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PubMed1980

Dendriform pulmonary ossification.

Four cases of dendriform pulmonary ossification are reported from postmortem roentgenography of isolated lungs. All showed pathoanatomical evidence of chronic fibrosing, mostly interstitial, rarely intraalveolar pneumonia, besides the typical manifestations of dendriform pulmonary ossification. Microscopy revealed fluid transition from proliferating, interstitially increased connective tissue to fully developed osseous structures. These dendriform structures can be seen in some analogy to the structural pattern of interstitial, bronchovascular as well as septal connective tissue; however, actual topographical correlation between bone structures and blood or lymph vessels could not be safely determined. Our observations suggest that dendriform pulmonary ossification may be interpreted as a rare complication, or special manifestation, of chronic fibrosing interstitial inflammation of the lung.

Aged↗
PubMed1984

The use of demineralized xenogeneic bone implants to correct phalangeal defects: a case report.

Demineralized bovine bone blocks and powder were used to reconstruct phalangeal defects created by excision of bulging endochondromas . Bony reconstruction was documented by roentgenography at 9 weeks and by biopsy at 7 months. Follow-up at 22 months has shown stability of the implants, further ossification, and no recurrence of the phalangeal endochondromas . The use of xenogeneic demineralized bone implants promotes induced osteogenesis and rapid healing, avoids harvesting procedures, and offers a potentially unlimited supply of banked material.

Adolescent↗
PubMed1991

Association between primary pulmonary hypertension and portal hypertension: analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations.

To determine the clinical, laboratory and hemodynamic profile in patients with primary pulmonary hypertension and associated portal hypertension, 7 new cases and 71 previously reported cases were analyzed. There was no gender predilection and the average age at diagnosis was 41 years. Liver cirrhosis was the most frequent cause of hypertension (82%) and a surgical portosystemic shunt was present in 29%. Almost invariably, portal hypertension either preceded or was diagnosed concurrently with pulmonary hypertension, favoring the hypothesis that in portal hypertension, the pulmonary vasculature may be exposed to vasoactive substances normally metabolized or produced by the diseased liver, possibly inducing vasoconstriction or direct toxic damage to the pulmonary arteries. Clinically, exertional dyspnea was the most frequent presenting symptom (81%); other symptoms, such as syncope, chest pain and fatigue, were present in less than 33%. An accentuated pulmonary component of the second heart sound (82%) and a systolic murmur (69%) were the most common physical findings. At least 75% of these patients had evidence of pulmonary hypertension on electrocardiography (right ventricular hypertrophy) or roentgenography (cardiomegaly or dilated main pulmonary arteries, or both). Hemodynamic findings included severe pulmonary hypertension (mean pulmonary artery pressure 59 +/- 19 mm Hg) with normal pulmonary capillary wedge pressure and cardiac output. Treatment was basically palliative and the mean and median survival times were 15 and 6 months, respectively. In brief, on the basis of clinical presentation and laboratory features, patients with combined primary pulmonary hypertension and portal hypertension seldom represent a diagnostic challenge. Further research is needed on treatment, which remains palliative. The survival rate is poor and worse than that seen in isolated primary pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Reliability of bedside evaluation in determining left ventricular function: correlation with left ventricular ejection fraction determined by radionuclide ventriculography.

