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PubMed1989

[Two cases of Mycoplasma pneumonia showing nodular shadows: computed tomographic findings].

Two cases of Mycoplasmal pneumonia showing nodular shadows on roentgenogram, in a 31 year-old woman and a 28 year-old man, were reported. The consequence of a radiographical analysis reveals that the nodular shadows on the roentgenogram were revealed on CT by the thickness of the bronchoarterial bundles and the nodular opacities which had a cetriacinar or centrilobular distribution, at the ends of the branches of the pulmonary arteries and bronchi. These findings suggest that the pulmonary lesions of Mycoplasmal pneumonia were located in the peribronchial and periarterial interstitium and the bronchioles and their adjacent alveoli. CT is useful in the evaluation of nodular shadows on roentgenogram.

Adult↗
PubMed1989

Basilar crescentic osteotomy. A three-dimensional computer simulation.

A three-dimensional computer simulation of the basilar crescentic osteotomy has been presented. The bunion deformity consists of hallux valgus, an increased first and second intermetatarsal angle, pronation of the great toe, and elevation of the first metatarsal head. Every foot is different and some may have more or less of each of the above noted components. Because the deformity is multiplanar, at least two roentgenograms are needed to evaluate the deformity. The weight-bearing, anterior-posterior roentgenogram is the principle radiograph used in preoperative planning. The use of a weight-bearing, sesamoid roentgenogram is recommended to quantify the anterior-posterior deflection and rotation of the first metatarsal head. A computer model (based on a cylinder) of the first metatarsal has been formulated. The osteotomy then was performed in a variety of scenarios in order to simulate the surgical correction. A great deal of flexibility is afforded by this osteotomy. The surgeon needs to be aware of the coupled motions that occur. That is, closure of the intermetatarsal angle may also cause head rotation, depression, or elevation. If the osteotomy is performed in an oblique multiplanar direction, then it is possible for the metatarsal head to elevate, pronate, and significantly shorten as the intermetatarsal angle is closed. If this scenario should occur, a poor surgical outcome will result. Excision of the medial eminence is recommended after the osteotomy has been completed and secured with stable fixation because of these rotational changes. The basilar crescentic osteotomy is an excellent method for correction of a marked metatarsus primus varus. It is important to pay close attention to a variety of anatomic considerations. The osteotomy must not be made in the diaphysis because of potential nonunion. There should be little dissection of the periosteum because of possible delayed union. As in any bunion surgery, it is essential to perform an adequate, distal, soft-tissue repair. Three dimensional preoperative planning is essential in obtaining correction of all components of a bunion. Specific guidelines, based on a three-dimensional computer model, are now available. An interactive computer program also is available to aid the surgeon in preoperative planning. We hope there will be better understanding of this technically difficult but highly versatile osteotomy.

Hallux Valgus↗
PubMed1989

A case report of Forestier's disease.

Radiologic studies are essential in diagnosing Forestier's disease and include lateral cervical spine roentgenograms, thoracic and lumbosacral vertebrae roentgenograms, esophagram, vertebrae roentgenograms, esophagram, and computed tomography. Patients with Forestier's disease may be considered to be operative candidates if they have persistent dysphagia, dysphonia, and a feeling of fullness or foreign body in the throat. The patient in our case report underwent anterior surgical resection of her anterior cervical osteophytes. Two months following surgery, she was no longer experiencing dysphagia or dyspnea.

Adult↗
PubMed1989

Load transfer characteristics of a noncemented total knee arthroplasty.

This study evaluated load transfer characteristics of femoral and tibial components of a total knee prosthesis that was designed to achieve distal femoral and proximal tibial compressive load-bearing. Strain gauge readings were highest on the cortex of the tibial metaphyseal flare. Roentgenograms of 110 patients with noncemented total knee arthroplasty (TKA) with follow-up periods of 12-24 months were evaluated. Cancellous bone hypertrophy bridging from the undersurface of the tibial component to the metaphyseal cortical bone was noted on all roentgenograms at six months, suggesting stress transfer through cancellous bone to this area. Anterolateral sinking was noted in six of the first 46 patients but was not seen again in the series after a design change was made to more rigidly fix the stem in the bone of the upper tibia. Roentgenograms of the femoral components demonstrated distal bone hypertrophy suggesting compressive load bearing. None of the femoral components migrated or sank.

