Acta radiologica: diagnosis最新文献

From a series of patients undergoing routine radiographic examination, 112 temporal bones with a high jugular fossa were selected. Among these, 43 jugular bulb diverticula were found. The structures affected by a high fossa or diverticulum were recorded and correlated to the clinical symptoms of the patient. The vestibule was suspected to be affected in five patients. Two of these patients had tinnitus and vertigo, and three had hearing loss. In one of the latter the hearing loss was most marked in the supine position. The cochlea was close to the fossa in three patients, all of whom had tinnitus. Four patients had a defect of the posterior semicircular canal. One of them lost his hearing after a severe fit of coughing, became unsteady and showed signs of a fistula. The internal acoustic meatus and the mastoid portion of the facial canal were affected in two and four patients, respectively, who had no recorded symptoms. Twelve of 34 patients with Menière's disease and a high jugular fossa on the side of the diseased ear had a dehiscence of the vestibular aqueduct caused by the fossa or diverticulum, compared with nine of 58 patients in the unselected material. For comparison and demonstration of topographic relationships, 58 casts of unselected radiographed temporal bone specimens with high jugular fossae or diverticula were investigated. In patients with a high jugular fossa or jugular bulb diverticulum, tomographic assessment may be of value.

Closure of the laryngeal vestibule during swallowing is important for protection of the airways. The present investigation included 53 patients with dysphagia examined cineradiographically with the head held in resting posture, flexion and extension. The ability to protect the airways by the downward movement of the epiglottis and by obliteration of the laryngeal vestibule was studied in different postures of the head. Of 35 patients with normal laryngeal obliteration with the head in resting position 10 showed a defective closure at swallowing in extension. In 18 patients with defective closure of the laryngeal vestibule in resting position 9 were improved on flexion and two on extension of the head. In one patient with defective closure of the laryngeal vestibule in resting position swallowing in flexion showed an aggravated dysfunction. In four other patients the defective closure became more marked on extension. Four patients had less effective downward movement of the epiglottis with the head in extension. Of 10 patients with defective epiglottic movement with the head in resting position two were improved on tilting the head forwards. The results show that the position of the head influences the closure of the airways during swallowing. Patients with defective protection of the laryngeal vestibule should be instructed to swallow with the head tilted forwards.

Methods for quantitative determination of bone mineral and bone mass in normal subjects and in patients with metabolic bone disorders can be measured by the Compton scattering technique, the neutron activation analysis, by measurement of metacarpal bone mass, by single and dual photon absorptiometry, and by quantitative computed tomography. Measurement on metacarpal bone (radiogrammetry) seems to be able to distinguish between resorption and/or new bone formation at the periosteal and/or endosteal surface. The intraindividual observer variation on combined cortical thickness (D-d), cortical area (D2-d2), metacarpal bone mass (D2-d2)/D2-varies from 0.7 to 2.5 per cent and the interindividual observer variation from 1.0 to 5.8 per cent. Single photon absorptiometry measures bone mineral content in the forearm with great precision. The reproducibility using repeated measurements and automatic selection of the measuring area is about one per cent and can be used to follow changes in mineral content with time in patients with metabolic bone diseases. The dual photon absorptiometry may be used for measurements of bone mineral content in lumbar spine, in the femoral neck and measurement of total body calcium with an accuracy of less than 6 per cent and a precision below 3 per cent. Quantitative computed tomography has the ability to measure trabecular and cortical bone both centrally and peripherally. Using CT scanning, scanner related changes with time (day-to-day variation +/- 4%), patient repositioning (less than 1.5%), and fat concentration (residual uncertainty of approximately 1/6 of the biologic variation) are important factors influencing the accuracy and reproducibility of the values of the measured bone mineral content.(ABSTRACT TRUNCATED AT 250 WORDS)

Digital subtraction radiography was used in 84 patients with suspected pulmonary embolism to obtain information about localized changes in ventilation of the lungs. Preliminary experiences in patients with carcinoma of the lung, emphysema and acute inflammatory diseases have also been obtained. Digital subtraction radiography is a simple, rapid and inexpensive method to obtain information about ventilation in the lungs. It is completely non-invasive and requires only minimal cooperation of the patient. The sensitivity appears to be as good as that of 133Xe radionuclide ventilation studies.

Bone scintigraphy proved valuable in diagnosing McCune-Albright's syndrome in a 6-year-old girl by detecting multiple, non-symptomatic foci in the skull, axial skeleton and in the extremities. Subsequent roentgen examination showed abnormal bone structure in the affected areas, consistent with fibrous dysplasia.

