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PubMed1986

Comparisons between CK-B and other clinical indicators of cardiac contusion following multiple trauma.

The activity of creatine kinase (CK) and creatine kinase B(CK-B) was measured in 17 patients with injuries to multiple organ systems, including the chest. The patients were closely observed for clinical signs of disturbed cardiac function by means of serial ECG, continuous monitoring of cardiac rhythm, daily cardiac auscultation, serial chest roentgenography and monitoring of central hemodynamic parameters. No statistically significant difference in CK and CK-B activity was found between the group of patients with normal cardiac function and the group with disturbed cardiac function. The CK-B activity was markedly elevated, but CK-B activity relative to CK activity was normal in both groups during the first 7 days after the trauma. The authors conclude that the significance of these enzymes' serum activity, measured with the immunoinhibition method, is diagnostically doubtful not only as regards cardiac contusions, but also in other cardiopathy preceding or following major trauma.

Abdominal Injuries↗

PubMed1989

Stenosis of the foramen magnum and rostral spinal canal, with spinal cord deformity, in Jeune's asphyxiating thoracic dystrophy.

Ventilatory compromise in Jeune's asphyxiating thoracic dystrophy (JTD) generally is attributed to abnormalities in thoracic configuration that produce restrictive pulmonary disease and pulmonary hypoplasia. We present our findings following dissection and roentgenography of the base of the skull and the vertebral column in a premature infant with JTD. They suggest that malformations of the vertebral laminae in JTD may lead to compression of the distal medulla and rostral cervical spinal cord. Similar compression is known to contribute to ventilatory dysfunction in other osteochondrodysplasias. It is possible that vertebral laminar malformations may be partly responsible for ventilatory dysfunction in some patients with JTD. We recommend attention at necropsy in JTD to malformations of the neural arch and to their possible sequelae.

Abnormalities, Multiple↗

PubMed1997

Lung injury related to consuming Sauropus androgynus vegetable.

BACKGROUND: Taking Sauropus androgynus, a Malaysian food, to reduce weight began as a fad in Taiwan in 1994. Some advocates of this fad developed pulmonary dysfunction. The aim of this study is to report the lung injury in patients taking Sauropus androgynus. METHODS: From July 1995 to November 1995, we investigated 104 nonsmoking patients (one male and 103 females) with chest roentgenography, pulmonary function, test, and Technetium 99m-labeled diethylene triamine penta-acetate (Tc-99m DTPA) radioaerosol inhalation lung scintigraphy. RESULTS: Among the 90 patients receiving Tc-99m DTPA inhalation lung scan, 46 (51.1%) patients had increased clearance of Tc-99m DTPA from lung and 20 (22.2%) patients had inhomogeneous deposition of the submicronic radioaerosol. Eighteen (18/100) patients had obstructive ventilatory impairment in pulmonary function test. Analyzing the results, we found that the patients with respiratory symptoms (n = 42) took more vegetables (p = 0.016), had increased clearance of Tc-99m DTPA (p = 0.010) and had lower FEV1 (p = 0.001), FEV1/FVC (p < 0.001), FEF25-75 (p = 0.001), VC (p = 0.002) and DLCO (p = 0.009) than the patients without respiratory symptoms (n = 62). FEV1 and FEV1/FVC were significantly reduced in patients with severe impairment of alveolar permeability. The cumulative dosage and duration of exposure were significantly associated with the reduction of FEV1 and FEV1/FVC. CONCLUSION: The lung injury after taking Sauropus androgynus involves alveoli and/or small airways and is manifest as obstructive ventilatory impairment with inhomogeneous aerosol distribution and increased lung epithelial permeability.

Adolescent↗

PubMed1976

Compression and the osteotomy gap.

The existence of a clearly visible osteotomy gap by optimal roentgenography even in cases where high compression had been applied is exemplified. One case of fracture of the osteosynthesis material used in a medial displacement osteotomy is illustrated. It is suggested that this and similar accidents are sometimes consequences of imperfect surface contact at the operation, visible only by central beam radiography.

Animals↗

PubMed1983

Community-acquired Legionella micdadei (Pittsburgh pneumonia agent) infection in Sweden.

The first case of Legionella micdadei (Pittsburgh Pneumonia Agent) infection in Sweden is presented. A previously healthy 68-yr-old man fell ill with diarrhoea, fever, and mental confusion. Subsequently chest roentgenography revealed pneumonic infiltrates and a seroconversion to L. micdadei was shown. No source or transmission of infection was established. The only notable event was that the patient had been drinking rain-water from a barrel 1 day prior to his illness. An alimentary route of infection was considered.

