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PubMed1975

Multiple-myeloma bone disease. The comparative effect of sodium fluoride and calcium carbonate or placebo.

A randomized double-blind study was carried out in 26 patients with multiple myeloma to compare the therapeutic effect of sodium fluoride (50 mg twice daily) plus calcium carbonate (1 g four times daily) and placebo. All patients also received melphalan and prednisone for one week every six weeks. Bone biopsies for microradiography and histology, and videodensitometry as well as conventional roentgenograms, 99mTc-polyphosphate bone scans, and bone densitometry of the mid and distal radius, were done initially and one year after therapy. Microradiography and videodensitometry studies revealed significant increases in bone formation (P less than 0.01) and bone mass (P less than 0.005) in the fluoride-calcium group. Bone trabeculae appeared thickened on roentgenograms of six of 13 fluoride-calcium-treated patients (P less than 0.02). Technetium bone scans and bone densitometry determinations proved insensitive for detection of skeletal changes. Fluoride calcium should be considered a useful adjunct in the treatment for multiple myeloma.

Bone Diseases↗
PubMed2005

Nephrolithiasis as primary symptom in sarcoidosis.

A 30-year-old black woman presented with a 1-year history of repeated episodes of worsening weight loss and fatigue. Physical examination showed no skin lesions and a chest roentgenogram was normal. Workup showed no obvious cause of recurrent renal stones. Finally, the detection of lymphadenopathy led to the diagnosis of extrapulmonary sarcoidosis. Up to 4% of all cases of sarcoidosis may present with urolithiasis only. Renal stones may be more common in severe cases of sarcoidosis, which affect blacks most frequently. Although not generally recommended for diagnostic purposes in sarcoidosis, in this case determination of the angiotensin-converting enzyme level was helpful in making the correct diagnosis. It is important that physicians are aware of the possibility that sarcoidosis may present as urolithiasis, even in the presence of a negative chest roentgenogram.

Adult↗
PubMed1976

Validity of the ultrasonic technique as a method of measuring subcutaneous adipose tissue.

Subcutaneous adipose tissue measurements, at abdomen, suprailiac, subscapular, and mid-triceps sites, made with the ultrasonic and skinfold caliper techniques were compared using data from 20 women and 17 men from a pool of subjects of 22 women and 20 men. In addition, comparisons were made between ultrasonic, soft-tissue roentgenographic and skinfold caliper techniques at the suprailiac and mid-triceps sites on 6 women and 12 men. Repeat measurements with the ultrasonic technique produced correlation coefficients of 0-87 and above. Correlations between skinfold caliper and ultrasonic measurements were generally higher among women than men over each of the four sites. A highly significant relationship, r = 0-88, was observed between the ultrasonic measurements and soft-tissue roentgenograms over the mid-triceps site. The correlation between the fat-muscle interface measured on the roentgenogram and ultrasonic measurements at the suprailiac site was 0-78. Multiple echoes and interfaces were observed at the suprailiac site on some subjects.

Abdomen↗
PubMed2002

Left ventricular hypertrophy is a risk factor independent of hypertension in survival of hemodialyzed patients.

Hemodialysis patients have low 5-year survival rates of approximately 60%, and the most common cause of death is cardiovascular diseases. Their population may be considered, therefore, as an accelerated model in analyzing the risk factors for cardiovascular diseases. We previously reported the role of blood pressure, one of the most important risk factors for cardiovascular diseases, in determining the prognosis of hemodialysis patients. In this study, we examined the effect of cardiomegaly detected on chest roentgenogram or electrocardiogram before initiating hemodialysis therapy on survival after introduction to maintenance hemodialysis. One hundred and sixty hemodialysis patients who had no history of ischemic heart disease or arrhythmia were followed up for 88.9 +/- 4.0 months, among whom 69 died. Heart enlargement, defined on chest roentgenogram, was detected in 104 patients, and left ventricular hypertrophy, defined on electrocardiogram, was detected in 105 patients. The presence of either finding shortened their survival. However, Cox's proportional hazards model and logistic multiple regression analysis identified only left ventricular hypertrophy as one of the significant determinants for survival, but heart enlargement was not independent. Correction of systolic hypertension on the maintenance phase had no significant favorable effect on survival in patients with left ventricular hypertrophy, while it improved in those with heart enlargement. This finding, together with those above from Cox's model and logistic analysis strongly suggests that risk from left ventricular hypertrophy is independent of, but one from heart enlargement is dependent on hypertension.

