin B given intravenously. The antimetabolite 5-fluorocytosine is a second-line drug to be used if resistance develops. All cases before the present one involved the knee joint initially. The case presented involved the left hip and was successfully treated with intravenous amphotericin B.
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