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Eighteen-year survival of unresected leiomyoblastoma of the stomach with liver and lymph node metastases.

A case of gastric leiomyoblastoma with liver and lymph node metastases occurring in a 31-year-old man, who has been alive with the tumor but without symptoms for more than 18 years after only an exploratory laparotomy without resection, is reported. On laparotomy, the liver metastasis and paragastric and para-aortic lymphadenopathies made it impossible to resect the stomach with the tumor. A diagnosis of malignant leiomyoblastoma was confirmed by incision of the liver and paragastric lymph nodes. Postoperative chemotherapy with mitomycin C and cyclophosphamide was performed for 6 months. As demonstrated by roentgenography, echography and computed tomography, the size of the tumor has remained almost identical for an 18-year period. Histologically, the low mitotic rate of the tumor in this case is considered primarily responsible for the long survival of the patient. A review of the records has revealed that our patient is the longest survivor to have unresectable gastric leiomyoblastoma with liver and lymph nodes metastases.

Adult↗

Surveillance for tuberculosis in Alaska, 1986.

The incidence of tuberculosis in the Native population in Alaska (92.2/100,000) continues to be higher than the U.S. tuberculosis incidence (9.3/100,000). This paper describes tuberculosis surveillance in Alaska and estimates the "predictive value positive" for cases recorded by the surveillance system during 1986. (Predictive value positive refers to the proportion of all people identified who actually have the disease.) Active surveillance components included an itinerant chest clinic and survey chest roentgenography program, epidemiologic case investigations, and skin testing. Passive components included cases reported by health-care providers and the U.S. Immigration and Naturalization Service. Half of all new cases were reported by health-care providers. Only 42% of cases were bacteriologically confirmed (vs 87% nationwide) suggesting that some cases may have been false positives. many cases did not have a contact investigation completed. Recommendations to improve the surveillance system include: 1) following the Centers for Disease Control/American Thoracic Society diagnostic criteria more closely, 2) increasing the number of cases which have contact investigations completed, and 3) targeting surveillance activities towards high risk subgroups such as Southeast Asian immigrants.

Alaska↗

Evaluation of thyroid calcification using computed radiography with image plate.

The value of lateral magnification soft x-ray roentgenography using a Computed Radiography (CR) system was studied. ROC curve analysis revealed that a CR system has virtually the same, or a better ability than a screen-film system for detecting thyroid calcification. According to our criteria the CR system an accuracy rate of 77.1% in malignant/benign diagnosis was obtained.

Calcinosis↗

Chondromyxoid fibroma of the fibula.

A 3 1/2-year-old girl presented with a lytic lesion in the diametaphyseal region of the right fibula. In addition to plain roentgenography, radiological evaluation consisted of bone scintigraphy and computed tomography. The radiological features suggested a benign lesion. Pathological examination revealed a chondromyxoid fibroma.

Bone Neoplasms↗

[Arteriography, lymphography, gammagraphy and computer tomography in the diagnosis of musculoskeletal tumors].

The authors emphasize the importance of early and exact diagnosis of musculoskeletal tumours of the extremities and spine. This aim cannot be achieved by common biochemical, haematological and X-ray examinations. Therefore the authors recommend to use already during the initial examination of the patient a combination of classical roentgenography, arteriography, possibly lymphography, gammagraphy and computed tomography. The authors present a detailed account of experience with the application of the above diagnostic methods in 146 patients. On arteriograms of 37 patients dislocated main arteries were found 16 times, blood lakes 20 times. Lymphography revealed metastatic affection of regional lymph nodes in 21% of all patients, most frequently in bone reticulosarcoma and in synovial sarcoma. All-body gammagraphy helped to make the localization and assessment of size of the tumour more accurate, in two-thirds of the patients it was larger when visualized by this method than on native roentgenograms. In 3 of 14 Ewing sarcomas all-body gammagraphy revealed a polyostotic localization of the tumour. Computed tomography revealed the extent of infiltration and destruction of bone and soft tissues in pelvic and spinal tumours.

Adolescent↗

[Long-term observation of patients with trauma of the lower anterior primary teeth].