Cardiovascular Diseases↗
PubMed1980

Pulmonary fibrosis, carcinoma, and ferruginous body counts in amosite asbestos workers. A study of six cases.

The Tyler Asbestos Workers Program is a continuing study of 1,105 former amosite asbestos workers. This report includes a study of six former workers, five of whom died and had autopsies, and one who underwent a lobectomy. Five of these men were exposed to asbestos for three months or less. Four had lung cancer, and one a rectal carcinoma. All were cigarette smokers. Ferruginous (asbestos) body content of the upper and lower lobes of the lungs was quantitated by a digestion technic. Tissue sections from upper and lower lobes were independently quantitated for fibrosis and ferruginous bodies, and chest roentgenograms were examined for interstitial fibrosis. (Control lung tissue was obtained from consecutive autopsies of 52 adults who did not have a known occupational exposure to asbestos.) Relatively low ferruginous body counts (less than 700/g lung tissue) were associated with mild degrees of fibrosis, and higher counts (greater than 10,000/g) with moderate to severe fibrosis. Mild to moderate pulmonary fibrosis could be identified on tissue sections before interstitial changes were detectable by chest roentgenograms.

Aged↗
PubMedDate not supplied

Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS.

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Disseminated histoplasmosis in patients infected with human immunodeficiency virus.

Progressive disseminated histoplasmosis (PDH) is a common opportunistic infection complicating the course of infection with human immunodeficiency virus (HIV). PDH has been noted in areas nonendemic for histoplasmosis and occurs more frequently in areas heavily endemic for the fungus. PDH is frequently the AIDS-defining illness and presents as a febrile and wasting disease. The respiratory component may be overshadowed by the severity of the systemic illness. Chest roentgenograms show diffuse reticulonodular infiltrates. Frequently, the initial chest roentgenogram may show no abnormalities. Timely diagnosis requires a high index of diagnostic suspicion. Blood cultures, with use of the lysis-centrifugation system, are highly useful, as is the examination of the bone marrow, the peripheral blood smear, and the respiratory secretions. An experimental serological test that detects histoplasma polysaccharide antigen appears to be the simplest diagnostic test. Amphotericin B is the drug of choice for initial therapy, followed by further administration of amphotericin B for suppression. Early results with itraconazole are encouraging for long-term suppression.

HIV Infections↗
PubMed1996

Increased radionuclide uptake on bone scintiscans: a common but not clinically significant finding for human immunodeficiency virus type 1-infected patients free of osteoarticular symptoms.

The aim of this study was to describe findings of bone scintiscans and their clinical significance for patients infected with human immunodeficiency virus type 1 (HIV-1); 33 HIV-1-infected patients (22 men and 11 women) free of osteoarticular symptoms were included in the study. Plain bone roentgenograms, bone mineral contents (measured by dual-photon absorptiometry), and scintiscans (determined with 99mTc diphosphonate) were obtained for all subjects. Plain bone roentgenograms showed no abnormalities, and bone mineral contents were within the normal range for all patients. Radionuclide bone scans were unremarkable for eight patients (24%) and showed symmetrical abnormally increased uptake in the epiphyseal region of the appendicular skeleton in 25 (76%). Follow-up of the patients for > or = 1 year ruled out subsequent development of osteoarticular disorders. Generalized, symmetrical increased radionuclide uptake on bone scans is a common finding for HIV-1 infected patients free of osteoarticular symptoms. This finding is probably related to bone marrow hypercellularity and is of no clinical significance; therefore, other diagnostic procedures are not required in the workup of these patients.

Adolescent↗
PubMed1998

Primary unknown cancer in pulmonary hilar lymph node with spontaneous transient regression: report of a case.

