Roentgenologic Findings Research Articles

Pseudoarthrosis of Calcaneus: Roentgenological Finding or Significant Condition?

Summary. Relevance. Calcaneus non-union (CNU) occurs in 1.3% of fracture cases; however, according to different authors, the frequency of this complication is much higher and is about 10%.
 Objective: to describe the clinical and roentgenological findings in patients with CNU; to highlight important aspects of diagnostics and surgical treatment.
 Materials and Methods. 9 patients with CNU have been observed. There were 7 males and 2 females. The average age was 34±1.5 (range 23-52) years. The average term from trauma to surgery was 13.5±1.5 (range 6-21) months. Changes in vertical talus-first metatarsal angle (vT1MA), pain syndrome (VAS), ankle range of motion, and foot function using AOFAS have been investigated. The indication for surgical treatment was symptomatic foot deformity; a subtalar arthrodesis with bone graft was used.
 Results. CNU was observed in 7 cases (77.8%) after the conservative treatment and in 2 cases (22.2%) after the surgical treatment. Roentgenologycally, the most characteristic feature was the extensor position of the talus and the associated with it the positive value of vT1MA, which causes an inverse relationship with the range of extension of the foot and reduces the height of the calcaneus. A subtalar arthrodesis with bone graft was performed in 7 cases (77.8%); in 2 cases (22.2%), the procedure was combined with calcaneus closing wedge osteotomy because of significant loss of hindfoot height. Bone fusion occurred within 8-10 weeks. vTMFA was 13±10 (13-150) before surgery and 8±10 (8-100) after surgery. Functional result by AOFAS was 63±2 points before surgery and 84±2 points 6 months after surgery.
 Conclusions. Calcaneus non-union is not accompanied by pain syndrome and is detected when the patient consults a doctor. The necessity of surgery in this case is decided on the basis of a detailed clinical and X-ray analysis and CT of the foot, taking into account the deformity of the hindfoot and the need for correction.

Lessons Learned From 35 Cases of Laryngeal Foreign Bodies Undergoing Misdiagnosis in Pediatric Population.

To present 35 cases of laryngeal foreign bodies (FBs) in pediatric population undergoing misdiagnosis so as to draw on our lessons to improve early diagnosis. A retrospective analysis over 15 years was conducted of 35 cases of laryngeal FBs undergoing misdiagnosis in children. Meanwhile, a control group, including 42 cases of laryngeal FBs without misdiagnosis in children, was set. These patients' clinical data were collected and analyzed to identify the risk factors for misdiagnosis. The results of chi-square test and univariate analysis both showed a significant difference in time elapsed between discomforts and admission, witnessed foreign body (FB) aspiration history, biphasic stridor, aphonia, roentgenologic findings, and type and size of FBs between the misdiagnosed group and control group. Multivariate analysis further identified delayed doctor visits, unwitnessed FB aspiration history, nonspecific symptoms, and negative roentgenologic manifestations as independent risk factors for misdiagnosis. Diagnosis of laryngeal FBs, especially small, thin, and radiolucent FBs, remains a challenge. We emphasized the importance of timely doctor visits, careful clinical history inquisition, and prompt performance of radiographic or endoscopic examinations for diagnosis.

Effectiveness of radiologic examination methods in diagnosis of pulmonary tuberculosis

To determine an optimal noninvasive radiologic examination method (computed tomography or roentgenography) in early diagnostics of pulmonary tuberculosis. We have selected 43 patients with diagnosis of pulmonary tuberculosis, who were examined using roentgenography and computed tomography during 2002-2006. Data were confirmed by biopsy or bacteriological test. Evaluation criteria were anamnesis, prolonged cough productive of sputum, prolonged fever, roentgenologic and laboratory findings (lymphocytosis, monocytosis), antibiotic therapy without response. Diagnostic signs of pulmonary tuberculosis were infiltration (89%), lymphadenopathy (63%), calcification in lymph nodes (49%), pneumofibrosis (56%), focus of tuberculosis (54%), foci in lung segments (67%). Other features were as follows: adhesions, pleural effusion, coated pleura, calcified tuberculoma. Biopsy was performed to 25% of patients: in 6 patients during fibrobronchoscopy, in 3 during operation, and in 2 during pleural puncture. Fibrobronchoscopy was done in 70% of patients, and findings were as follows: mucus (31%), blood (2%), bronchial deformations (22%), edema of bronchial wall (18%), and no pathology (31%). Only 8% had acid-resistant cocci. Computed tomography is 2 times more efficient than roentgenography in detection of lung alterations, dissemination with focal infiltration in the bronchioles, coated pleura, pleuritis, adhesions and 8 times more efficient in diagnosis of mediastinal lymphadenopathy. In evaluation of pulmonary consolidation, there was no significance difference between diagnostic methods.