Ninety-nine patients with chronic coronary artery disease were prospectively evaluated to determine the reliability of historical, physical, electrocardiographic and radiologic data in predicting left ventricular ejection fraction. The left ventricular ejection fraction measured by radionuclide angiography was normal (greater than or equal to 50%) in 44 patients (group 1) and abnormal (less than 50%) in 55 patients; 36 of those 55 patients had an ejection fraction between 30 and 49% (group 2) and the remaining 19 patients had an ejection fraction of less than 30% (group 3). The ejection fraction was correctly predicted in 33 of the 44 patients (75%) in group 1 and in 47 of the 55 patients (85%) with abnormal ejection fraction (groups 2 and 3), but the degree of ventricular dysfunction was correctly predicted in only 19 patients (53%) in group 2 and in only 9 patients (47%) in group 3. Stepwise linear regression analysis was performed. The single most predictive variable was cardiomegaly as seen on chest roentgenography (R2 = 0.52). Four optimal predictive variables--cardiomegaly, myocardial infarction as seen on electrocardiography, dyspnea and rales--could explain only 61% of the observed variables in left ventricular ejection fraction. Thus, radionuclide ventriculography adds significantly to the discriminant power of the clinical, radiographic and electrocardiographic characterization of ventricular function in patients with chronic coronary heart disease.

Adult↗
PubMed1998

Roentgenographic mimics of pneumonia in the critical care unit.

Clinicians are confronted with a complex challenge when a patient is admitted to a critical care unit (CCU) with a significant chest roentgenography (CXR) abnormality. The etiology of a new infiltrate seen on CXR in a patient already in the CCU is more difficult to establish, but is of equal concern.

Critical Care↗
PubMed1997

Human postmortem retrieval of total hip arthroplasty.

Postmortem retrieval of well-functioning prostheses from total hip arthroplasty is essential in determining the quality and success of the implant, implant fixation, and operative technique. This report describes the retrieval procedure, including details on informed consent, retrieval procedure, and types and benefits of specimen analysis. Bone densitometry, roentgenography, and microscopy studies permit a level of assessment of operative and prosthetic performance not obtainable from clinical and in vivo roentgenographic evaluation alone. Findings from these techniques yielding data on stress shielding, bone mineral density, extent of bone-prosthesis apposition and osseointegration, and histologic activity are ultimately of considerable clinical significance. The implementation of retrieval programs, along with establishing early family and patient cooperation and proper planning practices, will continue to contribute invaluably to advances in orthopaedic science.

Bone Density↗
PubMedDate not supplied

Direct demonstration of an air-fluid interface by two-dimensional echocardiography: a new diagnostic sign of hydropneumopericardium.

Hydropneumopericardium is an uncommon condition that requires prompt diagnosis and treatment if hemodynamic compromise is present. Chest roentgenography, computerized tomography, and echocardiography provide important information for the diagnosis. In this article a new distinctive echocardiographic sign of hydropneumopericardium is described: the direct demonstration of the air-fluid interface in the long-axis precordial view.

Echocardiography↗
PubMedDate not supplied

Small bowel carcinoid presenting as a barolith.

Baroliths are rare complications of barium contrast roentgenography that occur almost exclusively in the colon. Baroliths are often asymptomatic, but may be associated with abdominal pain, appendicitis, bowel obstruction, or perforation. We present an unusual case of a barolith which developed within the lumen of the small bowel, and resulted in the detection of an otherwise occult carcinoid tumor of the ileum.

Abdominal Pain↗
PubMed1999

Clinical features and oesophageal motility in patients with tight fundoplication.

