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PubMedDate not supplied

Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome.

Patients with an isolated diagnosis of rotator cuff impingement syndrome were prospectively entered into the study. Each of the 23 subjects was refractory to conservative therapy, had preoperative roentgenograms, and underwent an open acromioplasty. The roentgenograms included anteroposterior, axillary, 30 degrees caudal tilt, and supraspinatus outlet views. The roentgenograms were measured by four independent readers. The separate views were then scored for reliability, and the correlation of the measurements with intraoperative acromial measurements was assessed. Interobserver reliability was highest for the caudal tilt view (0.84) and lowest for the axillary view (0.09). The supraspinatus and caudal tilt views correlated significantly with distinct intraoperative measurements of acromial spur size. We continue to advocate the evaluation of both views for preoperative assessment of the acromial spur in the rotator cuff impingement syndrome.

Acromion↗
PubMed2003

Exogenous lipoid pneumonia: serial chest plain roentgenography and high-resolution computerized tomography findings.

Between May 1988 and July 2002, six patients with pneumonia due to diesel, animal, or vegetable oil aspiration were admitted to Kaohsiung Medical University Hospital. The purpose of this study was to demonstrate distinctive radiographic findings of oil-induced lipoid pneumonitis on initial serial chest roentgenograms and high-resolution computerized tomography (CT) scans. Initial chest roentgenograms (n = 6), CT scans (n = 6), and roentgenography and CT follow-up studies were analyzed retrospectively by two chest radiologists and two surgeons, focusing on the pattern and distribution of parenchymal abnormalities. The most common location was the right middle lobe, followed by the right lower lobe, the left lower lobe, and the lingular lobe. Follow-up chest roentgenograms (n = 6) showed complete disappearance of the parenchymal lesions in only one patient and partial decrease in the extent of lesions in five patients. Lipoid pneumonia presents non-specific findings on chest roentgenography. It is commonly located in both lower and the right middle lobes. On high-resolution CT, the lesions appear most commonly as areas of consolidation, ground-glass attenuation mixed with paving pattern, and poorly defined nodules.

Adult↗
PubMed1978

Prediction of breadth of permanent canines and premolars in the mixed dentition.

Multiple stepwise regression was used in the selection of mixed dentition variables capable of predicting the total breadth of the unerupted permanent canine and premolars. The material consisted of 77 children. Stone casts were made before and after eruption of the canine and premolars. At the first examination when the children were, on the average, 10 years old, intraoral roentgenograms were obtained of the canine and the premolars. To predict the total breadth of the upper canine and premolars the buccolingual breadth of the upper first permanent molar and measurements on roentgenograms of the breadths of the upper canine and premolars proved most useful. In the prediction of the total breadth of the lower canine and premolars the best results were obtained with measurement of the breadths of the teeth in the roentgenograms. The breadth of the incisors proved less useful as a predictor of the breadths of unerupted canines and premolars.

Bicuspid↗
PubMed2001

Haemoptysis: aetiology, evaluation and outcome--a prospective study in a third-world country.

Haemoptysis is an alarming symptom, and the management depends upon the aetiology. Emergency management depends upon localization of the site of bleeding by roentgenogram, computerized chest tompgraphy and bronchoscopy. We prospectively evaluated 52 patients with haemoptysis admitted to the Chest Hospital, Kuwait for 1 year (January 1998 to December 1998) and followed them up for 1 year (January 1999 to December 1999). There were 42 males (80.8%) and 10 (19.2%) females, with a mean age of 42.2 (16-86) years. Of these, 26.9% were Kuwaiti nationals, 36.5% were Arab non-Kuwaiti nationals, 34.6% were Asians and 1.9% were other nationals. The aetiologies of haemoptysis were bronchiectasis (21.2%), old pulmonary tuberculosis with bronchiectasis (17.3%), active pulmonary tuberculosis (15.4%), bronchitis (5.8%), aspergilloma, rheumatic heart disease and carcinoid (1.9%). Aetiology could not be identified in 25% of patients. The site of bleeding in haemoptysis could not be localized by the consultants in 18 (32%) by roentgenogram. 16 patients (37%) by CT scan and 23 patients (50%) by Fibreoptic bronchoscopy. Sequential estimation of hemoglobin showed a mean of 13.56 (SD 1.9) and 13.31 (SD 1.8) after 24 h. The difference in mean was statistically significant (p<0.036). Conservative management was given in 80.8%, and embolotherapy or surgical intervention in 19.2% of patients. Only 12% of patients had recurrent haemoptysis at 1-year follow up. In conclusion, bronchiectasis and pulmonary tuberculosis were the major causes of haemoptysis in this study. Roentgenogram, CT scan and fibreoptic bronchoscopy are useful for localizing the site of bleeding. Sequential estimation of haemoglobin may be helpful in assessing the severity of haemoptysis, but larger studies are required to address this observation. The outcome of haemoptysis is generally good, with a low mortality and recurrence rate.