A 69-year-old man was referred to our hospital in December 1993 because an abnormal mass had been detected in the right pulmonary hilum. Computed tomography (CT) of the chest revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, and an adherent tumor in the right ventrobasal segment (S8). Chest roentgenogram in February 1994, however, showed no evident tumor in the right lung field. In March 1996, the mass in the right pulmonary hilum reappeared on chest roentgenogram. Chest CT revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, but there was no tumor in right S8. The patient underwent video-assisted thoracoscopy on 17 May 1996. Intraoperative needle biopsy of the node revealed cancer cells. We performed right middle and lower bilobectomy with mediastinal dissection. Histological diagnosis revealed a large cell carcinoma almost completely occupying a hilar lymph node. The resected middle and lower lobes showed no tumors, except for a coagulation necrosis measuring 1.5 cm in diameter in S8b, corresponding to the site where a tumor shadow had been depicted on the CT image in December 1993. We concluded that the coagulation necrosis might have been the primary site of the tumor, which had spontaneously regressed and then appeared in the metastatic interlobar node.

Aged↗
PubMed1987

Reliability and validity of goniometric measurements at the knee.

The purposes of this study were to assess the intertester reliability of goniometric measurements at the knee and the validity of the clinical measurements by comparing them to measurements taken from roentgenograms. Thirty healthy subjects between the ages of 20 and 60 years were studied. The subjects were positioned on their right side on a roentgenographic table with their left lower extremity on a stabilizing board that was elevated 15 cm above the table's surface. For standardization of the position, an assistant placed the posterior aspect of the subject's left thigh in contact with two 15-cm pegs, which had been inserted perpendicularly into the stabilizing board. The assistant then moved the left leg to achieve an arbitrary angle of the knee joint and held the limb in that position. Two physical therapists then independently used a standard plastic goniometer to measure the knee joint angle in the sagittal plane using the greater trochanter, the lateral condyle of the femur, the head of the fibula, and the lateral malleolus as bony landmarks. A roentgenogram was taken of the extremity before the subject was moved. Pearson product-moment correlation coefficients (r's) and intraclass correlation coefficients (ICCs) were used to analyze the data. The data analysis revealed that the intertester reliability (r = .98; ICC = .99) and validity (r = .97-.98; ICC = .98-.99) were high. The results of this study indicate that goniometric measurements of the knee joint are both reliable and valid.

Adult↗
PubMed1997

Echocardiographic diagnosis of pericardial cyst.

A 52-year-old woman was seen with atypical chest pain. A routine chest roentgenogram revealed an enlarged cardiac silhouette. Results of transthoracic echocardiography performed using the standard views was normal. Because of the discrepancy between the findings of chest roentgenogram and transthoracic echocardiography, a biplane transesophageal echocardiogram was obtained and revealed the presence of a pericardial cyst.

Echocardiography↗
PubMed1993

Clinical significance of pulmonary aspiration during the perioperative period.

BACKGROUND: Pulmonary aspiration of gastric contents during the perioperative period may be associated with postoperative mortality or pulmonary morbidity. Recent determination of the incidence of perioperative pulmonary aspiration and evaluation of factors related to clinical outcomes is lacking. METHODS: We retrospectively reviewed the perioperative courses of 172,334 consecutive patients 18 yr of age or older who underwent 215,488 general anesthetics for procedures performed in all surgical specialties from July 1985 to June 1991. Pulmonary aspiration was defined as either the presence of bilious secretions or particulate matter in the tracheobronchial tree or, in patients who did not have their tracheobronchial airways directly examined after regurgitation, the presence of an infiltrate on postoperative chest roentgenogram that was not identified by preoperative roentgenogram or physical examination. RESULTS: Pulmonary aspiration occurred in 67 patients (1:3,216 anesthetics). Fifteen aspirations occurred in 13,427 (1:895) anesthetics of patients undergoing emergency surgery, and 52 occurred in 202,061 (1:3,886) anesthetics of patients undergoing elective surgery (P < .001). Of the 66 patients who survived their surgery, 42 (64%) did not develop a cough or wheeze, a decrease in arterial hemoglobin oxygen saturation while breathing room air > 10% less than the preoperative value, or radiographic abnormalities within 2 h of aspiration. These 42 patients had no respiratory sequelae. Of the 24 patients who had one or more of these findings, 13 required mechanical ventilatory support for more than 6 h. Three of the six patients whose lungs required mechanical ventilation for more than 24 h died from pulmonary insufficiency (overall mortality = 1:71,829 anesthetics). CONCLUSIONS: This study suggests that patients with clinically apparent aspiration who do not develop symptoms within 2 h are unlikely to have respiratory sequelae.