Three patients who had had trauma of the lower primary central incisors at the age of 1.5 years or less were observed with regard to the IIIB and/or IVA after eruption of the permanent dentition, and the findings were discussed from the viewpoint of space control. Patient 1 suffered shedding and loss of A perpendicular A following a fall downstairs at the age of 1.5 years. Measurement of the distance between B perpendicular B teeth revealed a tendency toward space closure and decrease until the age of 4 years and 6 months. At the age of 5 years and 11 months, the space was greater than that at the age of 4.5 years. The patient was also found to have brownish, partially parenchymatous defects of the permanent dentition, which were considered to be a sequela. Patient 2 suffered dislocation of A perpendicular A and root exposure at the age of 1 year and 1 month, and received treatment involving restoration and fixation for a 10-day period using a resin splint. Because of a fistula at the apical region of A and a discolored brown with internal resorption revealed by roentgenography, which were observed at the age of 4 years and 10 months, tooth extraction was performed and the course was observed with local space maintenance. When the patient was 6 years and 4 months old, eruption of 1 perpendicular 1 and hypoplasia of the labial surface were recognized. Since it proved possible to preserve A perpendicular A until the patient was 4 years old, the course was observed without any decrease in space until permanent dentition was accomplished. Patient 3 suffered shedding and loss of A perpendicular A at the age of 8 months. When the patient was 1 year and 3 months old, eruption of B perpendicular B occurred with mesial inclination. At the ages of 2 years and 7 months and 6 years and 4 months the patient underwent treatment with a space retainer and eruption of 1 perpendicular 1, respectively, without association of abnormal findings on the labial surface, probably because crown formation of 1 perpendicular 1 had not yet occurred due to the trauma suffered by the patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗

Preparation and evaluation of intragastric buoyant preparations.

The design and preparation of two drug formulations which float in gastric juice are described. One, a buoyant tablet, consisted of powdered soybean protein, drug and sodium bicarbonate. The other, a laminated film-type preparation, consisted of a drug film, an effervescing film containing sodium bicarbonate and outer drug release regulating films. Cinnarizine, an acid-soluble drug, was chosen as model drug, and carboxyvinyl polymer, ethyl cellulose and hydroxypropyl cellulose were used in the preparation of the films. Both formulations showed favorable buoyancy in an in vitro acidic dissolution test medium and also sustained release properties. In an absorption study using beagle dogs, cinnarizine was found in the blood even 24 hr after oral administration of the buoyant tablet or film-type preparation. Similar buoyant tablets containing barium sulfate were administered orally to a healthy volunteer, and it was confirmed by roentgenography that the tablets floated for almost three hours.

Administration, Oral↗

[The possibility of x-ray diagnosis of acute appendicitis in children].

The plain roentgenograms of the abdominal cavity, performed in 87 children at the age of from 7 to 14 years, who were hospitalized for suspected, acute appendicitis, are analysed. The findings of roentgenometry of the stomach were processed statistically. The conclusion of a low diagnostic accuracy of the plain roentgenography was made. It is shown, that in acute appendicitis, the tonicity of the walls of a stomach increases, manifesting by the reduction in its size.

Acute Disease↗

[Evaluation of diagnosis and treatment of various clinico-anatomical forms of lung cancer].

Among 3898 cases of primary lung cancer registered in Leningrad within 1985-1986, central cancer clearly predominated (61.9%). Central/peripheral cancer ratio was 1.6:1. The most common procedure used for treatment of central lung cancer was pneumonectomy (74.6% of cases) and lobectomy--for peripheral cancer management (85.7%). Significant differences in approach to diagnosis and surgical treatment of these pathologies were established. It seems unfeasible to increase resectability of central lung carcinoma by extending surgery. Such tumors should be diagnosed at the stage of segment involvement. However, prophylactic photo-roentgenography does not assure early detection of central lung cancer. Organization of lung cancer detection in Leningrad needs to be improved.

Aged↗

[Electroroentgenography in the diagnosis of soft tissue tumors].

