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PubMedDate not supplied

Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site.

Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site is relatively uncommon and presents a challenging diagnostic and therapeutic dilemma. Diagnostic evaluation includes fine-needle aspiration of the neck mass, chest roentgenography, computed tomography, and/or magnetic resonance imaging of the head and neck, followed by panendoscopy and biopsies. The primary tumor will be detected in approximately 40% of patients; approximately 80% of cancers are located in the base of the tongue or tonsillar fossa. Management options include treatment of the neck alone or both sides of the neck and the potential head and neck primary sites. The latter approach is associated with better long-term control above the clavicles. The 5-year survival rate is approximately 50% after treatment and is influenced by the extent of neck disease. In this article, we review the pertinent literature.

Biopsy, Needle↗
PubMed2000

Outcome of squamous cell carcinoma of the gingiva: a follow-up study of 83 cases.

BACKGROUND: Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications. PURPOSE: A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified. MATERIAL: From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection. METHODS: A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method. RESULTS: Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx. CONCLUSION: Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.

Adult↗
PubMed1977

Recurrent carcinoma of the colon in the anastomosis diagnosed by roentgen examination and colonoscopy.

After resection for cancer of the large bowel recurrence at the anastomosis occurs in about 10%. In 30 operated cases roentgenography and colonoscopy were performed. In 18 cases roentgen examination gave rise to suspicion of recurrence at the anastomosis but this was confirmed by colonoscopy and surgery only in 6 cases. In two additional cases with normal roentgenographic findings recurrence at the anastomosis and a second primary cancer were diagnosed by colonoscopy in one case each. The clinical symptoms provided no guidance in the diagnosis of recurrence. Roentgen examination is admittedly less conclusive than colonoscopy for discovery of recurrent and metachronous carcinoma. The methods are, however, complementary and both examinations should be regularly carried out in order to establish an early diagnosis.

Adenocarcinoma↗
PubMed1976

[Roentgenmorphologic findings in single homotransplantation of non immunosuppressive treated canine lungs (author's transl)].

According to plain chest roentgenography correlated to needle biopsies the following grades in the course of rejection after single lungtransplantation could be evaluated. 1) Begin of rejection: perihilar alveolar infiltrate. 2) Increase of the infiltrates (positive Airbronchogram). 3) Almost total consolidation of the graft. 4) Complete consolidation of the graft, mediastinal hernia caused by the own lung.

Animals↗
PubMed2000

[Unclear lactate acidosis in a patient with heart failure under long-term diuretic therapy].

HISTORY AND CLINICAL PRESENTATION: A severely ill 84-year old patient, known to suffer from a chronic congestive heart failure, was admitted to the emergency room because of increasing dyspnea. His blood pressure was stable (125/80), his heart rate normal (66/min), the respiratory rate, however, was elevated at 35/min and he exhibited substantial peripheral edema. There were no signs indicating an infectious process. EXAMINATIONS: Blood gas analysis yielded a marked, respiratorically compensated metabolic acidosis with a base excess of -8.6. The chest roentgenography showed a markedly dilated heart without pulmonary-vascular congestion or infiltrates. The serum lactate was substantially increased at 11.4 mmol/l (0.6-2.44). TREATMENT AND COURSE: A cardiovascular beriberi syndrome was suspected and 100 mg of thiamine administered i.v. Within hours the clinical picture improved significantly. Two hours after administration of thiamine serum lactate concentration was 5.7 mmol/l, about 12 hours later the patient suffered no longer from dyspnea and the lactate was at a normal level. CONCLUSION: Thiamine deficiency as a cause for an elevated serum lactate or lactate acidosis with or without cardiovascular failure may not be overlooked. Without adequate treatment it may end lethally, although it can be treated easily, effectively and without side effects. The potential frequency of thiamine deficiency among the normal population even in our society may be under-estimated due to the particular properties of this vitamin.

Acidosis, Lactic↗
PubMed2002

Pulmonary alveolar microlithiasis.