Adult↗
PubMed1975

Significance of a solitary lung shadow in patients with breast cancer.

From 1949 through 1972 at Memorial Sloan-Kettering Cancer Institute, 72 breast cancer patients developed a synchronous or metachronous solitary lung shadow. Forty-three had separate primary lung cancers; 23 had breast carcinoma metastases and six had benign lung lesions. Of these, 47% were asymptomatic and the lesions were discovered by routine chest roentgenograms. Among 49 patients who underwent pulmonary procedures, secondary involvement of regional lymphatics was noted in 22, nine of which were daughter metastases secondary to the breast deposit. In such a setting, a radical lobectomy (or pneumonectomy) would seem the operation of choice. Four patients who had primary lung cancer and five patients with pulmonary breast metastases survived five years after the thoracic procedure. Prolonged survival in these patients bore no relationship to age, sex, state of axillary lymph nodes or length of interlude between the breast and the lung cancer. Early diagnosis, the extent of the cancer and adequate excision seem to influence end results. When other primary cancers were present, in addition to those of breast and lung, these did not seem to diminish the chance for survival provided they were treated as if they existed alone. The need for strict periodic and continual followup examinations, not only in breast, but also for all cancer patients is essential for early detection of metastases or new primaries. Chest roentgenograms are an integral part of such a plan. The ambiguity of a solitary lung shadow (or at the most two or three opacities) with a known primary breast cancer requires clarification without delay as to its histologic nature so that proper treatment can be instituted and an accurate prognosis given.

Adult↗
PubMed1986

Routine breast screening. Survival after 10.5 years follow-up.

Beginning in 1973, the Breast Cancer Detection Demonstration Project at Georgia Baptist Medical Center screened 8058 supposedly asymptomatic volunteers. Those screenees found to have cancer were treated by various surgeons, using all types of treatment with varying expertise. There has been 100% follow-up after 10.5 years. The overall survival is 90.8%. The women over 50 in all categories survived longer than the younger age group. Those women with lesions 1 cm or smaller survived longer than those with larger lesions. The women whose tumor was not palpable clinically and was discovered by roentgenogram had the best survival rates (96.8%). In the less-than-50 age group whose cancer was detected by roentgenogram alone, 88.2% survived 10.5 years, while 100% of the older group is still living. These results do not consider the type of therapy nor the skill with which it was administered and is the result of routine screening only.

Age Factors↗
PubMed1986

The utility of computed tomography in colonic diverticulitis.

Forty-one patients admitted to our hospital during an 18-month period with the clinical diagnosis of colonic diverticulitis were analyzed to evaluate the utility of computed tomography (CT). Abdominal pain and leukocytosis were the most common presenting manifestations, 75 and 66%, respectively. Just over one-half of the patients also demonstrated hematuria. Twenty patients required surgical intervention, most commonly for failure to improve despite medical management. Preoperative studies included 10 sigmoidoscopies, 30 plain abdominal roentgenograms, 20 barium enemas (BE), and 24 CT scans. Two CT scans were also obtained after operation for successful percutaneous drainage of intra-abdominal abscesses. Abdominal roentgenograms were most commonly obtained but least helpful, with only one third demonstrating any abnormality whatsoever. Sigmoidoscopy was least commonly performed but almost universally abnormal. Specificity was low, however, in that spasm with inability to advance the endoscope was the most common finding. Of the 20 barium enemas obtained, 60% had findings consistent with diverticulitis, most commonly localized perforation or fixed narrow segment. Sixty-three per cent of CT scans were abnormal. The most frequent findings were localized thickening of the colonic wall and increased density in the pericolic fat. Diverticular abscess, which may be inferred by other studies, was definitely diagnosed in one third of the patients with abnormal CT scans. CT also provided the ability to identify extracolonic intra-abdominal pathology. The study demonstrates that both barium enema and CT are effective in diagnosing diverticulitis, although CT can be performed without risk. CT played no therapeutic role before operation, although two patients benefited after operation by CT-guided drainage of intra-abdominal abscesses. The decision for surgery was most frequently dependent on clinical examination and never solely on the basis of either the barium enema or CT in this study. The major benefit of CT appears to be its ability to identify both gross and subtle changes indicative of diverticular disease and extracolonic pathology in a relatively noninvasive manner.

