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PubMed1987

Advanced diagnostic imaging techniques in ophthalmology.

Diagnostic imaging techniques continue to gain tremendous importance in the evaluation of ocular and orbital disease as technical developments and refinements are made. This article presents key diagnostic imaging methods, with special focus directed toward the advanced modalities important in evaluation of the traumatized eye and orbit. The text has been prepared specifically for the clinical ophthalmologist. Each of the diagnostic modalities discussed is presented in terms of its basic biophysical mechanism, indications, and advantages and disadvantages. The techniques described include simple plain film roentgenography (and its contrast-related applications: dacryocystography, orbital venography, and angiography), axial hypocycloidal tomography, computed tomography, ultrasonography, and magnetic resonance imaging.

Diagnostic Imaging↗
PubMed1977

[Radioindication of bone graft healing].

To control the state of transplanted bone in different terms following the plastic procedure a radioisotope study by strontium-85 was performed in 29 patients. The results of scannography (in 31 cases) and radiometry (in 42 cases) were analysed. The determination of the character of strontium-85 distribution and the intensity of its accumulation in the operated extremity makes it possible to assess the graft condition and the intensity of osteogenesis a greater precision and earlier than does roentgenography. Radioisotope investigation conducted dynamically enable the prognostication of the course of the graft healing process.

Bone Neoplasms↗
PubMed1988

[Potentialities of an x-ray method of determining malignant changes in polyps of the large intestine].

The study was concerned with evaluation of the clinical and roentgenologic data on 57 cases of malignant polyps of the colon. Malignant polyps reaching 10 mm in length were found. Malignancies were identified using endoscopy and biopsy in 58.6% and X-ray examination--45.8%. Among the most effective methods of X-ray examination of the large bowel for cancer should be: high-voltage roentgenography employing incomplete barium enema, primary double contrast examination, direct blow-up and parietography. X-ray signs of malignant transformation of polyps are: persistent retention of barium, wavy and indistinct contours, irregular pattern, rapid growth of neoplasm, retraction of tumor base and disparity between polyp size and its pedicle length.

Colonic Polyps↗
PubMedDate not supplied

[Technical equipment for oral radiography].

Listed problems of dental roentgenography and technical characteristics of dental roentgenological equipment used in the Soviet stomatology demonstrate a lot of disadvantages. The principles of apparatus design need the improvements, indicated in the paper.

Equipment Design↗
PubMedDate not supplied

[Intramural bronchogenic esophageal cyst: an uncommon event in esophageal surgery].

Intramural bronchogenic cysts of the esophagus are uncommon. These benign esophageal tumors result from a wrong cleavage of the primitive gut in the 4 weeks old embryo. Symptoms are often absent or atypical. By roentgenography and esophagoscopy, the diagnosis of benign tumor can be made. Even CT-scan can't give absolute certainty about the exact nature of the lesion. An exploratory thoracotomy, with enucleation of the tumor, is needed in all cases for definite diagnosis and treatment. The cysts are lined by columnar ciliated epithelium of the respiratory type. The presence of hyaline cartilage within the wall of the cyst allows to make the difference for sure between an esophageal cyst of bronchogenic origin and a cyst of enterogenous origin.

Bronchogenic Cyst↗
PubMed1988

Bronchoalveolar mastocytosis in farmer's lung is related to the disease activity.

Patients (n = 10) at the acute phase of farmer's lung were investigated with chest roentgenography, lung function tests, and bronchoalveolar lavage (BAL) fluid analysis (n = 9). They had diffuse interstitial lung infiltrates and a reduction of the diffusion capacity. The dominating recovered cell types during BAL were lymphocytes; and in two patients, granulocytes. A prominent increase in mast cell numbers was seen in all patients. After avoidance of contact with moldy plant material for four to ten weeks (n = 7), lung function started to improve; and the BAL cell counts, to decrease. At clinical remission six to 14 months later (n = 7), the chest roentgenogram was normal and the diffusion capacity was slightly subnormal. The BAL numbers of mast cells and lymphocytes had further decreased but still remained increased compared with those in the healthy controls. Parallel to the normalization of the lung function and the recovery of BAL fluid cells, the increased BAL fluid concentrations of hyaluronic acid and procollagen III peptide started to decrease. These potential markers of fibroblast activation were significantly related to the mast cell number, but not to the lymphocyte number. The study has demonstrated that pulmonary mastocytosis is a prominent finding in farmer's lung and is related to the disease activity. The observed relationship between pulmonary mastocytosis and biochemical signs of lung fibroblast activation is further evidence to support the hypothesis of a mast cell interaction with lung connective tissue.