Comments on coxa vara infantum with shearing of the epiphysis of the femoral head in Seckel's syndrome (author's transl)

Seckel's syndrome, also known as bird-headed dwarf of Seckel or nanocephalic dwarf, occurs very rarely within the field of orthopaedic diseases. 20 cases only have been described in literature so far. The article gives a detailed explanation of the syndrome. In the two patients discussed here, the specifically orthopaedic aspect follows from an accompanying coxa vara infantum with shearing of the epiphysis of the femoral head. The article describes the pre-operative and post-operative clinical and roentgenological findings.

Radiological and histomorphological correlation of bone tumors and tumor-like diseases (author's transl)

In the diagnosis of bone tumors and tumor-like lesions the radiographic examination plays a dominant role in the phase before performing a biopsy, with the support of this examination important facts are available for the further diagnostic procedure, for planning the biopsy and also for getting the preliminary guiding principles how the therapy has to be performed. In order to interpret a radiograph of a diseased bone optimally it is necessary to know the histomorphological background of an X-ray feature. This more particularly as the reaction of bone to a pathological process is limited to only 2 radiographic images: osteolysis or/and osteosclerosis. On the basis of the histological pattern and the dynamic micromorphological process the picture of osteolysis and osteosclerosis is analysed. The periosteal reaction is also considered in this manner. After the representation of these general principles a detailed tabulated synopsis is given about the correlation between the histological and roentgenological findings of all benign and malignant bone tumors and tumor-like conditions.

Scoliosis in infancy

1. The paper deals with 101 patients (52 male, 49 female) who have been treated in the first and second years of life because of resolving scoliosis and could be re-examined later at the age of 15 between 17 years. 2. The clinical and roentgenological findings of seven patients only had been normalized, where as in all other cases low lateral deviations of the spinal column (77 times), frequently at a modified type of curvature (44 times) or structural modifications (77 times, 17 spinal columns without lateral deviations), or not rarely, even both of them, had been found. 3. During development it came to a displacement of the vertex-vertebra on a average of 1-2 vertebrae to caudal. 4. No inspected resolving scoliosis had change over into a progressive scoliosis, a coherence consists not with idiopathic scoliosis of the prepuberty and puberty.

Tratamiento fisioterápico en el asma infantil: a propósito de un caso clínico

AimsWe present the case history of an eight-year-old girl with persistent moderate asthma due to repetitive bronchopneumonia episodes. Patient and methodsThe patient was referred by the Pneumology Unit for respiratory physiotherapy at a private clinic, with the prioritary aim of rendering permeable her airways, which were obstructed by mucous plugs coursing with bronchopneumonia. An initial physiotherapeutic assessment was carried out according to the Spanish Guideline for the Management of Asthma; this was to be followed by a five-month respiratory physiotherapy programme with the objective of achieving successful control of her asthma. ResultsThe results show an improvement of her spirometric values, of the pulmonary auscultation, of the roentgenologic findings and of the physiotherapeutic anamnesis, and evident self-control of her asthma episodes. ConclusionsThe institution of a respiratory physiotherapy programme in cases of childhood asthma improves lung function and the child's quality of life.

Comparative skeletal features between Homo floresiensis and patients with primary growth hormone insensitivity (Laron syndrome)

Comparison between the skeletal remains of Homo floresiensis and the auxological and roentgenological findings in a large Israeli cohort of patients with Laron Syndrome (LS, primary or classical GH insensitivity or resistance) revealed striking morphological similarities, including extremely small stature and reduced cranial volume. LS is an autosomal recessive disease caused by a molecular defect of the Growth Hormone (GH) receptor or in the post-receptor cascades. Epidemiological studies have shown that LS occurs more often in consanguineous families and isolates, and it has been described in several countries in South East Asia. It is our conclusion that the findings from the island of Flores, which were attributed to a new species of the genus Homo, may in fact represent a local, highly inbred, Homo sapiens population in whom a mutation for the GH receptor had occurred.

