Biomedical subjects
Publications and source records attributed to D J Curtis.
The authors report 8 cases of erosion of an Angelchik anti-reflux prosthesis into the stomach. Erosion is detected by the appearance of the smooth contour of the device in the stomach. One device migrated distally.
Two forms of swallowing were observed during videofluoroscopy in 166 asymptomatic patients, consisting of an air-containing ("open") pharynx in 120 (72%) and an occluded ("closed") pharynx in 46 (28%). The epiglottis inverted differently in the two forms of swallowing.
In a review of 618 videorecordings of the pharynx and esophagus, 77 (10.8%) had cricopharyngeal abnormalities. This represents twice the reported frequency. This paper examines the cricopharyngeal abnormalities. The cricopharyngeal muscle was observed consistently malfunctioning in the same manner in 36 (47%) of the patients. It was observed most consistently (20%) as a prominent structure throughout the swallow (15 patients). It also was observed early in the swallow (13 patients), late in the swallow (six), and obstructing the pharyngoesophageal transition (two). It was observed rising and falling with the motion of the larynx during the swallow. Over half the time (53%), however, it was seen at different times during the swallow, altered its appearance from swallow to swallow, and was seen at different levels. The significance of the cricopharyngeal muscle to the patient's health remains to be determined.
Four radiologists reviewed 197 hand and wrist radiographs to determine the usefulness of routine soft-tissue evaluation in the delineation of bony trauma. Soft-tissue changes at four sites in the lateral view were evaluated. Dorsal-hand fat-plane swelling was associated with second through fifth metacarpal fractures (p less than 0.01). Dorsal-wrist fat-plane swelling was associated with carpal fractures and wrist dislocations (p less than 0.01). Pronator and dorsal radial swelling were both associated with forearm fractures and carpal dislocations (p less than 0.01). Soft-tissue changes at five sites in the posteroanterior view were evaluated. Thenar swelling was associated with thumb metacarpal fractures and dislocations (p less than 0.01). Hypothenar swelling was associated with second through fifth metacarpal fractures and dislocations (p less than 0.01). Navicular fat-pad swelling was associated with carpal fractures (p less than 0.01) and strongly suggested a navicular fracture when present. Pararadial swelling was significantly associated with distal radial fractures (p less than 0.01), while paraulnar swelling was significantly associated with ulnar fractures (p less than 0.01). The lateral view of the hand and wrist is useful in compartmentalizing fractures to the hand, wrist, and forearm. Swelling in any compartment should lead to closer evaluation of all bony structures contained within that compartment. The soft tissues found in the posteroanterior view of the hand and wrist help further localize hand and wrist fractures. Additional views should be considered when significant swelling is present in the absence of an obvious fracture or dislocation. When more than one fat plane is unequivocally disturbed, protective immobilization with reexamination in 10 days is recommended.
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Progression of epiglottic movement was demonstrated on video tape during a pharyngeal swallow in 618 patients. Dysfunction of extrinsic laryngeal musculature and restriction of normal epiglottic motion produced the most significant changes. Intrinsic muscular dysfunction creates minor abnormalities in epiglottic motion but may lead to laryngotracheal aspiration. Alterations in normal movement should be recognized as such and significant neuromuscular and malignant disease considered.
An anteroposterior view of the first metacarpophalangeal joint with patient-induced adduction and abduction stress is described. Radial and ulnar instabilities are illustrated. The importance of making a diagnosis of collateral ligament rupture is stressed.
A microcomputer-based teleradiology system was tested over a six-month period by linking a medical center with four distant clinics. Data from more than 4,000 diagnostic x-ray examinations were digitized and transmitted from the clinics to the center, where they were displayed on video terminals and interpreted by 30 military and civilian radiologists. The original radiographs were interpreted independently and the video and film reports compared to determine the feasibility of the teleradiology system. Evaluation of the clinical effectiveness of the system indicated that the quality of the video images resulted in diagnostic findings and impressions that were somewhat less accurate than those reported from comparable film images.
A review of 618 pharyngeal examinations with barium demonstrated laryngotracheal barium in 108 patients. Frame-by-frame analysis of the video studies of these patients suggested the muscle groups responsible for the observed dyscoordination or dysfunction. Review of the literature suggested multiple causes for barium in the airway. Knowledge of specific muscular causes of aspiration should enhance the understanding of neuromuscular dyscoordinations and dysfunctions of the pharynx.
Erect (luxatio erecta) and superior glenohumeral dislocations are extremely uncommon. In luxatio erecta, the humeral head is subglenoid or subcoracoid just as in the more common anterior dislocation, but the shaft of the humerus is parallel to the spine of the scapula, not parallel to the chest wall as seen in the anterior type. Superior dislocations have the humeral head overlying the acromion or the clavicle on the anteroposterior radiograph. Radiographic findings in seven cases are presented and some of the associated complications are discussed.
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Laryngeal symptomatology is diverse and may be subtle. The barium swallow may be the first indication of abnormality and must be performed in a recorded mode since neurigenic dysphagia may be impossible to detect without the benefit of slow motion and replay. Inspiration, phonation, and the Valsalva maneuvers may give additional information in plain film, tomographic, laryngographic, or videofluoroscopic modes. They should be interpreted together and a specific functional abnormality determined if possible. The modified Valsalva and Mueller maneuvers, on the other hand, are means of evaluating anatomic variations, but provide little dynamic information. Neurologic and otolaryngologic consultation should be made for confirmation as required for patient care.
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The Quality Assurance Program of Walter Reed Army Medical Center is described. This program has been in effect since January 1, 1978 and is ongoing. The logical derivation of the use of the repeat film analysis as the focus of the Quality Assurance Program is described in detail. This repeat analysis procedure includes (1) the collection of all repeat and discarded film; (2) the separation of all repeat and discarded film into types according to the etiology leading to their being discarded; and (3) evaluation of radiographic artifacts to analyzed the types of artifacts, the mistakes which lead to these artifacts, and the means of eliminating the causes of these artifacts. Artifacts are categorized according to patient error, physician error, radiographer error, machine error, film screen processor error, etc. Statistics of this analysis are presented from January 1, 1978 through July 1, 1979. Pertinent examples of different types of errors are illustrated and the logical step-by-step process leading to the elimination of causes is explained in detail.
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