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PubMed1981

Pulmonary arteriography in patients with hilar or mediastinal masses and lung scans suggesting pulmonary embolism.

Three patients with clinical features of pulmonary embolism were evaluated by chest roentgenograms, perfusion lung scanning, and pulmonary arteriography. All of them had hilar and/or mediastinal masses which were obvious in one patient, subtle in another, and not discernible in the third. The three patients had abnormalities on lung scans, including unilateral absence of perfusion in two and lobar absence of perfusion in one. The extent of the perfusion defects correlated poorly with the roentgenographically visible masses. Pulmonary arteriograms were abnormal but none showed evidence of pulmonary embolism. Lung scanning is often unreliable in establishing the diagnosis of pulmonary embolism in patients with hilar or mediastinal masses. Pulmonary arteriography may demonstrate the mass if it is vascular, or may show extrinsic compression upon the pulmonary vasculature. Lung scanning may be of value in localizing a mass not visible on chest roentgenogram in a patient suspected of harboring a bronchogenic carcinoma.

Adult↗
PubMed1983

Skull roentgenography in the evaluation of head injury.

The role of skull roentgenograms in determining choice of therapy, hospital admission, and length of hospitalization was evaluated in 106 consecutive patients with head injury. Thirty patients were discharged from the emergency room after initial evaluation and had uneventful recovery. Seventy-six were admitted and discharged without operative treatment one to ten days later. Only five had pathologic skull findings roentgenographically. Of these, one was discharged from the emergency department; the remaining four were admitted because of abnormal neurologic findings. All five recovered uneventfully. Another patient who had a normal roentgenographic evaluation required subsequent admission for craniotomy. Skull roentgenograms were an unimportant factor in the management of head injury patients and did not eliminate the need for complete and serial neurologic evaluation.

Accidents, Home↗
PubMed1983

Pulmonary arteriovenous fistula simulating a vanishing tumor.

In a patient with an asymptomatic left upper lobe pulmonary arteriovenous fistula, preoperative chest roentgenograms simulated bronchogenic carcinoma, but no overt feeding vessel was demonstrated. Intraoperatively no lesion could be palpated. Postoperative evaluation revealed a pulmonary arteriovenous fistula. This entity should be considered in the differential diagnosis of single or multiple pulmonary nodules. Careful review of chest roentgenograms for feeding arteries, or draining veins, and observation under fluoroscopy for changing size will aid in diagnosis, and potentially avoid bronchoscopy and possible transbronchoscopic biopsy of these vascular lesions.

Arteriovenous Fistula↗
PubMed1987

Limited stage small cell lung cancer: analysis of clinical prognostic factors.

In an attempt to identify clinical features of prognostic value in patients with limited stage small cell lung cancer, we retrospectively reviewed the records and chest roentgenograms of 101 such patients seen at Vanderbilt University Hospital. All patients were treated with combination chemotherapy regimens of comparable efficacy with or without chest radiotherapy and/or surgical resection. Median survival for the 101 patients was 16 months; the three-year actuarial survival was 14%. Elevated serum LDH level at the time of diagnosis was predictive of improved survival by both univariate and multivariate analyses (P less than .01). Initial tumor volume (calculated from tumor measurements) on chest roentgenogram and clinical TNM stage were unrelated to survival. Until the prognostic significance of an elevated serum LDH level is confirmed by other investigators, we cannot recommend any modification in the current system for staging small cell lung cancer. Although patients with limited stage small cell lung cancer form a clinically heterogeneous group, they should continue to be treated uniformly.

Actuarial Analysis↗
PubMed1990

Immediate postexcision mammography for occult noncalcified breast lesions.

To evaluate completeness of surgical excision, we studied the use of film screen mammography done immediately after excision of occult noncalcified breast lesions in 11 patients. The postoperative mammograms were well tolerated, and allowed high quality films to be obtained. Complete excision was documented in ten patients, and one patient had small artifacts that resolved on follow-up studies. Roentgenograms of the surgical specimen from ten patients showed a discrete lesion in only three. Histologic analysis revealed malignancy in two patients and benign changes in nine. These findings indicate that mammography done immediately after excision of occult noncalcified lesions is more reliable than roentgenograms of the specimen and may be a useful method for confirming extent of excision. This method may also eliminate the present delay of four to six weeks before adequate postoperative follow-up films can be obtained to evaluate excision.

Adult↗
PubMedDate not supplied

Transverse traction in the treatment of scoliosis. A preliminary report.