Clinical Characteristics of Aldosterone-Producing Microadenoma, Macroadenoma, and Idiopathic Hyperaldosteronism in 93 Patients with Primary Aldosteronism

Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a form of surgically curable secondary hypertension, and distinguishing APA from idiopathic hyperaldosteronism (IHA) is important for treatment. We made a differential diagnosis between APA and IHA using imaging tests such as adrenal CT and MRI as well as adrenal venous sampling (AVS) in all 93 cases of PA presenting at our institutions over the last decade. We identified 27 patients with aldosterone-producing microadenoma (APmicroA), all of whom could be diagnosed by AVS but not by the imaging tests. Then, we compared the clinical and roent-genological findings of these 27 patients with those of 42 patients with aldosterone-producing macroadenoma (APmacroA) and of 24 patients with IHA. Using surgically removed adrenal tissues, histopathological examinations and immunohistochemical analyses of steroidogenic enzymes were conducted. The findings for APmicroA were similar to those for APmacroA, except with respect to the diameter of the adrenal adenomas. Endocrinological and roentgenological findings for APmicroA were similar to those for IHA, but not to those for APmacroA. The rate of cure of hypertension was much greater in patients with APmicroA than in patients with APmacroA after the unilateral adrenalectomy (odds ratio, 4.0; p=0.028). In conclusion, it is important to accurately diagnose APmicroA, in which the laterality of the hyperproduction of aldosterone is only detectable by AVS, and to treat these patients by unilateral adrenalectomy in order to avoid long-term medical treatment and prevent hypertensive vascular complications.

Kashin-Beck disease: a historical overview.

In 1919, the first report on Kashin-Beck disease (KBD) made by a Japanese doctor described an endemic occurrence in the northern district of Korea. In the 1930s, Dr. Takamori and his colleagues at Manchuria Medical College produced a series of reports on its endemiology, clinical and roentgenological findings observed in the north-eastern district of China. In 1940s, a Tokyo University group led by Dr. Ogata found that the salivary glands of KBD patients were markedly degenerated. Administration of the condensed water taken from the endemic area into experimental rats produced degeneration of the salivary glands and changes in bones and joints similar to those of KBD. Thus, they proposed parotin deficiency theory as the etiology of KBD, and they recommended parotin therapy for KBD in its early stage. In the 1950s, Dr. Takizawa and his colleagues at Chiba University demonstrated that ferulic acid and p-hydroxy-cinnamic acid, found in the drinking water in the endemic area, caused degeneration of the salivary gland in rats. They recommended boiling the drinking water or using activated charcoal for the prevention of KBD. In the 1970s, the Japanese Ministry of Health and Welfare made a nationwide survey for the incidence of KBD in Japan. They concluded that there was no case of KBD in Japan with the exception of a few patients who had been brought up in the northeastern district of China and later had moved to Japan.

A CASE OF RECURRENT PNEUMATOSIS COLI WITH OXYGEN TREATMENT AT HOME

A 74-year-old man was admitted to the hospital because of a sense of abdominal fullness. Plain X-ray film of the abdomen showed lineal gas in the wall of the caecum, ascending colon and transverse colon. Moreover, free gas was found under the right subphrenic space. Under a diagnosis of pneumatosis coli with free gas in the abdomen, high density oxygen treatment was performed by T piece of 70% in concentration, 8l in flow after tracheotomy. The patient was discharged from the hospital after a cure on roentgenologic findings, but experienced a recurrence 2 months after discharge. As his condition was slighter than that at the first admission, high density oxygen treatment was performed by oxygen mask of 100% in concentration, 10l in flow. After discharge from the hospital, for the purpose of prevetion of recurrence, high density oxygen treatment was performed by oxygen mask of 90% in concentration, 3l in flow at home. The patient has now been followed for 1 year without any evidence of recurrence.

ISOKINETIC AND ISOMETRIC STRENGTH IN OSTEOARTHROSIS OF THE KNEE

Dynamic stability of the knee joint depends on the appropriate strength ratio of quadriceps and hamstring muscles. The purpose of this investigation was to determine the maximum peak torque (MPT) and MPT ratios of hamstrings to quadriceps (H/Q) muscles in patients with knee osteoarthritis (OA). Two groups of patients were included in the study. The first group consisted of 30 patients (Group A) with the clinical and radiologic findings of knee OA. The second group consisted of 30 patients (Group B) exhibiting knee joint pain without roentgenologic findings of knee OA. The findings of two patient groups were compared with each other and also with 30 healthy subjects (Group C). Isokinetic (at 60 degrees/s and at 180 degrees/s) and isometric (at 30 degrees and at 60 degrees of knee flexion) tests were performed by the rate-limiting isokinetic dynamometer system. Isokinetic and isometric MPT loss of knee flexors and extensors was found in both patient groups with respect to controls, but MPT ratios of H/Q muscles did not show a statistically significant difference compared with the control group. This may be related to the equal strength loss of knee flexors and knee extensors in patients with knee OA. It is concluded that strengthening exercises of hamstring muscles is as important as quadriceps strengthening in rehabilitation of knee OA.

