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PubMedDate not supplied

Digital perfusion of handball players. Effects of repeated ball impact on structures of the hand.

The effect of repeated ball impacts on the handball player's hands was studied by using thermography and routine roentgenography to determine evidence of altered perfusion or other tissue changes. Seventeen of 22 players had multiple areas of decreased perfusion. 12 of these 17 were symptomatic and 8 showed definite correlation between symptoms and thermographic findings. No skeletal or articular changes were noted. Players with more than 200 hr of accumulated playing time had increased risk of developing symptomatic, although nonprogressive, alterations in perfusion of their hands but did not have evident skeletal changes.

Adult↗

PubMedDate not supplied

Lateral roentgenographic projections of the acromioclavicular joint.

Although the acromioclavicular joint is frequently injured in both contact and noncontact sports, the treatment is nonspecific, as demonstrated by the numerous methods of treatment currently employed. Despite treatment, some shoulders still develop chronic symptoms and disability during overhead lifting, throwing, and swinging. Perhaps these difficulties develop as a result of an incomplete evaluation of the joint and because the exact nature of the injury is not appreciated. Therefore, the shoulder develops chronic problems. We have routinely utilized a lateral roentgenogram of the acromion to evaluate the acromioclavicular joint. This has significantly aided us in the diagnosis and treatment of acromioclavicular joint injuries, especially when there was posterior dislocation of the distal clavicle. This presentation reviews standard roentgenography of the acromioclavicular joint and illustrates the method of obtaining the lateral projection as described by O. M. Alexander. We will also show how this method has helped us clinically in detecting posterior dislocations of the distal end of the clavicle.

Accidents, Traffic↗

PubMedDate not supplied

Degenerative joint disease in female ballet dancers.

The relationship between long-term ballet dancing and eventual arthrosis of the hip, ankle, subtalar, and first metatarsophalangeal joint was examined in 19 former professional female dancers, aged 50 to 70 years. The dancers were compared with pair-matched controls. All 38 women underwent medical history taking, clinical examination, and roentgenography of the joints studied. The roentgenographs were independently judged by two investigators and grouped according to a modified classification of Hermodsson. We found a statistically significant increase in roentgenologic arthrosis of the ankle, subtalar, and first metatarsophalangeal joints in the ballet group compared with the control group. There was no significant difference regarding degenerative changes of the hip joint. However, subjects in the dance group who had evidence of degenerative changes on roentgenographs had no clinical complaints. There was a statistically significant increase in hallux valgus deformity in the ballet group (P < 0.05). The dancers also showed a statistically significant increase in flexion, external rotation, and abduction of the hip joint, dorsal flexion of the first metatarsophalangeal joint, and inversion and eversion of subtalar joint. But the control group had statistically significant increased plantar flexion of the first metatarsophalangeal joint. The most important cause of the statistically significant increase of arthrosis of the ankle and first metatarsophalangeal joints must be explained by repetitive microtrauma.

Aged↗

PubMed2005

Deviations of placement/function of permanent central vein catheters for hemodialysis.

Fourteen cases of malposition of a permanent central vein catheter for hemodialysis or poor blood flow associated with thrombosed central veins but correct catheter positioning, in 13 patients suffering from end stage renal disease, presented from September 1991 to December 2003 among 385 permanent central vein catheters for hemodialysis (3.6%). There were 8 episodes of catheter tip malplacement in the azygos vein (1 case), hemiazygos vein (1), left internal thoracic (mammalian) vein (1), contralateral innominate vein (5) and 6 cases with correct anatomical catheter tip placement but with blood inflow from the catheter through the collateral vein system because of thrombosis of a major vein trunk (hemiazygos vein system (2), azygos vein (2), ascending lumbar veins (1), or portal vein system (1)). The malposition was diagnosed using roentgenography, with or without contrast, and computer tomography. In 3 cases the catheter was removed, in 5 cases the position was corrected. In the remaining 6 cases its function was maintained using anticoagulation or/and thrombolytic therapy. In conclusion, the placement of a permanent central vein catheter for hemodialysis must be followed by simple or contrast medium x-ray evaluation of its correct position or function. The malposition must be corrected whereas in the case where there is no alternative solution the function of the catheter may be maintained in the incorrect position using a combination of anticoagulation or/and thrombolytic therapy.

Adolescent↗

PubMed2003

The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system.

