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PubMed1987

Laryngotracheal foreign bodies in children. A comparison with bronchial foreign bodies.

Twenty cases of laryngotracheal foreign bodies were reviewed over an 11-year period to determine features that differentiate these from bronchial foreign bodies. A history of choking or aspiration was obtained in 18 patients (90%). The most common presenting symptoms were stridor, wheezing, sternal retractions, and cough. The chest roentgenogram was most often normal (58% [11/19]). Posteroanterior and lateral neck roentgenograms suggested the diagnosis in 92% (12/13) of the patients. The correct diagnosis was made within the first 24 hours of presentation in 11 patients (55%); 19 patients (95%) were correctly diagnosed within one week. The incidence of major complications was 45% (9/20); however, in patients with a delay in diagnosis of over 24 hours the complication rate was 67% (6/9). For this reason, in children with a diagnosis of croup or reactive airway disease who respond poorly or whose condition deteriorates despite appropriate medical therapy, early endoscopy should be considered.

Adolescent↗

PubMed1985

Experimental posttraumatic pulmonary microembolism. Effects of methylprednisolone on its development.

The effects of methylprednisolone sodium succinate on the course of posttraumatic pulmonary microembolism were studied in pigs submitted to a reproducible high-energy trauma of the limb and then observed under long-term anesthesia. Methylprednisolone sodium succinate (30 mg/kg of body weight) was given one hour after trauma and thereafter every eighth hour during a 72-hour observation period. Intrapulmonary microembolism was quantitatively measured by repeated external detection of chromium 51-labeled platelets and iodine 125-labeled fibrinogen, sequential chest roentgenograms, and morphologic examination of the lungs post mortem. Methylprednisolone delayed the onset of pulmonary roentgenogram changes and modulated Pao2 and platelet count reductions, but, at the end of the observation period, the signs of microembolism changes were as pronounced as in the nontreated traumatized pigs. Methylprednisolone thus did not prevent posttraumatic pulmonary microembolism in this experimental situation.

Animals↗

PubMed1986

Shoulder harness traction for roentgenographic assessment of the cervical spine.

We evaluated the clinical usefulness of a new shoulder traction device to facilitate a rapid complete cervical spine examination in an uncooperative patient population with multiple trauma. Forty-eight patients were randomly designated to receive the shoulder traction device or the standard technique (manual traction on the patient's upper extremities). Patient groups were equivalent in mean coma scale scores, trauma scores, age, and incidence of cervical fracture. Male-female ratios differed between groups, yet were biased against the harness technique. Fewer roentgenograms (lateral view) were required to visualize adequately all cervical vertebrae when the harness device was utilized (mean roentgenograms per patient, 1.2 vs 2.6; P less than .01). Shoulder harness traction during roentgenographic evaluation of the cervical spine may be a useful method to promote visibility of the lower cervical vertebrae.

Accidents↗

PubMed1988

Bronchoscopy for aspirated foreign bodies in children. Experience in 131 cases.

One hundred thirty-one children underwent rigid bronchoscopy under general anesthesia for suspected aspirated foreign bodies. There were 79 boys and 52 girls, with a mean age of 2.1 years. Physical examination showed decreased breath sounds (n = 130) and wheezing (n = 119) over the affected site. Chest roentgenograms were diagnostic or suggestive of aspirated foreign bodies in 127 cases (97%). Radiopaque lesions were noted on roentgenograms in ten cases. Four infants had a preoperative hypoxic arrest. Two patients had negative results of bronchoscopy (1.5%). Extraction of the aspirated foreign body was carried out at laryngoscopy in two patients and by forceps under direct vision at bronchoscopy in 97 patients. A Fogarty catheter was used in 12 cases. Postendoscopic complications included fever (n = 27), pulmonary infiltrate (n = 11), ventilatory support (n = 4), and pneumothorax (n = 2). Rigid bronchoscopy for aspirated foreign body in children is a safe, effective, and sometimes life-saving procedure. Morbidity is low and mortality is zero.

Bronchi↗

PubMed1989

Evaluation of staging workup in malignant melanoma.

To evaluate the role of staging workup in primary and recurrent malignant melanoma, we reviewed the results in 115 patients with primary melanoma and in 28 patients with recurrent disease who underwent evaluation with chest roentgenograms, radionuclide bone and liver scans, and either a radionuclide brain scan or computed tomography of the brain. Upper gastrointestinal tract series with small-bowel follow-through were obtained in 42 patients. Metastatic disease was documented in nine of 143 chest roentgenograms, seven of 137 liver-spleen scans, three of 141 bone scans, two of 85 brain scans, two of 43 brain computed tomographic scans, and two of 42 upper gastrointestinal tract series. All documented metastasis was in stage II and recurrent melanoma. Postoperatively determined serum lactate dehydrogenase levels showed greater than 300 U/L in all patients with documented metastasis except in two with bone and one with brain metastases. We conclude that, in view of low yield, there is no role for routine metastatic workup to detect silent metastasis in malignant melanoma. Elevated postoperative serum lactate dehydrogenase levels indicate need for metastatic workup.

