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PubMedDate not supplied

Hypernasality in dysarthric speakers following severe closed head injury: a perceptual and instrumental analysis.

Hypernasality in the dysarthric speech of 20 severely closed-head-injured (CHI) subjects was investigated using both perceptual and instrumental techniques. A perceptual analysis of the speech of the CHI subjects was performed using a four-point rating scale for hypernasality. Instrumental assessment was carried out using a computerized accelerometric technique yielding a nasal coupling index. Results revealed a high incidence of perceived hypernasality (95%) in the speech of subjects in the CHI group. More than half of these subjects exhibited hypernasality of speech to a moderate to severe degree. When compared with a control group matched for age and sex the severely CHI subjects were perceived as being significantly more hypernasal. Instrumental assessment revealed that the functioning of the velopharyngeal valve in the group of CHI subjects was significantly impaired compared to the control group. The study highlighted the need to evaluate the perceptual and instrumental assessment results for the severely CHI subjects on an individual basis. The clinical implications of these findings are discussed.

Adolescent↗

PubMedDate not supplied

Arteriovenous malformation of the orbit and palate.

A patient was reported in which orbital and retinal arteriovenous malformations were noted. The value of oral examination in discovery of another palatal arteriovenous malformation is discussed.

Adolescent↗

PubMedDate not supplied

Facility report: New York University Imaging Science Center.

Current activity at the New York University Imaging Science Center, New York, is focused on diagnostic ultrasonographic imaging of soft tissues and computerized neurosurgery. For the latter, a new computed tomographic scanner has been designed.

Connective Tissue↗

PubMed1999

Spinous process fractures in a jockey: a case report.

Spinous process fractures typically represent avulsion injuries involving the lower cervical spine. This case report describes the clinical and radiographic findings in a patient with spinous process fractures at the T-2, T-3, and T-4 vertebral levels. The fractures, which were obscured on conventional radiographs by overlying osseous and soft-tissue structures, were optimally shown on axial and computer-reconstructed sagittal computed tomographic (CT) images. Although isolated spinous process fractures do not compromise spinal stability, chronic sequelae associated with fracture nonunion may occur if a fracture is not recognized and treated. Because conventional radiographic assessment of the thoracic posterior elements is often limited, cases of clinically suspected spinous process fracture often require CT evaluation to confirm the diagnosis.

Adult↗

PubMed1999

Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients.

To study the functional outcomes of patients with cervical herniated intervertebral discs with radiculopathy but without signs of cervical myelopathy using a retrospective cohort study design. The patients were retrospectively identified by chart reviews. Inclusion criteria were (a) cervical radiculopathy with defined neurological disturbances (sensory disorder, reflex abnormalities, and motor weakness); (b) a spinal computed tomograph scan or magnetic resonance image demonstrating neuroradiologic abnormalities (soft or hard disc); and (c) completion of conservative physical and pharmacological treatment. Of 119 consecutive patients who were treated at the Departments of Neurology and Neurosurgery, University of Erlangen-Nuremberg, between January 1, 1985, and December 31, 1995, 60 patients met the inclusion criteria and were prospectively assessed, with an average follow-up time of 5.5 years. The patients were interviewed with regard to their daily activities, ability to work, and the surgical treatment they had undergone. A complete neurological examination also was performed. In 88.3%, the onset of disease was acute and in 11.7% subacute or chronic. The most common signs and symptoms were brachialgia (98.3%), neck pain (93.3%), sensory disorders (88.3%), reflex abnormalities (61.7%), and motor weakness (51.7%). The neuroimaging procedures demonstrated a disc prolapse (soft disc) in approximately 90% and spondylotic osteophytes (hard disc) in approximately 10%. During an average follow-up time of 5.5 years (range, 4.6 months-10.6 years) 39 (65%) patients had been treated using only conservative methods (COG = conservatively treated group), and 21 (35%) patients had undergone surgery (ventral discectomy) (SUG = surgically treated group). Brachialgia was completely or essentially improved in 100% of the COG and 95.1% of the SUG. Sensory disorders remitted completely or markedly in 97% of the COG and 75% of the SUG. The reflex abnormalities normalized or improved in 59.2% of the COG and in 53.3% of the SUG. Motor weakness improved in 94.1% of the COG and in 50% of the SUG. Neck pain was difficult to treat. It improved in only 36.1% of the COG and in 20% of the SUG. Occupational capacity was lost in 10% of the COG and in 38.9% of the SUG. In a self-rating scale, 89.7% of patients in the COG did not feel disabled in their everyday activities, compared with 66.7% of the patients in the SUG. Patients with a herniated cervical intervertebral disc with radiculopathy can be treated conservatively with good results, although a residual intermittent neck pain syndrome often persists. The patients in the SUG, who initially showed more severe and long-lasting neurological disturbances, were improved at the time of examination, although with more marked residual disorders. Surgery is indicated only when appropriate conservative treatment for a reasonable time has failed.