Pulmonary alveolar microlithiasis is a rare pulmonary disorder of unknown etiology characterized by intra-alveolar development and deposition of microliths or calcispherytes consisting of calcium phosphate. Approximately 400 cases of this rare disorder have been described in the literature. The age range of patients is from newborn to 80 years, with a mean age at diagnosis of about 35 years. No sexual predominance has been noted. In about half of the reported cases, a familial pattern has been found, with the disease usually affecting the siblings. The progression of the disease is generally very slow, some patients having been followed up for more than 30 years without evidence of change. Pulmonary function studies demonstrate a tendency toward a restrictive pattern. Chest roentgenography, high-resolution computed tomographic chest scan, and technetium-99m lung scan are useful in the diagnosis. A definitive diagnosis can be established by bronchoalveolar lavage or lung biopsy. There is no known therapy for this unusual disorder. In patients who develop progressive respiratory insufficiency and cor pulmonale, lung transplantations have been performed.

Journal Article↗
PubMed2002

[MR Angiography: First choice for diagnosis of the arterial vascular system].

Contrast medium-enhanced, 3D MR angiography enables an extensive and diagnostically accurate evaluation of arterial vessels in the neck, thorax, abdomen, and limbs. Advances in the field of MR apparatus technology and the introduction of contrast-medium enhanced MR angiographic techniques have made this development possible. Contrast medium-enhanced MR angiography combines the intravenous bolus administration of a paramagnetic contrast medium with the rapid acquisition of 3D datasets. The possibilities for obtaining data in the thorax and abdomen within one breath-hold, the resulting high contrast between vessel lumen and surrounding soft tissue as well as the inherent 3D nature of the images allow for diagnostically relevant image quality. In many centers contrast-enhanced 3D MR angiography has widely replaced the conventional digital subtraction roentgenography for the clarification of pathologies in arterial vessels. This review presents a survey of the technical background of contrast medium eýnhanced 3D MRA. In addition, the spectrum of indications is given and discussed on the basis of clinical examples.

Arteries↗
PubMed1980

Diagnostic value of intraoperative fiberscopy for small-intestinal polyps in familial adenomatosis coli.

X-ray examination and intraoperative fiberscopy of the small intestine were performed in 20 patients with familial adenomatosis coli. Roentgenographic study detected polypoid lesions in the upper jejunum in 2 patients (10%), and in the terminal ileum in 9 (45%). In contrast, endoscopic study revealed polyps in the jejunum in 10 patients (50%), and in the ileum in 14 (70%). Polyps in most cases were multiple and small in size (less than 3 mm in diameter). Histology revealed the lesions of the jejunum to be adenomas, and those of the ileum to be lymphoid hyperplasia with or without adenoma. The present study suggests that intraoperative endoscopy is much more valuable than roentgenography in detecting these minute polyps of the small intestine in this disease.

Adolescent↗
PubMedDate not supplied

[Course and prognosis of systemic juvenile chronic arthritis--retrospective study of 187 patients].

The course of disease in 187 patients with systemic juvenile chronic arthritis was documented in a retrospective study 2-20 years after onset. Despite differences in joint involvement in the first 6 months of the disease, most of the patients subsequently developed a polyarthritis leading to severely impaired function in approximately 50% of them. Advanced degenerative changes identified by roentgenography were found in particular in the wrist and hip joints. There was an overall regression in the frequency of the extra-articular symptoms and the humoral pathologic activity. Fifteen years after the onset of disease only 30% of the patients still had systemic signs, and humoral activity was found in less than 50%. The mortality rate of 14% was primarily due to infections and kidney failure in amyloidosis. The course varies considerably from child to child. It has not so far been possible to differentiate prognostic factors for different subgroups.

Arthritis, Juvenile↗
PubMedDate not supplied

[Technique and value of imaging methods in the assessment of the elbow joint].

Roentgenography is the standard diagnostic tool for study of skeletal injuries and diseases around the elbow. The basic x-ray examination of the elbow includes the two standard static positions (frontal and lateral). If necessary oblique views are required to evaluate the radial head and the coronoid process. Dynamic examination (flexion-extension, ulnar-radial deviation) is indicated when instabilities are suspected. Indication, technique and interpretation of these images should be of general knowledge in the common practice of the orthopaedic surgeon. For further evaluation in unclear conditions the patient should be referred to a specialized orthopaedic surgeon, who has not only to decide about the indication of further imaging techniques but also has to establish a concept for the different treatment options (e.g. arthroscopy, open surgery).

Arthrography↗
PubMed1983

Heterotopic bone formation in abdominal midline scars.