Adult↗
PubMed1987

Heavy alcohol drinking and related symptoms in a population study of urban men.

An age-stratified random sample of 228 men was selected from the urban districts of Solna and Sundbyberg in Stockholm. Two hundred of these men (90%) underwent a health survey comprising a general medical examination, taking of a medical and social history, blood and urine tests, roentgenography of the heart and lungs, ECG, electroneurography and computed tomography of the brain. The purpose of the present study was to determine alcohol consumption levels and their correlation with symptoms of heavy drinking and with age. The subjects were collected according to a rectangular age distribution, with age ranges of 20-29, 30-39, 40-49, 50-59 and 60-65 years. Quartiles were used in order to obtain homogeneous strata and to group the sample concerning alcohol consumption. Two measures of alcohol consumption were used--the amount of alcohol consumed in the previous week in g of absolute alcohol per day, and the typical peak consumption in the last six months. Three symptoms related to heavy drinking were studied: (1) inability to cut down or stop drinking, referred to here as subjective, relative loss of control over drinking; (2) morning shakes and malaise relieved by drinking, termed morning drinks; (3) amnesia induced by alcohol, referred to as blackouts. Ten per cent of the men had all three alcohol symptoms and 52% had no alcohol symptoms at all. Twenty-nine per cent had lost control over the amount they drank. Blackouts were noted for 33% and morning drinks for 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Scintigraphic and x-ray bronchologic evaluation of the spread of bronchogenic cancer].

The potentialities of perfusion and positive pulmonary scintigraphy for the determination of spreading of bronchogenic cancer were studied in 83 patients and in terms of the assessment of effectiveness of radiation therapy in 28 patients. The results obtained by means of radionuclide methods were compared with those of roentgenography, tomography and bronchofibroscopy. Disorder of perfusion in the lung was shown to depend on primary tumor spreading as well as on the involvement of some groups of lymph nodes. Changes in the blood flow were greater than a degree of primary tumor spreading. It was shown that perfusion pulmonary scintigraphy could be used to predict a volume of radiation therapy. Scintigraphy of the chest with 67Ga-citrate permitted the determination of tumor sizes which was important for central cancer. At the same time potentialities for the detection of lymph node involvement were limited resulting from difficulties in differentiation of the affected lymph nodes from a primary tumor.

Adenocarcinoma↗
PubMed1987

Role of surgical treatment in the management of complications of the gastrointestinal tract in patients with leukemia.

The clinical course of patients with leukemia, specifically after treatment, is complicated by opportunistic infections, often derived from the gastrointestinal tract. Four hundred and thirty-eight patients with leukemia were treated at the Arizona Health Sciences Center from 1976 to 1985. Fifty-five (13 per cent) had 60 major gastrointestinal complications develop. Thirty-seven were treated medically with a mortality rate of 51 per cent, while 18 who were treated surgically had a 17 per cent mortality rate. These infections usually occur during induction or consolidation chemotherapy. Positive blood cultures and white blood cell counts of less than 2,500 per millimeter are a frequent occurrence. The most common complications of the gastrointestinal tract are enterocolitis, perirectal sepsis and bleeding. Because of the combined defects in phagocytosis (neutropenia), antibody production and cell mediated immunity, opportunistic infections (such as viral, fungal, parasitic or bacterial) are frequent and often lethal, despite routine antibiotic coverage. A protocol to identify a subset of patients with septic leukemia who may require emergency surgical treatment is vital since death in this group is most commonly from undiagnosed sepsis or progression of hematologic defects. This protocol should include repeated physical examinations, daily roentgenograms of the abdomen, liberal use of endoscopy, contrast roentgenography and computed tomography (CT) or ultrasound. Extensive surgical procedures can be safely carried out in patients with leukemia. The diagnosis of leukemia should not be a deterrent to emergency surgical exploration.

