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PubMedDate not supplied

Spontaneous pneumoperitoneum associated with colonic pseudo-obstruction.

Pneumoperitoneum is almost always pathognomonic of a perforated abdominal viscus requiring urgent surgical intervention. Spontaneous or non-surgical pneumoperitoneum is a rare clinical condition arising secondary to abdominal, thoracic, gynaecologic or idiopathic causes. In addition to good clinical judgement, an important component in the management process is to rule out other causes of pneumoperitoneum by performing appropriate investigations. We describe a 60-year-old man who presented with clinical features of pseudo-obstruction, following an injury to his back which was compounded by hypokalaemia. Roentgenography revealed massive pneumoperitoneum and colonic distension. As there were no overt clinical features of peritonitis, the patient was managed conservatively with parenteral nutrition and close observation. A water-soluble contrast enema and computed tomography of the abdomen were of no help in identifying the cause of his pneumoperitoneum but were helpful in eliminating the presence of hollow viscus perforation or an obvious inflammatory focus. The aetiology of pneumoperitoneum in our patient was most likely due to dissection of air through the distended colonic wall, secondary to large bowel pseudo-obstruction. The diagnosis of spontaneous or non-surgical pneumoperitoneum is one of exclusion and we stress the importance of relying on clinical parameters when managing such patients conservatively.

Colonic Pseudo-Obstruction↗
PubMed1975

Determining the cause of hematuria.

Hematuria must always be regarded as a serious symptom. A careful history and physical examination are important in determining the source and cause of the bleeding. Procedures useful in evaluating hematuria include roentgenography, cystoscopy, angiography, ultrasound, and urinary cytology. Of these, cystoscopy is the most important, particularly during periods of active bleeding. Renal biopsy is not routinely advised but is useful in certain cases. A diagnosis of idiopathic hematuria, or hematuria of unknown origin, is warranted only after careful, complete, and repeated examinations.

Hematuria↗
PubMed1982

Pitfalls in simple fracture care.

Many errors in diagnosing simple fractures are made because of inadequate roentgenography and inexperience in interpretation. Two views are almost always needed, and in some cases more. An x-ray film of the opposite uninjured extremity may be helpful for comparison. In many instances, stress views can differentiate bone injury and ligament injury. The first physical examination after injury must be thorough, with a search for peripheral nerve injury and vascular injury. A cast should not be used if certain conditions are present, eg, severe dermatitis, circulatory problems, venous insufficiency, paraplegia. When applying a cast, care must be taken to position the body structure correctly, include only the joints necessary, avoid too tight application, and choose the proper cast length. Prolonged immobilization can result in joint stiffness or even disability. The patient should be warned about danger signals, such as pain, numbness, and cyanosis, and should be monitored regularly for complications.

Blood Vessels↗
PubMed1987

Asymptomatic bronchogenic cyst of the mediastinum.

Bronchogenic cysts of the mediastinum are benign anomalies of the ventral foregut. The majority of adult patients are asymptomatic. Chest roentgenograms and computed tomographic scans are the primary diagnostic tools. Other procedures may be required, depending on the presentation and the entities being considered. Thoracotomy and complete resection are the recommended treatment. The patient described here represents a typical case of asymptomatic bronchogenic cyst detected on routine roentgenography.

Adult↗
PubMed1988

Bronchopulmonary sequestration. Unusual cause of a lung mass in an adult.

Bronchopulmonary sequestration is a relatively rare, albeit important, cause of pulmonary disease in the adult. It is characterized by a segment of non-functioning lung parenchyma that receives its blood supply from an anomalous systemic artery. Although chest roentgenography and arteriography are useful in detecting this condition, the most crucial element in diagnosis is a high index of suspicion. Bronchopulmonary sequestration is clinically significant because of its potential for medical and surgical complications. Surgery continues to be the appropriate treatment for symptomatic patients, but experts disagree on the most appropriate management for patients who are asymptomatic.