OBJECTIVE: Tight fundoplication is a well known complication of surgery for gastroesophageal reflux. We have noted, in clinical experience, that some patients operated for gastro-oesophageal reflux develop pharyngo-oesophageal dysphagia. This study was undertaken to elucidate, by comparing motility data in patients with and without tight fundoplication, the pathophysiologic characteristics of the swallowing mechanism and to clarify the cause of dysphagia in these patients. METHODS: Sixteen patients with postoperative persistent dysphagia following a fundoplication have been studied, of those 10 presented a lower oesophageal sphincter resting pressure above or equal to 30 mmHg (group A). Clinical work-up included a questionnaire, oendoscopy, manometry and barium meal or video-roentgenography. Oesophageal manometry was performed using a slow pull through technique while the stationary pull through technique was used for the pharyngo-oesophageal segment. The following parameters were evaluated: (a) amplitude of pharyngeal contraction; (b) upper oesophageal sphincter resting pressure; (c) amplitude of upper oesophageal sphincter contraction; (d) amplitude of oesophageal contraction; (e) lower oesophageal sphincter resting pressure. The results were compared to those of 21 patients who had a fundoplication with normal lower oesophageal sphincter pressure (group B). RESULTS: in group A there were three males and seven females, with a mean age of 51 years (ranging from 28 to 60 years). Previous operations were Nissen in two and Nissen Rossetti in eight patients. Three out of 10 patients of group A presented pharyngo-oesophageal dysphagia. Mean lower oesophageal sphincter 36 versus 21 mmHg and upper oesophageal sphincter 86 versus 42 mmHg resting pressure, pharyngeal 147 versus 76 mmHg and oesophageal amplitude, upper oesophageal contraction 251 versus 103 mmHg were significantly higher in patients of group A versus group B. An increased number of repetitive contractions was also found in group A. The presence of a strong correlation was demonstrated between the pharyngeal amplitude and the closing tone of the upper oesophageal sphincter (R2 0.742 and R2 0.739) in both groups. CONCLUSION: Tight fundoplication is, in our experience, always associated with total fundoplication. The appearance of pharyngo-oesophageal dysphagia in the postoperative period in patients operated on to correct gastroesophageal reflux using a total fundoplication, should not be under-estimated because it suggests an obstruction of the distal oesophagus.

Adult↗
PubMed1998

Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA.

A total of 119 patients were included in a randomized, double-blind, placebo-controlled trial in order to assess the S/DMOAD properties in OA of chondroitin sulfate (CS 4&6, 3 x 400 mg/day, Condrosulf IBSA, Lugano, CH). Posteranterior roentgenographies of the interphalangeal (IP) joints were carried out at the start of the study and at yearly intervals. This enabled the investigators to document the radiological progression of the anatomical lesions in the pathological finger joints over a 3-year period. It was shown that the progression of OA in the IP finger joints in an individual can be determined by the evolution of his finger joints through previously described anatomical phases: 'N' (not affected), 'S' (classical OA), 'J' (loss of joint space), 'E' (erosive OA) and 'R' (remodeled joint). Structure/disease-modifying anti-OA drug (S/DMOAD) properties were searched for by assaying the number of patients developing OA in previously normal IP joints ('N' > 'S'), or progressing through the described anatomical phases of the disease ('S' > 'J', 'S' > 'E', 'J' > 'E', 'S' > 'R', 'J' > 'R', 'E' > 'R'). In the CS 4&6 group we observed a significant decrease in the number of patients with new 'erosive' OA finger joints. This result is particularly important since OA of the finger joints becomes a clinical problem (pain, functional loss) when 'S' joints progress to 'J' and especially 'E' phases. During and after these 'E' phases, joints will remodel and show the nodular deformities characteristic of Heberden's and Bouchard's nodes. Treated patients were protected against erosive evolution.

Aged↗
PubMed1997

Identification of human remains: forensic radiology.

The identification of human remains is of paramount importance in medicolegal investigations. The comparison of antemortem and postmortem radiographic records is one of the main techniques used to achieve a positive identification. The purpose of this paper is to present a comprehensive review of the use of roentgenography in forensic medicine with special emphasis on the nature of the radiographic markers often utilized for identification. Clinical radiologists should be aware of the importance of storing radiographs over prolonged periods of time and of efficient record keeping methods to enable prompt retrieval of X-ray films in mass disaster situations. Furthermore, because of his skills in radiographic evaluation, the radiologist's expertise might prove invaluable in forensic consultations.

Journal Article↗
PubMed2001

Pulmonary infiltration with eosinophilia (PIE) syndrome induced by antibiotics, PIPC and TFLX during cancer treatment.

