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PubMed2005

[Chest X-ray interpretation on patients admitted in a short-stay unit. Relation with the mean length of stay].

INTRODUCTION: To assess the agreement between physicians of the emergency department and a radiologist in the interpretation of chest roentgenograms in patients admitted to the short-stay unit, and to determine the effect of concordance on the mean length of stay. MATERIAL AND METHOD: The medical records of patients admitted to the short-stay unit over a 4-month period were reviewed. The interpretation of the chest X-ray film made by the physician in charge of the patient at the emergency department with that made by the radiologist was compared. The mean length of stay was determined and it was analyzed if the reading of the radiograph made by the radiologist before admission would decrease the length of stay. RESULTS: A total of 260 medical records were reviewed. The overall degree of agreement was 74.2% but it was greater when the physician at the emergency department was a staff physician or a resident in the final period of training than a resident in the initial period of training (82% vs 66.4%, p < 0.003). There were no statistically significant differences regarding the day hours at which readings were made. A change in the diagnosis and/or treatment of the patient would had occurred in only 9 cases (3.5%). There were no changes in the mean length of stay according to the presence or absence of concordance, although there was a trend towards an increase in the length of stay for those cases in which diagnosis and/or treatment would had been different. CONCLUSIONS: Readings of chest roentgenograms by a radiologist before admission to a short-stay unit does not appear to be justified for all patients, although it may be justified when a staff physician or a resident in the final period of training have doubts regarding interpretation of the radiographic images. A better supervision of residents in the initial period of training may contribute to improve the diagnostic reliability of chest X-ray films.

Aged↗
PubMed1985

Cryptogenic hemoptysis. Clinical features, bronchoscopic findings, and natural history in 67 patients.

We reviewed the clinical outcome of 67 patients with hemoptysis and a normal or nonlocalizing chest roentgenogram and nondiagnostic fiberoptic bronchoscopic examination. During a 38 +/- 22 (SD) month period after bronchoscopy, 57 (85%) patients remained well without evidence of active tuberculosis or overlooked bronchogenic carcinoma, and 9 patients died of nonpulmonary conditions. One patient developed bronchogenic carcinoma 20 months after bronchoscopy and resolution of symptoms. Hemoptysis had resolved completely before hospital discharge in 38 (57%) patients, within 6 months in 60 (90%), and recurred in only 3. Five patients (7.5%) had intermittent episodes of bleeding for more than 1 year. Fiberoptic bronchoscopy effectively excludes specific underlying causes of hemoptysis in the setting of a normal chest roentgenogram. The prognosis for patients with cryptogenic hemoptysis is generally good, usually with resolution of bleeding within 6 months of evaluation.

Adult↗
PubMed1988

Nonspecific interstitial pneumonitis without evidence of Pneumocystis carinii in asymptomatic patients infected with human immunodeficiency virus (HIV).

STUDY OBJECTIVE: To assess how often Pneumocystis carinii organisms, P. carinii pneumonia, or other pulmonary pathologic processes were present in persons infected with human immunodeficiency virus (HIV) without pulmonary symptoms or previous history of P. carinii, and with a normal chest roentgenogram. DESIGN: Serial, prospective assessment of eligible HIV-seropositive patients over 21 months. PATIENTS: Twenty-four HIV-seropositive patients with either a nonpulmonary manifestation of the acquired immunodeficiency syndrome (AIDS) (n = 12) or an absolute CD4 lymphocyte count of 0.200 X 10(9) cells/L or less (n = 12), no pulmonary symptoms, a normal chest roentgenogram, no history of P. carinii pneumonia, and no history of treatment with antipneumocystis prophylaxis. INTERVENTIONS: Pulmonary assessment with arterial blood gases, pulmonary function tests, gallium-67 citrate scans, and bronchoscopy with bronchoalveolar lavage and transbronchial biopsies. MEASUREMENTS AND MAIN RESULTS: Mean alveolar-arterial gradient was 11.1 mm Hg +/- 8.5 and mean diffusion capacity was 73.0% +/- 20.0% of predicted. None of the 24 patients showed P. carinii or other pathogens on stains of bronchoalveolar lavage fluid. No patient had histologic evidence of P. carinii pneumonia. Transbronchial biopsy specimens showed chronic, nonspecific interstitial pneumonitis (11 of 23) and no pathologic abnormality (12 of 23). Six patients have developed P. carinii pneumonia during 2 to 18 months of follow-up. CONCLUSIONS: HIV-infected patients without pulmonary symptoms did not have detectable Pneumocystis organisms in bronchoalveolar lavage fluid or transbronchial biopsy specimens; but 11 of 23 had evidence of chronic, nonspecific interstitial pneumonitis. Pneumocystis organisms in a pulmonary specimen from a symptomatic patient probably indicate the cause of the pulmonary dysfunction even if only a few are detected.