This study included 92 patients with an accessory navicular (AN) noted on an anteroposterior roentgenography. This group was selected from 860 patients admitted to the authors' gait analysis laboratory. The medial longitudinal arch was evaluated by using an "arch index" calculated from the pressure picture obtained from a pressure distribution measurement system. The average arch index was 0.15 and there was no significant correlation between AN types and arch index. The study concluded that the presence and type of AN are not correlated with the height of the medial longitudinal arch of the foot and that AN is not associated with pes planus.

Adolescent↗

PubMed1982

Subtalar arthrodesis for adult traumatic arthritis.

In this study the effectiveness of the modified Grice extra-articular subtalar fusion in treatment of painful subtalar arthritis postintra-articular os calcis fractures was evaluated. Twenty-one patients with 23 Grice fusions returned for questioning, clinical assessment and roentgenography. There were 16 males and 5 females. The ages ranged from 20 to 69 years (average 43.3 years). The follow-up period ranged from 2 to 9 years (average 4.3 years). The back-to-work time ranged from 2 weeks to 2 years (average 6.2 months). The patients were questioned and examined according to a described rating system. The patients and surgeons rated 10 of 23 (43.5%) fusions good, 12 to 23 (52.2%) satisfactory, and 1 to 23 (4.4%) fusions unsatisfactory. Eighteen patients (85.7% were fully active, and 3 patients (13.3%) changed to lighter work or activities. All fusions were solid clinically and radiologically. Complications were few and included three mildly painful iliac crest graft donor site scars, one superficial wound infection which resolved quickly, and one foot neuroma. In summary, the modified Grice extra-articular subtalar fusion is simple, reliable, and effective in the treatment of painful traumatic subtalar arthritis.

Adult↗

PubMed1994

Magnetic resonance imaging for the diagnosis of osteomyelitis in the diabetic patient with a foot ulcer.

Twenty-seven diabetic patients (12 males and 15 females) with clinically suspected osteomyelitis complicating soft tissue infection of the foot underwent 29 magnetic resonance imaging studies of the suspected lesion. Of these patients, 26 had plain film radiographs, 11 had technetium bone scanning, and 12 had indium-labeled leukocyte scintigraphy performed within 2 weeks of the magnetic resonance imaging. Definitive diagnosis of the presence or absence of osteomyelitis was obtained on the basis of surgical findings, histological evidence, or resolution with nonoperative therapy. Magnetic resonance imaging was 90% accurate (sensitivity 77%, specificity 100%) in the diagnosis of osteomyelitis in this patient population. Technetium bone scan was 45% accurate (sensitivity 100%, specificity 25%); indium-labeled leukocyte scintigraphy was 50% accurate (80% sensitivity, 29% specificity); and plain film roentgenography was 73% accurate (60% sensitivity, 81% specificity). Magnetic resonance imaging is a powerful, noninvasive tool for determining the presence or absence of osteomyelitis in the patient with a diabetic foot ulcer.

Adult↗

PubMed1994

Detection of wooden foreign bodies in muscle tissue: experimental comparison of computed tomography, magnetic resonance imaging, and ultrasonography.

An experimental study was performed to compare computed tomography (CT), magnetic resonance imaging (MRI), and real-time, high resolution ultrasonography (US) for the detection of wooden foreign bodies in muscle tissue. Wooden splinters were prepared, measured for size, soaked in saline, and placed in porcine muscle distant from and adjacent to bone. The specimens were then examined using roentgenography, CT and MRI in planes parallel and perpendicular to the splinters, and US. The largest wooden foreign bodies (minimum smallest width = 10 mm) were easily detected by CT, MRI, and US. Almost all splinters of various sizes, small and large, soaked in saline for 5 months were easily detected by MRI. Smaller splinters (minimum smallest width = 1-4 mm) soaked for only 3 days and placed distant from bone were most easily detected by US; those soaked for 5 months were most easily detected by either US or MRI. The smaller splinters soaked for only 3 days and placed near bone were not reliably detected by any of the imaging methods; CT and MRI were both more sensitive than US in this situation. MRI scanning was more sensitive perpendicular than parallel to the long axis of the splinters. Therefore, either US or MRI may be the best initial imaging modality for evaluation of a suspected wooden foreign body, depending on availability of imaging method, chronicity of symptoms, and proximity to bone.

Animals↗

PubMed1998

Reflex sympathetic dystrophy: facts and hypotheses.