Bone Cements↗
PubMed1989

Roentgenographic changes in proximal femoral dimensions due to hip rotation.

Three human adult femurs were examined using anteroposterior (AP) roentgenograms in anatomical position and in 15 degrees, 30 degrees, and 45 degrees of internal and external rotation. Relatively small (15 degrees or less) amounts of femoral rotation can cause significant changes in proximal femoral dimensions on supine AP hip roentgenograms, and the magnitude of these changes increases with rotation. Fifteen degrees of rotation can change it by almost 3 mm. These changes are comparable to the medullary canal expansion of a normal adult femur over a five- to ten-year period. These changes in measured proximal femoral dimensions with rotation necessitate either an improved roentgenographic technique or precise rotational matching of standard supine roentgenograms to obtain accurate measurements of their changes over time.

Femur↗
PubMed1988

Subluxation of the patella. Computed tomography analysis of patellofemoral congruence.

Fifty patients who had patellar subluxation and thirty control subjects were examined using axial roentgenograms of the patellofemoral joint that were made with the knee in 30 and 45 degrees of flexion, as well as computed tomography scans that were made with the knee in full extension. The amount of lateral patellar tilt was quantitatively assessed using the lateral patellofemoral angle, as described by Laurin et al., and the congruence angle, as described by Merchant et al. In both the control subjects and the patients, the angle of Laurin et al. changed significantly when the knee was flexed from full extension to 30 degrees. The difference between the groups was statistically significant at each angle of flexion of the knee, and the difference between the groups was most prominent on the computed tomography scans that were made with the knee in full extension (p less than 0.001). In the patients, the average congruence angle (as described by Merchant et al.) was 5 degrees and in the control subjects, -10 degrees. This indicated that, in our patients, the extent of the patellar subluxation was less than that in previously reported series, and, as a result, the sensitivity of the congruence angle in diagnosing patellar subluxation was only 0.30. In contrast, the sensitivity and specificity of the computed tomography scans for diagnosing patellar subluxation were 0.96 and 0.90, respectively--that is, they were higher than the values that were obtained using any axial roentgenograms. Thus, our results indicated that patellar subluxation can be detected more accurately by using computed tomography with the knee in full extension than by using conventional axial roentgenograms.

Adolescent↗
PubMed1988

Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment.

Except after trauma resulting in an intracapsular fracture of the femoral neck or dislocation of the hip, the causes of pathogenesis in osteonecrosis of the femoral head have yet to emerge. The circulation to the femoral head may be impaired severely following a traumatic episode. Staging of the pathologic process is important as the selection of the appropriate surgical treatment depends upon the stage at the time of diagnosis. Anteroposterior and lateral roentgenograms are sufficiently accurate to make the diagnosis in Stages II to V. Tomography or Magnetic Resonance Imaging (MRI) are prescribed when roentgenograms are consistent with Stage II disease. This recommendation is made because subtle changes may be present that are not apparent on the roentgenogram, such as fracture of the surface or beginning segmental collapse. These changes would change the classification to Stage III rather than Stage II. MRI or core biopsy is required for diagnosis in Stage I. Many surgical treatment options have been proposed for the treatment of osteonecrosis of the femoral head. No one operation has been shown to be superior. Most papers do not have sufficient long-term follow-up evaluation or a significantly large number of cases to allow one to draw firm conclusions about the efficacy of the operation. Total hip replacement or hip arthrodesis is the treatment of choice for the end stages of the disease when the hip joint has degenerated.

Bone Transplantation↗
PubMed1988

Ulcerative colitis and steroid-responsive, diffuse interstitial lung disease. A trial of N = 1.

We describe a patient with ulcerative colitis and extracolonic manifestations in whom diffuse interstitial pulmonary disease developed that was responsive to glucocorticoid therapy one year after total proctocolectomy. The patient presented in December 1983 with a subacute course marked by cough and progressive exertional dyspnea, abnormal chest examination results, and a chest roentgenogram that revealed diffuse interstitial and alveolar infiltrates. A transbronchial biopsy specimen revealed a polymorphic interstitial infiltrate, mild interstitial fibrosis without apparent intraluminal fibrosis, and no vasculitis, granulomas, or significant eosinophilic infiltration. Within one week of the initiation of daily high-dose steroid therapy, the patient's symptoms dramatically improved; chest roentgenogram and forced vital capacity (60%) improved at a slower rate. All three measures deteriorated when alternate-day prednisone therapy was started but once again improved until the patient was totally asymptomatic, chest roentgenograms were normal, and forced vital capacity was 80% of the predicted value 2 1/2 years later.