Nineteen scoliotic patients were treated with the standard Harrington distraction rod supplemented with transverse traction. The latter consists of a compressive device (either Harrington';s or Cotrel's) applied to the convex side of the curve to correct disc space wedging and then drawn toward the distraction rod with a simple traction apparatus. Intraoperative roentgenograms were taken with the Harrington distraction rod alone after maximal distraction was applied. This was followed by postoperative roentgenograms with the transverse traction added. The 50.3% correction by distraction rod alone is increased to 66% with the addition of transverse traction. Detailed analysis of each curve, segment by segment, showed that the correction was augmented, not only in the center of the curve, where the compression corrected disc space wedging, but in the ends of the curve as well. This series uses each patient as his or her own control in demonstrating increased correction added by transverse traction.

Adolescent↗
PubMed1983

Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion.

One hundred patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent idiopathic scoliosis (2) completion of treatment before age 20, (3) a minimum follow-up of five years thereafter, (4) a minimum age of 22 years at final follow-up, and (5) operation performed by the senior author. Of these, 95 were personally examined. The surgical technique from 1968 to 1973 included a two-stage Harrington distraction, with fusion added at the second operation (52 patients). From 1973 to 1975, 48 patients were treated with a one-stage distraction and fusion after a week of preoperative Cotrel traction. Postoperatively, all patients were treated with a Milwaukee brace. A spinal examination and functional assessment, including a questionnaire and pain drawing, full standing anterior-posterior (AP), and lateral roentgenograms of the spine, was performed by independent observers. Eighty-five subjects without scoliosis served as a control group. The radiographic evaluation showed the usual nearly 50% permanent correction at the follow-up examination averaging nine years postoperatively. Lateral roentgenograms, however, demonstrated in 52% flattened or kyphotic cervical spines producing no significant complaints, non-significant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis. Fifteen of the 24 patients with distal hook insertion and fusion including L4 or L5 demonstrated retrolisthesis. All had significant low-back pain. Degenerative facet joint changes and disc space narrowing was noted in 11 patients, again with a distal hook purchase in L4 or L5. Compared to the controls, the operated patients, as a group, revealed no lessened activity or back pain at any location.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

A comparative analysis of x-ray findings of the lumbar spine in patients with and without lumbar pain.

Roentgenograms of the lumbar spine from 238 patients with lower back pain (LBP) with sciatica were compared with roentgenograms from 66 patients without LBP. No difference between the two groups could be demonstrated concerning the incidence of spondylosis and disc degeneration. Cases with wedge-shaped vertebral bodies are significantly more frequent in patients younger than 40 years old in the group having pain. The incidence of spondylosis and disc degeneration increase with increasing age.

Adult↗
PubMed1985

Evaluation of lumbar lordosis. A prospective and retrospective study.

Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review. The majority of the films were taken because of lumbar complaints. The mean lumbosacral (LS) angle (L2-Sacrum) was 45.05 degrees +/- .85 degrees. The mean lumbolumbar (LL) angle (L2-L5) was 29.96 degrees +/- .74 degrees. Only minor differences were found between a standardized (prospective) and a nonstandardized (retrospective) group. There was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed. A "routine" supine lateral lumbar spine roentgenogram is a very accurate means of measuring lordotic angles. A lordotic angle of less than 23 degrees defines hypolordosis and more than 68 degrees, hyperlordosis.

Adolescent↗
PubMedDate not supplied

Roentgenographic findings of the cervical spine in asymptomatic people.

The purpose of this study was to determine the incidence and severity of degenerative changes seen on lateral roentgenograms in 200 asymptomatic men and women in five age groups with an age range of 20-65 years and to determine the normal values of cervical lordosis and spinal canal sagittal diameters and their relationship to degenerative changes. It was found that by age 60-65, 95% of the men and 70% of the women had at least one degenerative change on their roentgenograms. A small sagittal diameter correlated with the presence of degenerative changes at the same disc level, and the strongest correlation was with the size of the posterior osteophytes at C5-6 (r = 0.52). Cervical lordosis measurements did not relate to degenerative changes except for subjects over age 50 with moderate or severe intervertebral narrowing. It is important to realize that although roentgenographic abnormalities represent structural changes in the spine, they do not necessarily cause symptoms.

Adult↗
PubMed1987

Analysis of the morphometric characteristics of the thoracic and lumbar pedicles.

