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PubMed1988

Epidemiologic study of workers exposed to titanium dioxide.

The objective of this study was to determine whether workers exposed to titanium dioxide (TiO2) had significantly higher risks of lung cancer, chronic respiratory disease, pleural thickening/plaques, or pulmonary fibrosis than referent groups. A total of 1,576 employees exposed to TiO2 were observed from 1956 through 1985 for cancer and chronic respiratory disease incidence, and from 1935 through 1983 for mortality. A cross-sectional sample of 398 employees was evaluated for chest roentgenogram abnormalities. Cohort analyses suggested that the risks of developing lung cancer and other fatal respiratory diseases were no higher for TiO2-exposed employees than for the referent groups. Nested case-control analyses found no statistically significant associations between TiO2 exposure and risk of lung cancer, chronic respiratory disease, and chest roentgenogram abnormalities. No cases of pulmonary fibrosis were observed among TiO2-exposed employees.

Cohort Studies↗
PubMed1992

Epidemiologic study of lung cancer mortality in workers exposed to titanium tetrachloride.

A study was done to examine whether workers exposed to titanium tetrachloride had significantly higher risks of lung cancer, chronic respiratory disease, pleural thickening/plaques, or pulmonary fibrosis than referent groups. A total of 2477 employees from two titanium dioxide plants were studied. Of that group, 969 employees exposed to titanium tetrachloride were observed from 1956 through 1985 for cancer and chronic respiratory disease incidence and from 1935 through 1983 for mortality. A cross-sectional sample of 398 employees was evaluated for chest roentgenogram abnormalities. Cohort analyses showed that the risk of developing lung cancer and other fatal respiratory diseases was not statistically significantly higher for the titanium tetrachloride-exposed workers than for the referent group. Nested case-control analyses found no statistically significant association between titanium tetrachloride exposure and risk of lung cancer, chronic respiratory disease, and chest roentgenogram abnormalities. No cases of pulmonary fibrosis were observed among titanium tetrachloride-exposed employees. Smoking was found to be a strong predictor of lung cancer mortality in the nonexposed employees with an increased risk of dying from lung cancer up to 7-fold higher in current smokers than in nonsmokers.

Case-Control Studies↗
PubMed1998

Respiratory findings in workers employed in the brick-manufacturing industry.

We studied 233 male workers employed in two brick-manufacturing plants and 149 matched control workers. The mean age of the brick workers was 35 years, with a mean duration of employment in this industry of 16 years. The prevalence of chronic respiratory symptoms as well as acute symptoms during the work shift were recorded. Lung function was measured on Monday during the work shift by recording maximum expiratory flow-volume (MEFV) curves, from which the forced vital capacity (FVC), the one-second forced expiratory volume (FEV1) and flow rates at 50% and the last 75% of the FVC (FEF50, FEF75) were measured. The results of periodic chest roentgenograms were reviewed. There was a significantly higher prevalence of chronic cough (31.8%), chronic phlegm (26.2%), and chest tightness (24.0%) in exposed workers, compared with control workers (20.1%; 18.1%; 0%) (P < 0.05). This increased symptom frequency was also documented among nonsmokers studied by age and by length of employment, suggesting a work-related effect. Among work shift-related symptoms, high prevalences were noted for upper respiratory tract symptoms (e.g., dry throat, eye irritation, throat irritation). The measured FVC and FEV1 were significantly lower than predicted for brick workers and suggested a restrictive pattern. The mean FVC (as a percent of predicted) was 78.1% and FEV1 was 88.1%. The FEF50 and FEF25 were not significantly decreased. A multiple regression analysis with age, exposure, and smoking as predictors and lung function parameters as response variables showed a significant effect between exposure and FVC. Significant chest roentgenographic abnormalities were not documented. These findings of a restrictive lung function pattern in brick workers with normal chest roentgenograms may suggest early interstitial disease. Additionally, a bronchitic component, as suggested by the respiratory symptoms, may also be present.

Adult↗
PubMed2005

Scoliosis after median sternotomy in children with congenital heart disease.

