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PubMed1991

Experience in the surgical treatment of 331 patients with pulmonary hydatidosis.

Echinococcus disease is prevalent in Chile, with a rate of occurrence of 8.2 per 100,000. During a 15-year-period (1970 to 1985) we operated on 331 patients for pulmonary hydatidosis. Chest roentgenography was the main method of diagnosis. Among the total of 508 surgical procedures performed, pulmonary cystectomy was the most common (61.4%), whereas pulmonary resection was used in 31.4% of patients. The arc 5 test was used to confirm the diagnosis. Results were positive in 85% of the patients in whom it was done. There were 12.9% immediate postoperative complications in 12.9%, with late complications occurring in 4.10% and an overall mortality rate of 4.21%. These data suggest that hydatid cyst is still a common disease in our country, causing an important number of hospital admissions and a high percentage of complications.

Echinococcosis, Pulmonary↗
PubMed1991

Diagnostic imaging of osteosarcoma.

The diagnosis, treatment planning, and follow-up evaluation of osteosarcoma rely heavily on a variety of imaging techniques. Plain roentgenography, radionuclide bone scanning, computed tomography, and magnetic resonance imaging play important roles in defining local tumor extent, detecting metastatic disease, and monitoring for recurrent tumor. Invasive studies such as angiography are now rarely necessary. In the future, newer imaging modalities, including positron emission tomography, can be expected to become important tools for evaluation of these tumors.

Angiography↗
PubMedDate not supplied

[X-ray diagnosis of a small quantity of liquid in the pericardial cavity].

X-ray symptomatology of small pericardial effusions was studied on the basis of analysis of clinicoroentgenological and echocardiographic investigation of 173 patients with various chest diseases. Comparison of x-ray and USI results led to a conclusion of the effectiveness of polypositional roentgenography for the detection of small amounts of fluid in the pericardial cavity.

Adult↗
PubMed1991

Evaluation of great heart vessels and pulmonary vasculature.

This year's literature relating to imaging of the great heart vessels was devoted primarily to measurements of aortic size and to comparisons of imaging modalities in evaluating aortic aneurysms, dissections, and coarctation. The imaging modalities compared were plain chest roentgenography, conventional CT, ultrafast CT, MR imaging, transcutaneous esophageal echocardiography, and Doppler echocardiography. The pulmonary vasculature literature dealt with MR imaging of pulmonary vessels and the estimations of pulmonary pressure using echocardiography and Doppler techniques.

Aorta, Thoracic↗
PubMed1991

[A long-term survival case of advanced gastric cancer undergoing radical gastrectomy by second-look operation after successful chemotherapy (CDDP, MMC, 5-FU)].

A 55-year-old woman with gastric cancer underwent laparotomy and was found to have an unresectable tumor characterized by S3 (invasion of the pancreas), N3, P0 and H0. She was then treated by combined administration of cisplatinum, mitomycin C and 5-fluorouracil. A remarkable response (CR) was confirmed by upper gastrointestinal roentgenography and endoscopy. Upon reoperation about 8 weeks after chemotherapy, a successful radical total gastrectomy with R2 (partially R3) lymphnode dissection was performed. Histological examination of the specimens, including the stomach and lymphnodes, revealed no cancer cells in any region (pCR). She had been given UFT and PSK for 4 years 4 months after reoperation. She has lived for 5 years 2 months after reoperation without any signs of recurrence or metastases.

Adenocarcinoma↗
PubMed1991

IgG-kappa type multiple myeloma in alcoholic cirrhosis--a case report.

Transition from polyclonal to monoclonal gammopathy resulted in myeloma in the course of cirrhosis is rare but of interest. We treated such a case of multiple myeloma of IgG-kappa type associated with alcoholic cirrhosis. The case was a 72-year-old Japanese male patient who was admitted because of ascites and edema. Physical examination and laboratory findings including liver histology were compatible with alcoholic cirrhosis. Serum electrophoresis revealed monoclonal hypergammaglobulinemia of IgG-kappa. Bence Jones protein in urine was positive. Bone scintigraphy and roentgenography revealed small punched out lesions in the skull. A bone marrow clot section showed marked infiltration of atypical plasma cells. From these findings multiple myeloma associated with alcoholic cirrhosis was diagnosed. On the basis of a review of the reported cases, the possible relationship between monoclonal gammopathy and chronic liver diseases was discussed.