Clinical, electroroentgenographic and X-ray studies of soft tissues were carried out in 425 patients with malignant (75), benign (246) soft tissue tumors and in cases of such soft tissue pathologies of the extremities and body (104) as bursitis, hematoma, cyst and ganglia which may clinically simulate tumors. The paper discusses the technicalities of electroroentgenography which produces on one roentgenogram separate images of all components of soft tissues and bones in a given segment. A comparison of image quality assured by electroroentgeno- and roentgenography did not establish any significant difference in soft tissue tumor semiotics. Electroroentgenography of soft tissues is relatively less sophisticated, time-consuming and cheaper; it does not require special medical facilities for examining patients bearing soft tissue tumor or suspect lesions.

Diagnosis, Differential↗

[Configuration of the cervical part of the spinal column in various age periods].

In order to estimate pathological deformities of the spinal column, it is necessary to know its normal configuration during various age periods. For this 240 men and women in age groups from 15 up to 60 years and older, having not any complaints, have been investigated. Each patient is subjected to a standard x-ray examination of the cervical part of the spinal column in 2 projections with a subsequent roentgenography In the roentgenograms (lateral projection) angles between ventral bodies CII and CVII are measured, as well as angles in every segment. Indices of the cervical lordosis for every age group in men and women are estimated. The form of the cervical part of the spinal cord in men and women is not equal and changes in different age periods. During the middle age lordosis decreases both in men and women and again increases in the elderly age.

Adolescent↗

[Investigation on an outbreak of allergic pulmonary alveolitis].

20 allergic alveolitis cases occurred abruptly within 10 days among teachers at a primary school in Shanghai. The cases make up 42.6% (20/47) of total staffs of the school. No patient discovered in pupils (137) though they had enough chance to contact with their teachers suffering the disease. Roentgenography and clinical findings were criteria of diagnosis. The findings of epidemiologic survey showed that the outbreak was caused by a single exposure of same agent, probably associated with sugarcane. The result of examinations in laboratory shows: 1. The content of IgE increased significantly in serum of convalescence patients. 2. Penicillium and Mucor were found as prevailing fungus strains benign isolated from the surface of sugarcane. 3. Did not find ascarid larva in sputum nor eggs in feces. In this paper we inferred reasonably that breathing of dust with fungus may be the cause of the outbreak.

Adult↗

[The greatest horizontal contour-line of the face. Meeting of anthropology and maxillofacial surgery (author's transl)].

The greatest horizontal contour-line of the face is convex, passes through the malar bone and the external side of the zygomatic arch, and can be defined as the geometric connection of the facial points most distant from the median plane. The study of this facial line of greatest contour is particularly important in the case of fractures of the malar and zygomatic arch. The roentgenography of this line is done with an x-ray plate held parallel to the Reid line (orbital meatus) and the principal ascending radius passing through the middle of the line which connects the two gonions. This technique leads to extreme accuracy in the reduction of zygomato-malar fractures. The method can be used in the operating room.

Anthropology, Physical↗

[Patients hospitalized with pulmonary tuberculosis presenting Koch's bacillus in direct sputum examination. Clinical, radiologic and bacteriologic characteristics].

To determine the influence of socio-economic, clinical and radiological factors on the detection of a Mycobacterium tuberculosis-positive direct sputum smear, we studied 531 patients hospitalized for pleuropulmonary tuberculosis over a 5 year period. M. tuberculosis positivity of the expectorate smear was found more frequently in clinically detected (43%) than in radiologically detected (26%) tuberculosis (P less than 0.001). On admission, a M. tuberculosis-positive sputum smear was more common in patients under 40 years old (P less than 0.02), blacks (P less than 0.05) and alcoholics (P = 0.001). M. tuberculosis positivity on direct sputum smears was more often associated with general (asthenia, sweating, fever greater than 38 degrees C) and functional respiratory symptoms (cough and sputum production) (P less than 0.003), bilateral diffusion of lung lesions and/or excavation on chest roentgenography (P less than 0.0001). Nevertheless, 21% of the asymptomatic radiologically detected tuberculosis patients had positive direct expectorate smears and should be considered contagious.

Adult↗

[Quality control in computed tomography].