STUDY DESIGN: A retrospective review of spinal deformity in patients with congenital heart disease surgically treated through a median sternotomy before the age of 8 years. Assessment was done on chest roentgenograms at skeletal maturity. OBJECTIVES: To determine if patients surgically treated through a median sternotomy present a higher prevalence of spinal deformity. SUMMARY OF BACKGROUND DATA: Congenital heart disease is associated with a higher prevalence of scoliosis. The etiology of scoliosis in this group of patients is unknown. Thoracotomy causes scoliosis, but median sternotomy has not been identified as a causal agent in these patients. METHODS: Chest roentgenograms were done after skeletal maturity in 128 patients to assess for the presence of a spinal deformity in the sagittal or coronal plane as a result of a median sternotomy for treatment of congenital heart disease before the age of 8 years in patients without any prior radiographic evidence of spinal or costal deformity before surgery. RESULTS: Forty-four (34.3%) of these patients had scoliosis greater than 10 degrees , 16 of them (12.5%) had curves greater than 20 degrees , and 33 (25.8%) had thoracic kyphosis lesser than 20 degrees . Patients operated before the age of 18 months had a significantly increased risk of developing scoliosis than those operated at a later age (odds ratio = 3.5; confidence interval = 1.3-9.6; P = 0.016). The presence of scoliosis was not related to the type of congenital heart disease. CONCLUSIONS: There is a high prevalence of scoliosis in patients with congenital heart disease surgically treated through a median sternotomy. The prevalence of scoliosis increases in patients operated at an earlier age.

Adolescent↗
PubMed2006

Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury.

OBJECTIVE: To find out if the extravascular lung water index (EVLWI) and the derived permeability indexes determined by the single transpulmonary thermodilution technique are associated with markers of acute lung injury in human septic shock. DESIGN: Prospective, observational study. SETTING: Mixed intensive care unit of a 900-bed university hospital. PATIENTS: Thirty-eight consecutive adult patients with septic shock and acute lung injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The variables were assessed over a 72-hr period and included hemodynamics, EVLWI, and pulmonary vascular permeability indexes determined with the single indicator transpulmonary thermodilution technique, lung compliance, oxygenation ratio (Pao2/Fio2), lung injury score, cell counts, and the plasma concentration of endothelin-1. At day 1, EVLWI was elevated (>or=7 mL/kg) in 28 (74%) patients and correlated with lung compliance (r=-.48, p=.002), Pao2/Fio2 (r=-.50, p=.001), lung injury score (r=.46, p=.004), roentgenogram quadrants (r=.39, p=.02), and platelet count (r=-.43, p=.007). At day 3, EVLWI correlated with compliance (r=-.51, p=.002), Pao2/Fio2 (r=-.49, p = .006), and lung injury score (r=.53, p=.003). At day 3, EVLWI and pulmonary vascular permeability indexes were higher in nonsurvivors (p<.05). The plasma concentration of endothelin-1 (mean+/-sd) was significantly higher in patients with elevated EVLWI (>or=7 mL/kg) (3.85+/-1.40 vs. 2.07+/-0.38 pg/mL, respectively). Twenty-two (59%) patients died before day 28. CONCLUSIONS: In human septic shock, EVLWI demonstrated moderate correlation with markers of acute lung injury, such as lung compliance, oxygenation ratio, roentgenogram quadrants, and lung injury score. In nonsurvivors, EVLWI and permeability indexes were significantly increased at day 3. Thus, EVLWI might be of value as an indicator of prognosis and severity of sepsis-induced acute lung injury.

Biomarkers↗
PubMed1981

Compression injury of the epiphyseal growth plate: fact or fiction?

It has been hypothesized that a longitudinal compression force on a growing long bone may cause partial or complete closure of a physis by crushing the germinal cell layer. In the absence of a fracture of the physis, the roentgenograms at the time of injury would be normal. Thus, this diagnosis can be made only in retrospect. In order to prove such a hypothesis, the following criteria would have to be met: (a) normal findings on roentgenograms taken in at least two planes at the time of injury, (b) no treatment, and (c) subsequent positive roentgenographic findings showing partial or complete closure of the physis, compared with the contralateral side. We have been unable to find, either in our files or in the literature, any cases that meet these criteria. Many other causes of premature closure of physes have been well documented in the literature.

Accidents, Traffic↗
PubMedDate not supplied

Magnetic resonance imaging in early diagnosis of Legg-Calvé-Perthes disease.

Two male patients, aged 6 and 9 years, were suspected of having unilateral Perthes disease because of typical symptoms and clinical signs. Roentgenograms, including scintigraphy, were normal. Magnetic resonance imaging (MRI) showed definite avascular necrosis in the affected hip. Roentgenograms subsequently also became positive for Perthes disease. These two cases document the advantages of MRI in early diagnosis of Perthes disease prior to development of typical radiologic changes.