Bronchopulmonary Sequestration↗
PubMed1999

Hydrosonography of the small intestine: comparison with radiologic barium study.

BACKGROUND: Transabdominal ultrasonography of the small intestine is hampered by luminal gas. We have developed a new sonographic method (hydrosonography) that largely eliminates the gas problem and have compared this method with radiologic barium study. METHODS: Fifty-six patients admitted for X-ray examination of the small bowel because of abdominal pain, diarrhoea, weight loss and/or known inflammatory bowel disease were examined. To remove luminal gas before performing transabdominal ultrasonography, 21 of polyethylene glycol solution was inserted through a nasojejunal tube by means of a peristaltic pump. Wall thickness, peristalsis, luminal narrowing, prestenotic dilatation, and extraintestinal complications were recorded. RESULTS: On ultrasonography we were able to visualize the terminal part of the ileum in 98% of the patients. Perfect agreement between hydrosonography and barium studies was seen in 50 of 55 patients. However, 44 patients had normal findings on both examinations. The sensitivity and specificity of hydrosonography were 64% and 100%, respectively. The positive predictive value was 100%. For X-ray examination sensitivity and specificity were 91% and 100%, respectively. Four patients with minor mucosal abnormalities or pathologic findings in the upper part of the small intestine accounted for the relatively low overall sensitivity found for hydrosonography compared with roentgenography. However, important extraintestinal complications were disclosed by ultrasound. CONCLUSIONS: Hydrosonography of the small bowel is a new, convenient, and reliable method for examining the lower part of the small intestine. However, it cannot replace barium studies in patients with mucosal abnormalities. especially in the upper part of the small bowel.

Adolescent↗
PubMedDate not supplied

Bone ageing: genetics versus environment.

Bone ageing results from a complex interaction between genetic and environmental factors (such as diet, climate and physical exercise) throughout human life. According to current literature, the most popular measures of bone ageing are osseometric measurements (OSM), bone mineral density (BMD) and osseographic scores (OSS), based on descriptive criteria of bone age. Plain roentgenography allows simultaneous assessment of all three measures. Ethnic differences with regard to these bone ageing characteristics have prompted us to study to the process anew, with the aim of elucidation the nature of the genetic and environmental components involved, and the possible interaction(s) between them. Despite abundant data on ethnic differences regarding these measures, modern knowledge on the genetics of these processes has derived primarily from the family studies of BMD, which pointed to strong involvement of the familial factors on bone mass. Segregation analysis performed by us in two ethnically different samples of pedigrees revealed a significant effect of the putative major gene on BMD of both compact and cancellous bone. The major finding of our bivariate segregation analysis was that it lead to the acceptance of the hypothesis predicating a single major locus with pleiotropy to both cancellous and compact BMD, but clearly rejecting the polygenic hypotheses. Our study of cortical index (CI) provided evidence that a single potential major gene controls not only the baseline trait level, but also the age at onset of the involutive bone changes, and the rate of the CI change with age. When we examined the environmental vs genetic influences on OSS variation in 32 human populations, we found very little environmental effect on the rate of bone change (r2 = 0.107), but a substantial effect on this rate of the genetic differences between populations (r = 0.480). Clarification of the genetic basis of bone ageing could have wide-ranging applications in the prevention and treatment of bone degenerative diseases such as osteoporosis and osteoarthritis, before irreversible damage takes place. There is thus a need to target the genetic analysis of BMD and the biochemical regulating factors of bone turnover through the use of molecular genetic techniques.

Aging↗
PubMed2000

Comparison of Tc-99m sestamibi, serum neuron-specific enolase and lactate dehydrogenase as predictors of response to chemotherapy in small cell lung cancer.

Neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) are tumor markers of small cell lung cancer (SCLC) which were reported to predict outcome of patients with SCLC. We previously reported that dipyridamole-modulated Tc-99m sestamibi (dipyridamole-MIBI) single photon emission computed tomography (SPECT) could predict the response to chemotherapy in SCLC patients. The purpose of this study was to compare dipyridamole-MIBI and pretreatment serum levels of NSE and LDH for the prediction of response to chemotherapy in SCLC. Twenty-eight SCLC patients underwent dipyridamole-MIBI SPECT 3 to 7 days before starting chemotherapy (80 mg/m2 etoposide and 80 mg/m2 cisplatin every 3 or 4 weeks for at lease two cycles). Serum levels of NSE and LDH were also measured at the same day of the imaging. Tomographic images before and after 0.84 mg/kg dipyridamole infusion were acquired 1 hour after injection of 370 (10 mCi) and 1,110 (30 mCi) MBq MIBI, respectively. The response to chemotherapy was grouped as specified as complete (CR), partial response (PR), no change (NC), and progressive disease (PD), according to the change in tumor size on chest roentgenography and CT. Patients showing CR and PR were classified as responders, and those who showed NC and PD were considered nonresponders. Among the 28 patients, 15 were responders (2 CR, 13 PR) and 13 were nonresponders (11 NC, 2 PD). The change of tumor-to-normal lung ratio (T:NL) after infusion of dipyridamole was significantly higher in responders as compared with nonresponders (0.38 +/- 0.64 vs. -0.38 +/- 0.50, respectively, p = 0.002). However, pretreatment serum NSE and LDH levels did not correlate with the response to chemotherapy. Increase of T:NL after dipyridamole infusion was a strong negative predictor of chemotherapeutic response in SCLC patients, while NSE and LDH could not predict it.

Aged↗
PubMed1995

Appropriateness of the use of clinical and radiologic examinations and laboratory tests in the follow-up of surgically-treated breast cancer patients. Results of the Working Group on the Clinical Aspects of Follow-up.

BACKGROUND: The aim of this working group was to assess the appropriateness of use of radiologic examinations, laboratory tests and periodic check-ups for surgically-treated, disease-free breast cancer patients. MATERIALS AND METHODS: A total of 252 clinical scenarios (36 for each of the 8 exams considered: clinical examination, mammography, chest roentgenography, hematochemical tests, markers, bone scan, liver echography/abdominal CT scan), each representing a specific surgically treated and disease-free breast cancer patient, were rated by the members of the panel. A 3 point scale was utilized as to whether the test in question was judged inappropriate (1), questionable (2), or appropriate (3) (in the latter case the panel member was also asked for the advised frequency of the exam expressed in months). RESULTS: After two assessment sessions, consensus among members of the panel was reached on 216 of the 252 scenarios; disagreement remained on only 36 clinical scenarios. CONCLUSIONS: The panel agreed that only clinical examinations and mammographies should be recommended for routine clinical follow-up of surgically-treated breast cancer patients. Given the current available therapeutic options, these would assure adequate medical care and psychological aid.

Aged↗
PubMed1993

Persistent fever due to occult dental infection: case report and review.

Dental sepsis is one potential cause of persistent fever that can escape detection. A patient with febrile episodes due to an occult tooth abscess of 2 years' duration is described. A search of the English-language literature revealed 20 other cases of fever of obscure origin arising from dental sources. This diagnosis may be suggested by repeated questioning of the patient about his or her medical history, repeated physical examination, an elevated erythrocyte sedimentation rate, or a history of failure to respond to antibiotic therapy. Dental infection is unlikely in patients who have a white blood cell count of > 11 x 10(9)/L, a temperature of > 39.5 degrees C, or positive blood cultures. The diagnosis may be made by repeated focused clinical examination, dental roentgenography, or radiolabeled leukocyte scintigraphy. Detection of dental sepsis is worthwhile since the febrile condition can be cured in all instances by tooth extraction and abscess drainage, with or without concurrent antibiotic therapy.

Erythromycin↗
PubMed1993

Disseminated bipolaris infection in an asthmatic patient: case report.