Aged↗

PubMed1980

Follow-up study with computerized tomography and clinical evaluation 5 to 10 years after surgery for pituitary adenoma.

This study was based on 24 consecutive patients operated on for pituitary adenoma with suprasellar extension, and treated postoperatively with radiotherapy. The follow-up period was 5 to 10 years. A clinical examination, endocrine evaluation, perimetry, computerized tomography (CT) and sellar roentgenography were performed in 19 of 20 surviving patients. The CT scans revealed four recurrences, while perimetry only showed an increased visual field defect in one patient. Plain sellar films were of no value for diagnosis of recurrence. Prolactin determinations seemed to have a limited value in recurrence diagnosis, but very high levels spoke in favor of a recurrence. Thus, CT was found to be the superior method of diagnosing recurrences. It is proposed that CT be used regularly in the follow-up study of patients operated on for a pituitary adenoma.

Adenoma↗

PubMedDate not supplied

The pathology of tumors. Part II: Diagnostic techniques.

Frozen section diagnosis of cancer is generally used to 1) determine the type and extent of treatment while the patient is in the operating room and 2) to confirm the adequacy of surgical excision. Frozen section diagnosis forms the basis for further surgery. Because of the pathologist's role in this decision, he should be as familiar as possible with pertinent clinical data (e.g., previous biopsy or surgery) prior to operation. In some cases he may wish to observe the lesion in situ or suggest an area to be biopsied. Frozen section is very reliable in cancer diagnosis. A recent review of 2,240 consecutive sections has shown an overall accuracy of 99.3 percent with 13 false-negatives and only five false-positives. The technique is useful for most specimens, even tissue from needle biopsies. When the pathologist receives the gross specimen he must orient it and describe the color, consistency and size of the tumor and record its appearance prior to sectioning. The specimen must be carefully examined for any indications of inadequate tumor excision. Specimens may have critical areas close to the wound limits and the sections must be careflly oriented to prove or disprove adequate excision. Specimen roentgenography is very useful in evaluating excision and in pinpointing the tumor area. Microscopic description of tumors includes details of pattern, nuclear changes, stroma, and many others. However, only the microscopic findings which have prognostic or therapeutic significance should be emphasized to the surgeon. Summarizing the pertinent findings in a final paragraph of the pathology report can translate routine microscopic description into constructive clinical information which will give the surgeon a clear idea of the probable behavior of the tumor. In addition to the standard procedures for preparing and examining specimens for final diagnosis, there are some special techniques which are extremely useful. These include immunohistochemical staining, electron microscopy, tissue culture and biochemical studies.

Biopsy↗

PubMedDate not supplied

Lung cancer: current concepts and prospects.

In the United States, lung cancer is now the leading cancer killer among men, and it will soon be the leader among women. Most lung cancers are attributable to cigarette smoking. Symptomatic lung cancer tends to be advanced and unresectable. Chest roentgenography and sputum cytology are the only techniques proved capable of detecting presymptomatic, early-stage disease. Treatment of lung cancer depends primarily on the cell type and the extent of the tumor. Small cell cancer tends to be widespread, and the favored treatment is combination chemotherapy. For non-small cell cancer, the treatment of choice, whenever possible, is surgical resection. Efforts directed toward early detection and treatment have failed to reduce lung cancer mortality substantially. Thus, primary prevention through control of cigarette smoking remains the single most important measure for combating this frustrating disease.

Adenocarcinoma↗

PubMed2005

Surgical treatment of giant esophageal leiomyoma.

AIM: To summarize the operative experiences for giant leiomyoma of esophagus. METHODS: Eight cases of giant esophageal leiomyoma (GEL) whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004. All of these cases received barium swallow roentgenography and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap (one case), esophagectomy and esophago-gastrostomy above the arch of aorta (three cases), total esophagectomy and esophageal replacement with colon (four cases). Histological examination confirmed that all of these cases were leiomyoma. RESULTS: All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophago-gastrostomy and was alleviated with medication. Thoracic colon syndrome (TCS) occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years. CONCLUSION: Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophago-gastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.

Adult↗

PubMed1976

[New method of anatomic localization of scintigram of various organs by simultaneous combination of emission scanning and transmission scanning].