Adolescent↗
PubMedDate not supplied

[Radiologic and computerized tomography evaluation of pedicle screw placement in lumbar spondylodesis].

PURPOSE: To determine the accuracy of a standard roentgenogram for the placement control of pedicle screws following spinal fusion. METHOD: From 1995 to 1997 we performed computed tomography (CT) after material removal following lumbar and lumbosacral spinal fusion in 16 patients. We compared the placement of the 76 pedicle screws in plain X-rays after spinal fusion with their appearance on CT. A correct placement was defined as no penetration of the pedicle cortex, no contact of the lateral or ventral cortex of the vertebral body or joint, and a sufficient screw length. RESULTS: We found correct placement of 58 screws (76.3%) on the standard roentgenogram, whereas by CT only 46 (60.5%) were placed correctly. The results of both radiological examinations correlated (correct/incorrect placement) for only 54 screws (71.1%). A penetration of the ventral cortex of the vertebral body in 21 cases (27.6%) was identified in only 11 screws (14.5%) on the postoperative X-rays. The two radiological methods in this instance correlated for 62 screws (81.6%). CONCLUSION: The value of postoperative standard roentgenogram for the placement control of pedicle screws following spinal fusion is low. By this method possible contact with the aorta, vena cava, dura or vertebral joint cannot sufficiently be excluded.

Bone Screws↗
PubMedDate not supplied

[Possibilities for interpreting digital migration analysis of cement-free PM total hip endoprostheses].

PURPOSE: Aim of this study was the validation of a digital measurement device for hip implants. METHODS: From 43 patients with a minimum of four subsequent roentgenograms 246 roentgenograms of PM-shafts (an average 5.72/shaft) and 142 roentgenograms of PM-cups (an average 6.45/cup) were digitized on a DiagnostiX 2048 basis station (Pace Systems, Germany). Modified Sutherland/Nunn methods were chosen for measuring purposes. Regression analysis was done and the results were correlated to implant loosening. RESULTS: Concerning the total vertical migration of the cup there is a significant (p < 0.04) difference between the loosened components (6.02 +/- 2.59 mm) and the fixed cups (2.26 +/- 2.89 mm). The average annual vertical migration rate of the stem shows a highly significant difference (p < 0.007) when comparing loosened stems (0.82 +/- 0.43 mm, total migration 4.78 +/- 2.89 mm) and fixed ones (0.20 +/- 0.54 mm, total migration 1.72 +/- 3.02 mm) CONCLUSIONS: Using the regression analysis and a sufficient number of pictures the system allows us to give migration values that make loosening likely. However for the single implant an individual prognosis of loosening is not possible.

Follow-Up Studies↗
PubMed1986

[Comparative x-ray and nuclear medical studies of osteosarcomas to evaluate the effectiveness of preoperative chemotherapy].

In 16 patients with a long bone osteosarcoma treated after the therapy regimen of COSS 80/82 (Cooperative Osteosarcoma Study) the tumour response to preoperative chemotherapy was assessed by conventional roentgenograms (plain films, tomograms, angiograms). The histological grade of regression determined in the operative specimen was used as a reference for the extent of tumour devitalisation. By their different typical roentgenological course the osteosarcomas with a very good and those with a rather poor response could be correctly identified (100%). On following the clinically used differentiation between "good responders" (histological grades I to III) and "poor responders" (grades IV to VI) the corresponding classification of these tumours by roentgenograms and functional scintigraphic imaging was found to be correct in 94% of the cases. The coincidence of the correct as well as the false results in both radiological methods was as high as 100% if those osteosarcomas showing only a "medium response" in their roentgenograms were added to the clinical group of good responders. There were no fundamentally discrepant results obtained by each of the two radiological techniques. With the combined workup of the roentgenological and the scintigraphic material any incorrect preoperative estimation of tumour regression with a harmful influence on therapy (date and type of surgery, mode of postoperative chemotherapy) could be avoided.

Adolescent↗
PubMed1999

Disconnection of a venous Port-A-Cath followed by embolization after saline flush: rare case report.

