The roentgenogram as scapegoat.
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Biomedical subjects
Publications and source records attributed to T L Pope.
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Maxillary sinusitis resulting from nasotracheal intubation is rare, occurring in approximately 2% of patients receiving ventilatory assistance. We have described two examples of this situation. In one case, the sinusitis caused bacteremia. The diagnosis can be made easily by a portable Water's view of the paranasal sinuses. Clinicians should be aware of this potentially serious complication in intubated patients.
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Bladder base impressions due to prostate hypertrophy are a common urographic finding in older males. A similar appearance may be occasionally seen in females and presents a more difficult diagnostic problem. Sixteen such cases of bladder base defects in females at two institutions were identified. The impressions were caused by symphysis pubis asymmetry, postoperative change, urethral diverticulum, levator ani impression, or "urethral syndrome." Vaginal fibromyoma, ectopic ureterocele, and intramural bladder neoplasm can also cause this defect, although no such cases were found in this series.
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We describe 15 patients with adenoid cystic carcinoma of the salivary glands treated by radiotherapy from 1960 to 1978. All patients were treated for localized disease either definitively or after surgical resection. The site of origin and local tumor extensions are reviewed and the results of treatment analyzed. Eighty-three percent of the tumors were controlled by combined treatment (surgery and postoperative radiotherapy) for one to ten years, 80% for more than five years. In the latter group, seven of ten patients had tumors with poor prognostic features. Eighteen patients treated by surgery alone have been reviewed for comparative five-year recurrence rates. This group and similar groups reported in the literature have higher recurrence rates at five years. Two patients treated definitively by radiotherapy have had tumor control for four years. This series and other reports demonstrate that adenoid cystic carcinoma is amenable to control by radiotherapy. Elective postoperative radiotherapy may assist in diminishing the high recurrence rates and improve survival.
Congenital ureteropelvic junction obstruction is well known. The traditional mainstay of diagnosis has been excretory urography. However, in the neonatal period ultrasound and renal scintigraphy should be the initial diagnostic procedures for this disease. Excretory urography may be tailored or eliminated using these 2 tests as guides. We report a case of bilateral ureteropelvic junction obstruction diagnosed in utero and suggest a diagnostic study, stressing the liabilities of excretory urography in the neonate or young child.
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Pseudosubluxation or anterior slippage of the axis on C-3 is a well recognized physiologic phenomenon in children. Because of a downward shifting of the apex of flexion of the cervical spine that occurs at about age 10, this physiologic offset of C-2 has been thought unlikely to occur in older individuals. However, a review of a series of flexion and extension cervical spine films showed six such cases in the 14- to 21-year age range.
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