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Simultaneous pulmonary and renal malignancy.

Simultaneous primary malignancy of the lung and kidney has been rarely recognized during life. Three patients with synchronous primary pulmonary and renal cancer are described. The pulmonary tumors were asymptomatic and were discovered on plain chest roentgenography. The renal tumors, also asymptomatic, were incidentally discovered on CT, performed for staging. Although one patient was treated with interleukin-2 for a presumed solitary pulmonary metastasis from renal carcinoma, in all three patients, both the kidney and lung tumors were eventually removed either concurrently or sequentially. Prior autopsy case series are reviewed. In the elderly, synchronous asymptomatic pulmonary and renal malignancy is not surprising, and it should be approached as a distinct clinical problem. With the use of chest roentgenography for screening high risk populations and CT for staging, simultaneous primary pulmonary and renal malignancy will probably be recognized increasingly.

Adenocarcinoma↗

A radiologic study of tuberculosis of the abdomen (gastrointestinal tract).

The roentgenologic features of 160 cases of tuberculosis of the abdomen are reviewed. The 3 standard examinations of the gastrointestinal tract (plain film abdominal roentgenography, barium meal and follow-through studies, and barium enema examinations) are required to provide useful pointers towards the diagnosis. In plain film roentgenography of the abdomen, the triad of ascites, absence of gas shadows in the right iliac fossa, and segmental dilatation of the terminal ileum demonstrates features which are very suspicious of intestinal tuberculosis. In the barium meal studies showing disordered small bowel patterns, tuberculosis of the abdomen should be considered when this pattern is associated with fixation of bowel loops on supine and erect roentgenograms, spiculation and the presence of multiple strictures in the small bowel. Although the duodenojejunal and ileocecal regions are the commonest sites involved, lesions are not confined to these sites alone, but may also involve any part of the alimentary canal such as the esophagus and the small and large bowel. However, no anorectal lesions were encountered in this study.

Ascites↗

Postoperative subphrenic abscess following gastrectomy for gastric cancer.

From 1985 to 1989, a total of 598 gastric cancer patients underwent gastrectomies in the First Department of Surgery at Kurume University School of Medicine. Of these, 24 patients (4.0%) incurred a subphrenic abscess, postoperatively. Subphrenic abscesses occurred most frequently after total gastrectomies at a rate of 17 of 197 (8.8%) cases. Leaking gastrointestinal anastomoses were responsible for 12 of the 17 (70.5%) abscesses. In 384 cases of distal gastrectomy, only 6 (1.6%) cases with a subphrenic abscess occurred, and only 3 were due to anastomotic leakage. Among the total of 24 cases with subphrenic abscesses, 16 (67%) were related to an anastomotic leakage including a pancreatic fistula, while the other 8 (33%) showed no leakage by contrast roentgenography. When chest roentgenography shows a pleural effusion and an elevation of the diaphragm, then a subphrenic abscess must be suspected. The majority of patients were treated by replacing the intraabdominal drainage catheter inserted during the gastrectomy with a larger catheter. The overall operative mortality rate was 4.1% due to a death in only one (MOF) patient.

Adult↗

[Radiation diagnosis of involutional osteopenia].

160 patients with involutive osteopaenia were investigated. The diagnostic possibilities of roentgenography, magnetic resonance imaging and computed tomography were evaluated. There was determined that roentgenography gives the possibility to determine the common localisation and the expressiveness of the pathologic process. MRI and CT give a valuable additional information on early stages of osteopaenia and it's complications.

Adult↗

[Diagnosis and treatment of primary malignant tumors of the small bowel].

OBJECTIVE: To study the clinical characteristics, effective diagnostic methods and therapeutic measures of primary malignant tumors of the small bowel so as to improve therapeutic effect. METHODS: In this paper 75 cases of primary malignant tumors of the small bowel were analyzed. Survival rates were calculated with Life Table, and computer Cox multivariate analysis model was used for survival analysis. RESULTS: The most frequent clinical manifestations of primary malignant tumors of the small bowel were abdominal pain, abdominal mass, emaciation and intestinal obstruction. Gastrointestinal barium meal roentgenography was performed in 13 cases, with an accurate diagnostic rate of 84.6%. The 1-,3- and 5-year survival rate after radical resection was 87.5%, 68.7% and 48.1%, respectively, while that for palliative resection was 57.9%, 33.8% and 24.1%, respectively. The factors including age, histological type, tumor site and type of resection were selected into Cox model in survival analysis. CONCLUSION: For primary malignant tumors of the small bowel, gastrointestinal barium meal roentgenography is the most valuable method for diagnosis, and surgical radical resection is the most effective therapy. The significant prognostic factors are age, histological type, tumor site and type of resection. Chemotherapy had no effect on prognosis.

