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Lower spinal mobility and external immobilization in the normal and pathologic condition.

The study presented here used lateral flexion and extension roentgenograms to determine lumbosacral motion in healthy persons and in patients with spondylolisthesis. The lumbosacral corset, Jewett extension brace, and plastic thoracolumbosacral orthosis (TLSO) were then placed and repeat roentgenograms were done to see if effective immobilization could be obtained. Although individual variation existed, there appeared to be no significant difference in lower lumbar motion between the two groups studied, and the orthotics acted in a similar fashion on both the volunteers and the patients. The lumbosacral corset was unable to immobilize the L3-S1 levels. There was a statistically significant decrease in the average lateral disk space motion at L3-4 and L4-5 with the use of the Jewett brace and the TLSO (P less than .01); however, the motion was never completely eliminated. No brace could adequately immobilize the L5-S1 level, and some people demonstrated increased motion at this level while wearing the orthotics.

Adolescent↗

[A retrospective study of preadoption x-ray findings in young children at the Social Child Aid: value and limitations].

French law requires that children awaiting adoption undergo full medical evaluation to detect anomalies which may influence decisions concerning adoption. As part of this evaluation, all infants admitted to the Saint-Vincent-de-Paul Preadoption Center in Paris undergo roentgenographic evaluation including frontal and lateral films of the skull, a frontal chest film, a frontal view of the pelvis, and frontal films of one upper limb and one lower limb. A study of the one hundred most recent evaluations, carried out in infants aged 1 to 14 months, disclosed 16 roentgenographic anomalies. Five of these anomalies were already known prior to the evaluation, 2 did not give rise to additional investigations, and 9 led to additional tests, a change of therapy or subsequent radioclinical monitoring. Among the six films taken in each patient, only the frontal views of the chest and pelvis proved informative. Screening using these two roentgenograms only is recommended, with other roentgenograms being performed if called for on the basis of clinical findings.

Adoption↗

[Clinical applications of devitalized autogenous calvarial bone flaps fixed with titanium clamps (CranioFix) for cranioplasty].

OBJECTIVE: To evaluate reimplantation of devitalized autogenous calvarial bone flaps and the fixation of titanium clamps (CranioFix) for cranioplasty. METHODS: From March 2000 to December 2003, 21 patients underwent (1) delayed reimplantation of preserved autogenous bone flaps, which were removed during the initial operations for increased intracranial pressure and stored in a freezer and autoclaved before use, or (2) immediate reimplantation of tumor invaded bone flaps that were devitalized by boiling. All of these flaps were fixed with titanium clamps (CranioFix). Resorption of the bone flaps was monitored by skull roentgenograms and computed tomography (CT). The clinical and aesthetic results were evaluated. RESULTS: During the follow-up period of 6 to 30 months, no complications were found. There was slight resorption of the bone flaps in all cases, but the edge of the bone flaps was within the range of the titanium clamps according to skull roentgenograms and CT. Clinical and aesthetic results were highly satisfactory. CONCLUSIONS: It is simple and practical using devitalized autogenous calvarial bone flaps for cranioplasty. The firmness decreasing of the reimplanted bone flap due to resorption can be prevented greatly by titanium clamps (CranioFix).

Adolescent↗

[A case of gold-induced pneumonitis showing a positive reaction in the drug lymphocyte stimulation test (DLST) for gold].

A case of acute interstitial pneumonia developing during gold therapy is reported. A 67-year-old female with rheumatoid arthritis for about twenty years who received a total dose of 80 mg of gold thiomalate (Shiosol) for about two months, developed high fever and dry cough. Exertional dyspnea developed and chest roentgenogram showed diffuse small nodular and reticular shadows. RA and RAPA tests were positive. Drug lymphocyte stimulation test (DLST) for Shiosol was positive. The dyspnea resolved on administration of methylprednisolone. Chest roentgenogram and CT-scan showed improvement. A total dose of 80 mg of gold thiomalate, as administered in this case, is the minimum dose previously reported in Japan. It has been recently reported that allergic reaction is the mechanism of gold lung. In the present case, positive DLST indicated the existence of many activated lymphocytes, and was very useful in the diagnosis of gold lung.

Aged↗

[Mediastinitis with bilateral empyemas following neck phlegmon].

A 46-year-old male complaining of fever and neck swelling was transferred to our department because of bilateral empyemas in the pleural spaces following neck phlegmon. A culture of the right pleural effusion obtained at his local hospital revealed Gram-positive anaerobic cocci. Chest roentgenogram showed bilateral effusions and widening of the upper mediastinum. Neck roentgenogram confirmed widening of the retropharyngeal space. CT clearly demonstrated a continuous lesion from the neck to the mediastinum and occupying the pleural spaces bilaterally. The patient responded to intravenous antibiotics and tube drainage of the pleural cavities, and was discharged after 10 weeks of hospitalization. Because no mediastinal abscess requiring drainage was recognized on CT, surgical drainage of the mediastinal space was not performed. Sequential CT was used to follow the lesion in the retropharyngeal space, mediastinum and pleural spaces, to check and reposition the tubes for drainage of pleural exudate.

