Roentgenologic Criteria Research Articles

Progressive fibrodysplasia ossificans

Clinics and diagnosis of a rare form of genetically grounded heterotopic ossification, i.e. progressive ossificating fibrodysplasia are presented on the basis of literature review and the authors experience. The authors described one patient, age 4,5 years, with heterotopic issificates on occipitocervical, subscapular and axillary zones. The patient had anomaly of great toes, flattened cervical vertebrae and deformity of the the fingers. The diagnosis of this syndrome is based on following clinical and roentgenologic criteria: presence of congenital deformity, shortening of toes and heterotopic ossification of soft tissues. Effective method of treatment does not exist.

COMPARISON OF THREE OPTIONS FOR TREATMENT OF CALCANEAL FRACTURE

Until now the problem of selecting a conservative or operative treatment option for calcaneal fractures and moreover the choice of the most optimal surgical procedure for such lesions have not been solved. Thus, comparative studies in this area is one of the most important tasks of the modern traumatology. Purpose of the study — to compare treatment outcomes, pattern and complications rate following the use of three treatment options for calcaneal fractures. Material and Methods. The authors analyzed treatment outcomes of 95 patients from 2013 till 2016. Mean age of patients was 39.04±12.51 years. Patients were divided into three groups: group 1 consisted of 41 patients with 54 fractures who underwent functional conservative treatment; group 2 consisted of 18 patients with 22 fractures treated by open reduction and plate fixation; group 3 consisted of 36 patients with 40 fractures treated by minimally invasive reduction and intramedullary fixation. Groups did not differ in respect of risk factors rate and rate of surgical risks under ABCDEF scale. Outcomes were evaluated basing on roentgenological criteria of reduction, complications rate and the functional scales FFI (Foot Function Index) and LEFS (Lower Extremity Functional Score). Results. Mean follow up was 20.8±9.0 months. Catamnesis was controlled in 68 out of 95 patients (71.6%). Variances were observed for all criteria of reduction quality between group 1 (no reduction) and groups 2 and 3. Groups 2 and 3 demonstrated similar criteria in respect of reduction quality of posterior articular surface, restoration of height and axis of calcaneus (р0.05). FFI and LEFS scores in group 1 were inferior to results in groups 2 and 3 (р0.05) at 6 and 12 months follow up. At 24 months follow up the variances persisted for mean values but were not statistically significant (р0.05). No differences between groups 2 and 3 were observed during all follow up terms (р0.05). Sum rate of complications in wound healing in group 2 was significantly higher than in groups 1 and 3 (р = 0.033). Conclusion. Any of the described options of surgical treatment resulted in an earlier functional restoration after calcaneal fractures as compared to conservative treatment. Reduction quality and late functional outcomes did not vary between the study groups, however, the rate of complications for wound healing in the group with open internal fixation was higher.