Adenocarcinoma↗

[Digital X-ray detection of extrapulmonary pathology during chest screening].

The outcomes of digital roentgenography are analysed at screening examinations of members of chest 8000 men: with a pathology lung--83, cardiovascular system--1625, thoracal spine--2034. The outcomes bear to high quality of the image not only lung, but also hearts, aorta, thoracal spin, allow to prefer digital roentgenography of members of a chest as to effective procedure screening of surveys of the population.

Adolescent↗

[Problems associated with mass-screening system for gastric cancer in Japan].

In the mass-screening system for gastric cancer, subjects are primarily examined by contrasted indirect roentgenography and if secondary examination is diagnosed to be necessary, they are examined by contrasted direct roentgenography or gastric fiberscopy. Methods for increasing the efficiency of this system from the standpoint of cost-effectiveness were studied, and the basis for decision of whether or not serological examinations such as of serum pepsinogens and serum anti-Helicobacter-antibodies should be brought in to the system, and in what manner serological examinations should be brought in to the system if proven to be effective were examined. Problems found in the present practiced system and the proposed new system with serological examinations were repetition interval for examinations, selection of high-risk subjects and communication between subjects and the medical staff or among the members of the medical staff. Analysis by receiver operating characteristics curve should be included when serological examinations are indicated. In addition whether the mass-screening system for gastric cancer produces an actual reduction in death by gastric cancer should be confirmed after the system is made more efficient.

Female↗

[Pathology and molecular pathogenesis of spondyloepiphyseal dysplasia tarda with progressive arthropathy caused by compound CCN6 heterogeneous gene mutations].

OBJECTIVE: To characterize the clinical manifestations, features of roentgenography and MR imaging, and the pathology of articular cartilage and matrix of spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA), to screen the mutations of the disease-causing CCN6 gene, and try to elucidate the molecular pathogenesis of SEDT-PA. METHODS: A questionnaire survey on the clinical manifestations and history was conducted among a pedigree of SEDT-PA with 57 persons (53 living members) in tolal, including 2 probands, a 19-year old female and a 9-year old male. Physical examination and roentgenography and MR imaging were used on the 2 probands to characterize the features of their joints and articular cartilage. The femoral head extracted during replacement of hip of the proband 1 underwent hematoxylin-eosin staining and toludine blue (TB) staining to observe the pathological changes and ultra-microstructure of the articular chondrocytes and cartilage matrix using electron microscopy. Peripheral blood samples were collected from these 53 living members and 100 healthy controls. PCR was used to examine and sequence the exons of CCN6. 3D-conformational illustration of mutant CCN6 proteins were predicted using the Prospect Software. RESULTS: The clinical manifestations, radiology, and MR imaging established the diagnosis of SEDT-PA. Pathologic examination demonstrated that the articular cartilage chondrocytes became hyper-proliferative and immature, while the density and diameter of matrix collagens were dramatically decreased. Mutation studies showed the two probands carried a deletion (840delT) mutation in maternal allele, that caused the truncated CCN6 protein to miss 43 residues in C-terminus; and a substitution mutation (1000T-->C, Ser334Pro) in paternal allele, which was also inherited down to other 4 members in the SEDT-PA kindred. The predicted 3D-conformational changes of the truncated mutant and the Ser334Pro mutant CCN6 proteins demonstrated that in comparison with the wild CCN6 protein, the single long peptide loop in the region from signal peptide to the beginning 24 amino acid residues in the first domain (IGFBP) was subjected to folding into two smaller cross-loops accompanied with a much shorter C-terminus in 840 delT truncated mutant CCN6 protein, and no substantial 3D-conformational change of Ser334Pro mutant CCN6 protein was detected except for the C-terminal peptide towards the opposite direction. CONCLUSION: Novel 840delT mutation of CCN6 gene is the leading cause of SEDT-PA though coexistence of T1000C substitution is necessary for the clinical onset of SEDT-PA, in which marked abnormalities of cartilage chondrocytes and matrix are morphologically and functionally presented.

Adult↗

Primary lung cancer arising from the wall of a giant bulla.