The heterotopic bone formation may occur in vertical upper abdominal midline scars. Fifteen such patients are reported. They all had annoying pressure symptoms and seven of them were operated due to the symptoms. The excised bone formation was located between the fascia and peritoneum fixed to the fascia. The ossification of the upper midline abdominal scar seems to be ten times more common in men than in women. The bone formation of the scar may cause problems in differential diagnosis, especially in the early phase of calcification. The radiological diagnosis is usually easy, either by plain roentgenography or if oblique views of the abdomen are taken.

Abdomen↗
PubMed1982

[Importance of cholegraphy for indicating litholysis].

Today patients with gallstones are treated surgically, by means of drugs, or by endoscopy. However, only cholesterol stones can be dissolved with bile acids. Besides the cholesterol stones in the gallbladder, insoluble pigment stones or insoluble stones with a high inorganic calcium content will be found. In every patient, the solubility of the gallbladder stones must be established by mineralogical analysis. Sonography is very helpful in detecting gallbladder stones, but it is impossible to perform a mineralogical analysis with this method. Plain radiography is likewise insufficient. The only way to obtain a relatively accurate selection of patients with soluble gallstones is the performance of roentgenography after cholecystography. Cholecystography for mineralogical analysis must always follow detection of gallstones by sonography.

Chenodeoxycholic Acid↗
PubMed1980

[Bronchopulmonary dysplasia: X-ray patterns and grading according to stages (author's transl)].

Bronchopulmonary dysplasia, first described by Northway in 1967 as a separate entity, was graded into four stages. Basing on thoracic x-ray films of 14 newborn and prematurely born infants an attempt has been made to analyse the x-ray patterns of signs characterising bronchopulmonary dysplasia and to establish a relation between the x-ray signs and the four stages. With few exceptions the various radiologic signs were seen in all stages, although with varying incidence. It follows that x-ray visualisation of the thorax yields limited pointers only to the actual stage of the disease. Roentgenography is the method of choice (in connection with the pattern of clinical signs) for diagnosing bronchopulmonary dysplasia and should be also employed for controlling the course of the disease and for the identification of eventual complications.

Bronchi↗
PubMed1984

Physiologic abnormalities of cardiac function in progressive systemic sclerosis with diffuse scleroderma.

To investigate cardiopulmonary function in progressive systemic sclerosis with diffuse scleroderma, we studied 26 patients with maximal exercise and redistribution thallium scans, rest and exercise radionuclide ventriculography, pulmonary-function testing, and chest roentgenography. Although only 6 patients had clinical evidence of cardiac involvement, 20 had abnormal thallium scans, including 10 with reversible exercise-induced defects and 18 with fixed defects (8 had both). Seven of the 10 patients who had exercise-induced defects and underwent cardiac catheterization had normal coronary angiograms. Mean resting left ventricular ejection fraction and mean resting right ventricular ejection fraction were lower in patients with post-exercise left ventricular thallium defect scores above the median (59 +/- 13 per cent vs. 69 +/- 6 per cent [P less than 0.025], and 36 +/- 12 per cent vs. 47 +/- 7 per cent [P less than 0.025], respectively). We conclude that in progressive systemic sclerosis with diffuse scleroderma, abnormalities of myocardial perfusion are common and appear to be due to a disturbance of the myocardial microcirculation. Both right and left ventricular dysfunction appear to be related to this circulatory disturbance, suggesting ischemically mediated injury.

Adult↗
PubMed1992

Treatment of postmenopausal osteoporosis with calcitriol or calcium.

BACKGROUND AND METHODS: Osteoporosis is a common problem whose management is controversial. To evaluate the efficacy and safety of calcitriol (1,25-dihydroxyvitamin D3) in the treatment of postmenopausal osteoporosis, we conducted a three-year prospective, multicenter, single-blind study in 622 women who had one or more vertebral compression fractures. The women were randomly assigned to receive treatment with calcitriol (0.25 micrograms twice a day) or supplemental calcium (1 g of elemental calcium daily) for three years. New vertebral fractures were detected by means of lateral roentgenography of the spine each year, and calcium absorption was measured in 392 of the women. RESULTS: The women who received calcitriol had a significant reduction in the rate of new vertebral fractures during the second and third years of treatment, as compared with the women who received calcium (second year, 9.3 vs. 25.0 fractures per 100 patient-years; third year, 9.9 vs. 31.5 fractures per 100 patient-years; P less than 0.001). This effect was evident only in women who had had five or fewer vertebral fractures at base line (second year, 5.2 vs. 25.3 fractures per 100 patient-years; third year, 4.2 vs. 31.0 fractures per 100 patient-years; P less than 0.0001). The groups also differed significantly in the number of peripheral fractures; 11 such fractures occurred in 11 women in the calcitriol group, whereas 24 occurred in 22 women in the calcium group (P less than 0.05). There was no significant difference between the groups in the incidence of side effects requiring withdrawal of treatment (8.6 percent in the calcitriol group vs. 6.5 percent in the calcium group). CONCLUSIONS: Continuous treatment of postmenopausal osteoporosis with calcitriol for three years is safe and significantly reduces the rate of new vertebral fractures in women with this disorder.