Cellulitis↗

[A case of alveolar hydatid disease of the lung in the Kansai district of Japan].

A 78-year-old man was admitted to hospital because of episodes of high grade fever and multiple nodular shadows on chest roentgenogram. He had a past history of percutaneous drainage and partial resection of the left lobe of the liver for liver abscess of unknown origin in 1987. The high grade fever was secondary to sepsis due to Citrobacter freundii. The sepsis improved with antibiotic therapy, but the abnormal shadows on chest roentgenogram did not improved. Immunoserological tests indicated a probable diagnosis of alveolar hydatid disease of the lung, which is very rare in the Kansai district of Japan. Open lung biopsy was performed and the diagnosis of alveolar hydatid disease of the lung was confirmed.

Aged↗

Blunt diaphragmatic rupture in elderly patients.

BACKGROUND/AIMS: Severe blunt torso trauma can cause diaphragmatic rupture. Such trauma remains a diagnostic challenge to the trauma surgeon, particularly when the initial chest roentgenogram is unrevealing. Owing to age, preexisting diseases, and poor physiological reserves, elderly patients suffer higher mortality rates after trauma than young patients. The difference between elderly and young patients in terms of blunt diaphragmatic rupture is particularly interesting. METHODOLOGY: Records from 78 patients presenting with blunt diaphragmatic rupture at our hospital from July 1992 to January 2001 were retrospectively reviewed. Age, gender, co-morbid disease, trauma mechanism, associated organ injury, injury severity score, hemodynamic status on arrival at our Emergency Room, injury side and size of diaphragmatic rupture, delay before operation, and postoperative complications and mortality were determined for elderly (> or = 65 years) and young (<65 years) patients. RESULTS: 10 elderly and 68 young patients were collected and reviewed. Elderly patients had higher rate of preexisting disease (60% vs. 16.2%), associated injury of long bone fracture (60% vs. 23%), and initial normal chest roentgenogram (50% vs. 12%) and they had significant delays before operation. Only 20% of elderly patients were operated on within 24 hours of trauma, compared to 87% of young patients, and 50% elderly patients were actually operated on over a week after the trauma. Furthermore, no statistically significant differences existed between elderly and young patients in ISS (19.9 +/- 6.3 & 22.8 +/- 10.4), or the injury side of diaphragmatic rupture, although elderly patients did display shorter diaphragmatic ruptures (5.6 +/- 3.3 & 10.0 +/- 6.0cm, p<0.05), and longer periods on postoperative ventilatory support (17.7 +/- 21.2 & 3.2 +/- 5.0 days, p<0.05). Finally, elderly patients also had significantly higher rates of postoperative complications of pneumonia (30% & 5.9%), and mortality (50% & 2.9%) than young patients did. CONCLUSIONS: Compared to young patients, elderly patients with blunt diaphragmatic rupture had significantly higher rates of initial normal CXR, partly due to shorter length of diaphragmatic rupture, and partly due to ventilatory support, and consequent higher rate of delays before surgery. Furthermore, they also needed longer postoperative ventilator help, and prevailed higher rates of co-morbid disease, postoperative pneumonia, and mortality. Careful initial investigation and prudent radiological follow-up is recommended for elderly patients with severe blunt torso trauma.

Abdominal Injuries↗

[A case of spontaneous regression of lung cancer with skin metastasis].

Spontaneous regression of a malignant tumor is a rare phenomenon, especially in advanced lung cancer. We reported a case of spontaneous regression of lung cancer with tracheal stenosis due to tumor invasion and multiple skin metastases. A 60-year-old man was admitted to our hospital on September 10, 1985, because of a dry cough. A chest roentgenogram showed a mass shadow in the right upper lung field. Bronchoscopic examination revealed tracheal stenosis due to the tumor mass, and transbronchial aspiration cytology (TBAC) yielded a diagnosis of large cell carcinoma of the lung. In spite of treatment by chemotherapy with cisplatin and vindesin and irradiation, dyspnea deteriorated and multiple skin metastases appeared. After Nd-YAG laser irradiation via a broncho-fiberscope to maintain his airway and ethanol injection into the skin metastases, his dyspnea improved and he was discharged on February 6, 1986. Two months after discharge all skin metastasis had completely disappeared, and the primary lesion also regressed and finally disappeared on chest roentgenogram until August, 1986. The mechanism of regression is unclear, but now he has been free of tumor clinically for four years.