We report a 58-year-old man who underwent surgical treatment of primary lung cancer arising from the wall of a giant bulla. Chest roentgenography and computed tomography revealed multiple emphysematous bullae in the bilateral upper lobes, and a right upper giant bulla with a mass measuring 6 cm arising on the bulla wall. Right upper lobectomy was performed, the postoperative pathological diagnosis was large cell carcinoma arising from the wall of a giant bulla. Although the postoperative course was uneventful and he was discharged, he underwent partial resection of the jejunum for recurrence of carcinoma in the jejunum, and postoperative chemotherapy, and he was alive 20 months after that operation. In general, patients with both pulmonary bullous disease and primary lung cancer have a very poor prognosis, because they receive treatment when the tumor is at an advanced stage. On the basis of our review of the literature, we recommend that middle-age male patients with a giant bulla who smoke should have annual chest roentgenography and/or chest computed tomography to screen for lung cancer arising in or close to the bullous disease, and that a giant bulla should be resected in patients older than 50 years because of the high incidence of coexisting cancer and bulla, to improve the prognosis of this disease.

Blister↗

[Clinical outcomes of treatment of glenohumeral osteoarthritis with new generation shoulder prosthesis].

OBJECTIVE: To investigate the clinical effects of arthroplasty with UNIVERS 3-D prosthesis, the representative of fourth generation of shoulder joint prosthesis proved to be more suitable to shoulder anatomy, in treatment of glenohumeral osteoarthritis. METHODS: Seventy-four patients with glenohumeral osteoarthritis, aged 67.07 (47 - 84), received shoulder arthroplasty with UNIVERS 3-D prosthesis and were followed up for 31.9 months (12 - 74 months). Roentgenography was conducted to observe the acromion, and acromion-humeral distance (AHD), glenohumeral distance (GHD), humerus height (HH), and humerus width (HW). Constant scoring and normalized Constant scoring were used to evaluate the function of the shoulder joint. RESULTS: The Constant score at the last follow-up was 68.40 +/- 16.91 points, significantly higher than that at beginning (34.094 +/- 15.00, P < 0.05), The normalized Constant score at the last follow-up was 92.27 +/- 22.53%, significantly higher than that at the beginning (45.29 +/- 19.87%, P < 0.05). The post-operative pain, daily life, activity score, and myodynamia scores were all significantly higher than those evaluated pre-operatively (all P < 0.05). Pre-operative roentgenography showed 93.47% of the cases with humeral head periarticular osteophytes located at the inferior side; 36.96% with humeral head necrosis; 8.69% with humeral head cyst; and 39.13% with periarticular osteophytes of glenoid, and showed that AHD was shortened (1.83 +/- 1.64 mm), and GHD, HH, and HW were all narrowed (10.91 +/- 3.03 mm; 5.71 +/- 4.32 mm, and 3.34 +/- 4.82 mm respectively). After the operation, the AHD, GHD, and HH were all significantly increased, and HW did not significantly changed. The humeral inclination angle was changed postoperatively from 126 degrees to 142 degrees. The incidence of radiolucent lines around the prosthesis of humeral shaft was 5.41%, most in the zones d, c, and e, all with the radiolucent index of less than 1. The overall complication rate was 12.2%. CONCLUSION: Treatment of glenohumeral osteoarthritis with UNIVERS 3-D prosthesis effectively reconstructs the anatomy of glenohumeral joint, and shows excellent clinical results with low incidence of radiolucency and postoperative complications.

Aged↗

[Diagnosis and treatment of diaphragmatic and hiatal hernia].

On the basis of analysis of the results of treatment of diaphragmatic hernia in 115 patients, the authors, recommend for more precise establishment of a diagnosis and choice of a method for surgical intervention, to perform in patients with axial hiatal hernia roentgenoscopy and roentgenography of the stomach and intestine, esophagogastroduodenoscopy and pH-metry, and in patients with traumatic diaphragmatic hernia--roentgenography of the chest and contrast roentgenological study of the stomach and intestine. In axial hiatal hernia and small paraesophageal hernia, the A. A. Shalimov operation is a method of choice; in large paraesophageal hernia--the left-sided thoracotomy with plasty of the hiatus according to Allison and Belsey.

Adult↗

Ultrasound in the diagnosis of congenital dysplasia and dislocation of the hip joints in children older than two years.

To evaluate the use of ultrasound in the diagnosis to congenital dysplasia and dislocation of the hip (CDH) in children older than two years of age, 64 patients with normal hip joints and 47 patients with present or previous CDH were examined. Lateral and anterior ultrasound scanning was employed, and the coverage of the femoral head by the acetabular roof was assessed. The ultrasound measurements were compared with standard roentgenography, and a good accordance between the methods was found. A lateral projection of the femoral head in relation to the bony acetabular rim of more than 8 mm in children younger than ten years of age indicated subluxation and more than 15 mm at age two to four years indicated dislocation. Reliable images were obtained by ultrasound at any age between two and 18 years. Ultrasound is recommended as the primary imaging technique in the evaluation of hip joints, even in older children, and ultrasound should replace roentgenography in most of the follow-up examinations of children with previous CDH.