CLINICAL AND ROENTGENOLOGICAL CRITERIA OF SPINE-PELVIS RATIOS IN CHILDREN WITH DYSPLASTIC FEMUR SUBLUXATION

Aim of the study — to identify clinical and roentgenological criteria of the sagittal profile status of spine-pelvis segment in children with dysplastic femur subluxation.Material and Methods. The present study included 40 female patients (50 hip joints) aged from 12 to 17 years (14.7±1.58) with unilateral and bilateral hip joint instability due to dysplasia. Children were divided into two groups – the first group included 30 patients (30 hip joints) with unilateral femur subluxation, the second group – 10 patients (20 hip joints) with bilateral femur subluxation. All patients underwent a standard orthopaedic clinical examination using a specialized scale to objectify complaints. All patients underwent X-ray examination of hip joints in AP and Lauenstein projections, CT scanning as well as lateral panoramic roentgenography of C1-S1 including femoral bones in standing position of the patient.Results. The authors observed a strong positive correlation between sacrum inclination and lumbar lordosis curvature, antetorsion angle of proximal femur and sacrum inclination angle, severity of pain syndrome during impingement test and sacrum tilt: Pearson correlation coefficient was 0.71, 0.81 and 0.88 respectively. The authors reported in all patients a thoracic normokyphosis and lumbar hyperlordosis with excessive pelvis anteversion. Global sagittal disbalance was observed in all patients.Conclusion. Apart from typical anatomical and roentgenological changes in pelvic and femoral componentsof the joint the children with dysplastic femur subluxation are characterized by excessive pelvic anteversion. Criteria of above parameters are identical and do not depend on the number of joints involved into the pathological process. Cranial dislocation of femoral head results to abnormalities of sagittal spine-pelvis ratios. Pathological process in hip joints and abnormality of spine-pelvis ratios results in negative changes of sagittal spine profile in the form of hyperlordosis, of physiological criteria of thoracic kyphosis and of the global sagittal disbalance. All of the above leads to overload of spinal motion segments and development of spine degenerative and dystrophic changes at early age.

OUR EXPERIENCE IN THE TREATMENT OF CHILDREN WITH FOREIGN BODIES IN THE LOWER RESPIRATORY TRACT

Urrently, the problem of foreign bodies in the airways of children continues to be relevant. Aim - to assess the effectiveness of diagnostics and treatment of children with foreign bodies in tracheobronchial tree. Materials and methods. In the Department of otorhinolaryngology, the SBHI of MAMRRCI n.a. M.F. Vladimirskiy, we performed an integrated research of 189 children of different age, who had aspirated foreign bodies in the airways. We studied anamnestic, clinical, roentgenological and endoscopic criteria for the diagnosis of this pathology; we also studied the frequency of clinical complications caused by aspiration. Results. Follow-up observation of these children shows a significant frequency of remaining changes in the lungs after removal of foreign bodies. Discussion. In our opinion, for correct diagnosis and provision of qualified care to sick children it is necessary to raise awareness of parents and primary care physicians about the dangers of this pathology. If there is a reason to suspect a foreign body in the airways, consultation in a specialized institution is vitally important. The only correct method of treating children with foreign body in the airways, even at the slightest suspicion, is timely performed tracheobronchoscopy.

Internal Thoracic Impedance - A Useful Method for Expedient Detection and Convenient Monitoring of Pleural Effusion

Measurement of internal thoracic impedance (ITI) is sensitive and accurate in detecting acute pulmonary edema even at its preclinical stage. We evaluated the suitability of the highly sensitive and noninvasive RS-207 monitor for detecting pleural effusion and for demonstrating increased ITI during its resolution. This prospective controlled study was performed in a single department of internal medicine of a university-affiliated hospital between 2012-2013. One-hundred patients aged 25–96 years were included, of whom 50 had bilateral or right pleural effusion of any etiology (study group) and 50 had no pleural effusion (controls). ITI, the main component of which is lung impedance, was continuously measured by the RS-207 monitor. The predictive value of ITI monitoring was determined by 8 measurements taken every 8 hours. Pleural effusion was diagnosed according to well-accepted clinical and roentgenological criteria. During treatment, the ITI of the study group increased from 32.9±4.2 ohm to 42.8±3.8 ohm (p<0.0001) compared to non-significant changes in the control group (59.6±6.6 ohm, p = 0.24). Prominent changes were observed in the respiratory rate of the study group: there was a decrease from 31.2±4.0 to 19.5±2.4 ohm (35.2%) compared to no change for the controls, and a mean increase from 83.6±5.3%-92.5±1.6% (13.2%) in O2 saturation compared to 94.2±1.7% for the controls. Determination of ITI for the detection and monitoring of treatment of patients with pleural effusion enables earlier diagnosis and more effective therapy, and can prevent hospitalization and serious complications, such as respiratory distress, and the need for mechanical ventilation.Trial RegistrationThe study is registered at ClinicalTrials.gov NCT01601444

