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[Magnetic-resonance imaging in the diagnosis of overload injuries of bones].

A comparative evaluation was done of quality of roentgenological and magnetic-resonance imaging (MRI) data for the early diagnosis of overload injuries of bones. 57 servicemen were examined presenting with the above changes at different stages of the pathological process in the bones of the foot, shank, and thighbone. MRI permits detecting changes in stress-induced injuries of bones 2-3 weeks earlier than X-ray does. MRI has been shown to allow a higher significance judgement about changes taking place in soft and paraossal tissues of the extremity in stress-induced fractures. MRI is an alternative in early diagnosis of stress-related injuries, the repeated roentgenography and MRI help in interpreting plain rhoentgenograms promoting the accuracy of diagnosis in the pathology above mentioned.

Adolescent↗

[Clinical features of pneumonia associated with influenza virus infection].

The history of influenza pandemics was reviewed and clinical manifestations of pneumonia associated with influenza virus infections are described. Several types of pneumonia associated with the influenza virus infection have been reported: 1) influenza complicated by secondary bacterial pneumonia, 2) primary influenza virus pneumonia, 3) combined influenza virus and bacterial pneumonia. Secondary bacterial pneumonia often produces a syndrome that is clinically distinguishable from that of primary viral pneumonia. In primary influenza virus pneumonia, chest roentgenography revealed bilateral infiltrations but no consolidation. Histologically, diffuse alveolar damage and hemorrhagic bronchiolitis were frequently observed in primary influenza virus pneumonia, in which case the prognosis was the worst. Although rare, the possibility of bronchiolitis obliterans organizing pneumonia associated with influenza virus infection should be recognized. H. influenzae, S. pneumoniae, or S. aureus were frequently associated with influenza viral infection, and treatment against these bacteria should be considered.

Adult↗

[Successful airway management using a Cook airway exchange catheter as an emergent dilator for life-threatening neoplastic stenosis of the trachea: a case report].

A 68-year-old male patient was referred to our hospital for his intractable and progressive dyspnea. Chest roentgenography and computerized tomography revealed severe lower tracheal stenosis due to neoplastic invasion. The tumor completely surrounded his trachea for 5 cm length and the remaining internal diameter of the trachea was less than 5 mm. To avoid fatal asphyxia, emergency airway security was required. After placing both femoral arterial and venous cannulae for percutaneous cardiopulmonary support system, we dilated the stenotic trachea using a Cook airway exchange catheter (CAEC), and then an armored tube of 7 mm inner diameter was introduced through the CAEC. The maneuver was smoothly completed within one minute without any complications. His dyspnea was completely relieved. Following chemotherapy and radiotherapy were so effective that the endotracheal tube was extubated two weeks later uneventfully. After several series of chemotherapy and 50 Gy irradiation, the patient was discharged three months later without symptoms. We concluded that CAEC could be one of the life-saving instruments for emergent airway management in case of severe organic tracheal stenosis.

Aged↗

[Clinical and functional characteristics of patients late after pneumonectomy with complicated course of postoperative period].

Results of examination of 65 patients, to whom twenty years before pneumonectomy was performed for pulmonary tuberculosis and chronic nonspecific pulmonary diseases, were analyzed. Peculiarities of postoperative period course were determined in patients with early complications, including the tuberculosis reactivation. Methods of examination: clinical investigation, standard laboratory tests, bacteriologic investigation of phlegm, roentgenography, multiradial roentgenoscopy of thoracic cage, bronchography, computeric tomography, roentgenokymography, spirography, pneumotachometry. Specific and nonspecific changes in lungs, which resided, were revealed accordingly in 20 and 23.3% patients. The tuberculosis reactivation is possible twenty years after the operation. Pneumonectomy performance permits to eliminate an active tuberculosis in 70-80% patients. The tuberculosis changes in residual lung worsen the patients quality of life after pulmonectomy performance due to progress of respiratory insufficiency.

Adult↗

[Injuries of pancreatoduodenal organs].

Ten-year experience of treatment of 213 patients with trauma of the pancreas and 56 patients with trauma of the duodenum is analyzed. Combined injury of other organs was seen in 80% patients. Diagnostic policy included intraoperative revision in open abdominal trauma and dynamic observation with US, roentgenography, CT and laboratory tests in closed trauma wich doesn't require urgent surgery. The diagnosis was verified during laparoscopy and contrast duodenography. Surgical treatment results in patients with trauma of the pancreas depending on the variant of surgery are analyzed. The role of drug treatment of traumatic pancreatitis with 5-ftoruracil and octreotid is stressed. It is demonstrated that these principles allowed us to reduce complications rate to 11.7% and lethality to 6.7% from 71.7% and 37.0% respectively. It is established that suturing of duodenal wall on the decompressive nasoduodenal tube is effective within 6 hours after trauma. Later, for prophylaxis of suture insufficiency the duodenum must be switched off. Adequate drainage and depression of secretion with octreotid are very important for success of surgery. In this approach there were no cases of sutures insufficiency among 16 patients in the last 3 years.

Abdominal Injuries↗

The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation.

In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty-three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation.

Adult↗

Vertebral compression fractures in the elderly.