Adult↗
PubMed1988

Bronchoalveolar lymphocytosis in patients with tropical spastic paraparesis associated with human T-cell lymphotropic virus type 1 (HTLV-1). Clinical, immunologic, and cytologic studies.

STUDY OBJECTIVE: To determine the features of pulmonary involvement in patients with tropical spastic paraparesis associated with human T-cell lymphotropic virus type 1. DESIGN: Nonrandomized prospective case series. SETTING: Tertiary care units in two university medical centers. PATIENTS: Consecutive sample of 21 patients with tropical spastic paraparesis associated with human T-cell lymphotropic virus type 1 infection. INTERVENTIONS: Chest roentgenogram and bronchoalveolar lavage were done in all patients. Fifteen patients had pulmonary function tests. Alveolar T-lymphocyte subsets were analysed in 10 patients and thoracic computed tomographic scans were done in 10 patients. MEASUREMENTS AND MAIN RESULTS: All patients were free of clinical pulmonary symptoms and had normal chest roentgenograms. Thoracic computed tomographic scans were normal in 9 of 10 patients and showed mild interstitial pneumonitis in 1. Pulmonary function tests were within the normal range in 13 patients and showed a mild restrictive syndrome in 2. Eighteen patients had increased absolute numbers of alveolar lymphocytes (mean, 77 +/- 39 X 10(3) lymphocytes/mL; range, 13.5 X 10(3) to 259 X 10(3) lymphocytes/mL). Sixteen patients had percentages of alveolar lymphocytes higher than 20% of all alveolar cells (mean, 33.5 +/- 12.7; range, 9 to 69). In all 10 patients tested, 64.2% +/- 13.2% of alveolar lymphocytes were CD8+ cells. CONCLUSIONS: Excessive absolute numbers and percentages of alveolar lymphocytes were observed in 18 and 16 patients, respectively. Most alveolar lymphocytes were CD8+ cells.

Adult↗
PubMed1989

Screening for lung cancer.

Lung cancer is the commonest cause of death from cancer in both men and women, with approximately 152,000 new cases and 139,000 deaths in 1988. The incidence and mortality rates are increasing rapidly in women. Two main tests have been used to screen for lung cancer: chest roentgenography and sputum cytology. Four recent controlled trials and one case-control study failed, however, to show that screening reduces lung cancer mortality even in high-risk persons (smokers). In the Mayo Lung Project, for example, the lung cancer death rate in high-risk men offered sputum cytology and chest roentgenogram every 4 months was 3.1 per 1000 person-years, compared with 3.0 per 1000 person-years in a control group. Chest roentgenograms and sputum cytology lead to false-positive test results in smokers of approximately 5% and 0.5%, respectively. Because of the lack of evidence of benefit and because of its potential harms and costs, screening for lung cancer is not recommended.

Costs and Cost Analysis↗
PubMed1990

Clinical prediction rule for pulmonary infiltrates.