CT staging of malignant lymphoma. How to avoid misinterpretations

Therapeutic strategy and prognosis of malignant lymphoma are influenced by staging. Therefore, evaluation of pattern of lymphatic involvement is highly relevant. There are numerous pitfalls possible in detection and description when malignant lymphomas are visualized by computed tomography (CT). Normal anatomic structures may be interpreted as pathologic lymph nodes by inexperienced radiologists. Assessment and detection of lymphomas require precise knowledge of normal anatomic structures as well as roentgenological criteria and adequate methods of imaging. This report provides an overview of the relevant pitfalls and often overlooked areas in staging of malignant lymphomas.

セメントレス人工股関節のステム側の変化について

From 1991 to 1994, we performed 31 cementless total hip arthroplasties in 30 patients. Of these we were able to follow 15 joints in 15 patients for more than one year. From these 15 total hip arthroplasties, we assessed roentgenologic criteria on the stem side. According to the assessment, there were two “unstable” stems and it seemed important to get cancellous condensation in the proximal femur.

人工股関節再置換術における機種選択の検討 セメント使用例とセメント非使用例の近隔成績

Twenty-seven patients (27 hips) received revision of total hip arthroplasties from 1985 in our hospital. Seventeen of these cases which could be followed for over six months were evaluated using the JOA score and roentgenologic criteria. All cases showed over 70 points on the JOA sore. According to the roentgenologic criteria, results are as follows; 1) Twenty-five % of the revision with cement showed Grade III and Stage III (Charnley's and Nagaya's criteria). 2) Forty % of the cup components and 10% of the stem components of the cementless revision proved to be unstable. 3) Four cementless cases were unstable at first, but proved to be stable at the follow up. Roentgenologic assessment is more sensitive than clinical evaluation to examine the result of the revision hip arthroplasties.

Crackles in the early detection of asbestosis.

We studied 386 workers exposed to asbestos to assess the value of chest auscultation by a trained technician in detecting asbestosis as defined by previously reported clinical, physiologic, and roentgenologic criteria. The presence and degree of crackles were assessed at preselected basilar lung sites by a technician whose performance was validated by comparison with computer-generated time-expanded waveforms of tape recordings of lung sounds. Asbestosis was present in only 2.8% of the total population, but it was present in 8.6% of those with over 25 yr or more of employment. The technician correctly identified all the workers in whom the diagnosis was most certain, that is, those with all criteria positive. The overall true positive rate was 55%. The majority (94.8%) of those with no abnormal criteria were correctly classified. Auscultation by an objectively validated technician can be a useful noninvasive method for screening industrial populations exposed to asbestos.

Colitis in the elderly. A reappraisal.

The records of 81 patients with colitis whose symptoms began after the age of 50 years were analyzed to determine the importance of ischemia as a cause of colitis in this age group and to evaluate the accuracy of previous diagnoses. Patients were classified by clinical, roentgenological and pathologic criteria. A retrospective diagnosis of ischemic colitis was made in three-fourths of the patients, one-half of whom had original discharge diagnoses of ulcerative, Crohn's or nonspecific colitis. This study supports our belief that ischemia is the most common cause of colitis beginning in patients older than 50 years of age. Moreover, the incorrect diagnosis of idiopathic inflammatory bowel disease in a large proportion of these patients may explain why colitis has been reported to behave differently in the elderly than in the young.

Relationships of carbon dioxide retention to ventilatory impairment and hypoxemia in chronic obstructive lung disease.