Various clinical and laboratory aspects in 15 kidney transplanted patients with urographic evidence of caliceal clubbing and adjacent parenchymal scarring in their native kidneys are reported. These lesions were found in 16 per cent of our series of kidney transplantations; below 35 years of age it was the second most frequent disease. In 9 of these patients severe vesicoureteral reflux had been demonstrated. In the remaining 6 patients reflux nephropathy was only a tentative diagnosis based on a striking similarity in the radiographs and in several clinical findings. Nine patients had symptoms (mainly related to urinary tract infection) from 1 to 17 years before diagnosis/urography, in 5 as early as the first year of life. Recurrent urinary tract infection and renal impairment were the most frequent disorders leading to the diagnosis. Replacement therapy was initiated at an average age of 32.7 years. Following renal transplantation urinary tract infection was documented in 37 per cent of patients whether the patient had been bilaterally nephrectomized or not.

The influence of bolus consistency on pharyngeal swallow was radiologically studied in 24 individuals by comparing liquid barium and solid meat after chewing. Pharyngeal function was apparently performed synchronously and symmetrically on both boluses. No definite conclusion about the influence on epiglottic mobility, closure of the laryngeal vestibule and relaxation of the cricopharyngeal muscle could be drawn from this study. There was no difference in the elevation of the pharynx and larynx. The transit time for a solid bolus was shorter compared with that of a fluid bolus. The transit time for the apex of the bolus was shorter than for the tail. A more marked elevation of the pharynx and larynx was followed by a shorter transit time. The width of the pharyngo-esophageal segment was larger in the transverse than in the sagittal diameter during the passage of the bolus and larger on solid compared with fluid swallow. Our results reflect the ability of pharyngeal swallow to be executed with precision and with few alterations due to variable bolus consistency.

Computed chest tomography was performed in 13 rats with pulmonary damage due to microembolism, caused by injection of thrombin (500 NIH/kg body weight) and tranexamic acid, a fibrinolytic inhibitor (200 mg/kg body weight), and in 9 control rats. The purpose of the investigation was to perform attenuation measurements at two levels of the right lung, each with three regions of interest (anterior, mid and posterior). Alterations in attenuation, compared with controls, were correlated with lung weight. Compared with controls, the attenuation was significantly increased in the anterior and posterior regions at both levels in animals with pulmonary damage, but not in the mid regions. There was a statistically significant correlation between increasing attenuation and increasing lung weight. A significant difference was found between damaged and control lungs regarding the microscopic grade of interstitial oedema, alveolar oedema and fibrin. Histograms of attenuation values in computed tomograms might be of value in detecting alveolar oedema. It is concluded that computed chest tomography is a good method for detecting pulmonary oedema at an early stage of experimental microembolism in the rat.

The subarcuate channel conveys the blood supply to the otic capsule of the semicircular canals, to part of the vestibule and to other neighbouring structures. It is often observed in conventional radiographs of the temporal bone and is reproduced to advantage by conventional multidirectional and computed tomography. The purpose of this report is to draw the attention of otoradiologists to this anatomic structure and to report on some results concerning the radioanatomy of the channel. Plastic casts of 100 radiographed and subsequently macerated temporal bones were evaluated. Fourteen temporal bone specimens were submitted to automatic serial cryomicrotomy. The radioanatomic variations of the channel were demonstrated. The radiographic reproducibility of the channel, length and width, were found to be dependent on the degree of perilabyrinthine and mastoid pneumatization of the temporal bone.

Pharyngolaryngeal function during swallowing was investigated cineradiographically in 22 patients with paresis of the recurrent nerve. Nineteen of these patients (86%) had defective closure of the laryngeal vestibule: 10 patients had defective apposition of the corniculate cartilages, (paresis of the oblique cricoarytenoid muscle), 9 patients had defective apposition of the arytenoid cartilages, (paresis of the interarytenoid muscle), 13 patients had defective movement of the epiglottis (paresis of, i.a. the thyrohyoid muscle), 1 patient had defective closure of the subepiglottic portion of the vestibule (paresis of the thyroepiglottic muscle), 2 patients had defective closure of the supraglottic portion of the vestibule (paresis of the superior ventricular segment of the thyroarytenoid muscle). Five patients with immobility of the epiglottis also had paresis of the pharyngeal constrictor musculature indicating paresis of the superior laryngeal nerve. Our investigation has shown that patients with paresis of the recurrent nerve who present with dysphagia with or without aspiration should be examined cineradiographically for pharyngolaryngeal function during swallowing.