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Air esophagogram and intestinal pseudoocclusion in a patient with scleroderma.

Air in the esophagus is unusual because it is collapsible. Its finding on a chest roentgenogram, particularly when not associated with a fluid level indicative of stricture, should strongly suggest systemic sclerosis (scleroderma). We describe a patient with scleroderma with intestinal pseudoocclusion and an air esophagogram. Study of chest roentgenograms of 83 patients with scleroderma, including those of 7 with pseudoocclusion, revealed no other instance of air esophagogram. This radiological sign, although rare, should suggest scleroderma and may be particularly useful in patients with "systemic sclerosis sine scleroderma."

Air↗

[Roentgenological manifestation of ossification of the posterior longitudinal ligament in the cervical spine causing severe spinal canal stenosis--a group comparison with and without marked spinal cord dysfunction].

Relationship between the degree of clinical symptoms and the lateral roentgenograms of the cervical OPLL causing severe spinal canal stenosis was studied among patients whose roentgenological minimum antero-posterior diameters of the available spinal canals were under 9mm. Lateral roentgenograms of 28 clinically mild patients were compared with those of 20 clinically severe patients. The type of ossification, the extent of OPLL, the narrowest level of the available spinal canal, and the minimum a-p diameter were not statistically significant parameters. The degree of canal stenosis at the 1cm cranial and 1cm caudal levels from the narrowest level, and the axial extent of canal stenosis around the narrowest level were less significantly in the group with mild symptoms than in the group with severe symptoms.

Adult↗

[Learning to read; roentgen photos and the Nederlandsch Tijdschrift voor Geneeskunde].

Reading articles from the earliest years of roentgenology, shortly after 1896, we find that reading a roentgenogram was an explicit mixture of technique, anatomy, clinical data, patient, pathology and shadow. Reading roentgenograms was not just deciphering the shadows in terms of an underlying, stable 'natural world', it was an active construction and representation of 'normal and pathological'. The articles on the 'new photography' in the Nederlandsch Tijdschrift voor Geneeskunde are not just a passive representation of this process: they also enable the contemporary to follow the construction in all its aspects and to use it in his own work with rays and photographs.

History, 19th Century↗

An objective method to measure and manage occult pneumothorax.

Of 457 patients with multisystem injuries undergoing abdominal computed tomographic (CT) scan, 26 patients were found to have 31 pneumothoraces. None of these were apparent on prior roentgenograms of the chest. Each pneumothorax was quantified by measuring its maximal width in millimeters and the number of 10 millimeter CT sections on which it appeared. Serial roentgenograms of the chest and patient charts were reviewed. The major factor determining the clinical course and management of these pneumothoraces was size. Seventeen per cent of pneumothoraces measuring less than 5 X 80 millimeters (group 1) and 85 per cent of those measuring greater than or equal to 5 X 80 millimeters (group 2) had tube thoracostomy performed. The percentage of pneumothoraces in each group with positive pressure ventilation was 55 and 77 per cent, respectively. Our results suggest that such occult pneumothoraces may be managed with close observation if they measure less than 5 X 80 millimeters, whether or not the patient is to receive positive pressure ventilation. Larger pneumothoraces and those associated with more than two rib fractures may require early treatment.

Adolescent↗

Limitations of radiography and computed tomography in the diagnosis of transverse sacral fracture from a high fall. A case report.

Transverse sacral fractures with sacral canal compression and neurologic deficit are rare sequelae of high falls. Nevertheless, a high index of suspicion is necessary as such an injury may present significant complications and may be missed on standard anteroposterior pelvic roentgenograms and pelvic computed tomography (CT) examinations obtained during the evaluation of multiple traumas. The saddle anesthesia, loss of bladder and sphincter function, and sexual dysfunction may be masked or unrecognized during the acute phase of polytrauma. Special attention must be directed to obtaining a lateral profile view of the sacrum, as this deformity may not be seen in any other view. Sagittal reconstruction images of the sacrum can be obtained during a pelvic CT examination if the initial lateral roentgenograms are technically inadequate because of the patient's obesity or limitations of portable radiographic equipment in the emergency department. The CT scoutview itself may show the acute sacral angulation if sufficient technique factors are employed. The roentgenographic suspicions can be confirmed with lateral multidirectional tomography or even with sagittal magnetic resonance imaging (MRI). Because this transverse sacral fracture is unstable in flexion, additional neurologic injury may result if the spine or hips are unwittingly manipulated in flexion.

Accidental Falls↗

[A solitary metastatic osteosarcoma of the lung with thin walled cavity: report of a case].

