The destructive wrist arthropathy of pseudogout.
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Biomedical subjects
Publications and source records attributed to C B Stelling.
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Three males with the X-linked disorder dyskeratosis congenita are described. Each suffered femoral fractures after minimal trauma with poor healing. Long bones showed coarse trabecular patterns of the metaphyses and small lucency areas in the diaphyses. Two of the males were retarded brothers who additionally showed intracranial calcifications.
Fifty posteroanterior hand radiographs from normal adults were reviewed retrospectively to assess the incidence of cortical indistinctness at the base of the proximal phalanges in a normal population. This radiographic change, reported to be an early indicator of rheumatoid arthritis, was seen in at least one site in 10% of the films reviewed. Focal areas of cortical erosion or indistinctness at the bases of the proximal phalanges are not considered to be a reliable sign of early rheumatoid arthritis in the absence of juxtaarticular osteoporosis or changes in the metacarpal heads.
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A new case of congenital absence of a lumbar pedicle prompted a review of the English literature describing this rare defect. The majority of cases reported in detail were associated with anomalous attachment of a small ipsilateral transverse process directly to the posterior-lateral margin of the vertebral body. This sign is illustrated as a helpful accessory radiographic finding in congenital pedicle aplasia at a lumbar level.
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Maxillary sinusitis resulting from nasotracheal intubation is rare, occurring in approximately 2% of patients receiving ventilatory assistance. We have described two examples of this situation. In one case, the sinusitis caused bacteremia. The diagnosis can be made easily by a portable Water's view of the paranasal sinuses. Clinicians should be aware of this potentially serious complication in intubated patients.
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A patient with achalasia and neurologic deficit permitting intermittent nasopharyngeal reflux developed unilateral maxillary sinusitis. Heavy metal density in the center of the inflamed sinus almost certainly was barium sulfate refluxed during an upper gastrointestinal study.
This case is presented as an uncommon example of valvulae thickening caused in part by work hypertrophy of the circular muscular layer. This normal response of smooth muscle may occur in association with progressively obstructing lesions of the colon or ileocecal valve. Recognition of a similar abnormal small-bowel appearance may suggest the presence of a more distal obstructing lesion.
In a double-blind crossover clinical trial, 10 healthy volunteers received placebo and 2 mg glucagon intramuscularly preceding barium enema examination on separate days. In addition, 50 patients were given either placebo or 2 mg glucagon prior to barium enema examination in a double-blind study. The results of 38 variables determined on each study population were similar. When glucagon was given, both the patients and examiners noted significantly less discomfort and more bowel relaxation. There were no significant changes in pulse, blood pressure, or electrocardiogram. Adverse reactions did not occur frequently enough to allow confident comparison of placebo and glucagon. It is concluded that the use of glucagon can provide a more comfortable barium examination with acceptable safety.
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