Antineoplastic Combined Chemotherapy Protocols↗

Radioisotopic detection of osseius metastases. Evaluation of 99mTc polyphosphate and 99mTc pyrophosphate.

A total of 146 patients were investigated for the presence of osseous metastases with 99mTc polyphosphate or 99mTc pyrophosphate bone scans. Results of bone imaging were retrospectively compared to roentgenographic results surveying similar anatomic areas in 128 patients. This comparison revealed that roentgenographic interpretations were in error in 19% of the cases. Thirty-three patients had bone scans and roentgenograms that were in agreement and considered abnormal, but in more than one third of these cases the patients had multiple abnormalities that were shown by the bone scan but were not recognized roentgenographically. In consideration of the low toxicity, ready availability, economy, shortened procedure time, and low radiation dose associated with the use of these new bone-seeking agents, it is concluded that they are superior to roentgenograms and previously utilized radionuclides for early detection of osseous metastases.

Bone Neoplasms↗

Unilateral hypertransradiancy in a child with recurrent chest infections.

A 3-year-old female child was treated for six recurrent episodes of cough, high grade fever and breathlessness during past one year. Every time total leucocyte counts used to range between 17,000 - 25,000 per mm3 with neutrophils over 80%. Except for diminished breath sounds in left basal region, systemic and chest examinations were normal. Her chest roentgenogram is shown in figure 1. A good quality chest roentgenogram could not be done because of persistent movements of the child.

Bronchi↗

Evaluation of the hip with pigmented villonodular synovitis. A case report.

Pigmented villonodular synovitis (PVNS) is an uncommon disorder of the synovium that rarely involves the hip joint. The natural history of an untreated case of PVNS is presented herein. A young adult with a painful hip and destructive changes on plain roentgenograms requires further diagnostic evaluation. The relative value of current imaging techniques is discussed in this report. Plain roentgenograms alone often suggest the correct diagnosis of PVNS of the hip, but traditional criteria have proven to be inaccurate. Computed tomography (CT) is helpful in demonstrating the location and degree of bone loss throughout the pelvis and assists in determining the need for bone graft or prosthetic modification in preoperative planning. Experience with magnetic resonance imaging (MRI) in this disorder is limited, but no clear advantage over CT has been demonstrated thus far. Three-dimensional reconstruction has provided no useful information not already found on plain CT or MRI. For diagnostic accuracy and effective preoperative planning, evaluation should include a complete blood count, sedimentation rate, CT scan, and MRI.

Adult↗

Severity of pulmonary asbestosis as classified by International Labour Organisation profusion of irregular opacities in 8749 asbestos-exposed American workers. Those who never smoked compared with those who ever smoked.

The profusion of irregular opacities on chest roentgenograms by International Labour Organisation pneumoconiosis criteria was used to assess the severity of asbestosis in 8749 asbestos-exposed active and retired American workers. Seventy-eight percent had no asbestosis (category 0/0 or 0/1), 18.6% had slight asbestosis (1/0 to 1/2), 3% had moderate asbestosis (2/1 to 2/3), and 0.3% had advanced disease (3/2 or greater). Significantly more current smokers had asbestosis than did those who had never smoked, and their average profusion of opacities was higher. The mean age of current smokers with asbestosis was 60 years, whereas subjects with the disease who had never smoked had a mean age of 64 years, a significant difference. Cigarette smoking and asbestosis appear to act synergistically to produce irregular opacities on chest roentgenograms of asbestos-exposed American workers.

Asbestosis↗

[Heart arrhythmias in chronic respiratory failure due to chronic obstructive bronchopneumopathy: the incidence and correlations with nocturnal respiratory disorders].

The aim of this study was to assess: frequency and type of cardiac arrhythmias in patients with severe stable chronic obstructive lung disease (COLD) and chronic respiratory failure (CRF); diurnal or nocturnal predominance of the detected arrhythmias; prospective relationships between arrhythmias and nocturnal hypoxemic-hypercapnic episodes. All patients were examined with careful and complete medical history, chest roentgenogram, standard electrocardiogram, mono and bidimensional echocardiogram, respiratory function tests, arterial blood gases at rest, 24-hour dynamic electrocardiographic recording and, simultaneously, transcutaneous nocturnal monitoring of respiratory gases (TCNM). We studied 14 men: all complained of exercise-induced dyspnoea for 8 +/- 6 years; 10 of them reported usual nocturnal snoring. Respiratory function tests provided the following values (expressed in percentage compared with theoretical ones): vital capacity 58.6 +/- 15, forced expiratory volume/s 36 +/- 19, Tiffeneau index 60 +/- 19, Motley index 160 +/- 35, carbon monoxide diffusion capacity 48 +/- 26. Arterial blood gas analysis at rest resulted: PO2 47 +/- 4.5 mmHg, PCO2 49 +/- 7.9 mmHg, pH 7.38 +/- 0.3. Right ventricular diameter obtained with mono and bidimensional echocardiogram was 32 +/- 4.6 mm. Right pulmonary descending artery measured on chest roentgenogram was 23 +/- 3.8 mm. Nocturnal transcutaneous monitoring of respiratory gases showed mean PO2 of 40 +/- 9.7 mmHg and mean PCO2 of 75 +/- 19 mmHg. During night-time maximum percentage reductions of PO2 (36 +/- 17%) were measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Skeletal surveys in renal osteodystrophy.