Adult↗
PubMed1988

Idiopathic scoliosis and growth--a biomechanical consideration.

Growth force proposed as an etiological factor in idiopathic scoliosis was analysed by a mathematical simulation; the results were compared with clinical roentgenograms of patients with idiopathic scoliosis. Growth force is a self-equilibrating internal stress derived from unbalanced growth between two adjacent structures with different growth rates. In the simulation, the localized growth force made the whole spinal column buckle. Two hundred anteroposterior roentgenograms were then compared with the buckling curves. The three most similar buckling curves for each roentgenogram were selected. Of the 600 selected curves, 406 were considered to have produced a high similarity. The curves produced by a growth force extending over a small area, especially at the mid-lower thoracic and lumbar regions, were qualified as curves with a high similarity. The growth force thus does not appear uniformly all over the spinal column but locally and at the mid-lower thoracic or lumbar region. This growth force may represent a factor in the etiology of idiopathic scoliosis.

Biomechanical Phenomena↗
PubMed1986

Predicting the healing of the displaced subcapital hip fracture via postoperative roentgenographic factors.

Postoperative roentgenograms of displaced subcapital hip fractures treated with a sliding, keyless compression screw were analyzed for the degree of osteoporosis, level of fracture, and adequacy of reduction. Reduction was graded by measuring the AP Garden angle, the lateral Garden angle, and displacement of the femoral head with comparison to the contralateral hip. Seventy-three displaced subcapital hip fractures were treated over a four-year period. On follow-up, 52 hips were available for analysis. Follow-up examination revealed that 28 hips had failed; these were converted to total hip arthroplasties, bipolar devices, or Girdlestones. Twenty-three hips had healed at a follow-up of 23.6 months. A 24th had become infected and was converted to a Girdlestone. A review of the postoperative roentgenograms revealed that the AP Garden angle was most successful in predicting healing. The lateral Garden angle and displacement of the femoral head on the AP and lateral roentgenograms were less successful predictors. The level of the fracture, the Singh index, and demographic factors, such as age and sex, were not found to be predictive or significant.

Aged↗
PubMed1986

[Diagnosis of pleural effusion using sector sonography in childhood].

Sectorsonographic examination was performed in 17 patients with pleural effusion after heart surgery (n = 15) and during bacterial pneumonia (n = 2). When pleural effusion could be diagnosed by chest roentgenogram, it was identified by ultrasound in every patient. On the other hand, it was possible to recognize pleural effusion by ultrasound in 6 patients in whom chest roentgenogram was equivocal or failed the diagnosis. Neither chest roentgenogram nor ultrasound allowed the differentiation between transsudate, exsudate, chylus, and blood in the pleural space. However, localization and mobility of the diaphragm as well as concomitant pericardial effusion and/or ascites can be identified by ultrasound. Sonographic examination, an easily repeatable harmless method without radiation exposure should be performed in pediatric patients whenever pleural effusion is suspected.

Ascites↗
PubMed1978

Pulmonary sequestration.

Pulmonary sequestration is an uncommon congenital abnormality in which nonfunctioning lung tissue is supplied by an anomalous systemic artery. Both the extralobar and intralobar forms probably develop from an accessory lung bud from the primitive foregut. Both forms are situated on the left side in about two-thirds of patients. The anomalous arterial supply usually originates from the descending thoracic aorta, and there may be a large left-to-left or left-to-right shunt through the sequestration. The sequestration may have a fistulous communication with the upper gastrointestinal tract. Congenital anomalies, particularly diaphragmatic hernia, are frequently associated with the extralobar form. Intralobar sequestration occasionally is an incidental finding on roentgenograms of the chest in an asymptomatic patient; however, the disorder is usually symptomatic and the most common presentation is recurrent pulmonary infection. Presentation may be characterized by gastrointestinal symptoms, congestive heart failure, hemoptysis or hemothorax. Extralobar sequestration is usually an incidental finding on routine roentgenograms of the chest or during the management of some other congenital anomaly. Infrequently, extralobar sequestration presents with symptoms similar to those seen with the intralobar form. Roentgenograms of the chest, upper gastrointestinal series and arteriography are the most helpful diagnostic aids. The usual treatment is resection of the sequestration by removal of only the sequestration in patients with the extralobar form and by lobectomy or segmental resection in patients with the intralobar form. The reported results of operation have generally been excellent.