Adolescent↗

[A case of cystic hygroma of the chest wall].

Hygroma is generally regarded as a benign tumor occurring favoritely in the cervical region of a child. Recently we have experienced a case of hygroma which was initially detected as a right chest wall tumor in a 16-year-old man, then was surgically diagnosed as cystic hygroma; chest roentgenography on a check up examination in his senior high school pointed out some anomaly, leading to his hospitalization. On admission, he had no subjective symptom, but chest roentgenography and CT confirmed an abnormal shadow in the right pulmonary area and a tumor with calcification on the right chest wall, respectively, so he was operated on for excisional biopsy. The tumor was extirpated together with the 7th intercostal muscle adhered to the tumor, and postoperative pathohistological examination led to diagnosis as cystic hygroma. Cystic hygroma of the chest wall is so rare that we would like to report this case, together with some addition consideration of related literature.

Adolescent↗

[Complex radiodiagnosis of osteomyelitis].

In 23 patients with chronic osteomyelitis roentgenography of the bones and three-phase scintigraphy including radionuclide angiography, investigation of the soft tissues and bones were performed. In comparison of the data of clinical examination, roentgenography and radionuclide methods of diagnosis, the correspondence of the data of radionuclide angiography to the phase of an inflammatory process was established.

Adolescent↗

Bone changes induced by diphenylhydantoin in chicks on a controlled vitamin D intake.

Florid rickets developed in chicks receiving doses of diphenylhydantoin analogous to doses used in humans as anticonvulsants, vitamin D3 being given in amounts sufficient for normal bone mineralization in controls. The changes in the bones were directly related to the dose of diphenylhydantoin and inversely related to the dose of vitamin D3. Bone mineralization was assessed by roentgenography, histological examination, microradiography, and measurement of bone ash. Of these methods, roentgenography was the least sensitive. Rachitic changes were detectable by light microscopy and microradiography in chicks whose skeletons appeared normal roentgenographically. Roentgenographic evidence of rickets became detectable only when the rickets was far advanced. Rickets developed at serum levels of diphenylhydantoin similar to those found in patients taking anticonvulsant medication.

Animals↗

Femoral anteversion in adolescents and adults measured by ultrasound.

Femoral anteversion (AV) was determined by ultrasound in 40 adolescent and adult patients with rotational disorders of the femur, and the results were compared with AV measurements by biplanar roentgenography. With the patients supine, their knees flexed 90 degrees, and their lower legs strapped in the vertical position, one scan only of the proximal femur was needed to measure the anteversion by ultrasound. The transducer was tilted until the desired measuring line appeared horizontal on the monitor screen. The angle of tilt of the transducer, which represented the AV angle, was measured with an attached clinometer. The correlation between ultrasound and roentgenographic AV angles was high, indicating that reliable results were obtained by ultrasound. The preferred reference line was the head-trochanter tangent, which is recommended for clinical use. Consistently greater AV values were measured by ultrasound than by roentgenography. Thus, 10 degrees should be subtracted from the ultrasound values in order to obtain the real AV angles. One of the benefits of ultrasound is the elimination of radiation hazards to the patients. Ultrasound is recommended as a screening technique for patients with rotational disorders of the femur.

Adolescent↗

[Image distortions occurring on intraoral dental x-rays and the ways to overcome them].

Typical errors occurring in roentgenography of the teeth were simulated in a series of experiments. The results evidence that erroneous centering and angle of the x-ray tube inclination, incorrect centering of the film lead to disproportionate distortion of the shape, size, and position of all anatomical elements, that make the results of x-ray examination unreliable. Standardization of methods of intraoral roentgenography implies strict adherence to the rules of roentgenogram recording and treatment; this will permit obtaining high-quality roentgenograms and reduce the x-ray load of the patients.

Adult↗

[Roentgeno-functional study of the talocrural joint in the long-term follow-up of a fracture of the crural bone].

On the basis of the results of clinicoroentgenological and tensographic investigations of 119 patients after traumas of the crural bones and ankle joint (2-36 yrs. ago) the authors showed the importance of roentgenofunctional investigation of the ankle joint, a patient being in a standing position with maximum flexion and extension of the foot. A specially designed footing was proposed. Of 77 patients after intra-articular fractures of the ankle bones various disorders in articular proportions, undetectable on routine roentgenography, were diagnosed in 29 by functional roentgenography. Articular changes on roentgenofunctional investigation were revealed in one patient only out of 42 patients with extra-articular fractures of the crural bones. Tensography showed disorders of foot biomechanics in all patients with subluxations in the ankle.

Adult↗