The authors reviewed the clinical usefulness of routine comprehensive skeletal surveys in monitoring renal osteodystrophy in 66 patients on chronic maintenance hemodialysis. Only fourteen (22%) of the 66 patients had roentgenographic evidence of hyperparathyroid bone disease. There were no significant differences in serum calcium, phosphate, or aluminum levels between patients with and without evidence of phalangeal subperiosteal bone resorption in the hands. However, serum levels of parathyroid hormone (PTH) (both intact and mid-molecule) and alkaline phosphatase values were significantly higher in the group with subperiosteal bone resorption (p less than 0.01 and p less than 0.02, respectively). Serum intact PTH correlated with alkaline phosphatase better than the mid-molecule assay. Neither intact nor mid-molecule PTH values correlated with serum calcium, phosphate, or aluminum. Hand roentgenograms were most sensitive in detecting early changes of hyperparathyroidism; symphysis pubis was the next best. Other skeletal roentgenographic findings were less revealing, and in a subset of 20 patients, roentgenograms correlated poorly with bone histology. During this study the authors found an 8% prevalence of vertebral compression fractures; all in postmenopausal white women.

Alkaline Phosphatase↗

Modified CHOP in an aged patient with non-Hodgkin's lymphoma and probable extensive pulmonary involvement.

A 75-year-old female was admitted to our hospital because of shortness of breath and palpitations. Chest roentgenogram together with a CT scan showed multiple nodular shadows in both lung fields, with hilar lymphadenopathy. The cervical lymph nodes were enlarged, and were biopsied to reveal diffuse large T-cell non-Hodgkin's lymphoma. Extensive pulmonary involvement was suspected and treatment with a modified CHOP regimen was begun. Following therapy, pulmonary symptoms were remarkably improved, and chest roentgenogram revealed virtually complete clearance of lung lesions. No severe side effects were observed as a result of the therapy.

Aged↗

[The value of residual volume testing in determining degree of emphysema in patients with pneumoconiosis].

A comparative study of chest roentgenograms and the value of RV/TLC% in determining degree of emphysema of patients with pneumoconiosis and workers exposed to dust was made in 400 cases. Accordance rate of RV/TLC% with roentgenograms in determining emphysema in the same subjects was 61.1% and that in the patients group, 67.7%. Moreover, the accordance rate increased with grade of pneumoconiosis diagnosed. The results showed that RV/TLC% was valuable in determining emphysema of patients with pneumoconiosis. The classes of degree of emphysema were proposed according to the testing value of RV/TLC%.

Adult↗

[A case of leiomyosarcoma of the esophagus].

A 67-year-old woman was admitted on June 21, 1990 because of an abnormality on chest roentgenogram, a three-month history of palpitations on exertion, and a 2 kg weight loss. Chest roentgenogram revealed a huge mass in the posterior mediastinum. The results of needle aspiration cytology from the mass and celiac angiography were suggestive of leiomyosarcoma of the esophagus. The patient underwent tumor enucleation. The tumor originated from the lower-portion of the thoracic esophagus, measured 23 x 13 x 13 cm, and weighted 1110 g. The tumor was diagnosed as leiomyosarcoma histologically. Esophageal leiomyosarcoma is a very rare malignant tumor. The present case had no history of dysphagia in spite of the large tumor size.

Aged↗

A pneumatic leg brace for the treatment of tibial stress fractures.

Forty-two competitive athletes with posterior medial pain in the lower one-half of the tibia were evaluated by plain roentgenograms and bone scans. Twenty stress fractures were diagnosed in 17 patients by plain roentgenograms or bone scans or both. The remaining 25 patients were diagnosed as having shin splints. All 42 patients subsequently had a pneumatic leg brace applied to the affected limb or limbs. The 17 patients with stress fractures were able to ambulate without pain and were allowed to resume light training in an average of one week. Their injuries were nontender to palpation. The patients were allowed to resume intensive training at an average of 3.7 weeks postinjury. Patients returned to competition at the preinjury level in an average of 5.3 weeks after application of the brace. The pneumatic leg brace allowed the athletes with tibial stress fractures to begin pain-free ambulation and rehabilitation, thus facilitating the maintenance of their cardiovascular fitness and permitting an early return to competition.

Adolescent↗