Child↗
PubMed1998

Bronchiolitis obliterans organizing pneumonia in Korea.

An analysis of the clinical features in 23 cases of bronchiolitis obliterans organizing pneumonia (BOOP) in Korea is presented. Six were men and 17 were female, with a male-to-female ratio of 1:2.4. Idiopathic BOOP was present in 18 of these patients, connective tissue disease-associated BOOP in five and all of them were females. The most frequent symptoms were dyspnoea and coughing in both groups; and crackles were the most prominent physical findings. Leukocytosis was observed in seven of the idiopathic BOOP group and all in the connective tissue disease-associated BOOP group. In most cases, FVC, FEV 1, diffusing capacity and arterial O2 pressure were reduced. In roentgenographic study, patchy air space consolidation was the major finding and subpleural predominance was observed in the majority of patients in both groups. Migration of lesions were identified in only two patients with idiopathic BOOP. Steroid treatment was effective in all of idiopathic BOOP. In contrast to previous reports, an analysis of the 23 Korean BOOP patients showed several interesting points. First, a female predominance was observed. Second, migration of lesion was rare. Third, it did not show any different prognosis in patients with reticular pattern on roentgenogram compared with patients with patchy air space consolidation on roentgenogram. Whether these differences were due to ethnic or environmental factors is to be determined.

Adult↗
PubMed1996

Chronic respiratory failure after acquired cytomegalovirus infection in a very low birthweight infant.

The case of a female infant who developed chronic respiratory failure after an acquired cytomegalovirus (CMV) infection is presented here. She was a very low birthweight (VLBW) infant and was free from oxygen supplement until 2 months after birth. Interstitial pneumonia occurred at 2 months of age, and her respiratory condition gradually deteriorated. A chest roentgenogram at 4 months revealed hyperinflation and reticular shadow, similar to that of severe chronic lung disease (CLD) in preterm infants. She was mechanically ventilated because of progressive respiratory deterioration, and oxygen dependency continued for 5 months after extubation. There are several previous reports of CMV pneumonia in term neonates or infants. However, there appears to be no published report on the pulmonary sequelae of CMV pneumonia in VLBW infants. The present case seems to indicate that acquired CMV pneumonia in VLBW infants causes chronic respiratory failure even when mechanical ventilation is not administered, and this respiratory failure is very similar to CLD in clinical symptoms and chest roentgenogram.

Chronic Disease↗
PubMed1976

Incidence of murmurs in the aging heart.

One hundred patients aged 60 or older were studied clinically after excluding those with cardiac enlargement, definite valvular lesions or electrocardiographic (ECG) evidence of left ventricular hypertrophy. In 30 of the the 100 patients a significant systolic murmur was heard on auscultation. Phonocardiograms (PCGs), mitral echograms and pulse tracings were obtained in 28 of these 30 patients (2 had died meanwhile), and the ECGs and chest roentgenograms were reviewed. In 23 PCG patients there was an early or midsystolic murmur, best recorded at the base of the heart and often transmiteed to the apex. Mitral valve echograms and carotid and jugular pulse tracings were normal in all cases. Chest roentgenograms revealed aortic enlargement in 83 percent of the 23 patients. In the elderly with no evidence of organic heart disease, a basal systolic murmur is probably an aortic flow phenomenon caused by either moderate aortic dilatation or minimal fibrotic fusion of one or more commissures of the aortic valve.

Age Factors↗
PubMed1981

Perforated peptic ulcer in the elderly.

From 1973 through 1979, 32 patients over 60 years of age were admitted to the Beth Israel Medical Center, New York, because of a perforated gastric or duodenal ulcer. In many of them, the symptoms and physical findings were minimal. In abdominal roentgenograms (subject erect or supine), only 17 (60 percent) of these patients showed free intraperitoneal air. Among the 29 surgically treated patients, plication of the ulcer was performed in 28 and hemigastrectomy-vagotomy in one. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The increased use is recommended of contrast roentgenograms of the stomach and duodenum and of endoscopy, in an effort to improve diagnostic accuracy in dealing with perforated peptic ulcers.

Aged↗
PubMed1993

[Pneumonia due to respiratory syncytial virus diagnosed by transtracheal aspiration in an adult].