Adult↗

PubMed2001

Utility of capromab pendetide (ProstaScint) imaging in the management of prostate cancer.

PURPOSE: Capromab pendetide (ProstaScint) is an indium In 111 ((111)In)-labeled monoclonal antibody to prostate-specific membrane antigen (PSMA) used to image prostate cancer. The appropriate techniques for obtaining images with this modality and the appropriate clinical indications for this study are in the process of being optimized. MATERIALS AND METHODS: From 1994 to 2000, 631 monoclonal antibody imaging studies with (111)In capromab pendetide were performed. The accuracy and utility of this modality in the primary staging of patients with disease at high risk of metastasis and patients with recurrent or residual disease after primary therapy were evaluated. RESULTS: In high-risk patients evaluated for risk of lymph node metastases prior to pelvic lymph node dissection, capromab pendetide imaging was found to have a positive predictive value (PPV) of 62%, negative predictive value (NPV) of 72%, sensitivity of 62%, and specificity of 72%. In patients evaluated with capromab pendetide imaging for prostatic fossa recurrence using prostatic fossa needle biopsy as the gold standard, capromab pendetide imaging was found to have a PPV of 50%, NPV of 70%, sensitivity of 49%, and specificity of 71%. CONCLUSIONS: The sensitivity and NPV of (111)In capromab pendetide imaging are better than those of computed tomography and magnetic resonance imaging for detection of soft-tissue and nodal metastases from prostate cancer. The utility of this modality has been demonstrated in the primary staging of patients with disease at high risk of metastasis. Patients with recurrent or residual disease after primary therapy also may benefit from capromab pendetide imaging prior to selection of salvage therapy. Innovative methods for the use of capromab pendetide imaging in radiation therapy treatment planning are under development.

Antibodies, Monoclonal↗

PubMed2002

[Stimulation and evaluation on maxillary distraction osteogenesis using CASSOS 2001].

OBJECTIVE: To simulate maxillary distraction osteogenesis and evaluate the change of soft and hard tissue before and after treatment, using Computer-Assisted Simulation System for Orthognathic Surgery( CASSOS 2001). METHODS: A fourteen-year-old boy with severe maxillary hypoplasia, due to unilateral cleft lip and palate, was analysed by cephalometric analysis. The simulations of maxillary distraction osteogenesis (Le Fort I osteotomy and Le Fort II osteotomy) were re-analysed. After the treatment, cephalometric analysis was preformed again. The data were compared. RESULTS: The maxillary hypoplasia was well treated using maxillary distraction osteogenesis; Compared with Le fort I osteotomy, more satisfactory results can be obtained by Le fort I distraction osteogenesis. CONCLUSION: Maxillary distraction osteogenesis is a better way to treat severe maxillary hypoplasia with operated CLP than maxillary osteotomy. CASSOS 2001 can help surgeons and patients on simulation and evaluation of maxillary distraction osteogenesis, and on decision of treatment plan.