When the photoscintillo-roentgenography is used for relating the scintigram of internal organs to the anatomic structures, this method is found to have some defects--the difference of magnification between the emission scan and the roentgenogram, the inaccuracy due to the geometric distortion of the X-ray image, the impossibility of the simultaneous photographing of the scan and the X-rays, etc. Then, to diminish the influence of these defects we improved on the photographic recording system of a dual-heal scanner, and made use of the transmission scanning method. That is, we combined the recording parts, Ch1 and Ch2, into one system, using Ch1 for the light source of transmission scan and Ch2 for that of emission scan. In this way, we managed to make the two incident rays from those light sources converge into a focus upon a film. Thus we could perform a simultaneous emission-transmission scanning, by moving, at the same time in the same direction, the scanning detector over the patient and the small radioactive source (241Am) under him. This method can be applied to any radioactive nuclide to be used in transmission scanning and emission scanning. As the result of applying this method clinically in our department, the method has proved to be very useful for anatomic localization.

Humans↗

PubMed1997

Aspiration pneumonia. Strategies for early recognition and prevention.

Aspiration is the result of dysfunction during the oral, pharyngeal, or esophageal stage of deglutition. Depending on the type of aspirate, the resultant lung injury may include chemical or bacterial inflammation or obstruction of the airways. Tools for evaluation include roentgenography, upper GI tract studies, bronchoscopy, and esophageal pH studies. Medical management is primarily supportive. Because aspiration pneumonia has a high morbidity rate, prevention involving early recognition and modification of predisposing factors whenever possible is critical for improving outcomes.

Humans↗

PubMedDate not supplied

Right pleural effusion due to a migrating ventriculoperitoneal shunt.

BACKGROUND: Pseudotumor cerebri or benign intracranial hypertension is a collection of disorders characterized by papilledema and increased intracranial pressure without associated neurologic abnormalities and wherein the cerebrospinal fluid composition is normal. Therapy may consist of diuretics, acetazolamide, and, in more severe cases, ventricular shunts. SUMMARY: A patient with pseudotumor cerebri and a ventriculoperitoneal shunt presented with dyspnea early in her pregnancy. Chest roentgenography revealed a right pleural effusion and a shunt catheter in the right pleural space. The patient underwent four thoracenteses, and a new shunt was placed after the baby was born. CONCLUSIONS: Physicians should recognize the potential for a ventriculoperitoneal shunt to migrate from the peritoneum to the pleural space. In a pregnant patient, it is reasonable to perform serial thoracenteses as a temporizing measure, and the shunt can be definitively revised in an elective surgical procedure postpartum.

Adult↗

PubMed1993

[Clinical observation of acute otitis media in children].

The efficacy of a combination of cefaclor and fosfomycin otic solution was investigated in 81 children with acute otitis media, who needed myringotomy for severe erythema and swelling of the tympanic membrane. The patients were followed up for one year to investigate correlations between test findings of early treatment and both clinical course and prognosis. These drugs were used for 10 days, and the effects of combined use were evaluated from findings in the tympanic membrane after the 10-day period. Three stages were assessed; cured, recovered and unchanged. In cured and recovered cases, the administration was evaluated to be effective. Within 2 weeks after the start of treatment, views of the ears, nose and epipharynx were roentgenographically examined for shadows of mastoid pneumatization and the paranasal sinuses, and the presence or absence of adenoid vegetation. After the antibiotic administration, the patients were instructed to visit us at least once every 3 months to rule out recurrence of acute otitis media and otitis media with effusion (possibly occurring one year after treatment). The following results were obtained. 1. The two drug combination was effective in 99% of patients, produced no side effects, and was deemed extremely useful. 2. The course of acute otitis media tended to be significantly prolonged in patients with mastoid pneumatization and paranasal sinus shadows as revealed by roentgenography.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1995

Mediastinal parathyroid cysts.

OBJECTIVE: To present our experience with mediastinal parathyroid cysts and summarize previously reported cases. DESIGN: We retrospectively reviewed medical records and reviewed the pertinent literature. MATERIAL AND METHODS: The clinical, operative, and pathologic findings in 7 cases of mediastinal parathyroid cysts encountered at one institution and 31 cases previously reported in the literature are described. RESULTS: Rarely, cysts may arise from an aberrant mediastinal parathyroid gland. Such cysts may manifest as a symptomatic mass, as an asymptomatic finding on roentgenography, or during the assessment of a patient with hyperparathyroidism. The diagnosis may be made by fine-needle aspiration or by excision and pathologic examination. CONCLUSION: Functioning parathyroid cysts represent degeneration of a hyperfunctioning gland, such as an adenoma, and are usually removed through a cervical approach. Nonfunctioning cysts in asymptomatic patients with normal serum calcium levels are considered indeterminate and should be managed accordingly. Excision is usually recommended.