In comparison to the constancy checks in conventional roentgenography, quality control in computed tomography (CT) should be limited to a few simple but essential checks for image quality and radiation burden. These requirements, however, can only be fulfilled in part, because of the complexity of CT systems. Possible parameters are: water and air values, pixel noise/contrast resolution, spatial resolution, artifacts, homogeneity, contrast scale/tube voltage, slice thickness, positioning accuracy, image quality of the topogram, radiation dose and film imaging. With a simple test program, comprising 4 CT-scans and a camera test image that is presently being tested, most of the mentioned quantities can be checked.

Quality Control↗

[Counter-flow gas contrast in the differential diagnosis of formation of the cardiodiaphragmatic angle].

X-ray examination using counter-flow gas contrast study was performed in 30 patients for differential diagnosis of cardiodiaphragmatic angular formations. Approximately 700 ml of gas was administered in to the mediastinum, 1500 ml into the abdominal cavity, followed by x-ray examination (roentgenoscopy, roentgenography and tomography) in 30 min. It made it possible to determine an accurate site of the formation and to make correct diagnosis in 28 cases. This method is highly informative and considerably reduces the diagnostic period, decreasing radiation exposure of a patient.

Diagnosis, Differential↗

Evaluation of allopurinol use in patients with gout.

The use of long-term allopurinol therapy in patients with gout was evaluated. A pharmacy computer printout was used to identify all outpatients for whom allopurinol had been prescribed during a six-month period in 1985 at a large Veterans Administration medical center. Medical records were reviewed to (1) classify patients as either having or not having definite indications for allopurinol treatment, (2) determine whether physicians had ordered roentgenographic and laboratory tests for presence of monosodium urate crystals, uric acid excretion, and renal function, and (3) identify gout-associated risk factors and disease entities that could cause hyperuricemia. A pharmacy record of all allopurinol and probenecid prescriptions for the six-month period was obtained, along with cost data. Of the 286 patients who received allopurinol, 32 received the drug for an indication that could not definitely be established as gout. Of the 254 remaining patients, only 45 (17.7%) had a definite indication for allopurinol use as defined by the pharmacy and therapeutics committee. Although pretreatment measurement of serum creatinine was common, only a few patients underwent joint aspiration, a 24-hour urine collection, or roentgenography of affected joints. Large proportions of the patients were found to have gout-associated risk factors. If the 209 patients without definite indications for allopurinol therapy had been treated with probenecid instead of allopurinol, the annual cost savings would have been about $3700. Most of the patients receiving allopurinol for gout could reasonably have been treated with a uricosuric agent such as probenecid at a lower cost. Generally, physicians did not use diagnostic tests optimally before prescribing allopurinol and did not attempt to modify risk factors for gout.

Allopurinol↗

Incidence and frequency or complications and management of Meckel's diverticulum.

During the last 27 years, 84 patients with Meckel's diverticulum (MD) have undergone resection at our institution (incidental findings, n = 50; MD with complications, n = 34). The most frequent complications of MD were obstruction and diverticulitis. Analysis of records of patients revealed that MD is a rare intraoperative finding. The calculated incidence was 2.4 per cent, and the ratio of diverticulectomy to appendectomy was 1:55. A preoperative diagnosis of MD was rare (4 per cent). Only in those patients with hemorrhage were diagnostic procedures (angiography, scintigraphy and roentgenography) useful. Ectopic tissues occurred in 23 per cent of all patients and were observed more often in patients with complications of MD. There was a correlation between hemorrhage and gastric heterotopic tissue. Another correlation was found between invagination and pancreatic tissue as well as diverticulitis. Postoperative adhesions causing ileus was the main complication found after resection for MD (8 per cent), whereas no other severe complications were observed (no insufficiency). There was no death as a result of resection. Because of the low rate of postoperative complications and the latent risk of complications arising sometime during life in sporadic episodes, a prophylactic resection is indicated but is often performed too late because the primary endangered group for complications is children who are less than two years of age. Predominantly in those with hemorrhage, the base of the diverticulum should be carefully checked for heterotopic tissue to prevent further complications.

Adolescent↗