Drugs induce a variety of pulmonary diseases including pulmonary infiltration with eosinophilia (PIE) syndrome. We report a case of PIE syndrome which was observed after neck dissection. An 83-year-old male patient attended our clinic complaining of upper neck swelling and was diagnosed as advanced lymph node metastasis related to previously resected oral carcinoma and underwent neck dissection. Despite administration of antibiotics (piperacillin sodium, PIPC; and tosufloxacin tosilate, TFLX), fever and an elevation of the c-reactive protein (CRP) level with neutrophilia appeared, and an infiltration shadow was observed in the right lower pulmonary field. With the suspicion of pneumonia, the antibiotics were exchanged for panipenem/betamipron. However, the pulmonary infiltration spread widely, CRP increased to 12.9 mg/dl and severe eosinophilia (23%) was observed a few days after changing the antibiotics. PIE syndrome was suspected, and the patient underwent steroid mini-pulse therapy consisting of methylprednisolone sodium succinate (500 mg) and prednisolone (60 mg). After steroid therapy, the pulmonary condition largely improved. However, about 2 weeks after the start of steroid administration, a fever and a further elevation of CRP were observed with an increase of beta-D-glucan in serum. Roentgenography revealed diffuse infiltration shadows throughout the lungs, and the patient died about 3 weeks after the onset from respiratory distress. In vitro, blastogenesis of patient's peripheral blood lymphocytes was strongly enhanced by PIPC and TFLX, and they generated a large amount of interleukin-5 in the presence of PIPC or TFLX. The clinical course and laboratory examination results revealed that PIE syndrome may have been induced by PIPC and TFLX and that PIE syndrome should be suspected in treatment of carcinomas when dyspnea and pulmonary infiltration are complicated with eosinophilia.

4-Quinolones↗
PubMed2004

Imaging of transmural migration of a retained surgical sponge: a case report.

A 61-year-old woman who had undergone a hysterectomy 15 years before this presentation had suffered from intermittent abdominal pain and a palpable lower abdominal mass for 3 months. Plain roentgenography revealed a radiopaque mass with serpiginous density in the pelvic region. Sonography showed curvilinear hyperechogenicity with an acoustic shadow. A small-bowel series revealed a huge amorphous filling defect inside the ileum. Computed tomography showed that the mass was a spongiform object with a whirl-like appearance mixed with air and with peripheral calcification.

Abdominal Pain↗
PubMed2003

Preliminary experience with anterior interbody titanium cage fusion for treatment of cervical disc disease.

This study evaluated the efficacy and safety of titanium cage implants in cervical reconstruction to treat cervical spondylosis. Surgical data covered a 4-year period from January 1999 to December 2002 and included 34 consecutive patients, 20 men and 14 women, with ages ranging from 27 to 84 years (mean, 57 years). Patients underwent anterior cervical microdiscectomy followed by interbody fusion with a titanium cage implant (rather than an autogenous iliac crest bone graft) at a single level ranging from C3 to C7. Twenty-one patients had a herniated intervertebral disc, nine had degenerative disc disease, and four had previous failed autograft fusion surgery that required revision. At clinical presentation, 26 patients had neck pain, 23 had radiculopathy, and nine had myelopathy. Diagnostic imaging studies included spinal dynamic roentgenography, computerized tomography, and magnetic resonance imaging. Lesions were located at C3-4 in seven cases, C4-5 in 14 cases, C5-6 in nine cases, and C6-7 in four cases. The follow-up period ranged from 7 to 48 months (mean, 26 months). Results revealed that the procedure was technically feasible. There were no intra- or postoperative complications. The most commonly used cage was 9 mm high. Imaging studies showed no cage instability, migration, or pseudarthrosis. Although mild subsidence (< 5 mm) was observed in three cases, these patients preserved adequate postoperative cervical lordosis and the subsidence did not preclude a good clinical result. The advantages of this procedure over a similar operation using traditional tricorticate bone graft are: no graft morbidity; shorter operation time (mean time saved, 35 minutes); reduced blood loss (average blood loss, 75 mL); and early postoperative ambulation (mean, 4.7 hospital days). Nearly all patients rapidly lost their neck pain (92%, 24/26) and radicular symptoms (87%, 20/23) after surgery. The recovery rate from myelopathy was 44% (4/9). Progressive bony shield formation over the anterior/posterior cortex (sentinel sign) indicated fusion in five cases.

