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Biomedical subjects

G Chaljub

Publications and source records attributed to G Chaljub.

35 records · Page 2Linked to original sources
PubMed1996

Skull base allergic fungal sinusitis with abducens palsy in the third trimester.

Allergic fungal sinusitis (AFS) usually follows a slow course, but bone erosion including that of the skull base can be seen. Patients may present with intracranial extension mimicking a cranial base neoplasm. We describe a 21-year-old pregnant female initially seen at 27 weeks gestation with a complete right sixth nerve paralysis. MR imaging showed an apparent nasopharyngeal neoplasm invading both temporal lobes. Further evaluation revealed typical findings of fungal sinusitis on both CT and MR images. Biopsy results fulfilled the diagnostic criteria of AFS, and after endoscopic treatment the sixth nerve palsy quickly resolved. Although abducens palsy has been reported with acute bacterial sinusitis and with mucocele, and limitation of eye motility has been described with orbital involvement by AFS, we are unaware of any prior reports of true cranial nerve palsy associated with proven AFS. Our patient had no evidence of mucocele or of bacterial infection. The palsy in this case was presumably the result of compression of the cavernous sinus. The patient's pregnancy made decision making regarding imaging and surgical intervention complex. Mother and child are alive and well 31 months after surgery.

Case Reports↗
PubMed1996

Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans.

BACKGROUND: Anesthetic agents inhibit the respiratory activity of upper airway muscles more than the diaphragm, creating a potential for narrowing or complete closure of the pharyngeal airway during anesthesia. Because the underlying mechanisms leading to airway obstruction in sleep apnea and during anesthesia are similar, it was hypothesized that anesthesia-induced pharyngeal narrowing could be counteracted by applying nasal continuous positive airway pressure (CPAP). METHODS: Anesthesia was induced in ten healthy volunteers (aged 25-34 yr) by intravenous administration of propofol in 50-mg increments every 30-s to a maximum of 300 mg. Magnetic resonance images of the upper airway (slice thickness of 5 mm or less) were obtained in the awake state, during propofol anesthesia, and during administration of propofol plus 10 cm nasal CPAP. RESULTS: Minimum anteroposterior diameter of the pharynx at the level of the soft palate decreased from 6.6 +/- 2.2 mm (SD) in the awake state to 2.7 +/- 1.5 mm (P < 0.05) during propofol anesthesia and increased to 8.43 +/- 2.5 mm (P < 0.05) after nasal CPAP application. Anteroposterior diameter of the pharynx at the level of the dorsum of the tongue increased from 7.9 +/- 3.5 mm during propofol anesthesia to 12.9 +/- 3.6 mm (P < 0.05) after nasal CPAP. Pharyngeal volume (from the tip of the epiglottis to the tip of the soft palate, assuming this space to be a truncated cone) significantly increased from 2,437 +/- 1,008 mm3 during propofol anesthesia to 5,847 +/- 2,827 mm3 (P < 0.05) after nasal CPAP application. CONCLUSIONS: In contrast to the traditional view that relaxation of the tongue causes airway obstruction, this study suggests that airway closure occurs at the level of the soft palate. Application of nasal CPAP can counteract an anesthesia-induced pharyngeal narrowing by functioning as a pneumatic splint. This is supported by the observed reduction in anteroposterior diameter at the level of the soft palate during propofol anesthesia and the subsequent increase in this measurement during nasal CPAP application.

Adult↗
PubMed1995

The arthroscopic appearance of lipoma arborescens of the knee.

Lipoma arborescens is a rare intra-articular lesion consisting of a villous lipomatous proliferation of the synovial lining. This case report draws attention to the history, physical findings, and arthroscopic appearance of lipoma arborescens, a rare lesion of the synovial lining of the knee. Arthroscopically, the lesion appears as a synovial lesion with numerous fatty-appearing globules and villous projections. In addition, magnetic resonance imaging is a valuable tool to differentiate the lesion from rheumatoid arthritis, pigmented villonodular synovitis, and synovial chondromatosis in those patients who present with a chronic, swollen, and painful joint.

