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At least 1,279 records · Page 71Linked to original sources
PubMed1989

Complications of esophageal prostheses: roentgenologic manifestations.

We reviewed the roentgenographic findings in 15 patients who had endoscopic placement of a new type of esophageal prosthesis for obstruction caused by a malignant neoplasm. Each patient was evaluated with an esophagogram. Chest roentgenography and computerized tomography were used to confirm abnormalities seen on esophagography. The complication rate was 74% (11 cases), and included five cases of migration or malposition, two cases of perforation, and one case of obstruction. The recognition of postprocedural complications is paramount to their successful management. The complications associated with this new esophageal prosthesis are no different from those reported with the Celestin tube, though the frequency may be higher.

Esophageal Neoplasms↗
PubMed1990

Computerized tomography in the evaluation of myasthenia gravis.

Thymomas occur in 10% to 15% of patients with myasthenia gravis. Since not all patients are referred for thymectomy, a test that could reliably predict the presence or absence of a thymoma would be of great assistance in the management of these patients. We studied all patients referred for thymectomy at Walter Reed Army Medical Center from 1983 to 1989. Complete records were available for 13 patients. Computerized tomography (CT) correctly predicted the presence of a thymoma in one patient and falsely predicted a thymoma in a patient with a thymic cyst; it accurately predicted the absence of a thymoma in the remaining 11 patients. The sensitivity of CT scanning was 100%, the specificity was 92%, and the accuracy was 92%, results that are in agreement with previously published data. Compared to conventional chest roentgenography, CT scanning provided a more precise anatomic localization, and accurately predicted local invasion. We recommend a CT scan of the mediastinum in all patients with myasthenia gravis to avoid delayed diagnosis of thymoma in patients who normally would not be referred for thymectomy.

Adult↗
PubMed1990

Tracheal agenesis.

Tracheal agenesis is a rare congenital anomaly. We report a case and review the cases previously reported. Clinical features that might indicate tracheal agenesis include antenatal polyhydramnios, severe respiratory distress, absence of an audible cry, failure to advance an endotracheal tube beyond the larynx, a palpable distal trachea, clinical improvement after esophageal intubation, and roentgenographic absence of a tracheal air column with an abnormal position of the carina. For immediate management of the affected infant, we recommend intubation of the esophagus with an endotracheal tube to provide an air passage, and determination of the level of the defect by careful use of contrast material and roentgenography. Infants having type I tracheal agenesis may benefit from immediate tracheostomy.

Bronchial Fistula↗
PubMed1988

School screening for scoliosis by the Chiba University Medical School screening program. Results of 1.24 million students over an 8-year period.

The screening program for scoliosis started by Chiba University in 1979 consists of using moiré topography, low-dose roentgenography and a final ordinary x-ray examination. The number of children screened through this Chiba University Medical School (CUMS) screening program to 1986 amounted to 1,246,798. The incidence of scoliosis of more than 15 degrees increased linearly according to age from the fifth grade primary school children (0.07% in boys, 0.44% in girls) to the second grade junior high school students (0.25% in boys, 1.77% in girls). The female predominance of scoliosis cases with curvatures of more than 20 degrees detected during the total period was 10:1 and this female predominance was the same for primary school children and junior high school students. According to a study of the incidence of scoliosis by districts, (areas were divided according to population density and urbanization) there were no significant differences in the fifth grade primary school children between the sparsely and densely populated areas. In the cases of children beyond the fifth grade primary school level, however, the incidence in the densely populated areas were significantly higher than those in the sparsely populated districts. The incidence of scoliosis of more than 20 degrees decreased significantly every year among junior high school students, because they were screened periodically in school and the scoliotic students who had already been detected were left out of the next screening. This study establishes that screening for scoliosis by the CUMS screening program is cost-effective with a low risk of radiation hazards.

Adolescent↗
PubMed1997

Reliability of roentgenogram evaluation of pedicle screw position.