Emergent Flexible Bronchoscopy for the Evaluation of Acute Chest Trauma

To determine the role of emergent flexible bronchoscopy (EFB) in the evaluation of acute chest trauma, we retrospectively reviewed the bronchoscopic reports of 30 consecutive patients. 26 male and 4 female, over a 3-year period. Twenty-two patients presented following blunt chest trauma and eight following penetrating injury. They all received EFB within the first 24 h of the trauma, 24 of them within 12 h of arrival. Eighteen patients (60%) had positive bronchoscopic findings: bleeding from a peripheral airway (four patients), mucus plugs or thick secretion (four), tracheal lacerations (three), bronchial transections (two), supraglottic tear (one), severe vocal cord synechiae (one), subglottic swelling (one), blood clot in the bronchus (one), and distortion of the bronchial mucosa (one). The physical and roentgen-ologic findings that indicated a high probability of positive bronchoscopic findings included open wound over chest, subcutaneous emphysema, decreased breathing sound, bilateral pneumothoraces, pneumomediastinum, and signs of tracheobronchial separation. Ten patients (33%) benefited from EFB by a contribution in early management based on the bronchoscopic findings, which consisted of emergency operation or relieving respiratory distress by suction of endobronchial blood clot or secretion. The cases that most benefited from bronchoscopy were the ones that underwent EFB within 12 h after arrival. There was no bronchoscopy-related morbidity or mortality. We conclude that while EFB is valuable in selected patients with acute blunt and penetrating chest trauma, no combination of physical findings and roentgenologic findings is able to satisfactorily predict which patients will benefit.

Spondyloepimetaphyseal dysplasia (SEMD) Shohat type

Recently a distinct spondyloepimetaphyseal dysplasia (SEMD) was reported in three members of a Jewish family. We present a 3.5-year-old Mexican boy with disproportionate short stature, peculiar face, short neck, small chest, abdominal distension, lumbar lordosis, short limbs, marked genua vara, and joint laxity. Roentgenologic findings include short long bones, wide and flared metaphyses with irregularities, delayed epiphyseal ossification, platyspondyly and morphological changes of vertebral bodies and fibular overgrowth. The striking resemblance of this patient to those previously reported confirms this form of SEMD as a distinct entity. Autosomal recessive inheritance is supported and the designation SEMD Shohat type is proposed.

頚椎後縦靭帯骨化症に対する片開き式脊柱管拡大術のＸ線所見と手術成績

We evaluated the roentgenological findings and operative results in 46 cases of ossification of the posterior logitudinal ligament in the cervical spine. All patients had open door laminoplasty at least a year previously. At follow-up ossification had elongated in size not less than 3mm in 31 cases, and thickened in size not less than 1mm in 17 cases. Ossification tended to expand after surgery in the cases with a short duration of myelopathy, young patients, and patients whose ossification edges were obscure and separated from the vertebral body or whose ossification seemed to grow twofold. In no patients did the ossification thicken by more than 2mm at the most stenotic site before surgery. Therefore we suggest that it is desirable that the spinal cord be decompressed even if the ossification is thickened by 2mm at the most stenotic site after surgery. It is necessary to enlarge the spinal canal sufficiently for the patient whose ossification is inclined to expand post-operatively, when we carry out open door laminoplasty.

Bone mineral density of the radius in patients with ossification of the cervical posterior longitudinal ligament. A longitudinal study.

Radial bone mineral density (BMD) in the distal one sixth and distal one third of the left radius was measured by single-photon absorptiometry (SPA) in patients with ossification of the cervical posterior longitudinal ligament (OPLL). Twenty-three OPLL patients (15 men and 8 women) with mean initial age of 60.1 years were studied longitudinally for mean follow-up period of 3.9 years. Based on roentgenologic findings, the patients were divided into two groups, those with advancing OPLL and those with non-advancing OPLL. The final value of distal 1/6th BMD in the advancing group was significantly lower than its initial value, but no change of the value of the distal 1/3rd BMD was observed in either group. The final value of distal 1/6th BMD/distal 1/3rd BMD ratio in the advancing group was significantly decreased compared with its initial value. These results suggest that, in the advancing OPLL group, trabecular bone mass decreased while cortical bone mass remained unchanged.

