Sonography of emphysematous cystitis.
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Biomedical subjects
Publications and source records attributed to E Barmeir.
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A case of giant left-sided frontal cerebral Echinococcus cyst causing headaches, galactorrhea--amenorrhea, secondary sterility, and gain in weight in an adult female patient is reported. The operative removal of this huge cyst led to complete neurological and endocrinologic recovery.
Computed tomography metrizamide myelography of the lumbar spine in the prone position is advocated for better visualisation of the thecal sac-disc annulus interface. This method allows a more precise diagnosis of disc herniation. Therefore, it is suggested that this technique should routinely be performed prone. In cases where suspended respiration in the prone position is difficult, the same result may be achieved by patient movement before scanning in the supine position.
Characteristic skeletal changes of dialysis bone disease associated with multiple fractures were found in ten patients on prolonged regular (high aluminium) haemodialysis. A subsequent prospective investigation with serial radiography demonstrated healing approximately twelve months after a changed treatment regime. The treatment used was deionized or reverse osmosis water dialysis and renal transplantation. The typical osteomalacic and osteosclerotic changes and particularly metaphyseal sclerosis were found to be associated with more rapid clinical healing, whereas secondary hyperparathyroidism indicated delayed healing. It is suggested that plasma aluminium imbalance may lead to disturbance of bone formation with fractures, while healing is associated with normal serum aluminium levels and is manifested radiologically by osteosclerosis, particularly in the metaphyses.
CT scans of 18 hips with typical congenital dislocation have been studied in 16 children. These show that the common position of dislocation is lateral, superior and slightly anterior, and that a "false acetabulum" can be distinguished even in young children. A defect in the posterior ischium causing distortion of the acetabulum was also present in most cases. The cartilage and the acetabular contents were well shown. Positions of reduction and the anteversion of the acetabulum and the femoral neck were studied. Hypotheses are presented on the mode of dislocation and on the cause of the pathological changes.
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The introduction of a small quantity of air by lumbar puncture in the lateral decubitus position followed by high-resolution computerized tomography (CT) scanning is a simple method allowing optimal visualization of the cerebellopontine angle cistern and the internal auditory meatus. Our experience with 37 CT pneumomeatographies in 22 patients who had clinical and audiometric findings suggestive of retrocochlear lesions is presented. Thirty-two examinations were normal, and 5 revealed small acoustic neuromas. In all cases, conventional X-rays, multidirectional tomography and contrast CT were nonconclusive. We advocate that CT pneumomeatography be the procedure of choice in the diagnosis of purely intracanalicular or very small extracanalicular acoustic neuromas.
A simple method of pelvic computed tomography after the inflation of a Foley balloon catheter in the uterine cavity is described. This method allows precise localization of the uterine corpus and determination of the relationships between normal and abnormal pelvic structures.
In many patients conventional radiographic procedures aid the detection of pericardial pathology. Echocardiography is undoubtedly the most satisfactory investigation for assessing pericardial thickening and fluid. However, in special circumstances CT of the mediastinum is able to offer additional information. Small quantities of pericardial air, associated tumor masses, and the extent of a pericardial effusion or pericardial calcification can be displayed most advantageously by CT.
Ten patients developed fracturing-bone disease (osteomalacia) while on dialysis against water with high levels of aluminium. Eight patients remained on dialysis, using de-ionized or reverse-osmosis water, and 2 received a renal transplant. Clinical improvement as regards bone pain and proximal muscle weakness occurred in 6 months and radiographic evidence of healing of the pseudofractures was seen at approximately 12 months. Associated osteopenia and hyperparathyroidism were found in most patients, but no significant change in either was noted during the study period. The serum parathyroid hormone levels rose significantly in the patients who remained on dialysis. The chest and pelvic deformities typical of healed osteomalacia were seen. This dramatic improvement can only be attributed to the removal of some water-borne element, either by changing the water used in the dialysis or by successful renal transplantation. Aluminium-containing phosphate binders were used throughout the study in the patients on dialysis, and hypophosphataemia was never a feature.
Computed tomography (CT) proved useful in the assessment of 14 cases of failed and complicated total hip arthroplasty. CT provided information in the axial plane about the extent of joint pathology and particularly acetabular involvement. The information obtained proved of aid to the orthopaedic surgeon in the operative planning, indicating the best approach and whether bone grafting to the acetabulum was required. In spite of computer artifact created by metallic implants in the scanning field we found that the required information about the bony components of the joint could be obtained.
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Subtle and isodense subdural haematomas present difficult problems on computed tomography (CT). The diagnosis is based predominantly on secondary signs of mass effect. A new sign is described, based on the detection of medial displacement of the grey-white matter interface (G-WMI). The presence and validity of this sign was evaluated in 66 cases with surgically proven subdural haematomas (SDH).
The anatomy of four baseline transaxial computed tomography (CT) slices of the hip is described and compared with the corresponding anatomical cuts in cadavers. Level I demonstrates the superior compartment of the joint and the superior aspect of the femoral head. Level II is clinically the most important in that it demonstrates the bone thickness of the medial acetabular wall. Level III is through the femoral neck and allows measurements of femoral anteversion and acetabular inclination. The fourth level demonstrates the calcar femorale, but is seldom performed. An easy method of achieving reference levels II and III without a survey radiograph is described; the radiation dose can therefore be reduced by performing only the clinically relevant slice.
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