A 77-year-old man presented with painful swelling of his Port-A-Cath insertion site soon after flushing with normal saline. No discomfort or abnormality was found during the saline flush. A chest roentgenogram showed that the disconnected catheter had separated from the disc and was absent from its original location. The disconnected catheter was found embolized, by chest roentgenogram and CT scan, to the right atrium and hepatic vein. The patient was treated successfully with an X-ray guided extraction of the catheter. The possibility of catheter disconnection with embolization should be considered and a chest roentgenogram performed immediately in cases of rapid swelling of subcutaneous tissue around the port chamber after fluid infusion.

Aged↗
PubMed1996

Vascular bundle implantation into bone for aseptic necrosis of the lunate.

Since April 1986, implantation of a vascular bundle containing the ramus carpeus dorsalis of the interosseal anterior artery and vein into the lunate has been undertaken for aseptic necrosis of the lunate bone. A series of 11 cases were performed in East-South Hospital with satisfactory results. The average follow-up period was 36 months. A series of follow-up roentgenograms reveal that necrosis of the lunate bone is being continuously repaired. Fourteen months postoperative, the following results are obtained: (1) the sclerosis of the lunate bone has completely disappeared on the roentgenograms, (2) the architecture and density of the lunate bone have returned to normal on the roentgenograms, (3) technically colorized X-ray films show that lunate bone density decreases after the operation (the decreasing range is 20 to 44 Gray scale [mean, 30.3 +/- 2.4 Gray scale]) and that the cyst formations on the lunate bone have completely disappeared postoperatively, and (4) pain in the affected wrists disappeared and patients have returned to their former work, including manual labor. The necrotized lunate bones are healed. Anatomic study shows that the presence of the ramus carpeus dorsalis of the interosseal anterior artery and vein on the wrist is 100%, and the structure as well as location of the ramus carpeus dorsalis has little anatomic variation and is long enough to be transplanted into the lunate bone.

Adult↗
PubMed2002

Use of capnometry to verify feeding tube placement.

OBJECTIVE: To investigate the effectiveness of capnometry (carbon dioxide monitoring) in verifying gastric placement of a stylet-guided nasogastric tube in intubated, mechanically ventilated patients. DESIGN: A prospective descriptive study. SETTING: Fourteen-bed medical-surgical intensive care unit, 11-bed coronary care unit, and 18-bed chronic ventilator unit in a 700-bed teaching hospital. PATIENTS: A total of 53 adult patients on mechanical ventilation and enteral feedings. INTERVENTIONS: After the feeding tube was inserted to 30-cm length and before the first chest roentgenogram was taken, the end-tidal carbon dioxide detector was attached to the proximal end of the feeding tube. It was left in place for 1 min and was observed for a change in color (originally purple, it will turn tan or even yellow on contact with carbon dioxide). If the end-tidal carbon dioxide detector remained purple, it was interpreted as gastrointestinal placement; if it turned tan or yellow, it was interpreted as airway placement. The first chest roentgenogram was taken to confirm observations made with the end-tidal carbon dioxide detector. The feeding tube was advanced and a final chest roentgenogram verified its position below the diaphragm. MEASUREMENTS AND MAIN RESULTS: In 52 of the 53 placements, no carbon dioxide was detected. The position in the gastrointestinal tract was confirmed by the two-step procedure. There were no false positives; the technique was 100% specific. One placement out of the 53 was found to be in the trachea. The end-tidal carbon dioxide detector appropriately detected carbon dioxide. This indicated no false negatives. To verify the sensitivity, 20 placements were made directly into the trachea through an endotracheal tube. In all 20 cases, carbon dioxide was detected. No false negatives occurred, indicating 100% sensitivity. Testing in spontaneously breathing patients was not conducted. CONCLUSIONS: Capnometry is a safe method for verifying proper feeding tube placement. The first chest roentgeno-gram can be safely eliminated. With this method, less time and money will be expended in feeding tube placement, making capnometry an efficacious new method.

Aged↗
PubMedDate not supplied

Accuracy of the chest radiograph in diagnosis of pulmonary embolism.

In an effort to determine the sensitivity and specificity of the chest roentgenogram for the diagnosis of pulmonary embolism, roentgenograms of 152 patients who were all suspected of having pulmonary embolism were randomized and presented to nine interpreters. One hundred eight patients in the series were proven to have pulmonary embolism on the basis of a positive pulmonary angiogram. Forty-four patients were assumed not to have embolism on the basis of either a normal perfusion isotope scan or a pulmonary angiogram which did not show embolism. The interpreters were requested to indicate whether pulmonary embolism was present or absent, or whether they could not tell from the roentgenogram. Readers had no prior knowledge of the actual disease state. The average true-positive ratio (sensitivity) was 0.33, with a range of 0.52 to 0.88. The average true-negative ratio (specificity) was 0.59, with a range of 0.31 to 0.80. The false-positive and false-negative ratios were respectively, 0.21 (range 0.05 to 0.39) and 0.41 (range 0.15 to 0.70). A predictive index, reflecting the overall accuracy of diagnosis, was calculated for the entire group and was 0.40, with a range of 0.17 to 0.57. There appeared to be no correlation between training or experience and accuracy of performance in this study.