Compression fracture of the vertebral body is common, especially in older adults. Vertebral compression fractures usually are caused by osteoporosis, and range from mild to severe. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening decline in the elderly patient who already has decreased reserves. While the diagnosis can be suspected from history and physical examination, plain roentgenography, as well as occasional computed tomography or magnetic resonance imaging, are often helpful in accurate diagnosis and prognosis. Traditional conservative treatment includes bed rest, pain control, and physical therapy. Interventional procedures such as vertebroplasty can be considered in those patients who do not respond to initial treatment. Family physicians can help patients prevent compression fractures by diagnosing and treating predisposing factors, identifying high-risk patients, and educating patients and the public about measures to prevent falls.

Activities of Daily Living↗

[Clinical analysis of orbital histocytosis X].

OBJECTIVE: To study the clinical and imaging features together with diagnosis and management of orbital histocytosis X. METHODS: In a retrospective study from 1973 to 1999, 47 cases of histocytosis X were reviewed related with clinical materials, including eosinophilic granuloma 17 cases and Hand-Schuller- Christian disease 30 cases. RESULTS: Most occur in children and teenagers, mainly in male. Characteristic clinical features, roentgenography, ultrasonography, CT, MRI provide the most diagnostic assistance. CONCLUSIONS: Solitary unifocal eosinophilic granuloma mainly involves teenagers. Hand-Schuller-Christian disease usually take places between birth and 5 years of age, which is characterized by multifocal variant of eosinophilic granuloma, especially the classic triad. Characteristic images contribute to the diagnosis. Multiple management is needed, including surgery, chemotherapy and radiotherapy. The prognosis varies with the three types.

Adolescent↗

[Effective dosage equivalents in evaluating radiation burden in patients in stomatologic roentgenology].

Risk coefficients are the main quantitative parameter when determining the extent of X-ray load in patients investigated with roentgenography. A concept of effective dose equivalent HE is used for this purpose. The present study is aimed on the determination of the HE for both orthopantomography and routine extra-oral roentgenogram of the mandibula. Measurements were performed on Alderson Rando phantom. The resulting effective dose equivalent for investigation with orthopantomograph represented 99.0 mu Sv and 80.9 mu Sv for the extra-oral projection, respectively. Based on the results obtained, the load with dental X-ray was shown to be disproportionately high.

Body Burden↗

Respiratory changes and pulmonary complications following orthotopic liver transplantation.

In conclusion, we observed a worsening of LIS post-OLT, especially on the fourth postoperative day. The drop in this score implies a complicated course accompanied by a high mortality rate and increased medical expenses. Among the four components, oxygenation index and chest roentgenography score play an important and practical role. Measuring the AaD(O2) has its clinical merit, while the PEEP score and compliance of the respiratory system are of limited usefulness in this setting. The pleural effusions developed after OLT showed a trend towards increasing in amount until the sixth day and then gradually decreasing, except those cases with complications.

Blood Volume↗

Clinical analysis of necrotizing pneumonia in children: three-year experience in a single medical center.

Necrotizing pneumonia (NP) is a rare but complex complication of lobar pneumonia in children. It is characterized by massive necrosis and liquification of lung tissues by the presence of multiple cavities rather than a solitary one. To evaluate the clinical features of NP, we enrolled 17 patients at Chang-Gung Memorial Hospital (Kaohsiung) from November 1999 to December 2002. The diagnosis of NP was based upon findings of chest computed tomography. There were six boys and 11 girls, ages ranging from 47 days to seven years. Streptococcus pneumoniae was the most common pathogen responsible for 9 cases in our study. Our patients remained febrile, even with the appropriate antibiotics administered, for a mean of 12.1 +/- 5.2 days and hospitalized for a mean of 22.7 +/- 7.0 days. The right lung was affected more than the left (12:7). On admission, laboratory data showed either leukocytosis, or normal leukocyte count, or leukopenia, but C-reactive protein was abnormally high (mean = 304.8 +/- 96.3 mg/L). Anemia and significant platelet count elevation developed at a mean period of 8.5 +/- 3.5 and 10.9 +/- 4.7 days after their hospitalization, respectively. Surgical intervention was performed in one case only in our series. Chest roentgenography took a mean of 60.3 +/- 15.6 days to resolve completely. Although the clinical course was prolonged, all patients with NP eventually recovered completely with no sequela.

Child↗

Mucoepidermoid carcinoma of the lung--a case report.

Mucoepidermoid carcinoma is an uncommon primary lung tumor. Mucoepidermoid carcinomas have been reported in all age group and equally in both sexes. A case of mucoepidermoid carcinoma histologically confirmed by biopsy is reported here. The patient is a 15 years old male presented with cough and dyspnoea for 5 days. Chest roentgenography showed segmental consolidation of right lower lobe. Chest computed tomography revealed a soft tissue mass with calcification within the lumen of lower trachea in precarinal location. The patient underwent thoracotomy for endotracheal mass and resection was done. Following operation, the patient is symptom free and follow-up CT scan shows normal tracheal outline.

Adolescent↗

[Pulmonary hypertension in sickle cell anemia. A case report].

