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The value of traction during roentgenography of the wrist and metacarpophalangeal joints.

Traction on wrist and metacarpophalangeal joints during radiography produces 'vacuum phenomenon' due to the release of intra-articular gas. The resultant pneumoarthrogram clearly portrays the articular cartilage. Manual traction radiography of the wrist and the metacarpophalangeal joints has the following potential uses. 1. Detection of joint effusion; increased interosseous space during traction without release of intraarticular gas is indicative of joint disease with effusion. 2. Separation of the carpal bones; the traction separates the carpal bones and allows evaluation. 3. Differentiation of arthralgia from arthritis. 4. Evaluation of midcarpal, radiocarpal compartments, and the metacarpophalangeal joints can be performed before the secondary ossification centers are ossified. 5. Evaluation of the integrity of the joint cartilage.

Adolescent↗

Study of the sensitivity and specificity of computerized tomography in the detection of calcified gallstones which appears radiolucent by conventional roentgenography.

Radiolucent gallstones frequently contain significant calcium deposits. Their detection is important in the evaluation of patients for medical gallstone dissolution treatment. The sensitivity and specificity of computerized tomography (CT) in detecting calcium was studied in 20 patients with radiolucent and in 3 with radiopaque gallstones. Although the sensitivity of the CT scan was somewhat higher than that of conventional radiography -- 46% versus 23%, respectively, for a calcium content of at least 4% -- the CT scan was negative in 4 out of 6 patients in whom the percentage of calcium in the gallstones ranged between 10 and 100. The CT scan was specific: there were no false positive results. The results of the CT scan were not related to the amount or type of calcium salt present. The study shows that the presently used CT scan of the gallbladder is not sensitive enough to select gallstone patients for medical dissolution treatment.

Adult↗

A comparison of colonoscopy and roentgenography for detecting polypoid lesions of the colon.

This study compares the effectiveness of the roentgen and colonoscopic examination of the colon for detecting polypoid lesions. We evaluated the findings in 64 patients with suspected or known polypoid lesions who received the same colon cleansing regimen for both examinations, and were studied by examiners of similar expertise. As in other studies, the endoscopist had the advantage of knowing the roentgen findings, and the colonoscopic findings were often taken to indicate whether or not a lesion was present. In about half the patients, however, a second roentgen examination, repeat colonoscopy, or surgical specimen provided additional information for scoring. For example, a filling defect of the same size and location on two roentgen examinations, but not demonstrated at colonoscopy was scored as a false negative colonoscopic finding. The study results indicate that 54% of small polyps less than or equal to 0.9 cm in size were missed on roentgen examination, whereas no proven misses for lesions of this size were shown for colonoscopy. This absence of colonoscopic false-negative findings for small polyps, however, may be partially explained by a relative insensitivity of the roentgen method. For larger lesions greater than or equal to 1.0 cm in size the miss-rate for the two examinations was similar: 15% for roentgen examination and 12% for colonoscopy. We conclude: (1) Colonoscopy is a more sensitive method than roentgen examination for detecting small polyps of the colon, and (2) Performance of the two examinations may be comparable for demonstrating lesions 1.0 cm or larger in size.

Colonic Neoplasms↗

Identification of left ventricular hypertrophy: chest roentgenography, echocardiography, and electrocardiography.

The assessment of cardiac anatomy and function in the hypertensive population is an important aspect of the total evaluation of this patient group. The finding of cardiomegaly requires elucidation of its etiology. The finding of left ventricular hypertrophy on electrocardiogram is a harbinger for potential catastrophe, but other studies have indicated that the electrocardiogram may miss a substantial portion of the left ventricular hypertrophy which can be shown by echocardiogram: a normal electrocardiogram does not mean left ventricular hypertrophy is absent. Subtle changes on the electrocardiogram suggestive of left atrial abnormality must be pursued with echocardiography to eliminate the possibility of changes in left ventricular compliance or left ventricular hypertrophy. The prevention of left ventricular hypertrophy (or regression thereof) should be of major consideration to the clinician as he initiates antihypertensive therapy. The finding of left ventricular hypertrophy at the time of diagnosis tells the physician to implement aggressive and effective antihypertensive therapy. The absence of these findings should never imply, however, that therapy be withheld until indices of early or frank left ventricular hypertrophy are apparent.

Antihypertensive Agents↗