Adult↗
PubMed2006

Relation between intracranial volume and the surface area of the foramen magnum.

Several investigators have estimated the intracranial volume (ICV) in the past which indirectly reflects the brain volume. Most of these studies have been made on the dry skulls using linear dimensions, packing methods or occasionally radiological methods. It is also reported that the etiology of cerebellar tonsillar herniation is closely related to the size of the foramen magnum (FM). In the present study the ICVs have been estimated in 28 dry skulls using filling water method and the surface area of FMs were measured planimetry method. The estimated mean ICV was 1,311 +/- 133 cm. Surface area of FM was 760 +/- 144 mm. Antero-posterior and lateral direct roentgenograms of the skulls were also taken and the width, height and length (WHL) of the skull were measured by means of the cephalometry on radiograms. The relationship between the ICV, WHL and surface area of FM were analyzed statistically. The ICV, WHL and surface area of FM was correlated well (r = 0.271, P < 0.005; r = 0.265, P < 0.005, respectively) and a regression formula was proposed. Our results showed that skulls with larger ICV and WHL have larger FM surface area. We also suggested a regression formula that could be used to predict the surface area of FM regarding to the ICV and WHL values. In the next step, we took roentgenograms of skulls and obtain ICV measuring the width, length and height of skulls by means of cephalometry and investigate the relation between the findings of cephalometry and surface area of FM. The cephalometry could apply on living subjects and, thereby, our findings could provide some data to evaluate the etiology of Arnold Chiari malformation and achondroplasia for living subjects.

Adult↗
PubMed1980

Osteolytic and osteoblastic metastases due to carcinoid tumors.

Gastrointestinal carcinoid tumors arising from the foregut and hindgut may metastasize within the abdomen. Bone metastases are rare, but their occurrence is well established. Both osteoblastic and osteolytic metastases can occur in the same patient without any bone symptoms. Three patients with malignant carcinoid tumors had no bone symptoms but demonstrated extensive bone metastases on radionuclide bone scans. Some of these lesions were abnormal on corresponding roentgenograms and some areas were negative on roentgenograms. The use of radionuclide bone scanning in the evaluation of patients with malignant carcinoid tumor is emphasized.

Adult↗
PubMed1986

Scintigraphic manifestation of fibrous dysplasia.

Scintigraphic manifestations of fibrous dysplasia were analyzed in 59 lesions of 26 patients (12 monostotic, 14 polystotic). Bone imaging with Tc-99m MDP revealed a high percentage of increased uptake of radioisotope in the lesions of fibrous dysplasia. Four (14%) of 29 cystic lesions and two (7%) of 30 lesions with the appearance of ground glass showed no increase in radioisotope uptake, although roentgenograms showed marked changes. Therefore, care must be taken in the diagnosis of fibrous dysplasia with bone imaging alone. Nuclear methods, however, are indispensable in evaluating the dynamic aspects of bone mineral behavior and in demonstrating disease where none was suspected, or in visualizing polyostotic involvement in those cases where only monostotic disease was suspected clinically. It is concluded that both scintigrams and roentgenograms are complementary procedures in the diagnosis of fibrous dysplasia.

Adolescent↗