OBJECTIVE: To derive and validate a clinical rule for predicting pneumonic infiltrates in adult patients with acute respiratory illness. DESIGN: Prevalence studies in three settings. SETTING: Emergency departments of the University of Illinois Hospital at Chicago, the University of Nebraska Medical Center at Omaha, and the Medical College of Virginia at Richmond. PATIENTS: Symptoms, signs, comorbidity data, and chest roentgenogram results were recorded for 1134 patients from Illinois (the derivation set), 150 patients from Nebraska, and 152 patients from Virginia (the validation sets). All patients presented to the emergency department and had a chest roentgenogram to evaluate fever or respiratory complaints. MEASUREMENTS AND MAIN RESULTS: Within the training set, temperature greater than 37.8 degrees C, pulse greater than 100 beats/min, rales, decreased breath sounds, and the absence of asthma were identified as significant predictors of radiographically proved pneumonia in a stepwise logistic regression model (P = 0.001). The logistic rule discriminated patients with and without pneumonia in the training set with a receiver operating characteristic (ROC) area of 0.82. In the validation sets, the rule discriminated pneumonia and nonpneumonia with ROC areas of 0.82 and 0.76 after adjusting for differences in disease prevalence (P greater than 0.2 compared with the training set). The predicted probability of having pneumonia for patients with different clinical findings corresponded closely with the incidence of pneumonia among patients with such findings in the three settings. CONCLUSIONS: Among adults presenting with acute respiratory illness, a prediction rule based on clinical findings accurately discriminated patients with and without radiographic pneumonia, and was used in two other samples of patients without significant decrement in discriminatory ability. This rule can be used by physicians to develop more effective strategies for detecting pneumonia and for helping to determine the need for radiologic study among patients with acute respiratory disease.

Acute Disease↗
PubMed1991

Acute reversible hypoxemia in systemic lupus erythematosus.

OBJECTIVE: To determine the frequency of unexplained reversible hypoxemia in patients with systemic lupus erythematosus and to assess the relation between hypoxemia and elevated plasma levels of complement split products. DESIGN: Cohort study. SETTING: Inpatient and outpatient facilities of the New York University Medical Center/Bellevue Hospital and the Hospital for Joint Diseases. PATIENTS: Case patients were 22 patients hospitalized with disease exacerbation and no evidence of parenchymal lung disease on chest roentgenogram. Four patients with stable disease were followed in the outpatient clinic, and five healthy normal volunteers served as controls. MEASUREMENTS: Plasma levels of complement split products (C3a, factor Bb fragment), alveolar-arterial (A-a) Po2 gradients, and pulmonary function were measured. MAIN RESULTS: Nine episodes of hypoxemia or hypocapnia (mean A-a gradient, 30.4 +/- 4.8 mm Hg) or both (despite normal chest roentgenogram results) were noted in six hospitalized patients (group 1). Gas exchange improved within 72 hours of steroid therapy (mean A-a gradient, 11.6 +/- 4.3 mm Hg; P less than 0.01). These patients had an elevated initial mean C3a level (938.4 +/- 246.8 ng/mL) that decreased within 72 hours (407.8 +/- 80.9 ng/mL; P less than 0.01), concomitant with improved oxygenation. Ventilation-perfusion scans, obtained for four of six group 1 patients, excluded pulmonary emboli. Four hospitalized patients (group 2) had a normal A-a gradient (mean, 7.5 +/- 2.7 mm Hg). The mean C3a level of this group (358.3 +/- 39.2 ng/mL) was lower than that of group 1 (P less than 0.05). Four patients with stable disease (group 3) had a mean A-a gradient and a mean C3a level of 3.3 +/- 2.7 mm Hg and 237.8 +/- 105.7 ng/mL, respectively, similar to values found in five normal volunteers, in whom the mean A-a gradient was 3.7 +/- 1.7 mm Hg and the mean C3a level was 124.8 +/- 9.2 ng/mL. CONCLUSION: A syndrome of reversible hypoxemia, unassociated with parenchymal lung disease, is unexpectedly common in acutely ill, hospitalized patients with systemic lupus erythematosus. The pathogenesis of this syndrome is unclear, although the data are compatible with the hypothesis that hypoxemia may be related to pulmonary leukoaggregation.