Adolescent↗
PubMed1987

Low risk of vertebral fracture in Mexican American women.

Ethnicity is important in assessing risk for osteoporotic fractures, and should be considered in decision-making about the use of prophylactic treatments. Few data are available, however, on fracture risks among Hispanic patients. To assess the risk of vertebral fracture in Mexican Americans, we determined the prevalence of vertebral fracture among 822 patients, aged 15 to 86 years, who underwent spinal roentgenography in a study of low-back pain. After adjusting for age, use of steroids, drug or alcohol abuse, and recent trauma, the odds ratio for Mexican American women compared with non-Hispanic whites was 0.55 (95% confidence interval, 0.32 to 0.95), indicating a substantially lower risk. These results are concordant with earlier data documenting a reduced risk of hip fracture among Mexican American women. Thus, recommendations for prophylactic treatments for osteoporosis may be different for Mexican Americans than for non-Hispanic whites.

Adult↗
PubMed1979

Agenesis or atrophy of the testis and vas deferens.

In this study the author examines the relationship between agenesis or atrophy of the testis and of the vas deferens. From a prospective study of 237 cases of unilateral and bilateral undescended testis, 12 cases of agenesis of a testis were seen; 9 of the 12 cases were associated with agenesis of the vas deferens and in 3 of these unilateral renal agenesis was also present, not necessarily ipsilaterally. Three other cases of testicular agenesis and four cases of extreme testicular atrophy were seen. In all seven, the vas deferens was present in part or in its entirety and roentgenography disclosed a normal upper urinary tract. Agenesis of the vas deferens was seen only in patients with monorchism. No patient was anorchid. It is concluded that an important link exists between agenesis of the vas deferens and agenesis of the testis.

Abnormalities, Multiple↗
PubMed1986

Noninvasive diagnosis of pulmonary hypertension: a World Health Organization study.

In the detection of pulmonary hypertension, especially that of only moderate extent usually associated with chronic obstructive lung disease, noninvasive methods, applied individually, are usually of insufficient accuracy. Accordingly, the World Health Organization undertook a prospective study in which several noninvasive methods were employed together in order to improve the diagnostic accuracy. The examinations analyzed encompassed chest roentgenography, electrocardiography, vectorcardiography, mechanocardiography, echocardiography, myocardial scintigraphy and ventriculography and pulmonary scintigraphy. From the chest X-ray, the size of the main pulmonary artery, the transpulmonary artery distance and the size of the right descending pulmonary artery were analyzed; correct identification of patients with or without pulmonary hypertension was achieved in only 40%. With respect to the electrocardiogram, the number of false negative and false positive findings renders this method of negligible usefulness. Mechanocardiography proved technically difficult and incurred inconsistencies in interpretation such that this method was only rarely useful in the diagnosis of pulmonary hypertension. The same held true for the use of echocardiography since it is technically difficult to obtain adequate imaging in patients with overinflated lungs and the pulmonic valve can only be visualized in about 50% of the patients. Right ventricular systolic time intervals would be interest but their measurement can only be accomplished in a small number of patients. Myocardial scintigraphy with thallium-201 may render indirect evidence of pulmonary hypertension if the right ventricular wall can be visualized; this is the case in 80% of patients in whom mean pulmonary artery pressure exceeds 30 mm Hg but only in 56% of those with mean pulmonary artery pressures between 21 and 30 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1986

Effects of obtaining a blood culture on subsequent management of young febrile children without an evident focus of infection.