Alkaline Phosphatase↗

PubMed1989

Delayed presentation of a right-sided diaphragmatic hernia and group B streptococcal sepsis. Two case reports and a review of the literature.

Group B streptococcal sepsis was associated with delayed presentation of an unsuspected right-sided diaphragmatic hernia in two neonates. These unusual clinical observations and a review of 24 similar cases from the literature form the basis of this report. Infants present with respiratory distress during the first few hours of life and have group B streptococcal sepsis confirmed by results of blood cultures. The right side of the diaphragm appears normal on the initial chest roentgenogram in the majority of cases. After initial improvement with antibiotic therapy and ventilatory support, sudden deterioration of respiratory status may occur. Subsequent chest roentgenograms often demonstrate herniated viscera in half of the cases, while ultrasound examination, isotopic liver scan, and peritoneography are useful in achieving a diagnosis in the other cases. If recognized, survival is 100% following hernia repair. Persistent respiratory symptoms in a neonate who is recovering from group B streptococcal sepsis should prompt a careful evaluation of the right side of the diaphragm for the presence of an unsuspected posterolateral hernia.

Hernia, Diaphragmatic↗

PubMed1982

Intractable rheumatoid arthritis. Treatment with combined cyclophosphamide, azathioprine, and hydroxychloroquine.

Seventeen patients (15 women, two men) with progressive, erosive seropositive rheumatoid arthritis (RA) refractory to conventional therapy were treated with cyclophosphamide, azathioprine, and hydroxychloroquine sulfate for an average of 27 +/- 19 months (mean +/- SD throughout) (range, five to 60 months). Disease suppression began in 14 patients within three to 16 months (mean, seven months). Five patients achieved complete remission, two had activity in a single joint only, seven had partial disease suppression, and three showed no response. Prednisone dosage was decreased or administration discontinued in nine of ten patients (5.8 +/- 1.2 to 2.7 +/- 3 mg/day). Serial hand roentgenograms showed recortication of erosions in nine patients, with "filling in" of some erosions in three of these. No change was seen in the roentgenograms of five patients, while progressive disease occurred in three instances. Combined therapy with small doses of three drugs, each with proved antirheumatic activity when used separately in larger doses, may provide satisfactory long-term disease control in patients with intractable RA. This regimen is experimental. Proof of efficacy requires a controlled study. Until such data are obtained, this drug combination is not recommended for general use.

Arthritis, Rheumatoid↗

PubMed1996

Prenatal development of cranial base in normal Korean fetuses.

BACKGROUND: The cranial base is not only an end result of complex segmental growth of rostral end of axial skeleton but also has a tremendous impact on the development of the brain and facial structure. However, little is known about the method for the systematic analysis of the shape of the cranial base in the developing human fetus. We used roentgenograms of the cranial base and eviscerated bones for the assessment of the development of the cranial bony complex. METHODS: The cranial base was removed from 64 normal human fetuses after 18-40 weeks of gestation. Roentgenograms were taken perpendicular to the cranial base. Major anatomical landmarks are defined as follows: the center of pituitary fossa of sphenoid bone (point S), the growth center of zygomatic bone, the anterior point of nasal septum, otic cartilage, and anterior and posterior growth centers of maxilla. The anterior cranial base angle, the middle cranial base angle, the posterior cranial base angle, the maxillary trapezoid area, the horizontal middle face area, and the occipital cranial base triangle area are defined from the landmarks, and the growth of each parameter was analyzed by gestational age. RESULTS: The proportional growth of the anterior, middle, and posterior cranial fossae could be assessed by the angles around the center of the pituitary fossa (point S) and by the anterior, middle, and posterior cranial base angles. The anterior cranial base angle was relatively constant during the fetal period at 107.4-112.5 degrees, whereas the middle cranial base angle gradually increased, and the posterior cranial base angle decreased. With increasing gestational age, the horizontal middle face area increased rapidly, in contrast to those of the maxillary trapezoid area, occipital cranial base triangle area, or foramen magnum area. CONCLUSIONS: The important keys in the structural development of the normal human cranial base are anterior, middle, and posterior cranial base angles. We could define the developmental pattern of human cranial base, which in turn provides a model of a standard growth pattern applicable to the study of the different malformations in the craniofacial structure.