Acute Disease↗
PubMed1994

Preferences of community physicians for cancer screening guidelines.

OBJECTIVE: To assess factors related to consensus among community physicians regarding appropriate screening intervals for eight cancer screening procedures for which guidelines have been published. DESIGN: Interviews were conducted with a national random sample of 3436 physicians in family practice, internal medicine, general surgery, and gynecology by mail or telephone or both. The overall response rate was 67%. MEASUREMENTS: Consensus by specialization and by physician and practice characteristics on the appropriate screening intervals for early detection of cancers of the breast, cervix, colon and rectum, and lung for asymptomatic adults at normal risk. RESULTS: More than 60% of the physicians surveyed agreed on the length of the screening intervals for six of eight procedures. Consensus most closely followed American Cancer Society- and National Cancer Institute-recommended screening intervals for all procedures except chest roentgenogram. Acceptance of screening intervals was not related to the extent of agreement among published guidelines. Surgeons tended to favor more aggressive screening than family physicians and internists; gynecologists most consistently favored aggressive screening for cancers occurring in women. Older physicians and those in solo practice tended to favor outmoded procedures such as routine chest roentgenograms and to be more conservative about screening intervals. CONCLUSIONS: Physicians stated that they follow the American Cancer Society and National Cancer Institute guidelines for cancer screening more than the guidelines published by their own specialty societies, but they also reported procedures not recommended in any guidelines. These findings suggest that changing physician screening practices will be difficult.

American Cancer Society↗
PubMed1981

The evolution of pulmonary cryptococcosis: clinical implications from a study of 41 patients with and without compromising host factors.

Over 14 years 41 patients were diagnosed as having pulmonary cryptococcosis. Cryptococcus neoformans remained localized to the lung in 12 cases and disseminated in the remaining 29. Thirty-four patients were compromised hosts. Disseminated disease developed in 28 of these 34, and four of these 28 patients with disseminated disease presented with concomitant pulmonary and meningeal infections. In all the remaining 24 central nervous system involvement developed 2 to 20 weeks after the finding of an abnormal chest roentgenogram. Seven patients were normal hosts, and in six of these cases disease remained localized to the lung. Four important conclusions were drawn from this study: pulmonary cryptococcosis is rarely considered in the differential diagnosis of an abnormal chest roentgenogram, thereby leading to missed diagnoses and therapeutic errors; the natural history of untreated pulmonary cryptococcosis in compromised hosts is extrapulmonic dissemination; compromised hosts with pulmonary cryptococcosis should receive antifungal therapy because of a high propensity for dissemination; and normal hosts in whom dissemination has been excluded generally do not need antifungal therapy.

Adolescent↗
PubMed1976

Roentgenographic evaluation of vertebral rotation.

To examine the accuracy of vertebral rotation determinations made from roentgenographic pedicle-shadow offset measurements, roentgenograms were made of fifteen cadaver vertebrae with different sagittal and frontal inclinations and longitudinal axis rotations ranging from 15 degrees left to 45 degrees right. It was found that significant uncertainties arise when vertebral rotation is evaluated from measurements of pedicle-shadow offset: true and apparent offsets in a single vertebra differ markedly; vertebrae from different spines have different offsets for the same degree of rotation and the same inclinations; and changes in the sagittal and frontal inclinations of a single vertebra alter its offset in the same manner as changes in rotation. From these results, it seems unlikely that precise measurements of rotation changes in spines with mild or moderate scolioses, for example, can be made from anteroposterior roentgenograms.

Biomechanical Phenomena↗
PubMed1978

Heterotopic ossification around the hip in spinal cord-injured patients. A long-term follow-up study.

Twenty patients with spinal cord injury complicated by ossification around the hip were followed for eighteen months or more. The bone scan, roentgenogram, level of alkaline phosphatase, and range of hip motion of each patient were analyzed. The average follow-up was forty months. The heterotopic ossification usually did not mature until after one and one-half years. The roentgenograms were of no value in judging its maturity. The bone scan correlated well with the results of the alkaline phosphatase testing in judging maturity of the ossification. We concluded that before operative resection, a patient should have a normal level of alkaline phosphatase, decreasing activity on the bone scans, and a restriction of motion to less than 50 degrees of hip flexion.