Aged↗
PubMedDate not supplied

[Conservative treatment of post-traumatic periduodenal hematoma: presentation of a clinical case and review of the literature].

The authors describe a case of post-traumatic hematoma of the duodenum in a two years old child. This is a very rare condition in paediatric age, but with the increasing incidence of traumatic pathology it can be predicted an increase of this condition. The duodenal hematoma can be treated either with surgical approach or with conservative treatment. The authors discuss the characteristics of the pathology, the etiopathogenetic mechanism, and propose the same classification adopted by some french authors. The type of lesion indicates the adequate therapy; in particular in the case report (type 1) a conservative treatment is adopted. The laboratory parametres are significative but none is diagnostic. In the present case the amylasemia is not elevated until two weeks after the trauma. Very important for diagnosis are T.C., roentgenography and echotomography, the last one can be easily used for the control of the resolution of the hematoma. The conservative treatment is based on nasogastric suction and parenteral nutrition; although the role of nonoperative treatment is emphasized, the importance of careful assessment for signs of peritonitis or enlarging tender mass cannot be overlooked.

Accidents, Traffic↗
PubMed1991

Mycoplasma pneumoniae pneumonia: clinical analysis of 45 cases.

Mycoplasma pneumoniae (M. Pneumoniae) is a primarily pathogen of the respiratory tract. The clinical characteristics, laboratory findings, and roentgenographic patterns of 45 patients with serologically proven M. pneumoniae pneumonia admitted to Chang Gung Hospital from 1981 to 1989 have been reviewed. There were 23 males and 22 females. Forty-one (91%) were below 40 years old and 13 patients (29%) were below 5 years old. Fever, cough and chest rales were the most common symptoms and signs. A transient mild elevation of liver enzymes was seen in 33% of the patients, most of whom were below the age of ten (73%). A leukocyte count over 15,000/cu mm was not rare (16%). Roentgenographic features included unilateral infiltration (84%), lower lobe predominance (60%), and either confluent (56%) or patchy (33%) consolidation. Pleural effusion occurred in 24% of the patients. Complete resolution of chest roentgenography took from 8 to 42 days with a mean of 20 days. The response of fever to treatment with erythromycin took from 1 to 6 days with a mean of 3 days. There were no life threatening pulmonic or extrapulmonic complications.

Adolescent↗
PubMed1991

Pseudonotch of the atlas vertebra simulating fracture with computed tomographic diagnosis. A case report.

Pseudonotch of the atlas represents a normal variation of the atlas related to a notched protuberance of the medial surface of its lateral masses. A case is presented in which cervical spine roentgenography revealed a prominent pseudonotch that mimicked a fracture of the lateral masses of the atlas. Minimal rotation of C-1 on C-2 was present without apophyseal joint subluxation. Computed tomography imaging provided an accurate diagnosis.

Adult↗
PubMed1991

Additive effects of prostaglandin E2 and pulsed electromagnetic fields on fracture healing.

Bone formation of fractured fibulae stimulated by pulsed electromagnetic fields (PEMF), PGE2, and combination of both was assessed with roentgenography and fluorescent labelling compounds, tetracycline, xylenol orange, and calcein. A total of 72 male New Zealand rabbits was osteotomized by creating a 1 mm-gap at fibulae and randomly divided into 8 groups: one control, one treated with PEMF, three treated with PGE2 of various dosages, and three treated with combined treatments of PEMF and PGE2 of specified dosages. PEMF had positive effects on bone formation. Exogenous PGE2 mimicked the effect of PEMF on linear bone growth. The effect of PGE2 on bone formation or bone remodelling was dose-related (5, 15, 50 micrograms/kg), with 5 micrograms/kg body weight as the optimal dosage in this study. Combination of PEMF and PGE2 exhibited a trend of additive effect on bone formation, especially at 15 micrograms/kg of PGE2. It is hypothesized that PEMF may exert its action on bone healing by increasing the endogenous PGE2. We therefore concluded that external stimulation such as PEMF and PGE2 was beneficial and stimulatory towards bone formation and healing in our animal model. However, the effects were somehow specific in electrical waveforms and dosage. Similar to PEMF, PGE2, therefore, may be a potential agent in promoting bone formation in the clinical treatments of fractures or perhaps non-union.

