Anteroposterior Roentgenograms Research Articles

Nausea, Vomiting, and Epigastric Pain in an Elderly Diabetic

A 61-year-old man presented with the complaints of nausea, vomiting, and severe epigastric pain. An anteroposterior roentgenogram of the abdomen demonstrated a conclusive diagnostic finding. History The patient was a noncompliant, poorly regulated diabetic receiving 54 units of isophane insulin (NPH [neutral protamine hagedorn] insulin) and 20 units of insulin by subcutaneous injection daily. His medical history was significant for multiple sequelae of diabetes. On physical examination, he was febrile (temperature, 38.5 °C), alert, and in no apparent distress. His abdomen was moderately distended, tender, and had normal bowel sounds. Laboratory findings included an elevated serum glucose level of 345 mg/ dL, urine glucose concentration of 3%, and white blood cell count of 19,000/cu mm. Roentgenograms of the chest and abdomen demonstrated radiological findings that will be described subsequently (Fig 1). (To the reader: Observe the area of the stomach with extra care.) Diagnosis Gastric emphysema associated with gastroparesis in

LONG-TERM ANATOMIC AND FUNCTIONAL CHANGES IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS TREATED WITH THE MILWAUKEE BRACE

Ninety-five patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: adolescent idiopathic scoliosis, completion of Milwaukee brace treatment before age 20, a minimum follow-up period of 5 years thereafter, minimum age of 22 years at final follow-up examination. Of these, 85 (90%) were examined personally by an independent investigator, including anteroposterior and lateral full-length spinal roentgenograms. The average length of follow-up was 7.5 years (range, 5-12 yrs). These patients who successfully completed the brace treatment program, in their mid-twenties ended up with curves that were of equal size (33 degrees +/- 3 degrees) as when the treatment started (30 degrees +/- 3 degrees). In the sagittal plane, the spines were normal; none exhibited hypokyphosis (less than 20 degrees). Compared with the straight control group and to a previously reported group of operated patients, the brace group functioned at the same level in regard to marriage, child bearing, sports activities, and job performance. Overall back pain was also reported at a normal rate, with low-back pain significantly less frequent than the control group. Ten patients showed an increase of their curves exceeding 5 degrees; eight of these had been pregnant multiple times before age 25. None of the patients pregnant after that age increased their curve size. This study demonstrates that those patients who complete a Milwaukee brace treatment for adolescent idiopathic scoliosis from a functional and social point of view do very well. Early pregnancy is a significant risk factor for progression after maturity.(ABSTRACT TRUNCATED AT 250 WORDS)

Hand Fractures in Children

A retrospective review of 354 pediatric hand fractures was performed with a minimum follow-up period of two years. The incidence of epiphyseal injury was 34% higher than reported elsewhere in the skeleton. Growth disturbance was extremely rare, occurring only in two patients with severe crush injury and infection. Fracture displacement was most common in the border digits with displacement within a given digit most common in the metacarpal; the next most common were the proximal phalanx and distal phalanges; the least common was the middle phalanx. Malunion most often was associated with failure to obtain adequate true lateral and anteroposterior roentgenograms of the individual digits, failure to evaluate postreduction alignment in a position of full finger flexion, and was based on an erroneous assumption that a growth would correct for deficient reduction. Although nondisplaced intra-articular fractures uniformly healed without malfunction, poor functional results were obtained from displaced intra-articular fractures. The following injuries presented particular problems: displaced intra-articular fractures, Salter I distal phalangeal fractures due to crushing injuries, displaced subcondylar fractures, and open fractures.

Traumatic Disorders of the Shoulder

TRAUMATIC derangements of the glenohumeral joint are commonly encountered in clinical practice. These abnormalities may be acute or chronic and involve the bony supporting structures, cartilaginous elements, and/or periarticular soft tissues of the shoulder. The clinical presentation is usually nonspecific, and appropriate radiological techniques may be diagnostic. Radiological Evaluation In most instances, a radiological examination consisting of two or three projections of the glenohumeral joint is adequate. Anteroposterior roentgenograms, obtained with the arm in internal and external rotation, constitute the basic study. In external rotation, the humeral head has a club shape, with the greater tuberosity forming a smooth protuberance along its lateral aspect (Fig 1, left). In internal rotation, the humeral head assumes a symmetrical shape resembling a light bulb, with the greater tuberosity observeden faceand the lesser tuberosity forming the medial border (Fig 1, right). These projections do not constitute an ideal examination since the glenohumeral