Cephalometry↗

PubMed1975

Measures to minimize small intestine injury in the irradiated pelvis.

Small intestine injury causes long-term suffering and high mortality. Five of 187of our patients had developed serious small intestine injury. Four patients had corrective surgery. Three patients died. All were women. Subsequently, all patients who received definitive pelvic irradiation had small intestine roentgenograms to determine itslocation and mobility. Female patients, thin patients, and elderly patients had larger amounts of small intestine in the whole pelvis, a deeper cul de sac, and a greater incidence of relatively immobile small intestine. Patients with relativelyimmobile small intestine in the treatment field may be predisposed to injury. There wasno relationship of the incidence of relatively immobile small intestine to prior pelvicsurgery. We used the findings from the small intestine roentgenograms to modify indiviually the radiotherapy regimen so as to minimize the risk for small intestine injury. Patients were placed in the prone position to displace the small intestineout of the treatment fields used for booster dose irradiation. The treatment field wasmodified to exclude the small intestine. The total tumor dose delivered was determinedby expectations for curve vs. complications. To date, none of the patients in this study group has developed small intestine injury. Cadaver studies showed the feasibility of elective shortening of the pelvic cul de sac. The small intestine can be displacedaway from the bladder, prostate, or cervix.

Age Factors↗

PubMed1975

Bony metastases from carcinoma of cervix. Occurrence, diagnosis, and treatment.

Fifty-five patients treated for cervical carcinoma developed bony metastases between January 1, 1961 and December 31, 1973. Roentgenograms were diagnostic in all but 2 of the patients. In 15 patients, a combination of radioactive scans and roentgenograms was used to establish the diagnosis. The most common mechanism of bony involvement from carcinoma of the cervix was extension of the neoplasm from para-aortic nodes, with involvement of the adjacent vertebral bodies. The earliest metastases were discovered at the time of the primary diagnosis. Thirteen years was the longest interval from the primary diagnosis until the discovery of bony metastases. Sixty-nine percent of the patients were diagnosed within 30 months. Ninety-six percent of the patients died within 18 months. Seventy-six percent of the patients received some form of therapy for their metastases. Thirty-six of these patients were treated with radiation therapy. Four of these patients received complete relief of symptoms, 24 some relief, and 8 patients received no relief.

Adenocarcinoma↗

PubMed1976

Bone metastases from breast cancer at the time or radical mastectomy as detected by bone scan. Eight-year follow-up.

Sixty-four women with Stage II breast cancer who had Sr85 bone scans at the time of radical mastectomy were followed for 8 years in a prospective study. Those women with positive scans had a slight, but statistically significant, increased incidence of metastic disease, particularly for metastases to bone.However, 40% of those women with positive bone scans and negative roentgenograms survived 8 years without evidence of any metastatic disease. Therefore, it has not been shown at this time that bone scans should be obtained in order to exclude bone metastasis before regional therapy for breast cancer is instituted. Also, a significant percentage of women with negative bone scans developed both bone and soft tissue metastases. As many as 30% of asymptomatic women with a history of breast cancer and positive bone scans and negative bone roentgenograms may still harbor disease in bone after 8 years.

Adult↗

PubMed1977

Detection of metastatic malignant melanoma by chest roentgenography.

The latest premortem chest roentgenogram on 17 patients with known metastatic malignant melanoma was examined and the results were compared with the findings in the chest at autopsy. In nine of the 17, disease not visible on the roentgenogram was found at autopsy. Preliminary data would indicate that a significant number of these metastases could have been identified premortem by other radiographic modalities, e.g., tomography.

Adult↗

PubMed1978

Pulmonary disease with chlorambucil therapy.

A 73-year-old female developed pulmonary disease during treatment with chlorambucil for polycythemia vera. Cough and dyspnea were prominent symptoms. A chest roentgenogram revealed interstitial fibrosis. The diffusing capacity was markedly reduced. Pathologic findings included alveolar lining cell dysplasia, interstitial round cell infiltrates and interstitial fibrosis. Resolution of the pulmonary symptoms and partial clearing of the fibrosis on chest roentgenogram followed discontinuation of the chlorambucil and institution of steroid treatment. Chlorambucil may cause pulmonary fibrosis similar to busulfan and cyclophosphamide and this may be a potential complication of all alkylating agents.

Aged↗

PubMed1982

Multiple simultaneous tumors in patients with head and neck cancer: a prospective, sequential panendoscopic study.