STUDY DESIGN: This was a human cadaver study of the accuracy of biplanar roentgenography in determining pedicle screw position. OBJECTIVE: To determine the independent accuracy of radiologic evaluation of screw placement and to determine if there are any particular screw malpositions that are more likely to produce a false sense of acceptable screw position. SUMMARY OF BACKGROUND DATA: Other investigators have reported the correlation between radiologic evaluation and anatomic dissection. However, in those studies the radiologic evaluation was not independent of the surgeons placing the screws. There has been no comment in the literature regarding particular screw malpositions that would lead the surgeon into a false sense of successful screw placement. METHODS: Pedicle screws were placed in cadaver spines, and biplanar roentgenograms of the specimens were evaluated by independent observers. The results of the roantgenogram evaluation then were compared to those of the anatomic dissection. RESULTS: The accuracy of roentgenogram evaluation varied from 73% to 83%, depending on the experience of the surgeon grading the roentgenograms. Screws misplaced medially into the spinal canal are more likely to give the surgeon a false sense of successful screw placement. CONCLUSIONS: The surgeon must not rely solely on the roentgenograms, but instead continue to use tactile sensory skills, anatomic knowledge, and additional modalities such as electromyography monitoring.

Bone Screws↗
PubMed1999

A comparative study of chemonucleolysis with recombinant human cathepsin L and chymopapain. A radiologic, histologic, and immunohistochemical assessment.

STUDY DESIGN: Investigation of the effects of recombinant human cathepsin L on intervertebral discs and comparison with the effects of chymopapain. OBJECTIVE: To evaluate the effects of cathepsin L on intervertebral discs as an agent for chemonucleolysis. SUMMARY BACKGROUND DATA: Cathepsin L is a typical cysteine proteinase that belongs to the papain superfamily. It plays a major role in intracellular proteolysis and is not believed to induce anaphylactic reactions. METHODS: In vivo: Rabbit intervertebral discs were injected with recombinant human cathepsin L, its buffer solution, and chymopapain. After 1, 4, and 16 weeks the animals were killed, and radiologic and histologic examinations were performed. In vitro: The enzymatic actions of recombinant human cathepsin L and chymopapain on human intervertebral disc proteoglycans were examined immunohistochemically using antiproteoglycan antibodies. RESULTS: In rabbit models, roentgenography showed that disc spaces treated with cathepsin L and chymopapain had become narrower 1 week after injection. Histologically, loss of safranin-O staining was observed in the anulus fibrosus of discs treated with cathepsin L. After 16 weeks, nucleus pulposus had regenerated with chondrocyte-like cells, and the safranin-O staining characteristics of the matrix also had recovered. In an immunohistochemical study, all components of the proteoglycan stained weakly after chymopapain digestion. After cathepsin L digestion, unsulfated chondroitin and core protein staining was weaker, but the chondroitin 6-sulfate staining was unaffected. CONCLUSIONS: Cathepsin L seems to be an effective agent for chemonucleolysis. Its enzymatic action on proteoglycan appears to be different from that of chymopapain.

Adult↗
PubMed2001

Traumatic T9 burst fracture in an 8-month-old infant: incomplete neurologic deficit and its recovery.

STUDY DESIGN: Case report of a rare burst fracture of the ninth thoracic vertebra in an 8-month-old male infant. OBJECTIVES: To describe a rare traumatic lesion in an infant. SUMMARY OF BACKGROUND DATA: There are two reported cases of fracture-dislocation in an infant in the literature, both of which were managed surgically. However, this is the first reported clinical case of burst fracture in an infant. METHODS: The patient was treated conservatively and observed for 40 months. His spine was examined by using roentgenography and magnetic resonance imaging. His neurologic condition was evaluated by clinical examination and somatosensory-evoked potential (SEP). RESULTS: The infant became ambulant with no need for support 2 years after injury. At that time, the burst vertebra was remodeling gradually and showed no spinal deformity. CONCLUSION: Fracture-dislocation of the spine with neurologic deficit requires surgical management. However, burst fracture can be managed conservatively, provided the neurologic condition improves.