Animals↗
PubMed1991

Ultrasound can affect bone healing both locally and systemically.

Bone formation of fractured fibulae stimulated by ultrasound was evaluated with roentgenography and fluorochromes labelling. The fibulae of male New Zealand rabbits were fractured to create a 3 mm-gap. A pilot study was performed to determine the treatment interval for fracture healing of the fibula. Ultrasonic treatment at 1.0 W/cm2, 1.5 MHz for 15 min/day significantly accelerated bone formation at the fracture site of the un-treated fibula, but suppressed the bone formation of the directly treated fractured fibula. Subsequent treatments with these specificities showed that ultrasonic treatment on the unoperated fibula also significantly accelerated the bone formation of the contralateral fractured fibula. It was suggested that locally applied ultrasound at the intensity of 1.0 W/cm2 was deleterious to the treated fracture or intact fibula, but simultaneously would stimulate bone formation of the contralateral fibula.

Animals↗
PubMedDate not supplied

Slipped capital femoral epiphysis: comparison of a roentgenographic method and computed tomography in determining slip severity.

Various conventional roentgenographic methods have been proposed to determine the severity of chronic slipped capital femoral epiphysis (SCFE) on the sagittal plane, with some maintaining that computed tomography (CT) is more accurate and reproduces better than roentgenography. We used a modified Dunlap's technique and angular measurement to determine slip severity. Three orthopaedists obtained data from roentgenograms and CT of 20 hips with chronic SCFE. Statistical analysis showed concordance between our method and the measurements and reproducibility produced with CT. The results suggest that our method is as effective as and less expensive than CT.

Adolescent↗
PubMed1991

[Long survival in a case of metastatic brain tumor].

A 45-year-old man was admitted after resection of a metastatic brain tumor (papillary adenomatous adenocarcinoma, well differentiated) for both therapy and a search for the primary and any other metastatic lesions. An extensive general examination revealed no evidence of malignant lesion except for fibrous change in the right lung apex by roentgenography and CT scan. Histological examination of the right upper lobe and group II lymph nodes revealed a scar cancer presenting the same histology but no evidence of metastasis. The patient, who received CAP and FVM alternately, is currently healthy with no recurrence after 4 years.

Adenocarcinoma↗
PubMed1991

Ipsilateral fractures of the femur and tibia in children and adolescents.

We reviewed forty-four consecutive cases of simultaneous fracture of the ipsilateral femur and tibia in forty-two children and adolescents. One patient died from concomitant cerebral injury and one had a fat-embolism syndrome. Thirty patients (thirty-two limbs) had an average follow-up of 5.1 years (range, one to fourteen years). Nineteen patients who had an average follow-up of 6.8 years were available for personal examination and roentgenography. Age was found to be the most important variable as related to clinical course. Of the fifteen patients who were less than ten years old, three had an early complication; the average time to full, unsupported weight-bearing was thirteen weeks; and the average combined femoral and tibial overgrowth was 1.8 centimeters. Of the fifteen children who were more than ten years old, eight had an early complication; the average time to full, unsupported weight-bearing was twenty weeks; and there was variable femoral and tibial growth. The juxta-articular pattern of fracture was associated with the highest incidence of early and late problems. Most of the children who were younger than ten years were treated successfully with closed methods, but limb-length discrepancy developed. The children who were older than ten years were treated successfully with reduction and fixation of the femoral fracture, but had a high rate of complications. There was a high incidence of concomitant injuries to the ligaments of the knee, resulting in long-term dysfunction of the extremity. Of the nineteen patients who had long-term follow-up, only seven had normal function without major problems. The remainder had a compromised result due to limb-length discrepancy, angular deformity, or instability of the knee, particularly ligamentous instability.