Arthroscopy↗
PubMed1995

MR imaging of nasal masses.

Magnetic resonance (MR) imaging is useful in evaluating the wide spectrum of diseases that cause nasal masses. MR imaging is most helpful in (a) defining tumor margins and possible intracranial extension and (b) differentiating tumor (which has intermediate, heterogeneous signal intensity on T2-weighted images) from concurrent postobstructive sinusitis and other infectious or inflammatory masses (which have high, homogeneous signal intensity on T2-weighted images if the secretions are well hydrated). The analysis becomes more complicated in cases with desiccated and mixed composition secretions. MR imaging also allows characterization of very vascular tumors, which show flow voids or marked enhancement. Low signal intensity on T1-weighted images and marked low signal intensity on T2-weighted images are characteristic of fungal sinusitis, and fat within a nasal mass indicates a dermoid or epidermoid cyst. Idiopathic midline granuloma, Wegener granulomatosis, and "cocaine nose" manifest as predominantly destructive midline masses. Despite the advantages of MR imaging, computed tomography remains the preferred imaging modality for evaluating nasal masses that contain calcification or originate from bone or cartilage.

Diagnosis, Differential↗
PubMed1993

CT of the spine: value of reformatted images.

Recent improvements in CT software allow rapid and high-quality two-dimensional reformatting of scans of the spine. Reformatting involves computer interpolation of two-dimensional multislice images acquired during routine axial CT scanning in order to generate a three-dimensional volume of data. From this block of data, new images are created and displayed in any desired plane. Reformatted images are acquired within minutes following axial CT scanning.

Humans↗
PubMed1993

Metastatic lesion of the optic nerve.

Metastatic disease to the optic nerve is uncommon. Optic nerve involvement has been described as an extension from choroidal, retinal, orbital, or central nervous system metastatic foci. Isolated optic nerve metastatic disease is extremely rare. We present the case of an isolated circumscribed metastatic lesion to the retrobulbar portion of the optic nerve detected radiographically.

Adult↗
PubMed1992

Massive epistaxis due to pseudoaneurysm. Treated with detachable balloons.

A case of massive epistaxis refractory to nasal packing and bilateral surgical ligation of the internal maxillary and ethmoidal arteries is presented. Angiography revealed a pseudoaneurysm of the cervical portion of the internal carotid artery, and intravascular detachable balloons were used for epistaxis control. The appropriate use of intravascular diagnostic and therapeutic techniques is described.

Adult↗
PubMed1992

MR imaging of clival and paraclival lesions.

A wide spectrum of diseases involve the clivus and paraclival structures. Primary neoplasms, metastatic tumors, and inflammatory, vascular, and hematopoietic disorders are the most common abnormalities to arise from or directly involve the clivus. MR imaging exquisitely shows and helps characterize the diseases that affect this area. Sagittal and coronal MR imaging allows precise localization and evaluation of the signal characteristics of a mass, enabling a more specific diagnosis. The multiplanar capabilities of MR imaging provide superb visualization of the adjacent cranial nerves and vascular structures, aiding in surgical planning and radiation therapy. In this pictorial essay, the MR imaging, CT, and conventional radiographic findings of various clival and paraclival lesions are illustrated.

Adult↗
PubMed1992

Pulmonary zygomycosis: a radiographic and clinical spectrum.