We present the case of a patient with a history of asthma who developed cough and hemoptysis that were unresponsive to antituberculous therapy. Chest roentgenography demonstrated right-sided collapse with consolidation and a pleural effusion. Bronchial biopsy revealed fungal hyphae, and cultures later yielded Bipolaris spicifera. In addition, weight loss and intractable hypotension in association with hyponatremia and elevated potassium levels suggested addisonian crisis, which was confirmed by measurement of serum ACTH and cortisol levels. Computed tomography of the abdomen revealed bilateral adrenal involvement. Tissue obtained on biopsy of the adrenal glands yielded B. spicifera. The patient responded to treatment with 2 g of iv amphotericin B; the adrenal masses and pneumonia resolved, and he remained well until last seen in July 1992. However, he requires replacement therapy with prednisone and fludrocortisone. On review of the available literature, we were unable to find a previously reported case.

Adrenal Gland Diseases↗
PubMed1993

Extraosseous epidural tuberculoma: case report and review.

Extraosseous epidural tuberculoma has been reported infrequently, in spite of the widespread availability in recent years of computerized axial tomography and magnetic resonance imaging that can detect bony involvement not apparent on roentgenography with plain films. Thirty-two cases of extraosseous epidural tuberculoma have been reported in the English-language literature; however, only seven of these were radiologically and microbiologically confirmed. The single case from North America was reported over 30 years ago. We describe a patient with a spinal epidural mass due to Mycobacterium tuberculosis that was not associated with bony involvement and review the epidemiology, pathophysiology, presentation, and outcome of the previously reported cases.

Adult↗
PubMed1995

Clinical features that differentiate hantavirus pulmonary syndrome from three other acute respiratory illnesses.

To elucidate the early clinical characteristics of hantavirus pulmonary syndrome (HPS), we compared the clinical features of 24 cases of HPS with those of cases of bacteremic pneumococcal pneumonia (n = 30), influenza (n = 33), or unexplained adult respiratory distress syndrome (ARDS, n = 21). On admission, patients with HPS were less likely than outpatients with influenza to have reported sore throat (OR = 0.02, P < .01) and cough (OR = 0.1, P = .01) and were less likely than patients with pneumococcal pneumonia to have lobar infiltrates detected by chest roentgenography (OR = 0, P < .01). Multivariate discriminant analysis revealed that three clinical characteristics at admission (dizziness, nausea or vomiting, and absence of cough) and three initial laboratory abnormalities (low platelet count, low serum bicarbonate level, and elevated hematocrit level) served to identify all patients with HPS and to exclude HPS in at least 80% of patients with unexplained ARDS. These findings warrant further study and should facilitate the early recognition of patients with HPS, who may benefit from early critical-care intervention.

Acute Disease↗
PubMedDate not supplied

Esophageal tuberculosis: mimicry of gastrointestinal malignancy.

A case of tuberculous involvement of the esophagus was studied in an adult with mediastinal lymphadenopathy unrecognized by roentgenography of the chest. The roentgenographic and endoscopic features in this case were more consistent with malignancy than with tuberculosis. Nineteen additional cases from the English-language literature were reviewed. Although esophageal tuberculosis is a rare disease, it should be strongly suspected in a patient with dysphagia who has a positive tuberculin skin test, active pulmonary disease, or mediastinal adenopathy.

Aged↗
PubMed1996

Combined effects of errors in frontal-view asymmetry diagnosis.

The aim of the present investigation was to determine the relative extent of geometric error and errors in point identification in postero-anterior roentgenography. In one series of tests a group of dry human skulls was used, and the same cephalometric landmarks were identified twice by two orthodontists, using postero-anterior roentgenographs, first using the dry skulls as such, and then the same skulls with metal markers inserted to show the exact locations of the cephalometric points. Consistency and normal variation in the reproducibility of head position in the cephalostat between repeated roentgenographs were studied by a photographic technique in a group of young healthy adults, measuring the extent of minor head movements. Geometric error was calculated using a computer-aided design program (CAD) by rotating the three-dimensional co-ordinates of the cephalometric landmarks and thus obtaining projection error in the frontal view. Accuracy in cephalometric point identification was best in dental landmarks and vertical orientation of superior orbital margins. Geometric error was least when landmarks near the anterior midsagittal plane, such as upper and lower dental midlines or point gonion were compared with each other. Width measurements from frontal-view cephalograms are most sensitive to minor movements in head posture. Due to combined errors, the use of width measurements in facial asymmetry diagnosis should not be used since variance in errors in landmark identification can be larger than that in actual landmark location.