Reflex sympathetic dystrophy (RSD) syndrome has been recognized clinically for many years. It is most often initiated by trauma to a nerve, neural plexus, or soft tissue. Diagnostic criteria are the presence of regional pain and other sensory changes following a noxious event. The pain is associated with changes in skin colour, skin temperature, abnormal sweating, oedema, and sometimes motor abnormalities. The clinical course is commonly divided into three stages: first (acute or hyperaemic), second (dystrophic or ischaemic), and third (atrophic) stage. The diagnosis is primarily clinical, but roentgenography, scintigraphy, thermography, electromyography and assessment of nerve conduction velocity can help to confirm the diagnosis. Although a wide variety of treatments have been recommended, the only therapies found to be effective in large studies aim at interfering with the activity of the sympathetic nervous system. To this end, efferent sympathetic nerve activity can be interrupted surgically or chemically. Alternatively, adrenoceptor blockers may be used to relieve pain. Numerous theories have been proposed to explain the pathophysiology. Sympathetic dysfunction, which often has been purported to play a pivotal role in RSD, has been suggested to consist of an increased rate of efferent sympathetic nerve impulses towards the involved extremity induced by increased afferent activity. However, the results of several experimental studies suggest that sympathetic dysfunction consists of supersensitivity to catecholamines induced by (partial) autonomic denervation. Besides, it has been suggested that excitation of sensory nerve fibres at axonal level causes release of neuropeptides at the peripheral endings of these fibres. These neuropeptides may induce vasodilation, increase vascular permeability, and excite surrounding sensory nerve fibres -- a phenomenon referred to as neurogenic inflammation. At the level of the central nervous system, it has been suggested that the increased input from peripheral nociceptors alters the central processing mechanisms.

Animals↗

PubMed1992

Changes in functional residual capacity and regional diaphragm lengths after upper abdominal surgery in anesthetized dogs.

The respiratory performance of the diaphragm may be altered by changes in mechanical or neural factors, or both, induced by upper abdominal surgery. We conducted this study to examine the effects of upper abdominal surgery on postoperative respiratory function. We studied resting lengths of four diaphragm regions, three in the costal and one in the crural diaphragm, with biplane video-roentgenography in six dogs immediately after upper abdominal surgery and up to 30 days postoperatively. Functional residual capacity was 16.7% smaller immediately after surgery compared with values obtained in the same animals after 30 days. Simultaneously measured resting lengths of each of the diaphragm regions immediately after surgery were longer, on average by 8.3%, than 30 days postoperatively. During the postoperative course, resting diaphragm lengths gradually and uniformly decreased as functional residual capacity increased. Phrenic nerve stimulation in four other dogs immediately after identical surgery resulted in large diaphragm shortening (from 42% to 55%), indicating that neither the diaphragm nor phrenic nerves were injured by the surgical manipulation. We hypothesize that respiratory dysfunction after upper abdominal surgery may be, at least in part, attributed to a decreased central drive for breathing caused by activation of the afferent limb of an inhibitory reflex owing to stretching of the diaphragm.

Abdomen↗

PubMed1986

Current neuroradiological investigation of spontaneous hemorrhage into the craniospinal axis.

Increasing experience-based statistical knowledge, expertise, and technical advancements in recent years have all contributed to the facility of investigations into the cause of spontaneous neuraxis hemorrhage. The sum of the neuroradiological evaluation has become increasingly more straightforward, simpler to execute, more informative, and safer to perform. Methods of investigation include the traditional forms of radiography such as skull roentgenography and conventional anteriography. However, the contribution of high resolution computed tomography, dynamic computed tomography, and venous and arterial digital subtraction angiography has been largely responsible for the progress in this complicated area of radiological diagnosis. The future advancement of radiological evaluation in patients with craniospinal hemorrhage will lie in the technical improvements of current imaging systems, as well as in the further development and refinement of new techniques such as magnetic resonance imaging.

Angiography↗

PubMed1987

Experimental spinal epidural abscess: a pathophysiological model in the rabbit.