Accidents, Traffic↗
PubMed1985

Lung allograft rejection in the rat. I. Accelerated rejection caused by graft lymphocytes.

To find out to what extent rejection of lungs differs from that of other organs, functional rejection of lung allografts was studied in five combinations of inbred rat strains. Rejection could be monitored accurately by perfusion scintigraphy, and equally well by chest roentgenography. The rejection of lung grafts was found to proceed remarkably fast, when compared with heart grafts, in combinations with strong RT1-incompatibilities. This accelerated rejection pattern could be converted into rejection at a normal pace by pretreatment of the donor with 10 Gy roentgen irradiation one day before transplantation. Donor pretreatment depleted the lung graft's bronchus-associated lymphoid tissue (BALT) of lymphocytes. When grafts were depleted of all other passenger cells as well--by retransplantation from a cyclosporine-treated intermediate host--they showed an even more reduced immunogenicity, probably because of the loss of donor-type dendritic cells. These results indicate that lymphocytes from the BALT of lung grafts are capable of accelerating the rejection response.

Animals↗
PubMed1991

Morphologic activation of lymphocytes in blood during rejection of heart and lung grafts in rats.

We investigated morphologic activation of lymphocytes in blood in a standardized, infection-free rat model and compared lymphocyte activation during rejection of heart grafts and that of lung grafts with other parameters of rejection. For heart grafts the other parameters were histology and palpation, and for lung grafts they were histology, bronchoalveolar lavage, and chest roentgenography. During acute rejection of heart grafts, lymphocyte activation in blood increased when histology of the heart grafts showed already moderate-to-severe rejection with myocyte necrosis. Lymphocyte activation in blood detected acute heart rejection clearly later than histology but somewhat earlier than palpation. During acute rejection of lung grafts, lymphocyte activation in blood increased when histology of the lung grafts showed the (early) vascular phase of rejection, without apparent tissue damage. Lymphocyte activation in blood detected acute lung rejection only slightly later than histology, at approximately the same time as bronchoalveolar lavage and earlier than chest roentgenograms. Lymphocyte activation was higher during acute lung rejection than during acute heart rejection. During "chronic" rejection of long-surviving heart grafts and lung grafts, lymphocyte activation in blood did not increase consistently. The early and strong increase of morphologic activation of lymphocytes in blood during acute lung rejection may imply for clinical transplantation that monitoring of lymphocyte activation in blood is more useful for early detection of acute rejection after lung transplantation than after heart transplantation.

Acute Disease↗
PubMed2000

Clinical and basic laboratory assessment of children for possible congenital heart disease.

Accurate and cost-effective detection of congenital heart disease is a priority for the primary care physician, but there are many diagnostic modalities and strategies available. Within the past year, investigators have reported factors that contribute to the failure to diagnose congenital heart disease before autopsy. Recent research also highlights the strengths and weaknesses of the clinical evaluation by the primary care physician. An examination by a pediatric cardiologist is a more specific discriminator between heart disease and innocent murmur and can, in many instances, eliminate the expense of relying on echocardiography for diagnosis. Current reports document substantial limitations of diagnostic utility of electrocardiography and chest roentgenography. Suspicions that echocardiography can be misleading when performed in laboratories without expertise in congenital heart disease are confirmed in recent organized comparisons of accuracy. High-quality, well-designed tele-echocardiography programs are shown to be effective solutions when maldistribution of pediatric cardiology services hampers diagnostic efficiency.

Adult↗
PubMed2001

Inflammatory bowel disease-like colitis in glycogen storage disease type 1b.