Adult↗
PubMed2003

Primary malignant fibrous histiocytoma of the lung: a case report.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. However, primary MFH of the lung is rare, with only a few cases reported in the literature. Here, we report the case of an 86-year-old male who was admitted to our hospital with the chief complaint of exertional dyspnea and poor appetite. Chest roentgenography revealed a 9 x 15 cm, pleural-based opacity in the left lower lobe. Chest computerized tomography disclosed a well-defined mass with heterogeneous density in the left lower lung field. The diagnosis of MFH was confirmed by thoracoscopic lung biopsy and pathologic examination. Supportive care was given because of extreme old age and poor performance status (the patient's Karnofsky performance status was 30). The patient died from respiratory failure 2 months later.

Aged↗
PubMed1990

Gastrointestinal transit of nondisintegrating, nonerodible oral dosage forms in pigs.

Gastrointestinal (GI) transit data necessary as "baseline" or "control" information were collected using pigs as animal models preliminary to bioavailability studies of new sustained action formulations. Density and size effects of nondisintegrating dosage forms on GI transit were investigated. Initially, enteric-coated nondisintegrating magnesium hydroxide caplets (density, 1.5 g/ml; size, 19.6 x 9.5 mm; weight, 1.2 g) were utilized in seven pigs. Prolonged gastric residence (greater than 5 days) occurred in every case for this dosage form. Therefore, nondisintegrating caplets of three densities (1.25, 1.45, and 2.3 g/ml) and three different sizes (large, 20 x 10 mm; medium, 10 x 10 mm; small, 5 x 10 mm) were studied in two more pigs. Roentgenography was used to visualize passage of caplets through the GI tract. Heidelberg pH capsules (size, 8 x 20 mm; density, 1.61 g/ml) were also used in this study. Total GI transit times range from 2 to 33 days for 22 administrations of these nondisintegrating dosage forms. Pigs are found to not be an appropriate model for evaluating bioavailability of nondisintegrating controlled-release dosage forms because total GI transit time (especially gastric transit) is much too long.

Animals↗
PubMed1989

Cephalometric and cineradiographic study of deviant resonance in hearing-impaired speakers.

To study physiological basis for deviant resonance in hearing-impaired speakers, cephalometric roentgenography and cineradiography were applied to analyze oral/pharyngeal relationships during vowels produced in isolation and within a sentence context. The films, synchronized with sound recording, were traced and measured for 10 normal hearing and 4 hearing-impaired women with deviant resonance. Vocal tract conformations and dimensions were defined by measures of the lips, tongue, mandible, velum, hyoid bone, epiglottis, and laryngeal sinus. Means, standard deviations, and analyses of variance were applied to facilitate descriptions and comparisons between the groups. The hearing-impaired speakers had near normal lip openings for /i/ and /u/ but more open positions for /a/. The tongue tended to retract for the front vowel and front for the back vowel /u/. For high vowels, most of the hearing-impaired speakers had an elevated hyoid, an unusually large vertical dimension between hyoid and laryngeal sinus, and a retracted tongue root, which was associated with a marked retraction or deflection of the epiglottis toward the pharyngeal wall. The cine analysis of the normal hearing speakers showed rather well defined and consistent shifts in tongue position for the front vowels produced in the sentence context. The hearing-impaired speakers with deviant resonance showed greater variation among speakers in tongue body position and a significant retrusion of the dorsum of the tongue at a site significantly lower than observed in hearing speakers. The consistent tongue root retraction during static as well as dynamic speech production is interpreted as support for Boone's hypothesized cause of pharyngeal resonance in speech of the hearing impaired.

Adult↗