A 13-year-old girl had a history of wide resection of the left fibula under the diagnosis of osteosarcoma three years before. Postoperatively, a thin walled cystic lesion in the right upper lung field, which enlarged gradually with thickening of the wall was found on the chest roentgenogram. The right upper lobectomy was performed after clinical evaluation. The pathologic examination confirmed that the tumor was the metastatic osteosarcoma of the lung. Although metastatic osteosarcoma is common in the lung, very rare cases demonstrate thin walled cavity formation in chest roentgenogram. We reported herein a case of a solitary metastatic osteosarcoma of the lung with thin walled cavity considering with pathogenesis of the lung.

Adolescent↗

"Hybrid" total knee arthroplasty with the Miller-Galante prosthesis. A prospective clinical and roentgenographic evaluation.

Twenty-nine "hybrid" Miller-Galante total knee arthroplasties, in 22 patients, were evaluated prospectively and according to the clinical and roentgenographic guidelines of The Knee Society. Selection of this technique, incorporating an uncemented, porous-ingrowth femoral component and a cemented tibial component, was based on patient age, medical condition, activity level, and intraoperative assessment of bone quality and ligament competency. The average age of the patients at the time of surgery was 71 years. The average preoperative Knee Society Knee Score was 32; average pain score was 14; and the average function score, 47. After an average follow-up interval of 28 months postsurgery (minimum, 24 months), the average Knee Society Knee Score was 93; the average pain score, 47; and the average function score, 79. Range of motion averaged 110 degrees. Only one knee, with persistent pain of obscure origin, rated an unsuccessful result. No arthroplasties were revised for any reason. Twenty-three knees had fluoroscopically guided roentgenograms to assess the bone-prosthesis and bone-cement interfaces. No significant or progressive radiolucencies were noted under any of the components. No apparent adverse bone remodeling was associated with the uncemented femoral component. The fluoroscopically guided roentgenograms were significantly more sensitive in detecting interface radiolucencies than plain ones. Clinical and roentgenographic evidence of component loosening were absent in all patients. Results of this study suggest that the hybrid fixation technique can reliably provide satisfactory pain relief and restoration of function in properly selected patients. Potential advantages of an uncemented femoral component include decreased operative time, reduction of polyethylene wear from cement debris, and avoidance of a possible adverse biologic response to polymethylmethacrylate.

Aged↗

The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-year follow-up study.

Although fractures of the distal radius are very common, an optimal treatment has not been clearly delineated. This is a prospective study of 40 patients, mainly young and active adults, with comminuted and unstable intraarticular fractures of the distal radius. The end results of closed reduction and rigid fixation with the small AO external fixator includes 36 patients (90%) with excellent and good results. Roentgenograms of 33 of these patients showed accurate alignment of the healed fractures. Four patients (10%) had a fair functional result, with a partial restriction of the range of movement, although roentgenograms demonstrated good alignment of the healed fractures. The small AO external fixator is both a useful and convenient method for the reconstruction and treatment of comminuted intraarticular fractures of the distal radius.

Adult↗

Management of the asymptomatic patient with a stab wound to the chest.

We prospectively studied 126 asymptomatic patients who had a total of 144 stab wounds (average size, 2 cm) to the chest to determine their need for hospitalization. Their average age was 32 years; 102 of them were men. Four left against medical advice. The remaining 122 patients were judged to be asymptomatic when inspiratory and expiratory chest roentgenograms, recorded serially over a 24-hour period, revealed no intrathoracic trauma. Subcutaneous air was found in five of the patients, and an aorto-right ventricular fistula was found in one patient during his follow-up visit to the clinic a week later. The fistula was repaired uneventfully. No late-developing complications were detected in a review of the charts a year later. We believe a patient with a stab wound to the chest but with no evidence of intrathoracic injury may be appropriately managed with limited observation, including serial inspiratory and expiratory roentgenograms of the chest.

Adolescent↗

Fractures of the atlas.

Thirty-four patients who had fractures of the atlas (the first cervical vertebra) were reviewed at an average follow-up of 4.5 years. Seventeen patients had bilateral fracture of the posterior arch of the first cervical vertebra. Eight were treated with immobilization in a cervical orthosis, with no long-term problems secondary to the injury. Nine of these patients had additional fractures in the first and second cervical vertebral complex, complicating the management of the fractures of the posterior arch. Two of the nine patients died, and the treatment of the other seven was dependent on the additional fractures. A second group of six patients had a fracture in the area of the lateral mass, with one fracture just anterior to or within the anterior portion of the lateral mass of the first cervical vertebra and a second fracture posterior to the lateral mass of the first cervical vertebra on the same side; resultant asymmetrical displacement of the lateral masses was seen on the open-mouth roentgenogram that was made for each patient. A third group of eleven patients sustained a Jefferson, or burst, fracture of the first cervical vertebra. These patients had either four fractures (two in the anterior arch and two in the posterior arch) or three fractures (one in the anterior arch and two in the posterior arch). Spreading of the lateral masses was relatively symmetrical on the open-mouth roentgenogram. Patients who had fractures with displacement of two to seven millimeters were treated with immobilization in a halo vest. Patients who had fractures with severe spreading of the lateral masses (more than seven millimeters) were treated with reduction of the lateral masses by axial traction until healing of the arch had occurred. No atlanto-axial instability was evident in any patient at follow-up.