False Negative Reactions↗
PubMed1993

Analysis of skull anthropometric measurements in patients with neurofibromatosis type-1.

RATIONALE AND OBJECTIVES: The authors studied selected anthropometric measurements of plain postero-anterior and lateral skull roentgenograms to ascertain whether these were useful in distinguishing patients with clinically probable neurofibromatosis type-1 from controls. METHODS: A retrospective review of medical records of patients for whom skull roentgenograms were available was conducted. Patients were assigned to one of three groups: definite neurofibromatosis type-1 (DNF), probable neurofibromatosis type-1 (PNF), and controls. A blinded analysis of 29 measurements, 9 qualitative assessments, and 3 area/volume calculations was performed. RESULTS: There were 58 patients (29 controls, 14 DNF, and 15 PNF). The majority (75%) of all predetermined landmarks could be ascertained in 43 of these subjects. After age and gender were held constant, analysis of covariance showed that both DNF and PNF subjects could be distinguished from controls, but not from each other when comparing the mean: sella turcica height (P < .001), sella turcica depth (P < .005), skull width (P < .001), skull length (P < .002), skull height (P < .003), and skull volume (P < .0001). CONCLUSIONS: Anthropometric analysis of skull roentgenograms coupled with results of clinical examination improves the ability to distinguish between patients with DNF and PNF from controls.

Adolescent↗
PubMed1991

A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance.

The role of CT scanning as an adjunct to plain roentgenograms of the cervical spine was reviewed in acutely injured blunt trauma patients. Following institution of a protocol to evaluate the cervical spine in all blunt trauma patients, 179 patients underwent CT scanning of their cervical spine. This was performed for patients whose x-ray findings were positive, for patients with plain x-ray films suggestive of a pathologic condition, for patients with plain x-ray films that did not reveal all of the cervical vertebrae, and for patients who had persistent pain or neurologic deficits despite normal plain x-ray films. Of 123 patients not able to have their cervical spine cleared by normal roentgenograms, 93% were cleared within 24 hours of admission based on CT scans. There were no missed injuries in this setting. A false-positive rate of 28% and a false-negative rate of 1.5% were found for plain roentgenograms. Computed tomographic scans detected 98% of the injuries in our study and when combined with a three-view plain x-ray series of the cervical spine, 100% of cervical spine injuries were detected. Computed tomographic scanning as an adjunct to plain x-ray films of the cervical spine is a highly accurate and expedient modality to clear the cervical spine of blunt trauma patients.

Adolescent↗
PubMed1991

Sagittally oriented fractures of the lateral masses of the cervical vertebrae.

Lateral flexion of the cervical spine may cause a sagittally oriented fracture of the lateral mass with shearing of all or part of the lateral mass away from the vertebral body. We report 22 patients with 24 sagittal fractures of the cervical lateral masses. Cross-table lateral roentgenograms suggested the presence of a sagittal lateral mass fracture in two thirds of the cases based upon malalignment or widening of the facet joints, displaced fracture fragments, subluxation of the spine, or rotation of the spine above the level of abnormality. However, the cross-table lateral roentgenogram was normal in one third of cases. Oblique roentgenograms were available in eight cases; these were positive in five, equivocal in one, and negative in two. Visible fracture lines, often associated with lateral displacement of part or all of the lateral mass, allowed all 24 fractures to be detected on the supine anteroposterior view films. Sagittal lateral mass fractures were unstable in 59% (13/22) of the cases; neurologic deficits, including quadriplegia, hemiplegia, and radiculopathy, were present in 45% (10/22). Computed tomography and complex-motion tomography were useful in confirming the sagittal lateral mass fracture and in detecting other associated fractures.

Adult↗
PubMed1993

The etiology of missed cervical spine injuries.