A healthy-looking 44-year-old female was admitted to our hospital complaining of fever and hemosputum. The chest roentgenogram on admission showed patchy infiltrates of the segment 3 and 8 of the right lung. Laboratory studies showed a leukocyte count of 9700/microliters, erythrocytes sedimentation rate of 55 mm/hour and C reactive protein of 8.7 mg/dl. The arterial PO2 was 71.9 torr while the patient was breathing room air. Transtracheal aspiration was performed on admission, and strains and culture for bacteria, acid fast bacilli, fungi and mycoplasma were negative. Respiratory syncytial virus was isolated from transtracheal aspirates. The RSV complement fixing antibody titers rose from 1:40 to 1:16. She became afebrile on the fourth day after admission and her chest roentgenogram improved gradually. RSV infection should be considered in the differential diagnosis of atypical adult pneumonias.

Adult↗
PubMed1995

[An outbreak of acute pulmonary histoplasmosis among travelers to a bat-inhabited cave in Brazil].

Histoplasmosis is known to be endemic in various parts of the world, especially in North and Latin America. In Japan, Histoplasma capsulatum has rarely been isolated from the natural environment. To date, only seven cases of histoplasmosis have been reported in Japan including some that were contracted in foreign countries. Herein, we report the occurrence of acute histoplasmosis among Japanese travelers who were exposed to bat guano in a cave near Manaus, Brazil. A group of 8 Japanese travelers entered a cave for a total of 2 hours in March, 1993. All the visitors had been healthy and had no history of abnormal chest roentgenograms. From 10 to 20 days after the exposure, 7 (87.5%) of the 8 individuals developed abnormal symptoms including fever, malaise, loss of appetite, myalgia, arthralgia, chest pain and dry cough. Five (62.5%) had nodular infiltrative shadows with or without hilar lymphadenopathy in the chest roentgenograms. Eight (100%) of the individuals showed serologic evidence of histoplasmosis. Despite the small number of subjects, this high rate of infection may be related to the fact that the subjects stayed in an enclosed area where air exchange was minimal, at the end of a deep cave infested with numerous bats. The cave involved has never been documented as being endemic for histoplasmosis. The threat of H. capsulatum infection in bat-inhabited caves should be emphasized to travelers and also to physicians.

Adult↗
PubMed1986

Altered pulmonary epithelial permeability in canine radiation lung injury.

A radioaerosol scanning technique measuring regional clearance of sodium pertechnetate (99mTcO-4) and 99mTc-labeled diethylenetriaminepentaacetate (99mTc-DTPA) was used to assess changes in canine pulmonary epithelial permeability following lung irradiation. Doses of 2,000 cGy (11 dogs), 1,000 cGy (2 dogs), and 500 cGy (2 dogs) were given in one fraction to either the entire right hemithorax (500 cGy) or the right lower lung (1,000 and 2,000 cGy). Radioaerosol scans, chest roentgenograms, and computerized tomograms (CT) were obtained before and serially after irradiation. A dose of 2,000 cGy resulted in a decrease in regional pulmonary epithelial permeability to both 99mTcO4- and 99mTc-DTPA; both showed significant decreases from the 2nd wk postirradiation onward. In comparison, CT and chest roentgenogram did not become abnormal until 7.1 +/- 2.8 (SD) and 8.2 +/- 2.6 wk, respectively. Doses of 1,000 and 500 cGy produced reversible decreases in 99mTcO4- clearance. Lung morphology showed definite changes of radiation pneumonitis after 2,000 and 1,000 cGy but not after 500 cGy at approximately 9, 17, and 12 wk postirradiation, respectively. These results suggest that dose-dependent changes in pulmonary physiology may precede obvious structural alterations in radiation lung injury.

Aerosols↗
PubMed1999

Treatment of community-acquired pneumonia in outpatients: randomized study of clarithromycin alone versus clarithromycin and cefuroxime.