Adolescent↗

Ankle arthrodesis with the Calandruccio frame and bimalleolar onlay grafting.

Twelve patients had ankle arthrodesis between the years 1984 to 1987 at one facility. In each case, the Calandruccio triangular compression device (Richards Medical Co., Memphis, Tennessee) and a two-incision technique were used to achieve maximum cancellous apposition and compression. Eleven patients (92%) achieved solid bony fusion. Two patients were deceased and one was lost to follow-up evaluation at the time of this study. These three patients were evaluated from clinical records and roentgenograms alone. Nine patients (mean age, 49 years), however, returned for evaluation by the authors (average postsurgery period, 1.7 years). A questionnaire, clinical exam, and a series of roentgenograms were obtained. An ankle rating scale was utilized and six patients were rated good or excellent. Two were rated poor and one was not rated because of underlying disease causing a weakened ambulatory status. Pain was the main determinant in placing a patient in the poor category. Both patients who rated poor had acceptable function. In this population, the hybrid combination of bimalleolar onlay grafting and triangular compression was found to be satisfactory in achieving a high degree of fusion and patient gratification.

Adult↗

Neuropathies of the foot and ankle in athletes.

Although neuropathies in the athlete's foot and ankle are uncommon, they are often underdiagnosed. This is primarily due to the complex interplay of factors that are required for their presentation. The most frequently encountered entrapment syndromes (in decreasing order) involve the interdigital nerves, first branch of the lateral plantar nerve, isolated medial or lateral plantar nerves, posterior tibial nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, and saphenous nerve. A thorough knowledge of peripheral nerve anatomy is essential in establishing the diagnosis. Roentgenograms may reveal bony abnormalities that are the diagnosis. Roentgenograms may reveal bony abnormalities that are commonly contributory. Electrodiagnostic tests may be normal because these dynamic syndromes often resolve at rest. In most cases, correction of underlying etiologies combined with rest, NSAIDs, and occasionally injections will allow resolution of the syndrome. Recalcitrant cases may require surgical decompression, which frequently provides satisfactory results.

Adult↗

Tumors about the knee in children.

Tumors are rare causes of knee symptoms in children but must be considered in the differential diagnosis of pediatric knee pain in order to avoid errors in treatment that could result in loss of limb or even life. Experience with 199 bone and soft-tissue tumors about the knee in children are reviewed. The majority of lesions were benign bone tumors (n = 101), with osteocartilaginous exostoses, nonossifying fibromas, and chondroblastomas predominating. Malignant bone tumors (n = 59) were less frequent, and osteosarcoma (n = 48) was by far the most common sarcoma. Soft-tissue lesions (n = 31) were much less frequent and included rhabdomyosarcoma, synovial sarcoma, fibrosarcoma, and desmoid tumors. A careful history, physical examination, and review of roentgenograms are essential to avoid errors in diagnosis. Malignant tumors require roentgenograms and laboratory studies in sequence to stage the patient. A properly performed biopsy established the diagnosis in most instances. Popliteal cysts, stress fractures, infection, myositis ossificans, histiocytosis, and other lesions can mimic tumors and delay correct diagnosis.

Adolescent↗

Radiographic determination of prenatal basicranial ossification.

In a previous investigation on prenatal development of the human cranial base, the sequence in which the bones develop in the midsagittal region was elucidated. The purpose of the present study was to identify fetal ossification on horizontal plane roentgenograms of the occipital and sphenoid bones in the central part of the cranial base, and establish stages in bone appearance related to general fetal developmental parameters. This study is based upon roentgenograms of the cranial base of 145 human fetuses from the first half of the prenatal period. Two different maturation patterns of the sphenoid bone were observed. The first, most common pattern is characterized by a midsagittal centre of ossification and the second by bilateral centres of ossification in the corpus of the sphenoid bone. These bilateral centres might in some cases be connected by a slight bony bridge. It appears that these different maturation patterns are maintained throughout the period investigated. The material was divided into five well-defined developmental stages for both maturation patterns and general parameters of fetal development. Mapping different aspects of ossification in normal cranial development is necessary for understanding deviations of cranial maturation and growth.