Colonic Obstruction

History This 46-year-old man, admitted to the psychiatric service, was given amitriptyline hydrochloride, 125 mg daily, for depression. Six days later, nausea, vomiting, abdominal tenderness, and progressive distention of the abdomen developed. No bowel movement had occurred for two days. An anteroposterior roentgenogram of the abdomen demonstrated a large pelvic mass (Fig 1) with dilated large bowel. A prone horizontal-beam roentgenogram showed multiple airfluid levels, indicating large-bowel obstruction (Fig 2). An emergency barium enema examination showed a large mass compressing the colon extrinsically. The lumen of the sigmoid colon was narrowed and the mucosa appeared irregular, suggesting transmural involvement (Fig 3). Catheterization of the urinary bladder evacuated approximately 2.3 L of urine, and the signs and symptoms of intestinal obstruction disappeared. A postcatheterization barium enema examination outlined a normal colon. Diagnosis Mechanical obstruction of the sigmoid colon secondary to distention of the urinary bladder. Comment Distention of the urinary bladder

Ascites and cardiac failure in a diabetic man

History A 55-year-old man was admitted with increasing abdominal girth and deteriorating mental status over a one-month period. His medical history included the presence of diabetes mellitus, congestive heart failure, and degenerative arthritis. No history of alcohol abuse was obtained. The history indicated that two siblings had similar, although less severe, complaints. Physical examination revealed a cachetic man, with a metallic gray color to the skin. Tense ascites was noted, but no hepatosplenomegaly. Both testicles were atrophic. Figure 1 is an anteroposterior roentgenogram of the abdomen, Fig 2 is an unenhanced computed tomographic (CT) scan, and Fig 3 is a roentgenogram of the right hand and wrist (oblique). Diagnosis Primary hemochromatosis. Comment Both Figs 1 and 2 demonstrate a dense and markedly contracted liver in association with massive ascites. Increased attenuation of the spleen also is present on the CT scan. A single calcified gallstone and adynamic ileus are additional

The significance of roentgenographic measurement in scoliosis.

SummaryThe variability in measurement of the angle of curvature in scoliotic spines was estimated by having 50 anteroposterior roentgenograms read in random order twice by five orthopedic surgeons. The average error was ±9 (±2 SD) on duplicate readings, with a range of ±5° to ±15.1° for individual o

Intertrochanteric Flexion Osteotomy as an Only Alternative to Total Hip Arthroplasty in Advanced Osteoarthritis

This report is based on the study of 63 intertrochanteric flexion osteotomies of the hip with a ten-year follow-up. Every patient had severe osteoarthritis of the hip where abduction or adduction osteotomies could not possibly have recentered the femoral head in the acetabulum. The only alternative would have been a total hip arthroplasty. The reappearance of a congruent joint space on the anteroposterior roentgenogram of the proximal femoral epiphysis in flexion was the criterion for intertrochanteric flexion osteotomy. At ten-year follow-up, 65% had a good result, 10% fair, and 25% poor. This per cent of poor results is comparable to some statistics of late complications following total hip arthroplasties. After osteotomy, infection seldom occurs. Moreover, intertrochanteric osteotomy does not complicate the results of total hip arthroplasty.

A Colocutaneous Fistula in the Inguinal Area

History A 52-year-old woman experienced sudden pain in her right groin while feeding bales of hay to cattle. A tender swelling appeared in her right groin 48 hours later. One week later she saw her family physician because of reddened swelling in the groin. The swelling was assumed to represent an abscess and was incised. Fecal drainage developed from the site of the incision. Three weeks later the patient was admitted to the hospital and a barium enema examination was performed (Fig 1 and 2). Diagnosis Richter's hernia of the cecum. The barium enema examination demonstrated a knuckle of cecum (lateral margin) extending beneath the inguinal ligament to the site of the draining sinus. Figure 1 is a lateral roentgenogram demonstrating the intestinal-cutaneous fistula (arrows). Figure 2 is an anteroposterior roentgenogram showing knuckle of cecum herniated into the femoral canal (arrow). Comment A laparotomy was performed that established that the

Laryngocele. Radiological diagnosis.