OBJECTIVE: To evaluate the efficacy of clarithromycin alone in comparison with the combination of clarithromycin and cefuroxime in the treatment of nonhospitalized patients with community-acquired pneumonia (CAP) in a Mediterranean population. METHODS: CAP was defined as the acute onset of fever (>38 degrees C) with pulmonary opacity on chest roentgenogram. The American Thoracic Society (ATS) criteria (1993) were used to decide on patient hospitalization. Ninety subjects, of whom 53 (59%) were men, with a mean age (+/-SD) of 38+/-15 years, were randomized: 45 received clarithromycin 500 mg b.i.d. orally for 14 days (CL group), and 45 received clarithromycin plus cefuroxime 500 mg b.i.d. orally for 7 days (CLCE group). Patients were monitored with clinical, radiological, and laboratory controls at 3 and 21 days. There were no significant differences between the two groups with regard to demographic, clinical, physical and laboratory data. RESULTS: The mean time to defervescence was 2.4+/-1.4 and 2.4+/-1.5 days, respectively. Chest roentgenogram clearance was complete in all cases, without statistically significant differences in the time to resolution between both arms. Side effects were mild (no significant differences between groups): 5 patients in the CL group and 3 in the CLCE group showed gastrointestinal symptoms. Two patients (2.2%), both in the CLCE group, needed hospital admission during follow-up, but all 90 patients showed an excellent outcome. A causative agent was determined in 25 cases (28%). Legionella pneumophila, Streptococcus pneumoniae, and Mycoplasma pneumoniae were the most frequent pathogens. CONCLUSION: Empirical treatment of outpatient CAP with clarithromycin can be considered adequate in the Mediterranean area, independently of the microbiological etiology. ATS criteria for admitting patients with CAP are appropriate in this population.

Adult↗
PubMed1975

Tele-Autotomogram and Application of the Pneumoencephalographic Chair in Stereotactic Operations.

In order to obtain clearly demonstrated reference points in a preliminary air study for target calculations in stereotactic brain operations, a tele-autotomogram taken with the rotating pneumoencephalographic chair has been used with excellent results. By means of multiaxial rotations of the chair, tele-roentgenograms, including an autotomogram with a constant small magnification, can be obtained easily at any position of the patient with one floor X-ray tube. The same chair, modified to support the stereotactic base ring, can serve as an excellent stereotactic operating table with good maneuverability, offering wide adjustment of the patient's position suitable for various operative approaches. Simultaneously, it produces identical tele-roentgenograms with the same magnification as in the preliminary study, which economizes calculation time and avoids possible measurment error during stereotactic operations.

Humans↗
PubMed1980

[Real-time B-scan ultrasonic evaluation of pleural effusion and intrathoracic masses adjacent to the pleura (author's transl)].

106 pleural effusions or pleural opacities suggesting fluid were evaluated in a prospective study by B-mode real-life sonography and radiography. 41 cases were first investigated by means of ultrasound, 65 by the conventional erect roentgenogram. The correct diagnosis of pleural fluid was made by ultrasound in 95.3% and by radiologic examination in 86.8% of the cases. Radiography failed to distinguish between pleural effusion and solid pleural thickening in 7.5%, sonography in 1.9% of the cases. In 8 patients with normal roentgenograms, small epidiaphragmal pleural effusions were detected by means of ultrasound. In diagnosis of pleural effusion, sonography was found to be superior to the conventional radiologic technique both in sensitivity and in diagnosing the consistency. The value of the ultrasonic method both in establishing the quality of intrathoracic masses adjacent to the pleura and in sonographically guided needle puncture is emphasized.

Diagnosis, Differential↗
PubMed1979

Acute lymphatic leukemia with mediastinal involvement.

Mediastinal involvement was found in 11 (group A) of 43 patients affected with acute lymphatic leukemia when early thoracic roentgenograms of these patients were reviewed. Several clinicobiological characteristics of these patients were compared with those with a normal mediastinum as shown in their roentgenograms (group B). Statistically significant differences were observed between group A and group B not only as far as age was concerned (13 years group A, 7.4 years group B) but also in the ratio males/females (10:1 group A, 10:20 group B) and with regard to the leukocyte counts (266 x 10(9)/liter group A, 20 x 10(9)/liter group B). In addition, patients from group A showed a greater 'tumoral mass' and a more prominent extrahematological involvement (45% group A, 15% group B). In these cases 'convoluted' cells were frequently discovered and the blastic cells exhibited significantly lower scores of PAS-positivity and more marked acid phosphatase activity than those in group B. Although the rate of complete remissions (CR) obtained in both groups was similar (80% group A, 93% group B), marked differences were observed not only in the duration of CR but in the period of survival after CR as well, both factors being more prolonged in group B patients. 50% of patients with mediastinal involvement (group A) relapsed in the first 6 months of the evolution of the disease.

Adolescent↗