Gestational Age↗

[A case of pulmonary tuberculosis associated with adult respiratory distress syndrome during corticosteroid treatment of rheumatoid arthritis].

We reported a case of 64 year-old female patient of pulmonary tuberculosis associated with ARDS during corticosteroid treatment of Rheumatoid Arthritis. On admission her chief complaints were fever, fatigue and dyspnea. A chest roentgenogram showed diffuse alveolar infiltration consistent with pulmonary edema. Arterial blood gas studies showed severe hypoxemia. We clinically diagnosed so-called ARDS. Smears of sputum for acid fast bacilli were negative, but transbronchial lung brushing by bronchofiberscope revealed many acid fast bacilli. Intensive therapy with anti-tuberculosis drugs (INH, RFP, SM), high dose corticosteroid (methylprednisolone) therapy and mechanical ventilation was started. During the following 2 weeks, the PaO2 rose gradually and the alveolar infiltration on the chest roentgenogram disappeared. The experience of this case to emphasized the importance of suspecting this condition because pulmonary tuberculosis is a potentially curable cause of ARDS and it should also be emphasized that the good treatment effect could be expected with combined use of high dose corticosteroid and mechanical ventilation.

Arthritis, Rheumatoid↗

Pleuropulmonary manifestations of hepatic amebiasis.

Pleuropulmonary manifestations of hepatic amebiasis occurred in 30 patients; 18 (60%) presented with at least 1 pulmonary complaint and 10 (33%) had multiple pulmonary symptoms. In 14 patients (47%), abnormalities were found on examination of the chest. In 16 chest roentgenograms (53%), there was at least 1 abnormality: right-sided pleural effusion (9 patients) and elevated right hemidiaphragm (8 patients) were the most common. All patients were treated with metronidazole (Flagyl) and had resolution of the amebic liver abscess and pulmonary disease. Pleuropulmonary disease is a common complication of amebic liver abscess. The clinical presentation and chest roentgenograms are virtually diagnostic and obviate the need for invasive procedures to confirm the diagnosis. Pleuropulmonary disease resolves with amebicidal treatment of the hepatic abscess.

Abdominal Pain↗

Radionuclide imaging of asymptomatic versus symptomatic total knee arthroplasties.

Ninety-eight total knee prostheses were evaluated by roentgenograms and bone scans. Fifty-three were asymptomatic, and 45 were symptomatic. Thirteen prostheses required revision surgery. At a mean of 54 months, asymptomatic knee replacements generally showed only mild uptake in one or more zones. Only one knee had uptake equal to surrounding bone. However, symptomatic knee replacements showed significantly greater uptake in the patella, femur, and medial and lateral tibial plateau regions (Mann-Whitney two-sample rank test). Bone scans in the symptomatic group were obtained at a mean of 44 months. Excluding those patients who had revision surgery, the differences remained significant. Furthermore, symptomatic knee replacements with normal roentgenograms also had significantly greater uptake. Radiolucent lines were noted in 30% of asymptomatic patients, whereas 29% of symptomatic knees had radiolucencies. Radiolucencies were not generally associated with significantly greater uptake. Lateral release had no effect on the patellar score.

Adult↗

Cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger.

The results of 68 cemented total knee arthroplasties (TKAs) in 50 patients with gonarthrosis who were 55 years old or younger at the time of surgery were reviewed. These patients were operated on between 1979 and 1987 and were followed for an average of 6.2 years. The average age of the patients was 50 years. Patients were evaluated by the Hospital for Special Surgery knee score. The average preoperative score was 53, and the average follow-up score was 90. Overall, 55 TKAs were rated as excellent and 13 as good. Using the knee rating score advocated by the Knee Society, the average postoperative score was 92 for pain and 84 for function. There were four successful reoperations for patellar component loosening, all in metal-backed patellae. The femoral and tibial components in these patients were intact, and at the follow-up period, two knees were rated as excellent and two as good. Detailed roentgenographic evaluation demonstrated that 20% of tibial components had radiolucencies in at least one zone on the anteroposterior roentgenogram and in 11% on the lateral roentgenogram. Femoral radiolucencies occurred in only 2% of knees. Patellar radiolucencies in one or more zones occurred in 20% of knees that had not had patellar revision. No complete or progressive radiolucencies at the bone-cement interface were noted for any component, and no components were considered to be roentgenographically loose. Cemented TKAs can achieve excellent long-term results in patients younger than 55 years old with gonarthrosis of the knee. These results compare with those obtained in published reports on older age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