Chronic inflammatory bowel disease (IBD)-like colitis is occasionally associated with glycogen storage disease-type 1b (GSD-1b). We describe a 17-year old boy with GSD-1b who developed an IBD-like colitis. Roentgenography and colonoscopy showed the lead-pipe appearance of the colon and circumferential ulcers. Histopathologic examination revealed nonspecific inflammation without granulomatous lesions. High-dose granulocyte-colony stimulating factor (G-CSF) and sulfasalazine led to the resolution of the colitis, although neutropenia continued. Besides this case, 10 published cases of GSD-1b and IBD-like colitis were reviewed. All cases had severe neutropenia and/or neutrophil dysfunction. The mean onset of bowel disease was 12.3 years of age. Seven cases required surgical treatment. All five patients with G-CSF/GM-CSF therapy showed clinical remission. These findings suggest that IBD-like colitis is a grave complication of GSD-1b and that recurrent enteric infections due to neutrophil deficiency may contribute to the development of this bowel disease.

Adolescent↗
PubMed2003

The accuracy of computed tomography in assessing cervical pedicle screw placement.

STUDY DESIGN: A blinded, prospective comparison of computed tomography scan accuracy for determining the location of cervical pedicle screw position in human cadavers. OBJECTIVES: To establish recommended computed tomography technique guidelines for assessing location of cervical pedicle screws. SUMMARY OF BACKGROUND DATA: A small number of studies have described the accuracy of roentgenography regarding the assessment of pedicle screw position. However, a few studies have investigated the accuracy of computed tomography in this respect. Ebraheim et al evaluated the relation of lateral mass screws to the nerve roots within the intervertebral foramen on oblique radiographs. No study has been undertaken, to our knowledge, to specifically define the reliability and validity of computed tomography scans in the case of cervical pedicle screw placement. METHODS: As a pilot study, 10 cadaveric cervical spines from another study with bilateral 3.5 mm titanium pedicle screws were scanned with 1.0 mm axial slices. After the scans were interpreted by three blinded readers, each panel member was "trained" with regard to individual accuracy. Ten more cadaveric cervical spines were instrumented with 3.5 mm titanium screws in each pedicle (C2-C7). The specimens were then scanned with a variety of computed tomography techniques, including spiral acquisitions at 1.0 mm, 1.0 mm + reconstruction, 2.5 mm, 5.0 mm slices, and the three-dimensional Stealth Station recipes. The specimens were dissected, and malpositioned screws were recorded and photographed by independent raters. The same three readers from the pilot study then read each new scan in random order. RESULTS: Reader accuracies in the pretraining pilot study were 74%, 68%, and 52%, with kappa coefficients of 0.49, 0.37, and 0.07, respectively, and significant intrarater variances (P = 0.014). After training, the accuracy rate improved significantly to 89%, 88%, and 85% in posttraining study, and the kappa coefficients were 0.81, 0.78, and 0.73, respectively. Kappa statistical analysis showed negligible interreader variance on the entire pivotal study except by the three-dimensional Stealth Station format. The overall mean kappa coefficients were 0.77, 0.75, and 0.73. Assessment of pedicle screw position was statistically inferior with 5.0 mm axial slices, in contrast to slices <3.0 mm. CONCLUSIONS: We demonstrated that reliance on computed tomography scan data in determining the misplacement of a pedicle screw is usually accurate given proper scan acquisition, presentation windows, and adequate reader training, but a clinically significant error rate remains. A conventional computed tomography scan should not be treated as a gold standard, particularly without regard to the readers' training.

Bone Screws↗
PubMed2006

Comparative study of maxillary growth and occlusal outcome after autogenous rib grafting in complete cleft palate defect.