To define the pathophysiology of spinal cord dysfunction associated with spinal epidural abscess formation, we developed an experimental model. Spinal epidural abscesses were produced in rabbits by injecting Staphylococcus aureus into the posterior thoracolumbar epidural space under direct vision. Progressive neurological deficits were detected in 18 of 20 animals; severe paraparesis or paraplegia occurred in 75%, and sphincter dysfunction occurred in 55%. Clinical data, including the results of plain spine roentgenography, myelography, and biochemical and bacteriological examination of the cerebrospinal fluid, were recorded. Epidural abscesses with varying degrees of spinal cord compression were confirmed pathologically in 95% of the experimental group. Spinal cord white matter changes included vacuolization, loss of myelin, and axonal swelling. The gray matter of the spinal cords was relatively preserved. There was no microscopic evidence of thrombosis or vasculitis in the major blood vessels supplying the spinal cords. Histopathological changes detected in the spinal cords were more consistent with direct compression of neural tissue than with infarction. The progressive clinical course and the histopathological changes in the spinal cord after compression by abscess closely resembled those of experimental compression of the spinal cord by epidural neoplasm.

Abscess↗

PubMed1988

Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging.

Intramedullary dermoid tumors are unusual. Traditional methods of diagnosing spinal tumors have included clinical suspicion, plain roentgenography, myelography, and computed tomography. A case of intramedullary tumor provisionally diagnosed preoperatively by traditional methods and specifically as dermoid tumor with the assistance of magnetic resonance imaging is presented. Diagnosis and treatment of spinal dermoid tumors with an emphasis on magnetic resonance imaging is discussed.

Adult↗

PubMed1980

Vectorcardiographical and pathological approach to the relationship between cardiac hypertrophy and coronary arteriosclerosis in spontaneously hypertensive rats (SHR).

To study the pathophysiology and the pathogenesis of hypertensive cardiac diseases such as cardiac hypertrophy and ischemic heart diseases, and to determine the relationship between these cardiopathies, spontaneously hypertensive rats (SHR) and stroke-prone SHR (SHRSP) were used as models. Vectorcardiography was applied to the rat according to orthogonal Takayasu lead system and "vectorcardiography for small animals" with a good reproducibility was established. Characteristic vectorcardiogram (VCG) was obtained from 5-month-old SHR, compared with normotensive Wistar-Kyoto rats (WK). Left superior (posterior) deviation of QRS vector usually with ST-T changes was recognized as LVH (Left Ventricular Hypertrophy) pattern of SHR and such corresponded to the pathological findings of the increased heart weight and the increased weight and thickness of the left ventricular wall, and also to the high blood pressure. Macroscopical morphological features of the heart were also studied. Chest roentgenography showed and increased cardiothoracic ratio (CTR) and the protrusion of the left ventricular portion in the posteroanterior cardiac silhouette of SHR. The horizontal view of the chest, cross-sectioned by the apparatus of whole body autoradiography, PMV-cryomicrotome 450 MP, indicated the left anterior orientation of the interventricular septum in rats, as is the case in humans, and the clockwise rotation of the left ventricular cavity in SHR, compared with WK. The coronary arterial wall thickening with narrowed lumen was noted even in the prehypertensive 1-month-old SHR. Such correlated well with the wall thickening of the left ventricle. From these vectorcardiographical and morphological studies on SHR and SHRSP, genetic hypertension was ascertained to be significant not only for cardiac hypertrophy but for the coronary arterial wall thickening, both of which may also enhance the myocardial lesions in SHR, particularly in SHRSP.

Animals↗

PubMed1992

Clinical significance of normal cardiac silhouette in dilated cardiomyopathy--evaluation based upon echocardiography and magnetic resonance imaging.

It is generally believed that patients with dilated cardiomyopathy have a large cardiac silhouette on chest roentgenography. Contrary to this general belief, we have recently examined several patients with a dilated left ventricle (LV) on echocardiography but in whom the cardiothoracic ratio (CTR) was within normal limits. To investigate this apparent discrepancy, we evaluated the relationship between LV dimensions, measured on M-mode echocardiography, and CTR in 49 patients with dilated cardiomyopathy. Among these patients, 11 (22%) had a CTR less than 50% and 38 (78%) had a CTR greater than 50%. The spatial orientation (cardiac rotation) of the LV within the thorax was evaluated by magnetic resonance imaging (MRI) in 5 patients with a CTR less than 50% and in 7 patients with a CTR greater than 50%, in comparison with 7 normal controls. In each of these patients, cardiac rotation was assessed from both a transverse and a frontal MRI section. In both groups, LV end-diastolic dimension was greater than 5 cm. Transverse cardiac rotation was 32 +/- 8 degrees in patients with a CTR less than 50%. This was significantly lower than in the 7 normal controls (43 +/- 7 degrees) (p less than 0.05). In patients with a CTR greater than 50%, however, transverse cardiac rotation (55 +/- 5 degrees) was significantly greater than in normal controls (p less than 0.01). No differences in frontal cardiac rotation was observed between the 2 groups. These data indicate that a normal cardiac silhouette in patients with dilated cardiomyopathy can be explained on the basis of a counterclockwise transverse rotation of the heart within the thorax, and it cannot always rule out the dilatation of the LV.