A prospective panendoscopic study (bronchoscopy, laryngoscopy, esophagoscopy) was carried out in 81 consecutively seen, untreated patients newly diagnosed as having a mucosal neoplasm in the upper aerodigestive tract, to determine how many had a synchronous second primary lesion of the aerodigestive tract. Fourteen patients (17%) proved to have multiple primary lesions (14 second-primary and two third-primary lesions). Three lesions were hypopharyngeal, six esophageal, three pulmonary, two laryngeal, and two oropharyngeal. Two of the additional lesions were found during routine head and neck examination, nine lesions would have been found with a single routine symptom- or roentgenogram-directed endoscopic examination; five, because of their location or small size, would not have been found without panendoscopy, even after chest roentgenography, indirect laryngoscopy, and barium esophagography had been done. The most productive endoscopic examinations for detecting second primary lesions were esophagoscopy and laryngoscopy, the former detecting six lesions, the latter five lesions. The yield of chest roentgenograms was low (1/79). No complications resulted from this prospective panendoscopic protocol study. THese findings should reinforce the belief that head and neck cancer is a panmucosal disease of the aerodigestive tract, that silent second synchronous primary lesions are not uncommon, and that every effort should be made to find all primary sites before treatment of the index tumor is begun.

Bronchoscopy↗

PubMed1979

The Summitt syndrome: observations on a third case.

A 6 1/2 year old male presented with acrocephaly, brachydactyly, clinodactyly, mild syndactyly of the hands and feet, genu valgum, and marked obesity. Roentgenograms of the hands revealed hypoplasia or aplasia of the middle phalanges. Roentgenograms of the feet revealed hypoplasia of the middle phalanges and deformity of the proximal phalangeal epiphyses of the great toes. Chromosomes studies revealed a normal 46,XY karyotype, and psychological testing revealed low normal intelligence. Current data support autosomal recessive inheritance, although X-linkage cannot be excluded.

Child↗

PubMed1979

Clinical correlations of CT scan-detected calcifications of the basal ganglia.

A review of CT scans of 7,081 patients demonstrated calcifications of the basal ganglia in 53. The calcifications were evident in the skull roentgenograms of only 4 patients out of 40 in whom both CT scans and plain roentgenograms were available, demonstrating the superior resolution of this new method. Seventy-five percent of the patients were older than 50 years of age. Of the younger patients, 5 had had prior cranial irradiation; 1 had received cranial irradiation and intrathecal methotrexate therapy for meningeal leukemia; and 2 others had deep-seated arteriovenous malformations. Serum concentrations of calcium and phosphorus were normal in all 46 patients in whom they were measured. We conclude that the detection of small calcifications of the basal ganglia in persons above 50 years of age is infrequently associated with either clinical signs of basal ganglia dysfunction or calcium and phosphorus abnormalities. Calcium deposition in these patients may be related to vascular changes associated with aging. In younger patients a specific pathogenetic factor or underlying process is infrequently found.

Adolescent↗

PubMed1990

Effect of occlusal functional forces on incisor socket morphology and location in the rat mandible.

The effect of functional occlusal stress on dimensional alterations of the rat incisor socket and mandible were studied from roentgenograms. In 12 rats, the lower left incisor was shortened twice weekly, whereas the lower right incisor was allowed to remain in contact with both upper incisors. Thus, the right incisors were subjected to hyperfunction, and the left ones, to hypofunction. The lower incisors of 16 rats with normal occlusal contact served as control. Following an experimental period of 3 months, the animals were killed and standardized radiographs were taken of the cleaned mandibles. Socket and mandibular dimensions were measured on magnified tracings of the roentgenograms. Socket area, its posterior length, posterior mandibular length, and gonial angle changed in the same direction under both hyper- and hypofunction. The anterior socket was relocated in opposite directions: under hyperfunction, it assumed a more inferior position, whereas in hypofunction, it moved superiorly. The angulation of the socket became significantly more acute under hyperfunction, whereas in hypofunction, this parameter remained unchanged. It is concluded that altered functional demands affect the morphology of the incisor socket and its location within the mandibular borders.

Animals↗

PubMedDate not supplied

Chondrocalcinosis in elderly persons.

Fifty-eight elderly people were surveyed for chondrocalcinosis with knee, hip and pelvic roentgenograms using Type M industrial x-ray film. Chondrocalcinosis was found in 16 subjects (27.6%), an incidence greater than reported in previous studies. Roentgenograms of the knees alone showed the presence of chondrocalcinosis in 15 subjects. Varus deformity of the knees, increased wrist complaints and wrist involvement with clinical arthritis were significantly more common in subjects with chondrocalcinosis. Symptoms associated with acute inflammatory arthritis were not more common in people with chondrocalcinosis.

Aged↗