Adolescent↗
PubMed1991

Disorders of esophageal motility.

Patients with esophageal motility disorders usually have dysphagia and many also have chest pain similar to angina. The diagnosis is suggested by the clinical presentation, and supporting evidence is often provided by contrast roentgenography. Esophageal manometry is usually necessary to confirm the diagnosis. Conservative therapy using pharmacologic agents is often useful as an initial trial, although many patients who continue to be symptomatic ultimately require surgical intervention.

Esophageal Motility Disorders↗
PubMed1991

Preoperative and postoperative evaluations by means of three-dimensional computed tomography in cases of Chiari osteotomy.

Three-dimensional computed tomography was employed to investigate the changes of pelvic and hip morphology in nine adult cases of congenital hip dysplasia. Six cases were treated with Chiari pelvic osteotomy and were reexamined postoperatively using the same technique. This new method clearly showed a number of important anatomic features that were not easy to detect with conventional roentgenography. Information provided by three-dimensional computed tomography imaging is useful in selecting the appropriate type of surgical treatment and in evaluating the results of Chiari pelvic osteotomy.

Adolescent↗
PubMed1991

Ebstein's anomaly appearing in the neonate. A new surgical approach.

Ebstein's anomaly appearing during the neonatal period carries a high mortality rate. These infants exhibit cyanosis, acidosis, and congestive heart failure. The pathophysiologic characteristics consist of severe tricuspid regurgitation and functional pulmonary atresia. As a result of the inability of the right ventricle to generate forward flow through the pulmonary arteries, these infants remain dependent on ductal patency. Since May 1988, five newborn infants with severe Ebstein's anomaly have been admitted for treatment at our institution. At initial examination, they weighed 3.6 +/- 1.8 kg and had a mean oxygen tension of 29.6 +/- 2.3 mm Hg and a mean pH of 7.20 +/- 0.05. Chest roentgenography demonstrated a mean cardiothoracic ratio of 0.81 +/- 0.02. As determined by echocardiography, the right atria were massively enlarged, severe tricuspid regurgitation was present in all patients, and the pulmonary valves were not opening. All infants were dependent on prostaglandin E1 and attempts to wean them from this drug were unsuccessful. Palliative treatment consisted of tricuspid closure with autologous pericardium and an aortopulmonary shunt of 4 mm polytetrafluoroethylene tubing. There were no operative or late deaths. At discharge, mean oxygen tension was 42.2 +/- 0.85 mm Hg and mean systemic oxygen saturation was 83.2% +/- 1.94%. Infants have grown satisfactorily during the follow-up period. Three infants have since returned for further surgical intervention. One infant, at 11 months of age, underwent a Glenn anastomosis for progressive oxygen desaturation. Two infants have returned, at ages 23 and 22 months, for Fontan procedures, which represent their definitive operative management. We believe this new procedure offers excellent palliative treatment for Ebstein's anomaly in critically ill neonates. Feasibility of later definitive correction is demonstrated by the good results obtained with the Fontan procedure in two infants.

Ebstein Anomaly↗
PubMed1991

[Tracheal agenesis, a rare cause of respiratory insufficiency in newborn infants].

Tracheal agenesis is a rare congenital anomaly which presents immediately after birth an absolute respiratory insufficency. This report describes a new-born infant with a tracheal agenesis Typ II which was combined with an esophageal atresia and distal esophagotracheal fistula. In addition, costal synostosis was found. These malformations can be added to the VATER-association. Resuscitation of our patient (orotracheal and esophageal intubation, emergency coniotomy) was unsuccessful. However, in most cases of tracheal agenesis with esophagotracheal communication primary resuscitation is possible by esophageal intubation and by application of continuous positive pressure ventilation. Diagnosis must be confirmed by immediate contrast roentgenography or endoscopy. The results of surgery are disappointing until now.

Abnormalities, Multiple↗