Adult↗

PubMed1995

Sarcoidosis.

Sarcoidosis is a systemic granulomatous process of unknown cause. Pathologically, it is characterized by noncaseous granuloma, and in more than 90% of patients, the lung or intrathoracic lymph nodes are affected. A roentgenographic staging system (stages I, II, and III), based on the appearance of the plain chest roentgenogram, conveys important information about prognosis, degree of symptoms, and pulmonary function abnormalities. The diagnosis should be confirmed by histopathologic examination and exclusion of known causes for the noncaseous granulomatous reaction. When indicated, treatment with alternate-day regimens of prednisone is highly effective. Serial chest roentgenography, pulmonary function studies, and the serum angiotensin-converting enzyme level are useful for monitoring the course of the disease.

Algorithms↗

PubMed1995

Chronic cough associated with subacute bacterial endocarditis.

Although the literature on subacute bacterial endocarditis from both the preantibiotic and antibiotic eras mentions cough as a symptom, neither bacteremia nor endocarditis is listed in reviews on chronic cough. Herein we describe a 74-year-old man who underwent an extensive workup as an outpatient because of chronic cough of 7 months' duration. Chest roentgenography, chest and sinus computed tomography, fiberoptic bronchoscopy, gallium scan, transthoracic echocardiography, and other studies revealed no apparent cause for his nonproductive cough. Because of a persistently increased erythrocyte sedimentation rate and associated weight loss, blood cultures were obtained, all of which grew Streptococcus constellatus. A transesophageal echocardiogram revealed mitral valve vegetation. After antibiotic therapy was administered, the patient's cough completely resolved. He has experienced no coughing for more than 14 months. Bacteremia in conjunction with endocarditis should be added to the list of uncommon causes of chronic cough. The mechanism of cough is unknown.

Aged↗

PubMed1996

Prospective evaluation of the utility of molecular techniques for diagnosing nosocomial transmission of multidrug-resistant tuberculosis.

OBJECTIVE: To compare molecular techniques with conventional diagnostic methods for evaluating nosocomial transmission of multidrug-resistant tuberculosis (MDR-TB). DESIGN: We conducted a 12-week postexposure inception cohort study of health-care personnel who had been exposed to a patient with MDR-TB. MATERIAL AND METHODS: In addition to baseline and follow-up tuberculin skin tests and chest roentgenography, weekly pulmonary specimens were evaluated by (1) auramine-rhodamine fluorescent staining, (2) culture for mycobacteria, and (3) polymerase chain reaction (PCR) to amplify IS6110, a nucleic acid insertion sequence unique to the Mycobactrium tuberculosis complex. RESULTS: The index patient's isolate of M. tuberculosis showed a mutation in codon 531 of the RNA polymerase beta subunit (rpoB) gene of M. tuberculosis, which is associated with rifampin resistance and considered a marker for this MDR-TB strain. All pulmonary and gastric specimens from study participants had negative auramine stains and cultures for mycobacteria, One person, however, had separate specimens with repeatedly positive PCR results for IS6110 sequences, but the specimens contained a wild-type M. tuberculosis rpoB codon 531 dissimilar from the index patient's strain. CONCLUSION: Although both molecular and conventional testing showed that no exposed person was infected with the MDR-TB strain, molecular test results were available sooner and seemed more sensitive for detecting M. tuberculosis in one exposed person, presumably in a preinfection or "colonized" stage. Molecular methods provided information that helped distinguish this person's M. tuberculosis strain from the index patient's MDR-TB strain. Additional prospective studies should assess the value of these molecular techniques in similar clinical settings.

Antitubercular Agents↗

PubMed1997

Malignant melanoma: an emerging and preventable medical catastrophe.

The natural history of malignant melanoma, including the diagnosis, prognosis, and treatment options, is reviewed in an attempt to formulate appropriate management strategies. Awareness on the part of clinicians is important, inasmuch as early detection of malignant melanoma offers the best chance for improved survival. Most lesions are excised with a margin of 1 to 3 cm, and follow-up assessment intervals are based on the depth of the primary lesion. Follow-up usually consists of a medical history, physical examination, chest roentgenography, and hematologic and chemistry profiles. Routine use of sophisticated imaging studies is unnecessary because the yield from such an approach has been low. Patients with melanomas thicker than 1.6 mm and those with histologic evidence of involvement of regional lymph nodes are at risk for development of disseminated disease and may be candidates for adjuvant therapy. In patients with severe weight loss and poor nutrition because of advanced disease, analgesic agents, stool softeners, and appetite enhancers are palliative measures that should be considered.

Adult↗