To assess the effects of obtaining a blood culture on the subsequent diagnostic and therapeutic management of young febrile children without an evident focus of bacterial infection, we carried out a randomized controlled clinical trial of this procedure in 146 children 3 to 24 months of age who presented to our emergency department with an unexplained temperature of 39.0 degrees C or higher. Random assignment to either have (67 children) or not have (79) a blood sample taken for culture resulted in groups equivalent in age, sex, weight, socioeconomic status, temperature at enrolment and laboratory test results. No differences were detected in the rates of subsequent hospital admission, outpatient visits, determination of complete blood count or other blood tests, urinalysis or urine culture, chest or other roentgenography, or administration of antibiotics or other medications. Knowledge of the absence of such differences should be helpful in evaluating the relative benefits and costs of blood culture for young febrile children.

Ambulatory Care Facilities↗
PubMed1987

Surgical management of esophageal perforation.

The recognition and management of esophageal perforation remain a problem. Diagnostic and treatment delays are common, and controversy continues regarding approaches to surgical intervention. Overall survival has increased with improved adjunctive modalities; however, morbidity and mortality remain high. A total of 115 consecutive cases of nonmalignant esophageal perforation were reviewed. There were 69 thoracic, 27 cervical, and 19 abdominal perforations. Etiology of the perforations was iatrogenic in 65 patients, traumatic in 28, and spontaneous perforation in 22. Symptoms included pain (71%), fever (51%), dyspnea (24%), and crepitus (22%). Contrast roentgenography was used in 78 patients and demonstrated the perforation in all but two patients. All but 20 patients had operations. In the last decade, the survival rate was 11.4 per cent for patients treated within 24 hours of perforation. Survival significantly improved in the last 10 years because of hyperalimentation, cardiopulmonary monitoring, and better antibiotic coverage. Treatment of choice is primary closure with drainage, regardless of the duration of the perforation. In selected patients who have cervical esophageal perforation, nonoperative management has a role.

Esophageal Diseases↗
PubMed1987

Experience with distal in-situ vein grafts.

Recent reported experience with in-situ vein grafting has been positive and encouraging. At the Queen Elizabeth Hospital in Charlottetown, PEI, since January 1983, 111 in-situ vein grafts have been placed. Fifty-one were to sites distal to the tibioperoneal trunk; 18 were to the ankle and foot and included grafts to the tarsal and plantar arteries. All patients requiring distal grafts complained of rest pain or had tissue necrosis. The early in-hospital and 1-month patency of the 51 distal grafts (93%) was similar to that of 60 femoropopliteal grafts (87%), but the 3-year patency rate of the distal grafts was only 50% compared with 82% for the femoropopliteal grafts. The high late failure rate of the distal grafts was disappointing. It was not related to the level of the distal anastomotic site in the lower leg or foot, to the level of the proximal anastomotic site, the particular vessel chosen for the distal site, or to whether the distal site was visualized by contrast roentgenography or located preoperatively by ultrasonography. Continued smoking was an important factor in failure, and mechanical trauma to the distal saphenous vein may have been important. Intimal hyperplasia was the usual cause of failure and may be a negative aspect of the vitality of in-situ vein grafts. Its clinical presentation and histologic features were florid and distinctive.

Aged↗
PubMedDate not supplied

Intraarticular epiphyseal osteoid osteoma of the distal femur.

A 9-year-old boy had pain in the medial side of the right knee with limited range of motion and limping. Roentgenography showed a small sclerotic shadow (8 X 8 mm2) in the medial femoral condyle, where bone scintigraphy revealed a high uptake area and angiography showed a nidus. Five months after initial presentation, en bloc excision was done through the posteromedial approach. Histological examination showed a network of osteoid trabeculae, differentiated osteoblasts, and multinucleated giant cells in this nidus, which were compatible with those of osteoid osteoma. Complete relief of pain was obtained at follow-up 1 year after the operation.

Child↗
PubMedDate not supplied

[Limits on increasing the sensitivity of x-ray diagnostic screens].

The irradiation dose for patients is proportional to that necessary to receive sufficiently informative image. The minimum value of this dose for different examination methods (roentgenography, photoroentgenography and roentgenoscopy) is evaluated by comparing the quantum fluctuation level with the visual "noise" and other components of the threshold contrast. The role of these components balance and the optimization of conditions and hardware for X-ray examination have been discussed.

Humans↗