Cleft palate is a congenital deformity with soft tissue and hard tissue defects. Normal cleft palate repairing surgery only repairs soft tissue defects, whereas bone defects in the hard palate still exist. Therefore, we conducted this study in beagles to observe the influence of bone grafting at primary surgery on craniofacial growth and occlusal relationships in individuals with complete cleft palate and to provide experimental evidence for optimal surgical procedures for cleft palate. Using 60 beagle puppies as subjects, we tested the effects of bone grafting in surgically induced palatal defect. The animals were randomly and equally divided into four groups: (1) unoperated controls; (2) surgically induced unilateral cleft palate, not repaired; (3) two-flap palatoplasty used to close the soft defect of the surgically induced cleft palate; (4) autogenous bone (a piece of rib bone) implanted into the palatal defect before two-flap palatoplasty was performed.Cephalometric roentgenography and plaster casts of the maxillary were taken preoperatively and every 4 weeks after surgery. Sixty metric cranial variables were measured directly from the cleaned skulls after the animals were killed the 34th week postoperatively. The measurement results indicated that bone grafting may reduce the disturbance of maxillary growth caused by the cleft palate and the denuded bone, but it may cause other maxillary deformities. This finding suggests that surgeons should be careful in choosing the method of primary bone grafting in repairing complete cleft palate.

Animals↗
PubMedDate not supplied

Sonographic measurement of vertebral dislocation in spondylolisthesis.

The vertebral dislocation in spondylolisthesis was measured by both sonography and roentgenography in 20 patients with spondylolysis and 6-28 mm of spondylolisthesis. The two methods were applied independently of each other. The difference between the sonographic and roentgenographic measure of vertebral dislocation was 0-3 mm (mean 1.3 mm). The accuracy of sonography is sufficient for clinical work. The advantage of sonography is that the radiation burden of patients with spondylolysis can be decreased by replacing roentgenographic follow-up with sonography.

Adolescent↗
PubMedDate not supplied

Pathomechanism of atlantoaxial rotatory fixation in children.

The pathomechanism of atlantoaxial rotatory fixation (AARF) was studied using roentgenography and computerized tomography in affected children as well as cadaver studies of upper cervical spine anatomy. The increased incidence of AARF in children may be related to certain anatomical differences between children and adults. The dens-facet angle of the axis was steeper in children than in adults. Meniscus-like synovial folds were found in the C0/1 and C1/2 facet joints of the spines of children but not in those of adults.

Adolescent↗
PubMedDate not supplied

Avascular necrosis of the hip in multiple epiphyseal dysplasia.

We observed radiographic changes of avascular necrosis (AVN) of the capital femoral epiphysis in 9 hips of 11 patients with multiple epiphyseal dysplasia (MED). Plain roentgenography, bone scintigraphy, and magnetic resonance imaging (MRI) studies all revealed characteristic asymmetric changes in the presence of AVN superimposed on dysplastic femoral heads.

Child↗
PubMed1992

CT findings in tuberculous spondylitis.

The computed tomographic (CT) features of ten documented cases of spinal tuberculosis were analyzed. All cases showed evidence of vertebral body destruction, with paravertebral soft tissue masses. Four cases revealed extension of involvement into the neural arches. Calcification within the paraspinal soft tissue was found in only two cases. Two of four cases who received intravenous contrast medium demonstrated evidence of rim enhancement around multilocuated fluid collections. Compared to conventional roentgenography, CT better delineated the extent of bony destruction, involvement of the spinal canal and existence of paraspinal soft tissue masses.

Adolescent↗
PubMed1988

An autopsy case of sarcoidosis followed up for 27 years, with special reference to pulmonary fibrosis.

An autopsy case of sarcoidosis followed up for 27 years in a 48-year-old woman with pulmonary fibrosis is presented. Chest roentgenography demonstrated an interstitial pneumonia-like pattern with gradual contraction of the upper lobes. Focal and extending fibrosis and hyalinization were observed in various organs including the lung, lymph nodes, heart and liver. Most of the fibrosis was thought to be derived from solitary or confluent granuloma, showing hyalinized nodular, stellate or band-like fibrosis. There was also another type of fibrosis, not derived from granuloma, manifested as fibrosing alveolitis in the lung, and diffuse fibrosis extending throughout the other organs. In the lymph nodes, chromogenic bodies (Hamazaki-Wesenberg bodies) were seen. The process of fibrosis and the significance of chromogenic bodies in cases of chronic sarcoidosis are discussed.

Female↗