Abnormalities, Multiple↗
PubMed1986

Neurapraxia of the cervical spinal cord with transient quadriplegia.

The purpose of this study was to define as a distinct clinical entity the syndrome of neurapraxia of the cervical spinal cord with transient quadriplegia. The sensory changes include burning pain, numbness, tingling, and loss of sensation, while the motor changes range from weakness to complete paralysis. The episodes are transient and complete recovery usually occurs in ten to fifteen minutes, although in some patients gradual resolution occurs over a period of thirty-six to forty-eight hours. Except for burning paresthesia, pain in the neck is not present at the time of injury and there is complete return of motor function and full, pain-free motion of the cervical spine. In our series, routine roentgenograms of the cervical spine were negative for fractures or dislocations in all patients. However, the roentgenographic findings did include developmental spinal stenosis in seventeen patients, congenital fusion in five patients, cervical instability in four patients, and intervertebral disc disease in six patients. Spinal stenosis was determined by two different roentgenographic methods. The first was the standard method, and the second was a ratio method devised by us. Both measurements were made at the level of the third through the sixth vertebral body on a routine lateral roentgenogram of the cervical spine that was available for twenty-four of the thirty-two patients and for a control group of forty-nine male subjects of similar age who did not have any neurological complaints. Using the ratio method, a measurement of less than 0.80 indicated significant spinal stenosis in the group of twenty-four patients for whom roentgenograms were available, as compared with a ratio of approximately 1.00 or more in the control group. There was statistically significant spinal stenosis (p less than 0.0001) in all of the patients as compared with the control subjects by both methods of determining spinal stenosis. A survey of 503 schools participating in National Collegiate Athletic Association (NCAA) football in the 1984 season found that 1.3 per 10,000 athletes had a history that was suggestive of neurapraxia of the cervical spinal cord. The phenomenon of neurapraxia of the cervical spinal cord occurs in individuals with developmental stenosis of the cervical spine, congenital fusion, cervical instability, or protrusion of an intervertebral disc in association with a decrease in the anteroposterior diameter of the spinal canal. We postulate that in athletes with diminution of the anteroposterior diameter of the spinal canal the spinal cord can, on forced hyperextension or hyperflexion, be compressed, causing transitory motor and sensory manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

Chronic cough. Diagnosis and treatment.

Cough is a common symptom in the smoking and non-smoking patient seeking medical attention from the office-based physician. Often, a comprehensive history and physical examination suggest the correct diagnosis, and specific therapy can be directed to the underlying disease. A chest roentgenogram is an essential part of the workup; it may suggest tuberculosis, chronic fungal infection, bronchiectasis, or lung abscess. In addition, bronchogenic carcinoma, which is increasing in frequency in the population, has several common manifestations that can be recognized on the chest roentgenogram. Pulmonary function studies are often helpful in the workup of the patient with chronic cough. A pattern of obstructive lung disease is seen with asthma, chronic bronchitis, and bronchiectasis. Diseases that cause lung fibrosis, such as idiopathic pulmonary fibrosis, sarcoidosis, and pneumoconiosis, give a restrictive ventilatory defect. Bronchoprovocation testing can be helpful when baseline pulmonary function tests are normal and the diagnosis of postviral bronchitis or cough-variant asthma is suggested. If the bronchial inhalation challenge is negative, these diagnoses can be excluded. Chronic rhinosinusitis with associated postnasal drip is one of the most common causes of chronic cough and is often difficult to confirm because the physical examination and roentgenogram of the paranasal sinuses may be normal. In a great majority of patients with chronic cough, a diagnosis can be established by simple, clinical and laboratory procedures used in the outpatient setting.

Asthma↗
PubMed1985

Pneumothorax during positive-pressure mechanical ventilation.