Adult↗
PubMed1996

A case of extragonadal germ cell tumor with elevated postchemotherapy HCG successfully treated by resection of a solitary metastasis and chronic oral etoposide.

We report a 39 year-old man with disseminated extragonadal germ cell tumor (GCT), whose serum level of human chorionic gonadotropin (HCG) increased again after platinum-based combination chemotherapy, high-dose chemotherapy with autologous bone marrow rescue and radical adjunctive surgery. The increase in the HCG level was progressive in spite of multiple chemotherapy, and after a while, a coin lesion in the right lung was identified by chest roentgenography. The pulmonary lesion was refractory to additional chemotherapy. After a systemic survey to confirm that the lesion was solitary, video-assisted thoracoscopic wedge resection of the right lower lobe was performed. Because the resected tumor included viable tumor cells and the serum HCG level remained slightly high one month after the operation, oral low-dose etoposide was begun. In a short time, the level of the serum tumor marker decreased and remained normal during the subsequent 7 months of therapy and thereafter. The patient remains in complete remission 13 months after completion of the final therapy and 3 years after the initial diagnosis. Even if the level of a serum tumor marker is high, salvage resection can be a promising therapeutic option for operable tumors that are refractory to chemotherapy. The usefulness of chronic oral etoposide for patients with GCT should be examined by further clinical trials.

Administration, Oral↗
PubMed1996

Factors affecting the rate and pattern of the first costal cartilage ossification.

In the present study, the extent of costochondral ossification of the first rib was determined from 78 chest roentgenograms of 13 healthy male soldiers subjected to a periodic follow-up. Roentgenography was performed at a mean interval of 2.9 years over a 15-year period. Mean subject age was 24 years at the commencement of the study and 37 years at its termination. Our results show that ossification of the first costal cartilage may start early in adult life and progress at individual rates. The ossification process proceeded from the costal toward the sternal end of the cartilage in an anteromedial direction. The morphological age-related changes ranged from the formation of small osseous islands in the cartilage to a complete ossification between the first rib and the sternum. The main conclusion of the study is that the degree of ossification of the first costal cartilage as an indicator of age does not provide the precision necessary for anthropological or forensic studies.

Adult↗
PubMed1998

Pulmonary clear cell carcinoid tumor: another entity in the differential diagnosis of pulmonary clear cell neoplasia.

A clear cell variant of primary pulmonary carcinoid tumor is described. The tumor arose in a 53-year-old woman who was incidentally found to have a solitary pulmonary nodule in the left upper lobe during routine chest roentgenography. Histologically, the tumor was composed of predominantly clear to lightly eosinophilic, polygonal cells with bland nuclei arranged in sheets and nests. Nuclear pleomorphism, necrosis, vascular invasion, and mitotic figures were not seen. The tumor cells were negative for oil-red-O and periodic acid-Schiff stains with and without diastase pretreatment on frozen and formalin-fixed sections, respectively. During immunohistochemical evaluation, the tumor cells were focally positive for cytokeratin and diffusely positive for neuron-specific enolase and chromogranin. Electron microscopy performed on paraffin block-retrieved tissue showed the presence of electron-dense, neurosecretory-type granules and variably sized vacuolated areas within the cytoplasm. the nature of which remained unclear. Intracytoplasmic glycogen or lipid were not identified. To our knowledge, this is the first report of pulmonary clear cell carcinoid tumor.

Carcinoid Tumor↗