Missed or delayed diagnosis of cervical spine (C-spine) injuries may lead to extension of those injuries and subsequent preventable mortality or morbidity. Previous reports examining the incidence of missed C-spine injuries have not determined the nature of the causal clinical errors made or the extent to which these errors are avoidable. This study was undertaken to (1) determine the incidence of delayed or missed diagnosis of C-spine injuries and the consequences of those missed injuries; (2) define the clinical errors leading to the delays; and (3) to determine if these errors are the result of fundamental problems or a lack of advanced diagnostic skills or equipment. Between August 1985 and February 1991, 32,117 trauma patients were admitted to one of the six trauma centers in San Diego county. Cervical spine injuries were identified in 740 patients and the diagnosis was delayed or missed in 34 patients (4.6%). Ten of the 34 patients (29%) developed permanent sequelae as a result of these delays. The single most common error was the failure to obtain an adequate series of C-spine roentgenograms. Delayed diagnosis could have been avoided in at least 31 of 34 injuries by the appropriate use of a standard three-view C-spine series and careful interpretation of those roentgenograms. Patients at risk for C-spine injuries require a technically adequate three-view C-spine series and skilled radiographic interpretation. Cervical spine precautions should be maintained, particularly in high risk patients, until appropriate and expert review of the cervical spine roentgenograms can be obtained.

Adolescent↗
PubMed1997

Computed tomography of the chest in blunt thoracic trauma: results of a prospective study.

BACKGROUND: Computed tomography of the chest (CTC) is more sensitive than conventional roentgenography at detecting blunt thoracic injuries. Its effect on subsequent therapy remains incompletely characterized. METHODS: Nine criteria believed to represent the presence of, or the potential for, significant thoracic injuries were defined, and patients were followed prospectively. Forty consecutive patients had CTC after initial evaluation. Physiologic and anatomic findings were compared, and the effect of CTC on therapy was analyzed. RESULTS: CTC detected 76 injuries not found on plain roentgenograms, and plain roentgenograms detected 25 injuries not visible on CTC scans. Six patients had therapy changes based on CTC findings, five of which involved chest tube modification. The percentage of pulmonary contusion did not predict the need for mechanical ventilation but did correlate with physiologic contusion. CONCLUSIONS: Blunt thoracic injuries detected by CTC infrequently require immediate therapy. If immediate therapy is needed, findings will be visible on plain roentgenograms or on clinical exam. Routine CTC in blunt trauma is not recommended but may be helpful in selected cases.

Adolescent↗
PubMed1998

Sepsis evaluations in hospitalized infants with bronchiolitis.

OBJECTIVES: To define variation in the decision to perform a sepsis evaluation in hospitalized infants with bronchiolitis, to define predictors of the decision and to measure the clinical and cost outcomes. METHODS: Retrospective chart review of all nonintensive care unit infants < or = 60 days with any discharge diagnosis of bronchiolitis (n = 282 from 1993 to 1995 in a 232-bed pediatric hospital. Process variables included temperature at sepsis work-up or Tmax if no sepsis workup. Outcome variables were charges, length of stay, sepsis workup and serious bacterial infection. RESULTS: There was no difference in mean temperature between groups with or without sepsis evaluation (38.1 degrees C, P = 0.75). Of 282 infants 140 had a sepsis workup; 5 (1.8%) had serious bacterial infection. Infants with sepsis workup had an average total charge of $4507 and length of stay of 3.4 days compared with $2998 and 2.8 days for those without (P = 0.0001 and P = 0.002, respectively). A multivariate logistic regression model was constructed with sepsis workup as the dichotomous dependent variable. Significant (P < or = 0.05) predictor variables with a positive coefficient were: higher bronchiolitis score and normal chest roentgenogram. Significant variables with a negative coefficient were: admission diagnosis of bronchiolitis, chest roentgenogram typical for bronchiolitis and age > 28 days. CONCLUSIONS: Temperature was not a predictor of sepsis evaluation. Infants with respiratory distress and normal chest roentgenogram were more likely to receive sepsis evaluations; those with recognized typical bronchiolitis and those > 28 days of age were less likely. Risk of serious bacterial infection is low; the costs of a sepsis evaluation outweigh the benefits in infants with obvious bronchiolitis.

Bronchiolitis↗
PubMed1977

Operative treatment of the acutely ruptured lateral ligament of the ankle.

Twenty-seven patients with acute inversion injuries of the ankle were treated surgically during the past ten years. Instability indicative of rupture of the lateral collateral ligament was demonstrated by anteroposterior stress inversion roentgenograms. Ruptures of a component or components of this ligament were found at operation in every case. The ligament and capsule were repaired and the ankle was immobilized by a plaster of Paris cast for six to eight weeks. Of 26 patients available for follow-up examination, none complained of instability although nine had minor residual symptoms. Postoperative stability was demonstrated by roentgenograms in 13 patients. In the other 13, clinical examination showed that the ankles were stable on forcible inversion of the foot and ankle. Our results indicate that surgical repair offers the best prospect for successful treatment when definite passive instability can be demonstrated by properly performed stress inversion roentgenograms.

Adolescent↗