A total of 2,905 pedicle measurements were made from T1-L5. Measurements were made from spinal computerized tomography (CT) scan examinations and individual vertebral specimen roentgenograms. Parameters considered were the pedicle isthmus width in the transverse and sagittal planes, pedicle angles in the transverse and sagittal planes, and the depth to the anterior cortex in a line parallel to the midline of the vertebral body and along the pedicle axis. There was no significant difference between data obtained from CT scans and specimen roentgenograms. Pedicles were widest at L5 and narrowest at T5 in the transverse plane. The widest pedicles in the sagittal plane were seen at T11, the narrowest at T1. Due to the oval shape of the pedicle, the sagittal plane width was generally larger than the transverse plane width. The largest pedicle angle in the transverse plane was at L5. The posterolateral to anterolateral pedicle axis orientation in the transverse plane, seen at other levels throughout the thoracolumbar spine, reversed at T12. In the sagittal plane, the pedicles angled caudally at L5 and cephaladly from L3-T1. The depth to the anterior cortex was significantly longer along the pedicle axis than along a line parallel to the midline of the vertebral body at all levels with the exception of T12 and T11.

Adult↗
PubMed1987

Primary tumors of the spine.

Eighty-two cases of primary neoplasms of the spine, diagnosed and treated at the University of Iowa, were reviewed in an attempt to identify features of diagnostic and prognostic importance, and to evaluate the effectiveness of surgical treatment with respect to survival. Thirty-one benign and 51 malignant tumors were identified. The mean follow-up in benign lesions was 9.7 years and 3.8 years in malignant lesions. Plain roentgenograms demonstrated the spinal lesion in 81 of 82 cases (99%). All spinal segments were involved, the cervical spine least frequently. Malignancy proved to be associated with an older age at diagnosis, a higher incidence of neurologic deficit, and a higher incidence of occurrence in the vertebral body. Five-year survival for patients with benign tumors was 86%, with no significant relationship between type of surgery and survival. Five-year survival in malignant lesions did correlate with the extent of initial surgery and with the tumor type. Five-year survival in patients undergoing curettage for malignancy was nil, in those undergoing incomplete resection, 18.7%, and in patients having complete excision, 75%. Plain anteroposterior and lateral roentgenograms should be obtained as a screening study in patients with persistent or atypical back pain or neurologic signs. CT scanning, myelography, and magnetic resonance imaging studies may be utilized to establish the physical margins of the lesion and to evaluate cord impingement. Surgical extirpation should be attempted whenever possible in malignant and benign aggressive lesions. In this series, the prolonged survival seen with complete excision justifies an aggressive surgical approach to the treatment of these tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Degenerative adult onset scoliosis.

There are people who have no history of scoliosis who develop spinal deformity of a progressive nature as adults, associated with severe degenerative disc disease. The clinical syndrome associated with this deformity is not well documented. In an attempt to describe this clinical syndrome more precisely, 21 patients with the diagnosis of degenerative scoliosis were identified and reviewed. Review included history with pain drawings when available, physical examination, bone densities, and standing spinal roentgenograms. Patients with spinal compression fractures, spondylolyses, prior history of scoliosis or radiographic findings consistent with an idiopathic scoliosis were excluded. Our review shows that these patients can develop, along with progressive scoliosis, loss of lumbar lordosis with a resulting flat back deformity. These patients commonly present in the sixth decade with a predominantly stenotic symptom complex, but often lack the classic feature of relief in a sitting posture. The number of male and female patients was approximately equal. Roentgenogram findings show a high angle deformity over a short number of spinal segments and an absence of bony features associated with idiopathic scoliosis such as lateral vertebral wedging and alterations of the lamina. The incidence of this condition remains to be established.

Adult↗
PubMed1988

Functional radiographic diagnosis of the cervical spine: flexion/extension.

The cervical spines of 59 adults were examined by means of functional roentgenograms. They were divided into two groups consisting of 28 healthy adults and 31 patients who had sustained soft tissue injury to the cervical spine and who were complaining of neck pain. Roentgenographic lateral views were taken in active flexion and extension as well as in passive maximal flexion and extension. Measurements using the techniques of Penning and Buetti-Bauml were made by three observers independently. There was a highly significant difference between the active and passive segmental ranges of motion in healthy adults. Based on the normal values obtained in this study, 19 hypermobile segments could be diagnosed during the active examination, while 31 hypermobile segments were found during the passive examination. In addition, the active examination found 60 hypomobile segments, while the passive examination showed only 43 hypomobile segments. The Penning Method of measurement was found to be more reliable than that of Buetti-Bauml. If possible, the functional roentgenogram examination of the cervical spine in the sagittal plane should be performed by including passive movement and the range of motion should be compared with the normal values obtained by passive examination.

Adult↗
PubMed1995

Scoliosis and congenital heart disease.