LARYNGOCELE is an abnormal saccular dilation and elongation of the appendix of the laryngeal ventricle of Morgagni (Fig 1). The term laryngocele was introduced by Virchow in 1867.¹The laryngeal ventricle is a small elliptical recess between the false and the true vocal cords. Anteriorly it ends in a blind pouch known as the laryngeal appendix. This pouch varies in length, and if it extends above the upper border of the thyroid cartilage it is considered abnormal.²This appendix is present at birth and is relatively large. It begins to regress by the end of the sixth year. Though laryngoceles are uncommonly reported, they are not rare and occur more than the literature indicates.³Some examples are presented. Figure 2 is an anteroposterior roentgenogram of the neck of a 53-year-old man who complained of hoarseness of two months' duration. Before his admission he was given antibiotics, resulting

Laryngocele

LARYNGOCELE is an abnormal saccular dilation and elongation of the appendix of the laryngeal ventricle of Morgagni (Fig 1). The term laryngocele was introduced by Virchow in 1867. 1 The laryngeal ventricle is a small elliptical recess between the false and the true vocal cords. Anteriorly it ends in a blind pouch known as the laryngeal appendix. This pouch varies in length, and if it extends above the upper border of the thyroid cartilage it is considered abnormal. 2 This appendix is present at birth and is relatively large. It begins to regress by the end of the sixth year. Though laryngoceles are uncommonly reported, they are not rare and occur more than the literature indicates. 3 Some examples are presented. Figure 2 is an anteroposterior roentgenogram of the neck of a 53-year-old man who complained of hoarseness of two months' duration. Before his admission he was given antibiotics, resulting

Surgical treatment of compressive cervical band

Compression of the lower portion of the brachial plexus by a cervical band continuous with the scalenus medius is a rare but well-defined cause of arm pain. The syndrome should be suspected in a patient who presents with chronic arm pain and thenar atrophy. Cervical ribs or prominent C-7 transverse processes will be present on an anteroposterior roentgenogram of the cervical spine, and the diagnosis is confirmed by characteristic electromyographic findings. The syndrome should be differentiated from other causes of chronic arm pain, such as herniated cervical disc, syringomyelia, spinal cord tumor, or carpal tunnel syndrome. The condition is readily treated by surgical division of the compressive band, approached through a supraclavicular incision. (Neurosurgery, 7: 10-13, 1980)

A simple biplanar method of measuring femoral anteversion and neck-shaft angle.

A simple biplanar roentgenographic technique for measurement of femoral anteversion and neck-shaft angle is described in which no special equipment is required. An anteroposterior roentgenogram of the pelvis and the femoral neck is made with the hip in neutral rotation. The true lateral roentgenogram is made with the patient's limb in a lateral position with the hip and knee flexed and with the entire lateral aspect of the leg in contact with the top of the table. Projected cervicofemoral angulations are measured on the roentgenograms. The method is described to determine the true angles by dynamically illustrating the projected angles. Graphs have been prepared with which one can readily determine the anteversion and neck-shaft angles once the projected cervicofemoral angulations have been measured.

Duodenal Filling Defect

DUODENAL villous tumors are rare lesions that often have a characteristic roentgenographic appearance on upper gastrointestinal series. A typical example is discussed along with the important features of this interesting entity. Report of a Case A 55-year-old woman with a previous history of adult-onset diabetes mellitus, hypertension, and organic dementia was admitted to The New York Hospital with complaints of increasingly severe, crampy lower quadrant abdominal pain, no bowel movements for one week, and nausea and vomiting for three days. Findings from a physical examination were unremarkable, and admission laboratory results disclosed hypokalemia (presumably from chronic diuretic therapy), leukocytosis (from a urinary tract infection), glycosuria, ketonuria, and anemia. Anteroposterior and right lateral (Figure) roentgenograms from an upper gastrointestinal series show multilocular cauliflower-like filling defect in the descending duodenum. Diagnosis.— Adenocarcinoma arising in a villous adenoma of the duodenum with submucosal invasion. Comment The upper gastrointestinal tract series showed a multilocular

