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Biomedical subjects

J C Mall

Publications and source records attributed to J C Mall.

At least 19 recordsLinked to original sources

Measurement of fetal shoulder width with computed tomography in diabetic women.

We conducted a feasibility study of the use of computed tomography (CT) to measure the width of the fetal shoulders and to predict large birth weight in infants of diabetic mothers. Computed tomography pelvimetry using low-dose digital radiographs was performed before delivery at term in 22 diabetic women. Shoulder width was estimated by direct electronic measurement on a single axial section through the shoulders of the fetus, and by orthopedic calipers within 48 hours of birth. Shoulder width by CT was 11.4-16.5 cm, and correlated significantly with postnatal measurements (r = 0.66, P = .01). Shoulder width by CT also correlated well with birth weight (r = 0.84, P less than .01), and measured more than 14 cm in all seven infants with birth weights more than 4200 g. Using 14 cm as a positive test and birth weight 4200 g as an abnormal result, the predictive value of a positive test was 78% and the predictive value of a negative test was 100%. This technique deserves further evaluation in assessing the risk of shoulder dystocia in potentially macrosomic infants.

Birth Weight

Emery-Dreifuss muscular dystrophy with autosomal dominant transmission.

A woman with early-onset, slowly progressive, humeroperoneal muscle weakness had marked restriction of neck flexion with contracture at the elbows. She developed exertional dyspnea at age 25, atrial fibrillation with slow ventricular rate was discovered, and a cardiac pacemaker was implanted. Her father had a similar disorder. There is at least one other report of autosomal dominant transmission of this clinical picture, which had previously only been reported as Emery-Dreifuss muscular dystrophy with X-linked recessive inheritance. Thus, more than one mode of inheritance is possible for this unusual and distinctive form of muscular dystrophy.

Adult

Diagnosis of Caroli disease by computed tomography: report of two cases.

Two patients are discussed in whom Caroli diseases was diagnosed with the aid of computed tomography (CT). One patient had the pure form of the disease, characterized primarily by saccular dilatation of the intrahepatic bile ducts and clinically manifesting as recurrent cholangitis. The second patient had a form ccharacterized primarily by hepatic fibrosis and clinically manifesting as portal hypertension. These are the first patients studied with CT to be reported to the authors' knowledge; CT is recommended as the optimal noninvasive method to evaluate such patients.

Adult

99mTc-methylene diphosphonate bone imaging in the evaluation of total hip prostheses.

A retrospective study was performed to determine the accuracy of 99mTc-methylene diphosphonate bone imaging in the evaluation of total hip arthrosplasty for lossening and/or infection. Using focally increased activity at the tip of the femoral component or in the region of the acetabular component as a criterion, the examination was 77% specific and 100% sensitive for loosening and/or infection. A possible explanation for the increased uptake at the tip of the femoral component and the role of this examination in the management of a painful total hip prosthesis are discussed.

Bone Diseases

HLA-B27 associated arthropathies.

The association between histo-compatibility antigens and disease is reviewed, in particular that between HLA-B27 and spondylitic disorders, i.e., ankylosing spondylitis, Reiter's arthritis, psoriatic arthritis, and ankylosing hyperostosis. We determined whether the presence of HLA-B27 predicted specific radiographic findings and, conversely, whether specific radiographic changes predicted antigenic status. The prevalences of the HLA-B27 antigen in our patients were: ankylosing spondylitis, 100%; Reiter's arthritis, 93%; psoriatic arthritis, 55%; and ankylosing hyperostosis, 12%. The only specific radiographic finding associated with B27 positivity was severe spondylitis in psoriasis.

Arthritis

Post-thoracotomy lung herniation.

Two cases of lung herniation complicating thoracotomy are presented. The classification and radiographic findings of lung hernia are reviewed.

Adult

Direct radiographic magnification for skeletal radiology. An assessment of image quality and clinical application.

Recent advances in technology have made radiographic magnification of the skeleton clinically feasible. A new electron gun micro-focal tube combined with new high-resolution recording systems were used to perform magnification radiography which was then compared with conventional contact radiography. Quantitative evaluation included measurements of speed, contrast, resolution, and noise. Qualitative evaluation included an analysis of 215 clinical cases in which both techniques were used. The superior image quality of direct radiographic magnification is confirmed and the clinical areas in which it proved most helpful are defined.

Arthritis

A unified radiological approach to the detection of skeletal metastases.

Radiographic bone surveys and radionuclide images, the principal methods of detection of skeletal metastases, have traditionally been treated as separate entities. Since their interpretation is reltaed, we attempted to determine the practicability of a unified radiological approach which employs both methods. All consultation requests for "skeletal surveys" or bone scans were reviewed, and an appropriate examination was "tailored" for each patient. During the inital four-month period, 141 patients were examined. Comparison of the final "tailored" examination with the original consultation request indicated that, without radiological guidance, excessive (18%), and inappropriate or inadequate (27%) examinations were ordered in many cases. The unified approach has proven to be feasible and desirable, resulting in a significant reduction of inappropriate examinations.

Bone Neoplasms

Efficacy of emergency radionuclide perfusion lung studies.

Over a one-year period, 206 patients with suspected pulmonary embolism received gamma camera perfusion lung images on an emergency 24 hr. basis. Clinical diagnosis listed pulmonary embolism in 37 of 39 patients whose images showed a high probability of it, in 28 of 69 whose images were abnormal but rated uncertain probability, and 5 of 98 with normal images. Retrospective clinical evaluation indicated 89 of the emergency images to be considered important, 95 contributory, and 22 not helpful in clinical management. As a result of the images, 80 patients were placed on heparin therapy of 198 considered for it, and 22 of 29 patients referred for hospital admission were placed on an outpatient basis. Delay in obtaining lung images creates the possibility of diagnostic uncertainty in interpreting the image.

Adolescent

Matrix calculi.

Matrix calculi are an uncommon form of urinary tract concretion. They must be considered in the differential diagnosis of a radiolucent mass within the renal collecting system or ureter. The clinical and radiographic features of three cases are presented and the literature of matrix calculi is reviewed.

Bacteriuria