Radiation dosimetry in Panorex roentgenography. I. Use of phantoms in dental radiation dosimetric research.
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The records of 30 patients with mediastinal masses were reviewed to evaluate the signs, symptoms, and preoperative tests that were most useful in diagnosing and localizing the masses. Sixteen (53%) of the tumors were benign, and 14 (47%) were malignant. Twenty patients were seen with symptoms. The most common symptoms suggesting malignancy were pain, weight loss, fever, and cough. Four of the 5 patients who were truly asymptomatic had benign lesions. All 4 patients with palpable adenopathy had malignant tumors. Posteroanterior and lateral chest roentgenograms detected the mediastinal mass in 29 (97%) of the 30 patients. All patients were operated on for tissue diagnosis or resection (13, median sternotomy; 8, right thoracotomy; 3, left thoracotomy; 2, low anterior cervical approach). Eight patients underwent mediastinoscopy, which was diagnostic in 6 and obviated the need for operation in 4. It was of particular value for patients with lymphoma, who can be managed without resection.
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Despite the availability of many methods for the structural and functional evaluation of the larynx, this study suggests that plain roentgenographic techniques are simple and effective means of providing diagnostic and prognostic data useful in the management of hemilaryngeal dysfunction. Lateral soft tissue and anteroposterior views of the neck can demonstrate unilateral vocal cord dysfunction within a few hours after onset. Complete recovery of vocal cord function is most likely to occur when hemilaryngeal dysfunction is not associated with the appearance of a distended ventricle on the lateral soft tissue roentgenogram of the neck. Conversely, when the distended ventricle assumes a delta or Y configuration, it is unlikely that the hemilarynx will resume its normal mobility. Laryngeal immobility lasting more than six months is usually irreversible.
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