We report the case of a 33-years-girl with SCA and severe PH. She developed six month before admission, non productive cough and dyspnea. Physical examination at admission revealed shortness of breath and right heart ventricular failure. Electrocardiography showed sinus rhythm and an incomplete left bundle branch block. Chest roentgenography revealed cardiomegaly with cardiothoracic index at 0.66 and pulmonary infiltrates. Laboratory tests revealed an anemia with hemoglobin of 7.1 g/dl, white blood cell count of 12,500/mm, moderate renal failure (cretininemia = 178 mumol/l) and hypoxemia with oxygen pressure of 60 mmHg. Hemoglobin electrophoresis revealed on heterozygous SCA. Echocardiography revealed dilatation of right heart cavities and a systolic pulmonary artery pressure of 60 mmHg. A perfusion lung scintigraphy demonstrated multiple subsegmental perfusion defects. PH is a common complication of adult patients with SCA. Appropriate therapies and strategies for prevention of PH in SCA are unknown. Further research exploring therapies such as oxygen, nitric oxide, prostacyclin and hydroxyurea are indicated.

Adult↗

[New aspects in the diagnosis of pulmonary embolism].

Pulmonary embolism (PE) and deep venous thrombosis (DVT), venous thromboembolism (VTE) respectively, are relatively frequent diseases. Despite progress in early detection and treatment, the rates of mortality and recurrent PE, remain high. Clinical findings include oligosymptomatic conditions with unexplained chest discomfort or shortness of breath that cannot be recognized as PE, but also and massive embolism with hemodynamic colapse and sudden cardiac death (SCD). The time from the first symptoms, till PE diagnosis is the most important for prognosis. Diagnostic methods include non imaging methods as plasma d-dimer Elisa, electrocardiogram, and many imaging methods from roentgenography, echocardiography, lung scanning, spiral chest computed tomography, magnetic resonance imaging to pulmonary angiography as "the gold standard" for PE diagnosis. It is recommended integrated diagnostic approach and various algorithms according to medical equipment and staff skill of a hospital.

Humans↗

[The risk factors of cerebrovascular disorders in the vertebro-basilar zone in the persons belonging to the flying staff].

The investigation of cerebral hemodynamics in 318 pilots with the use of ultrasonic dopplerography and transcranial dopplerography has shown that the earliest and most frequent manifestations of cerebrovascular disorders are observed in the vertebrobasilar zone (VBZ). The significant indices characterizing the morphofunctional condition of cerebral arteries are the results of triplex scanning of the main vessels. The pathologic changes in VBZ arteries, the variants of abnormal disposition of vertebral arteries, the secondary changes connected with extravasal effect are often detected during the early cerebrovascular disorders. According to the results of cervical vertebra roentgenography the degenerative-and-dystrophic changes, the congenital anomaly and traumatic injuries could play a certain role in the development of early cerebrovascular disorders in VBZ. Most frequently the symptoms of vertebrobasilar vascular insufficiency develop due to the cervical vertebral dislocation, uncovertebral arthrosis, Kimmerle's anomaly and other changes.

Aerospace Medicine↗

CORRECTION OF ANOMALOUS VENOUS RETURN FROM THE RIGHT LUNG TO THE INFERIOR VENA CAVA (SCIMITAR DEFORMITY).

Anomalous pulmonary venous drainage to the inferior vena cava is a rare congenital cardiac defect. Oxygenated blood from the right lung enters the right atrium resulting in a left-to-right shunt. Because the radiographic shadow of the anomalous vein resembles a curved saber, this defect has been called the "scimitar" deformity. From 1958 through June 30, 1975, 11 patients underwent surgical correction of this anomaly at our institution with 10 survivors. Diagnosis was made by routine roentgenography of the chest in all but one patient. Eight patients had total correction which consisted of implanting the anomalous vein into the right atrium, opening the interatrial septum and applying a patch graft as a baffle to direct pulmonary venous blood into the left atrium. Five patients had associated cardiac defects which were also repaired. Three patients underwent pneumonectomy and all survived. The only operative death occurred in a 5-year-old female with an atrial septal defect and endocardial cushion defect. We believe the existence of a large left-to-right shunt justifies surgical intervention. The prognosis appears to depend upon the presence of other cardiac or pulmonary anomalies.

Journal Article↗

[A case of ammonium urate urinary stone].

An 18-year-old female, who had undergone antireflux surgery for bilateral vesicoureteral reflux 5 years ago, was admitted to our department with complaints of fever and left-sided back pain. Bilateral renal stones and pyelonephritis were diagnosed after roentgenography, ultrasonography and urinalysis. Pyelonephritis was successfully treated with antibiotics and the left renal stone was completely disintegrated with extracorporeal shock wave lithotripsy. Spectrophotometric analysis revealed that the stone was composed of pure ammonium urate (AU). The patient had not experienced any episodes of urinary tract infection from the antireflux surgery until the present event, but had lost 20 kg in body weight during the last year due to a low-caloric diet and laxative abuse. AU urinary stones have been infrequently reported in Japan, and they are supposed to be associated with a low-caloric diet, laxative abuse, and anorexia nervosa.

Adolescent↗