Limitation of annual screening chest radiography for the diagnosis of lung cancer. A retrospective study

The incidence and mortality rates of lung cancer have been increasing in many countries. However, the true effectiveness of screening for lung cancer is still controversial. This study aimed to examine the growth pattern of lung cancer and to evaluate the efficacy of screening. The authors linked the records of annual radiologic screening to cancer registry data and conducted a retrospective follow-up study of radiographs in all patients with lung cancer arising in a population undergoing screening. Among a total of 305,934 participants, screening detected 206 lung cancers, 103 of which were Stage I disease. Seventy-one of the 131 adenocarcinomas were Stage I, and 58% of them showed evidence of cancer for 2 years on a retrospective review of radiographs. Presentation as small faint lesions overlapping the normal chest structures delayed the early detection of adenocarcinoma. The overall sensitivity of screening was 70%, 52% for squamous cell carcinoma and 50% for small cell carcinoma. Rapidly growing Stage II-IV tumors without retrospective evidence of cancer on previous radiographs accounted for most of the cancers detected during the intervals between screening. Both the low detectability of Stage I adenocarcinoma and the late recognition of rapidly growing small cell and squamous cell carcinomas reduced the effectiveness of screening. More effective imaging methods and an antismoking campaign are required to reduce lung cancer mortality.

Cytologic diagnosis of oral, esophageal, and peripheral lung cancer

Oral cavity. Most carcinomas in situ of the oral cavity present as red or pink lesions that do not have a keratinized surface. Scrapings of such lesions readily disclose abnormal squamous cells diagnostic of cancer. Scrapings of the keratinized white lesions (so-called leukoplakia) are of no diagnostic value. Dentists, who are most likely to uncover precancerous lesions, are apparently not aware of the diagnostic options based on simple scrape smears. The method is also applicable to follow-up of patients with treated cancer of the oral cavity. Esophagus. Cytologic evaluation of esophageal cancer, initially by washings and subsequently by brushings under endoscopic control, is an established method of diagnosis. The diagnostic results are very good in symptomatic cancer patients and have an accuracy reaching 85-90%. Unfortunately the results of treatment of advanced lesions are very poor, with 5-year survival of only about 5%. Serious efforts at detection of early esophageal cancer started in China in the 1960s, using an abrasive balloon technique which was applied to asymptomatic populations in high risk areas such as Linxian in the Henan province of Central China. The Chinese investigators reported the finding of numerous precancerous lesions of the esophagus classified as carcinoma in situ and as dysplasia. Surgical resection of some of the precursor lesions apparently resulted in a significant drop in the rate of invasive carcinoma, although the statistical results were not convincingly presented. The balloon technique has been tested by us and by others in South Africa and in Transkei, confirming its efficacy in the diagnosis of early esophageal cancer. Peripheral lung. Sputum and bronchial brush cytology may uncover bronchogenic carcinoma in situ and early invasive cancers located in the primary or secondary bronchi. Small, peripheral lung lesions usually do not shed cells in sputum or brushings, and their discovery is usually based on roentgenologic finding. The identity of such lesions can be confirmed in most cases by a transcutaneous aspiration. Most of the peripheral malignant lesions are small adenocarcinomas or epidermoid carcinomas, both resectable by routine surgical procedures. Less commonly, oat cell carcinomas may be observed and these lesions should not be treated by surgery. Benign lesions such as granulomatous inflammation and fungal infections may also be identified by aspiration techniques. The prognosis of the resectable carcinomas varies with their size and the presence or absence of regional lymph node metastases.(ABSTRACT TRUNCATED AT 400 WORDS)

Neutrophil Recruitment in the Respiratory Tract of a Patient with Plasma Cell Granuloma of the Lung

A 69-year-old woman had plasma cell granuloma of the left middle lobe of the lung. Her symptoms and roentgenologic findings improved with antibiotic treatment. Before treatment, the number of neutrophils and NCA were markedly increased in BAL fluid obtained from the affected region of the left lung and moderately increased in BAL fluid obtained from the nonaffected region of the right lung. The number of neutrophils, the NCA as well as the contents of C5 and C5a des Arg (neutrophil chemotactic factors) in the BAL fluids from both these regions decreased during treatment. These findings suggest that plasma cell granuloma was due to chronic immune and inflammatory reactions in the lung, that neutrophils are involved in development of the symptoms and signs of this disease, and that neutrophil chemotactic factors, including complement-derived factors, are important in neutrophil recruitment at the lesion and in nonaffected parts of the lung.

Rickets and Metabolic Disorders

To the Editor.— The short report of Morrison and Kerr1 entitled "Growth Plate: Roentgenologic Findings in a Case of Tyrosinosis" deserves some comments. In addition to phenylketonuria and homocystinuria which were mentioned by the authors, roentgenologic bony changes were shown recently in a 5-month-old boy with mucolipidosis II (I-cell disease).2 Alkaline phosphatase was found to be elevated, and calcium and phosphorus levels were somewhat decreased in most of these cases. With the addition of roentgenologic findings one can be sure that all of these patients had rickets.