The hemodynamic and respiratory effects of unilateral pneumothorax were studied during positive-pressure mechanical ventilation in five sheep. The sheep were anesthetized, intubated, and placed on mechanical ventilation with positive end-expiratory pressure (5 cm H2O). After baseline studies, including chest roentgenograms, were taken, increments of air were injected into the right pleural cavity. Measurements were repeated at pneumothoraces of 500, 1,000, and 1,500 ml. There was a steady fall in cardiac output (p less than 0.02) at pneumothoraces of 1,000 and 1,500 ml. The decrease in cardiac stroke volume paralleled that of cardiac output. Heart rate rose (p less than 0.05) at a pneumothorax of 1,500 ml. There appeared to be a linear relationship between the percent increase in pneumothorax as estimated by roentgenogram and the percent fall in cardiac output (r = 0.991). There was a steady rise in mean pulmonary arterial, pulmonary arterial capillary wedge, superior vena caval, and inferior vena caval pressures, although the changes in inferior vena caval pressure were not statistically different from baseline. Peak airway pressure increased from baseline at pneumothoraces of 1,000 and 1,500 ml. Both right and left end-expiratory intrapleural pressures increased and were statistically different (p less than 0.01) from baseline. However, there was a substantially greater rise in right intrapleural pressure than left. Arterial oxygen tension remained physiological throughout the study. This study indicates that cardiac output decreases as the amount of pneumothorax increases in sheep during mechanical ventilation. This study also demonstrates that, during positive-pressure mechanical ventilation, a relatively benign-appearing pneumothorax by chest roentgenogram may be associated with a significantly depressed cardiac output. In addition, arterial oxygen tension may not be useful in predicting the onset of pneumothorax during mechanical ventilation.

Animals↗
PubMed1985

[Correlation of roentgen picture and lung function testing within the scope of silicosis evaluation].

The chest roentgenograms codified according to the 1980 ILO classification and the lung function tests of 100 persons with silicosis have been compared with each other. The results show that, with a higher degree of dissemination and a growing size of nodes, there is a statistically significant tendency to increasing gravity of pathological results of resistance and the arterial blood gas analysis. A correlation between the degree of dissemination and the size of nodes to other lung function parameters (vital capacity, intrathoracic gas volume) cannot be finally established. Furthermore, neither coding as category B nor the employment of the symbols em (emphysema) and tb (tuberculosis) allow conclusions to be drawn about the results of lung function tests. The poor correlation is caused on one hand by the insufficient description of the morphological parameters important for function, due to the restricted classification. On the other hand there is little correlation between chest roentgenogram and lung function, as lung function in anthracosis is essentially influenced by obstructive bronchitis, which has only a loose connection with silicosis.--Lung function must be the central point in the process of forming an opinion. Chest roentgenograms are important for clarifying the causes of pathological changes and allow a simple observation of progress.

Airway Resistance↗
PubMed1979

Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability.

Long-standing lateral ligament instability of the ankle results in unbalanced loading of the medial joint space and the possible development of degenerative arthritis. Thirty-six patients who had had lateral ankle instability for at least ten years and complaints of increasing ankle pain evidence degenerative changes of the articular cartilage over the medial half of the talar and tibial surfaces of the ankle joint. These changes were minimally apparent on roentgenograms unless weight-bearing roentgenograms were made, but arthroscopy of the joint accurately revealed the extent of degeneration. After reconstruction of the lateral ankle ligaments, fourteen of twenty-two patients with mild to moderate arthritic changes showed both symptomatic improvement and demonstrable widening of the medial joint space on weight-bearing roentgenograms. Four of five patients with severe degenerative arthritis subsequently had a total ankle replacement.

Adult↗
PubMed1979

Roentgenographic follow-up of acute pneumonia in children.

The need for follow-up roentgenograms documenting complete clearing of pulmonary infiltrates in the pediatric patient with acute pneumonia was studied prospectively. Seventy of 129 children enrolled in the study had a repeat roentgenogram within three to four weeks after initial diagnosis. Twenty percent of this group had residual pulmonary infiltrates. Of the two thirds of those who returned for a second follow-up roetgenogram, the infiltratrates had cleared completely within three months. Routine repeat chest roentgenograms may not be necessary unless there is clinical evidence of persistent respiratory difficulty or failure to thrive.

Acute Disease↗