Adolescent↗

PubMed1993

Assessment of pulmonary edema based on extravascular thermal volume in dogs.

To establish criteria of pulmonary edema by extravascular thermal volume (ETV), ETV and a roentgenogram of the thorax were compared in normal and experimental hydrostatic pulmonary edema dogs. ETV was measured by the double indicator dilution technique using heat as a diffusible indicator and sodium ions as a non-diffusible indicator (thermal-Na method). Mean ETV in 14 dogs under physiologic conditions was 8.20 +/- 1.44 ml/kg. Comparison of ETV with the roentgenogram indicated the density of thoracic the roentgenogram to increase when ETV exceeded 11 ml/kg. Pulmonary edema was recognized clearly in the thoracic roentgenogram at more than 15 ml/kg of ETV. Further increase in ETV did not occur with additional radiographic change. ETV was significantly (P < 0.01) correlated with arterial oxygen tension (PaO2) but not statistically correlated with colloid oncotic pressure (COP), pulmonary arterial wedge pressure (PAWP) or PAWP-COP. Measurement of ETV would thus, appear to be a reliable method for evaluating the severity of pulmonary edema, which has been difficult to diagnose by roentgenography and should facilitate the early diagnosis and management of pulmonary edema.

Animals↗

PubMed1991

Auscultated forced expiratory time as a clinical and epidemiologic test of airway obstruction.

OBJECTIVE: Seeking an inexpensive, readily available, clinical, screening, and field surveillance test of airway obstruction, we determined the validity of current dogma that forced expiratory time (FET) is a good clinical test of airway obstruction yet is of no epidemiologic use given excessive intrasubject variability. SUBJECTS AND METHODS: Two hundred twenty-nine white male plumbers and pipefitters were evaluated by spirometry, chest roentgenography, and a standardized respiratory questionnaire during a union-sponsored asbestos screening program. Subjects were classified as having large airway obstruction (LAO), small airway obstruction (SAO) alone, or no obstruction, on the basis of standard spirometric prediction equations. Two physicians, blinded to clinical and spirometric data, independently measured FET while auscultating the trachea with a stethoscope. The FET was defined as the time taken for an individual to forcefully exhale through an open mouth from total lung capacity until airflow became inaudible. Five such times were recorded for each subject. The mean of the three times having the narrowest range was deemed the FET for calculating test sensitivity and specificity. Based on previous literature, an FET greater than or equal to 6 s was considered abnormally prolonged. RESULTS: Two hundred five subjects completed both spirometry and FET testing; 67 had LAO, 5 SAO, and 133 no obstruction. A total of 83 percent had three FETs reproducible within a range of less than or equal to 1 s. The sensitivity and specificity of FET for LAO were 92 and 43 percent, respectively, while for SAO alone, 60 and 44 percent, respectively. Overall, FET misclassified 56 percent of nonobstructed subjects. Adjusting the normal-abnormal cutoff points for both FET and SAO minimally improved the performance of FET. CONCLUSION: Although FET is a simple, inexpensive, sensitive, and fairly reproducible clinical test of LAO, it cannot be recommended as a clinical or an epidemiologic tool because of its extremely low specificity.

Asbestosis↗

PubMed1997

Diverse presentation of aberrant origin of the right subclavian artery: two case reports.

Aberrant origin of the right subclavian artery occurs in up to 1% of the population and can result in a wide range of symptoms. In this report, two cases of this anomaly are presented. In the first case, a patient developed fatal group A streptococcal aortitis. In the second case, the patient complained of chronic cough and intermittent dyspnea. The embryologic genesis of this abnormality is discussed and the current literature is summarized. Although relatively uncommon, it is important to consider this vascular anomaly in the differential diagnosis of patients with dysphagia, dyspnea, chest pain, fever, or mediastinal widening evidenced on chest roentgenography.

Adult↗