Adolescent↗
PubMed1998

Gait analysis before or after varus osteotomy of the femur for hip osteoarthritis.

SUMMARY OF BACKGROUND: Intertrochanteric varus osteotomy of the femur for hip osteoarthritis is expected to bring improved congruity and increased weight-bearing surface area of the hip joint. Before surgery, we usually make a tracing on a paper using an anteroposterior roentgenogram of the hip to simulate the operating procedures and obtain better conditions in the hip. Nevertheless, there have been some cases in which this procedure does not provide satisfactory postoperative results in terms of relief of pain or locomotion, with long-term limp due to weakness of the hip abductor muscle group and shortening of the leg. OBJECTIVES: To confirm if the improved congruity and increased covering of the weight-bearing surface area obtained by varus osteotomy can be actually reproduced during walking, and to evaluate the kinetic mechanism of the effects of this procedure using gait analysis. METHODS: We measured the strength ratio of the hip abductor muscles as the percent of the opposite side, and analyzed the pelvic movement and data of dynamic electromyography (EMG) recorded during locomotion in 24 female patients who underwent unilateral intertrochanteric varus osteotomy of the femur for hip osteoarthritis, 30 non-surgically-treated female patients with hip osteoarthritis, and 54 healthy women. In the operated patients, the roentgenograms obtained during one-legged stance on the affected side disclosed that 10 were positive for Trendelenburg's phenomenon (T(+) group) and 14 were negative for Trendelenburg's phenomenon (T(-) group). All subjects walked with bare feet at a comfortable pace on a walkway containing a force plate. Photo switches were placed in a walkway to measure the gait velocity and to determine the stance phase time of one gait cycle. Frontal and sagittal trajectories of body surface markers for computerized joint-angle motion analysis were acquired using the Quick-MAG system. EMG data for the gluteus maximus, gluteus medius, tensor fascia latae, and lateral hamstrings recorded using surface electrodes were integrated to quantify as the percent of maximum voluntary contraction (% MVC). RESULTS: This study disclosed that the stance phase time was shorter and the strength ratio of the hip abductor muscles was lower in the operated patients than those in the other 2 groups, and the change of the pelvic obliquity was smaller and the % MVC of the gluteus medius and tensor fascia latae were greater than those in the normal subjects. The change of the pelvic tilt showed the same pattern with those of the pelvic obliquity. The T(+) group showed decreased strength ratio of the hip abductor muscles and increased % MVC for the gluteus medius and the tensor fascia latae compared to the T(-) group, but the changes of both the pelvic obliquity and pelvic tilt did not significantly differ in the 2 groups. CONCLUSION: This study showed the postoperative reappearance of the simulated conditions in the hip before varus osteotomy of the femur, providing evidence that the pelvis was horizontally maintained during walking due to decreased stance phase time and increased performance of the hip abductor muscles after this procedure.

Adult↗
PubMed1976

[Clinical and x-ray studies on the relationship between interruption of pregnancy and premature labor].

On the basis of the number of premature babies of 1975 the possible interdependence is checked between interruptio of pregnancy and subsequent premature birth and is compared with the dates obtained in 1974. Besides the hysterograms of women with premature birth whose anamnesis indicates an interruptio of pregnancy, are examined with regard to lesions of the cervix demonstrable in roentgenograms. As in the years of 1974 and 1975 the number of premature birth has been approximatively constant we conclude, basing ourselves on the investigations of roentgenograms, that no causal relation may be established between interruptio of pregnancy and premature birth in our material.

Abortion, Induced↗
PubMed1999

[Pulmonary nocardiosis associated with Cushing's syndrome].