Aged↗
PubMed1995

Outbreak of tuberculosis among regular patrons of a neighborhood bar.

BACKGROUND: Outbreaks of tuberculosis have been reported in prisons, nursing homes, urban homeless shelters, and other crowded settings. We report a nonresidential outbreak of tuberculosis that originated in a neighborhood bar. METHODS: A homeless patient with highly infectious pulmonary tuberculosis was a regular patron of a neighborhood bar during a long symptomatic interval before diagnosis. We investigated 97 other regular customers and employees of the bar through interviews, tuberculin skin testing, and chest roentgenography. We performed DNA fingerprinting on isolates from the index patient and 11 other patients. RESULTS: The index patient apparently infected 41 of 97 contacts (42 percent), resulting in 14 cases of active tuberculosis and 27 cases of infection but no disease (indicated by positive tuberculin skin tests). Four other cases of active tuberculosis occurred among regular customers of the bar who were missed by the contact investigation. There were also two secondary cases. Radiographic findings in active cases included upper-lobe disease in seven cases (three cavitary) and negative chest films at the time of diagnosis in four cases. All 12 culture isolates we tested had the same chromosomal-DNA restriction pattern. CONCLUSIONS: The spread of tuberculosis in a neighborhood bar can be a major public health problem. The high rate of infection and disease among the contacts was unexpected and was not due to coinfection with the human immunodeficiency virus. Possible explanations include heavy alcohol use among the contacts, high infectivity of the index case, or both. Sputum cultures must be performed in tuberculin-positive contacts who have symptoms, even if the chest films are normal.

Alcoholism↗
PubMed2000

Adult-onset recalcitrant eczema: a marker of noncutaneous lymphoma or leukemia.

BACKGROUND: Generalized eczema or erythroderma may be the presenting sign of cutaneous T-cell lymphoma. Additionally, intractable pruritus has been associated with Hodgkin's lymphoma. However, reports of adult-onset eczematous dermatitis has rarely been linked to noncutaneous lymphoproliferative disorders. OBSERVATIONS: We observed one patient in 1993 who had the onset of intractable dermatitis characterized by prurigo nodularis-like lesions and widespread erythematous plaques. After 18 months of cutaneous symptoms he experienced dyspnea. At this time Hodgkin's disease was diagnosed. This observation prompted us to evaluate subsequent patients with adult-onset eczema who were poorly responsive to therapy and in whom an obvious cause could not be determined. Over the next 24 months we identified an additional 2 patients with lymphoma who met this criteria. CONCLUSION: Unexplained eczema of adult onset may be associated with an underlying lymphoproliferative malignancy. When a readily identifiable cause (eg, contactants, drugs, or atopy) is not found, a systematic evaluation should be pursued. Patients should be evaluated with a careful physical examination, complete blood cell counts, peripheral blood smears, chest roentgenography, computed tomography of the chest and abdomen, and serum protein electrophoresis.

Adult↗
PubMed2001

Subungual exostosis of the third toe.

Subungual exostosis is a variant of osteochondroma that appears as a pinkish nodule under the free end of the nail plate. It becomes symptomatic when large enough to disrupt the overlying nail on the digit or through mechanical irritation of the exostosis from physical activity. Appropriate workup of such a lesion is important, because many cases of subungual exostosis are initially misdiagnosed by a variety of specialists, including dermatologists. With the use of history and roentgenography, subungual exostosis can be effectively diagnosed or excluded. Appropriate treatment of subungual exostosis can be selected- surgical excision of the lesion with significant cure rates achieved. Although most cases of subungual exostosis are localized to the great toe, we describe a 32-year-old woman who developed a subungual exostosis on her right third toe. Appropriate diagnostic workup and surgical treatment of the right third-toe exostosis has resulted in complete relief of symptoms with no signs of recurrence 7 months after surgery.

Adult↗