In a group of 80 male patients (average age 52.5 years) with severe obstructive ventilatory impairment (FEV1.0 less than 40% of predicted) due to chronic bronchitis and/or emphysema, the blood carbon dioxide tension measured at rest, in a stable clinical status, was confronted to the spirometric variables and the oxygen tension. PaCO2 (range 31--60 mm Hg) was loosely related to the VC (r = -0.28) and the FEV (r = -0.30, both p less than 0.05) and strongly related to the PaO2 (r = 0.60; p less than 0.001). When patients were classified as bronchitic or emphysematous according to clinical, roentgenologic and biological criteria, the correlations above were found to be higher for bronchitics. In patients with chronic bronchitis with severe obstruction a very good estimation of PaCO2 is possible from PaO2: PaCO2 = 75.8-0.44 PaO2 (SEE 0.4 MM Hg).

Urodynamic studies in boys with disorders of the lower urinary tract. IV. Congenital bladder neck obstruction. A pre- and postoperative study.

Eighteen boys with diagnose of bladder neck obstruction, based on roentgenological criteria, underwent urodynamic investigations. In the majority of patients, urodynamics clearly deviated from the normal range, substantiating that bladder neck obstruction, although rare, really exists in male infants and children. A rather uniform radiographic appearance of the bladder neck was associated with different urodynamic patterns, suggesting that various pathophysiological mechanisms may be involved.

Vergleichende Untersuchungen zur Versorgung von Sektionsschnittnephrotomien mit konventioneller Nahttechnik und mit Duragurtung

On 13 rabbits total longitudinal nephrotomies were performed on both kidneys. On the right side the margins of the parenchyma were sutured together with figure eight sutures. On the left, the nephrotomies were closed by tying ribbons of human dura around the kidney. Excretory urograms after 4-8 months showed no differences on both sides. On histological examination there was no difference of the scars. After roentgenological and histological criteria there are no advantages by closing kidney wounds with dura ribbons versus conventional suturing technique.

PREDICTIVE CRITERIA OF SURGICAL CURABILITY OF RENOVASCULAR HYPERTENSION

Abstract. The data available before a hypertensive patient undergoes surgical treatment for renovascular hypertension have been assessed as to their value in predicting the effect of the operation on the hypertension. The 43 patients studied were selected to exclude secondary complications and technically unsatisfactory surgical procedures. The data were assessed individually and also by discriminant analysis to determine the best combination of criteria for preoperative prediction of surgical results. The best individual criteria were (in order of decreasing importance): 1) increased urinary concentration of creatinine or inulin on the diseased side or increased plasma renin activity (PRA) in the suprarenal inferior vena cava; 2) hemadynamic delay beyond the arterial stenosis (renal arteriogram); 3) duration of hypertension; and 4) sum of criteria from excretory urogram. Combination of clinical and roentgenologic criteria provided correct prediction in 80 to 85% of the cases, which is about the accuracy provided by the best individual criteria.

ACCURACY OF PREDICTING PULMONARY BLOOD FLOW, PULMONARY ARTERIOLAR RESISTANCE AND PULMONARY VENOUS PRESSURE FROM CHEST ROENTGENOGRAMS

ACCURACY OF PREDICTING PULMONARY BLOOD FLOW, PULMONARY ARTERIOLAR RESISTANCE AND PULMONARY VENOUS PRESSURE FROM CHEST ROENTGENOGRAMSARTHUR LIEBER, M.D., HAROLD D. ROSENBAUM, M.D., DANIEL J. HANSON, M.D. and H. M. KWAAN, M.D.Audio Available | Share

THE ROENTGENOGRAPHIC FINDINGS IN TOTAL LIPODYSTROPHY

THE ROENTGENOGRAPHIC FINDINGS IN TOTAL LIPODYSTROPHYRICHARD L. WESENBERG, M.D., JOHN L. GWINN, M.D. and GEORGE R. BARNES, JR., M.D.Audio Available | Share

A study of roentgenologic criteria for rheumatoid arthritis of the cervical spine.