A 54-year-old man was admitted for further investigation of multiple nodules disclosed by a chest roentgenogram. Adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome was diagnosed because serum ACTH and serum cortisol levels were elevated with a loss of diurnal rhythm. Because several extensive examinations, including inferior petrosal sinus sampling, did not detest ACTH-producing tumors, the patient was also given a diagnosis of occult ectopic ACTH syndrome. The nodules disclosed on chest roentgenograms increased gradually in size and number, and some were cavitary. Bronchial secretion samples obtained by fiberoptic bronchoscopy contained numerous Nocardia asteroides bacteria. After treatment with sulfamethoxazole-trimethoprim, the nodules gradually disappeared, leaving only scars. Although mitotane had been continuously administered to inhibit the synthesis of intrinsic corticosteroids, pulmonary nocardiosis relapsed in the patient following the termination of sulfamethoxazole-trimethoprim therapy.

ACTH Syndrome, Ectopic↗
PubMed1999

[Intrapulmonary lymph node detected as a small coin lesion: a case report and a review of the Japanese literature].

Intrapulmonary lymph node (IPLN) is commonly identified to the level of fourth-order bronchi and is seldom recognized on a plain chest roentgenogram. We experienced a case of intrapulmonary lymph node, and presented a review of the Japanese literature. A 52-year-old female without a smoking history was discovered to have a coin lesion in a mass screening chest roentgenogram. A Chest CT scan showed a small peripheral nodule in segment 9 of the left lung. Malignancy could not be ruled out and an exploratory thoracotomy was performed, and the definite diagnosis was IPLN. We have encountered more frequent detection of small peripheral pulmonary nodules because of increasing availability of chest CT scans. Although reports of IPLN are rare, it should be considered as one of differential diagnoses for benign or malignant pulmonary nodules.

Female↗
PubMed1999

Use of the Heimlich valve for treating pneumothorax.

BACKGROUND AND AIMS: The aim of this retrospective study was to compare the use of a small caliber tube connected to Heimlich flutter valve with a conventional thoracic drainage system in the treatment of pneumothorax. MATERIALS AND METHODS: Patients with simple pneumothorax during the years 1991-1995 in Satakunta Central Hospital were included in this study. Nineteen patients were treated with the Heimlich flutter valve and 57 patients were treated with the standard drainage tube connected to an underwater seal device. The data were collected from hospital records focusing on the duration of chest drainage, the number of chest roentgenograms and the length of hospital stay. RESULTS: In the Heimlich valve group the mean drainage time was 2,2+/-0.9 days and in the standard thoracic drainage group 3.4+/-3.8 days (p <0.05) respectively. The mean length of hospitalization in the Heimlich valve group was 3.3+/-2.2 days and in the standard thoracic drainage group 5+/-4.9 days (p < 0.01). The number of chest roentgenograms in the Heimlich valve group was 3+/-1.1 and in the standard thoracic drainage group 4.6+/-2.7 (p < 0.001). CONCLUSION: We believe that the treatment with a small caliber tube and Heimlich valve is a safe and effective procedure. It also reduces the duration of chest drainage and the length of hospital stay.

Adult↗
PubMed1976

[Method of x-ray osteophotometry of the lumbar region of the spinal column].

The content of mineral salts in all diseases of the skeleton has greater or less deviations from the norm. The change of the mineral content can be visually determined in routine roentgenograms when the deviation is not less than 20-30% from normal. This estimation has a great share of subjectivism. The optical density of the bone in roentgenogram objectively shows the content of calcium salts and its structure. Under study was the influence of soft tissues surrounding the lumbar part of the vertebral column upon the optical density index. Ten preparations of lumbar divisions by means of the aluminium wedge.

Absorptiometry, Photon↗
PubMed1999

[Constitutional features of cardiovascular shadow characteristics].

The front straight projection roentgenograms of the chest of 1210 healthy persons of age 17-22 and 212 roentgenograms of the chest in left side projection were studied. Their somatic type was defined beforehand on the different variation levels. It was determined, that the position and size of the cardiovascular shadow depend on the somatic type on the gabarital, componental and proportional variation levels. The cardial position and roentgeno-cardiometrical indexes' values of the both sex persons of different somatic types are described.

Adolescent↗