Eight documented cases of pulmonary zygomycosis were analyzed retrospectively with regard to radiographic and clinical features. Predisposing factors were diabetes mellitus in six cases, lymphoblastic lymphoma in one case, and surgery to correct a tracheoesophageal fistula in one case. Two of the patients with diabetes had also undergone renal transplantation for diabetic nephropathy and were immunosuppressed. The more usual radiographic findings of pulmonary zygomycosis represent a spectrum that comprises a normal chest radiograph, a lung abscess, subacute or chronic pneumonia that often evolves into a lung abscess, and rapidly progressive fatal pneumonia. Awareness of the various presentations of pulmonary zygomycosis is important because early diagnosis and appropriate therapy clearly have been shown to improve the survival rate of these patients. Zygomycosis should be included in the differential diagnosis when patients with diabetes mellitus, patients with leukemia or lymphoma, or immunocompromised patients present with or develop perplexing pulmonary abnormalities.

Adolescent↗
PubMedDate not supplied

Allergic fungal sinusitis with cranial base erosion.

BACKGROUND: Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses. METHODS: Our series of 28 cases of AFS was reviewed. We identified 6 cases of AFS with definite radiographic evidence of skull base erosion. RESULTS: Histologic diagnostic criteria for AFS were present in all 6 cases. All patients were managed with surgery, most recently conservative endoscopic surgery. An earlier patient underwent dural resection. Antibiotics were used in all patients, but no antifungal agents were administered. No patient has had a permanent neurologic complication, although one was seen with abducens palsy. There have been no cerebrospinal fluid (CSF) leaks. All 6 cases also had orbital bone erosion, but none has had permanent ophthalmologic sequelae. All patients were initially suspected to have a neoplastic disease. CONCLUSIONS: We propose a new diagnostic entity, "skull base allergic fungal sinusitis" (SBAFS), which incorporates the histologic diagnostic criteria of AFS with the computed tomographic (CT) criteria of bone erosion. Biopsy is necessary to rule out invasive fungus or tumor. Otolaryngologists, ophthalmologists, and neurosurgeons should be familiar with SBAFS so that systemic antifungal agents, craniotomy, and dural resection-which might initially appear necessary-can be avoided. Endoscopic surgical debridement and drainage combined with topical steroids can lead to resolution of disease, even in the presence of marked bone erosion and cranial neuropathy.

Adolescent↗
PubMedDate not supplied

In vivo MRI characteristics of lipoma arborescens utilizing fat suppression and contrast administration.

Lipoma arborescens or villous lipomatous proliferation of the synovium is a rare lesion. We describe the in vivo imaging characteristics of lipoma arborescens of the knee utilizing fat suppression techniques and contrast medium administration. As expected, the lesion demonstrated signal loss when utilizing fat suppression. In addition, no contrast enhancement was noted. When a synovial process demonstrates isointensity with subcutaneous fat on all pulse sequences and no contrast enhancement, lipoma arborescens should be the primary diagnosis consideration.

Adipose Tissue↗
PubMedDate not supplied

The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries.

The purpose of this study was to contrast the magnetic resonance imaging appearance of uninjured components of the posterolateral knee with that of injured structures, and to assess the accuracy of magnetic resonance imaging in identifying posterolateral knee complex injuries. Thin-slice coronal oblique T1-weighted images through the entire fibular head were used to identify the posterolateral structures in seven uninjured knees. The appearance of corresponding grade III injuries to these structures was identified prospectively in 20 patients and verified at the time of surgical reconstruction. The sensitivity, specificity, and accuracy of imaging for the most frequently injured posterolateral knee structures in this series were as follows: iliotibial band-deep layer (91.7%, 100%, and 95%), short head of the biceps femoris-direct arm (81.3%, 100%, and 85%), short head of the biceps femoris-anterior arm (92.9%, 100%, and 95%), midthird lateral capsular ligament-meniscotibial (93.8%, 100%, and 95%), fibular collateral ligament (94.4%, 100%, and 95%), popliteus origin on femur (93.3%, 80%, and 90%), popliteofibular ligament (68.8%, 66.7%, and 68%), and the fabellofibular ligament (85.7%, 85.7%, and 85.7%). Magnetic resonance imaging of the knee was accurate in the identification of these injuries.

Humans↗