STUDY DESIGN: This study analyzed clinical characteristics of scoliosis associated with congenital heart disease. Chest roentgenograms were reviewed to determine frequency, type, onset, and progression of scoliosis associated with congenital heart disease. OBJECTIVES: To determine which patients with scoliosis and congenital heart disease should be followed-up carefully. SUMMARY OF BACKGROUND DATA: Although several studies have been reported on scoliosis and congenital heart disease, the etiology of scoliosis in patients with congenital heart disease is still unknown. Furthermore, it has been difficult to determine the progression of scoliosis. METHODS: Chest roentgenograms of 680 patients who underwent cardiac operations because of congenital heart disease were evaluated. RESULTS: Seventy-four (10.9%) of these patients had scoliosis of more than 10 degrees, although most of them had mild curves. Scoliosis in patients under 10 years old undergoing cardiac operations was more severe than in those older than 10 years who underwent surgery. Scoliosis associated with congenital heart disease showed no particular features. Patients with patent ductus arteriosus showed left convex, high thoracic scoliosis after surgery. CONCLUSIONS: The mechanisms of onset of scoliosis in patients with congenital heart disease were not simple and were affected by several factors, including age at operation, side of approach, and type of congenital heart disease.

Adolescent↗
PubMed1997

Acute axis fractures. Analysis of management and outcome in 340 consecutive cases.

STUDY DESIGN: Retrospective review of acute axis fractures treated at a tertiary referral center. OBJECTIVE: To determine the optimal treatment of axis fractures based on 340 cases from a single institution. SUMMARY OF BACKGROUND DATA: Axis fractures account for almost 20% of acute cervical spine fractures. However, their management and the clinical criteria predictive of nonoperative failure remain unclear. METHODS: Admission imaging studies and clinical variables were obtained for 340 consecutive axis fracture patients. Fractures were classified as as odontoid Type I, II, or III with dena displacement on admission roentgenograms; hangman's fractures of Francis grade and Effendi type; and miscellaneous fractures. Treatment methods were documented, and outcomes were based on dynamic lateral roentgenograms, clinical examination, or telephone interviews at last follow-up. RESULTS: Follow-up data were available in 92% of cases. Type II odontoid fractures comprised 35% of all axis fractures, were the most difficult to treat, and had the highest nonunion rate (28.4%). Odontoid displacement of 6 mm or more was associated with Type II nonunion (chi-square = 33.74, P < 0.0001). Patients underwent surgical fusion if fracture alignment could not be maintained by an external orthosis, or if they had odontoid fractures with transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm, or hangman's fractures of severe Francis grade or Effendi type. CONCLUSIONS: Type II odontoid fractures have the highest nonunion rate and were associated with dens displacement of 6 mm or greater. Early surgical fusion is recommended for acute fracture instability despite external immobilization, transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm on admission, or severe Francis grade or Effendi-type hangman's fractures. Otherwise, nonoperative management is sufficient.

Adolescent↗
PubMed2001

The arthrodesis rate in multilevel anterior cervical fusions using autogenous fibula.

STUDY DESIGN: This study was a roentgenographic review of 145 patients who underwent multilevel anterior cervical arthrodesis using autogenous fibula. OBJECTIVE: To determine the arthrodesis rate in multilevel cervical fusions using autogenous fibula. SUMMARY OF BACKGROUND DATA: Previous studies have shown an unacceptably high rate of nonunions with multilevel anterior cervical arthrodesis. However, this has not been the clinical experience of the author's group. METHODS: Lateral roentgenograms taken a minimum of 2 years after surgery were reviewed independently by two radiologists. If either radiologist questioned any fusion level, the final decision was made on the basis of flexion-extension roentgenograms. RESULTS: An overall union rate of 90% and 94% per patient was found for each level of attempted fusion. A solid arthrodesis was achieved in 93% of the patients with two-level fusions, and 84% of the three-level fusions were solid. The difference was not statistically significant. CONCLUSION: Autogenous fibula used as a strut graft results in an acceptable union rate for multilevel anterior cervical arthrodesis.

Adult↗
PubMed1988

'B-readers' and asbestos medical surveillance.

"B-readers" certified in International Labor Office methodology interpret large numbers of randomly distributed asbestos medical surveillance roentgenograms of US Navy employees. Analysis of 23 participating observers, interpreting more than 105,000 radiographs, demonstrated a 300-fold prevalence range of perceived "definite" pulmonary parenchymal abnormalities. There was an evident geographic component to interpretation habits, with East and West Coast observers more likely to interpret films as abnormal than observers from the midcontinent. The most expert observers, a group who instruct the course leading to National Institute for Occupational Safety and Health certification in International Labor Office methodology, also perceived fewer abnormalities than other readers or coastal observers. Instructors still exhibited a sevenfold prevalence range of positive interpretation. Under usual surveillance conditions, the habits of B-readers appear to have a major impact upon the diagnosis of asbestosis from roentgenograms. Certification in B-reading should not be the only quality assurance for radiographic surveillance programs, medical decision-making, epidemiologic comparisons, nor related legal activities.

Asbestosis↗