T HE incidence of cervical spine involvement in rheumatoid arthritis is 86 to 88 per cent.”7’9 Lawrence4 found a surprisingly high prevalence of roentgenologic rheumatoid arthritis in random samples of the population, rising progressively with age to as much as 24 per cent in persons over the age of 75 years. These cases had not been diagnosed as rheumatoid arthritis by physicians prior to the population survey. There was a correlation between pain in the neck and arms, and roentgenologic involvement was noted in the cervical spine, hands and feet in all age groups; the sheep cell agglutination test was positively correlated in patients up to 64 years of age. In a clinical, roentgenologic and pathologic study of rheumatoid arthritis of the cervical spine, it was hoped that roentgenologic criteria could be established for the disease so that certain definite signs could be considered diagnostic by both radiologists and nonradiologists.’ Roentgenologic signs, reported in the literature6’8’9 as indicating rheumatoid arthritis were listed. Although 14 roentgenologic criteria were initially employed, studies determining interand intra-observer error disclosed that only io could be used by the 3 readers (a rheumatologist, J.H.B., a radiologist, F.W.V.B., and a Senior Fellow in Rheumatology, C.D.D.) and by individual readers from one time to another (Table i) without introducing interand intra-observer error. Investigators examined the roentgenograms together, prior to the blind readings, in order to agree on the identification of the roentgenologic signs and to ensure that all were reading concordantly. TABLE I

Method of radiologic diagnosis of congenital heart disease in children.

The systematic application of roentgenologic criteria here proposed permits the objective classification of patients with congenital heart disease. The basic criterion is the degree of pulmonary arterial vascularity, which may be increased, normal, or decreased. The first class, marked by increased pulmonary vascularity, is the largest, it includes interventricular and interatrial septal defects, the most frequent congenital heart lesions. The second largest class, marked by decreased pulmonary vascularity, includes another frequently seen lesion, the tetralogy of Fallot. The third class, with normal pulmonary vascularity, includes such lesions as coarctation of the aorta. Conventional films and fluoroscopy may need to be supplemented by retrograde aortography and angiocardiography; in addition, roentgenographic findings during heart catheterization often give valuable diagnostic clues. Analysis of the roentgenologic features of a case, obtained by conventional x-ray examination without contrast, considered along with the simple clinical data, will generally yield a working diagnosis.

Lesser Peritoneal Sac Perforation Complicating Gastric Carcinoma

Summary In a consecutive autopsy study of 1,522 cases, of all ages, 20 cases of gastric carcinoma were found, in which there were 3 cases of perforation. Of the 3 perforated cases, 2 involved the lesser peritoneal sac. These 2 cases are described with autopsy findings. In neither case was a clinical diagnosis made of lesser peritoneal sac involvement. The clinical and roentgenologic examinations presented no findings indicative of this condition. In one case both the lesser and greater peritoneal cavities were involved, in the other only the lesser sac was affected. The spread of the carcinomatous lesion in the latter case corresponded to the anatomic relation of the adjacent organs with the lesser omental sac. A detailed description of the clinical and roentgenologic diagnostic criteria of lesser peritoneal sac involvement following gastroduodenal perforations are more fully described in the preceding paper.

Spindle-Cell Tumors of the Gastro-Intestinal Tract

Tumors in the gastro-intestinal tract are rarely non-epithelial in origin. The present discussion is limited to the small percentage which are found arising primarily from mesodermal tissue, the so-called spindle-cell tumors. The typical subdivisions of this group—the neurinoma or neurofibroma, the leiomyoma, and the fibroma—are histologically well defined. Many cases, however, falling into intermediate groups, are difficult to classify, and this difficulty becomes exaggerated when malignant counterparts of benign tumors (”sarcomas”) are encountered. For this reason, the general terms “benign” and “malignant” spindle-cell tumor have been used. This investigation attempts to determine (a) the incidence of spindle-cell tumors in the gastro-intestinal tract; (b) the prospect for the patient in whom such a tumor is found; (c) what, if any, roentgenologic criteria there may be to aid in diagnosis, particularly in distinguishing between benign and malignant lesions. Material The study is based on 140 cases of s...