Effects of Ligamentous Injury on Ankle and Subtalar Joints

Using 10 normal fresh cadaveric legs, kinematic effects of ligamentous injuries around the ankle joint were studied while the ankle joint moved from maximum plantar flexion to maximum dorsiflexion in saggittal plane. A series of anteroposterior and lateral sequential roentgenograms was taken both in the normal and subsequently created injured condition, to evaluate instant center of rotation and horizontal rotation pattern in the hindfoot complex. Although the pattern of instant center of rotation of the ankle joint varied among normal condition, the majority fell in a prescribed area. The deviation of instant centers from those in uninjured condition was most evident in lateral ligament injury. The average horizontal rotation between the tibia and calcaneus was 8 degrees in the uninjured condition; 6 degrees in the subtalar joint and 2 degrees in the ankle joint. In both medial and lateral injuries, more rotation in the subtalar joint was noted in plantar flexion phase. In the ankle joint, the degree of excessive rotation in plantar flexion range was greater in lateral injury than medial injury, but that in dorsiflexion range was greater in medial injury. It appeared that while every component of collateral ligaments around the ankle was important in controlling rotation in plantar flexion range, the posterior portion of the deltoid ligament is most important in the forsiflexion range.

Legg-Calv??-Perthes Disease

The major controversy in Legg-Calvé-Perthes disease concerns its treatment. All authors recognize the need for containment of the femoral head but do not agree on the method of containment. Surgical containment is constant, does not require an endpoint for discontinuing treatment and has a short treatment period. Conservative treatment, however, produces comparable results, avoids operative and anesthetic complications but requires prolonged immobilization. The concept of Ferguson and Howorth can be validated and indicates that when early subchondral reossification is present on both the anteroposterior and lateral roentgenograms that conservative containment treatment can be safely discontinued thus shortening outpatient time to 12 months or less. The results of 165 hips undergoing conservative treatment and 27 who received surgery are analyzed. Eighty-one conservatively treated hips were mobilized early and followed for an average of 5 years. Their results were identical to those treated until the time of complete restoration of the capital femoral epiphysis. This reduction in outpatient treatment and the decrease in potential complications minimizes several of the major arguments in favor of surgical management.

Position of the Medial Internal Capsular Border in Relation to Third-Ventricular Width

The position of the medial internal capsular border (lateral thalamic border) in relation to the width of the third ventricle is of considerable importance to stereotactic surgeons. Close estimation of its position from anteroposterior roentgenograms diminishes the possibility of multiple brain penetrations in an attempt to find it by electrophysiological methods. By correlating the position of the medial capsular border found by a stimulation technique, with the width of the third ventricle, in a series of 130 patients, reliable ranges of its position were obtained.

The roentgenographic manifestations and clinical features of lumbar spinal stenosis with special emphasis on the superior articular process.

Sixty-three cases of surgically confirmed lumbar spinal stenosis were studied with regard to the clinical manifestations, routine spine films, and myelograms. The results are compared with the data in the literature. While our clinical and myelographic findings correspond in general with those published data, we have found important features of the superior articular process seen on routine anteroposterior roentgenograms which have not been described in the literature. Two illustrative cases are presented to demonstrate such features.

Operative Treatment of the Acutely Ruptured Lateral Ligament of the Ankle

Twenty-seven patients with acute inversion injuries of the ankle were treated surgically during the past ten years. Instability indicative of rupture of the lateral collateral ligament was demonstrated by anteroposterior stress inversion roentgenograms. Ruptures of a component or components of this ligament were found at operation in every case. The ligament and capsule were repaired and the ankle was immobilized by a plaster of Paris cast for six to eight weeks. Of 26 patients available for follow-up examination, none complained of instability although nine had minor residual symptoms. Postoperative stability was demonstrated by roentgenograms in 13 patients. In the other 13, clinical examination showed that the ankles were stable on forcible inversion of the foot and ankle. Our results indicate that surgical repair offers the best prospect for successful treatment when definite passive instability can be demonstrated by properly performed stress inversion roentgenograms.

Unusual Gas Shadow in Pelvis of Asymptomatic Patient

<h3>History</h3> A 47-year-old patient had anteroposterior and lateral films of the pelvis taken because of a minor injury to the left hip and knee. <h3>Diagnosis</h3> Transsexual pelvis. <h3>Comment</h3> A 47-year-old patient, originally a male, had had a transsexual conversion some years ago at another hospital. The anteroposterior roentgenogram of the pelvis (Fig 1) shows a typical normal male bony contour and structure (heavy bones and small pelvic cavity), with what appears to be a semiopaque speculum or obturator in the midline. The lateral view (Fig 2) locates this shadow not in the rectum but in the vagina. The patient then indicated that the shadow was that of a vaginal dilator, used frequently and over long periods to maintain patency in the surgically produced vagina. The dilator is a standard product produced by dealers in gynecologic material and measures about 13.34 cm in length and about 3.18 cm in diameter (Fig