English Abstract↗

PubMed2004

Transoral penetration of a half-split chopstick between the basion and the dens.

A 6-year-old girl was admitted for transoral penetrating injury by a half-split chopstick. Subsequent CT imaging examinations showed that the chopstick had passed between the basion and the dens and reached the subarachnoid space just at the medulla oblongata. A sagittal reconstructed CT scan was useful for the evaluation of the injury. Imaging findings and their clinical relevance are discussed.

Brain Injuries↗

PubMed2004

Endoscopic sinus surgery treatment for a huge sinonasal fibroma.

Fibromas are rare tumors of the nasal cavity, which may result from progressive inflammation or fibroblastic proliferation of the nasal mucosa. The tumors are usually too small to cause symptoms. We present a 47-year-old woman suffering through right nasal obstruction, purulent rhinorrhea and severe headaches for 6 months. A gray-white, smooth-surfaced, gigantic firm mass occupying the right nostril was found in physical examination. Sinus computed tomography revealed 4 x 3 x 3 cm soft-tissue-density mass in the right nasal cavity and right maxillary sinusitis. The huge sinonasal fibroma measuring 4.5 x 3 x 3-cm in the right posterior ethmoid sinus, which was successfully endoscopically resected. The final diagnosis of fibroma was made histologically, according to light microscopy and immunohistochemical stain examinations, which were important for determining the patient's treatment. After endoscopic resection, her initial signs and symptoms were relieved and no recurrence was noted after 2 years of follow up.

Endoscopy↗

PubMed2005

Total necrosis of the intranasal structures and soft palate as a result of nasal inhalation of crushed OxyContin.

Nasal inhalation of substances such as cocaine has long been linked to septal necrosis and more recently to palatal perforation. This report describes the case of a 37-year-old man who was addicted to crushed OxyContin (sustained-release oxycodone HCl) tablets and who presented with total necrosis of the septum, sinuses, and soft palate. To the best of the author's knowledge, this is the first reported case of nasal and palatal necrosis linked to nasal inhalation of crushed OxyContin, which is a relatively new form of drug abuse. The pathophysiology of drug-induced sinonasal disease and a review of the literature are also presented.

Administration, Intranasal↗

PubMed2005

Abdominal aorta and inferior vena cava thromboses in advanced stage of malignant fibrous histiocytoma.

Asymptomatic simultaneous thrombosis of abdominal aorta and inferior vena cava is a rare complication in advanced malignancy. We described an incidental finding of this clinical entity in our patient who presented with advance stage of malignant fibrous hystiocytoma of soft tissue and pathological fracture. The radiological evaluation with spiral computed tomography scan of abdominal aorta and inferior vena cava are presented and the subsequent management highlighted.

Aorta, Abdominal↗

PubMed1991

[Retention cyst of the prostate with projection of hyperplastic tissue: report of a case].

A 46-year-old man presented at Kasukabe City Hospital because of urinary retention. Digital rectal examination revealed soft distended mass in the retrovesical space. Transrectal ultrasonography and computed tomography showed a retrovesical cystic lesion of 14 x 11 x 10 cm in size and a mass protruding into the cyst from posterior lobe of the prostate. The cyst and the mass were removed suprapubically. The cyst was filled with 400 ml of clear yellowish fluid containing acid-phosphatase and prostate-specific antigen in a high concentration, but no spermatozoa. The mass protruded posteriorily from the prostate. The wall of the cyst was partly lined with double layer of columnar epithelium. The histological examination of the mass showed marked nodular hyperplasia and dilated acini of the prostate gland was seen around the cyst. A diagnosis of retention cyst of the prostate and nodular hyperplasia of the prostate were made. Cysts of the prostate are uncommon and retention cysts protruded by markedly hyperplastic prostatic tissue are extremely rare.

Cysts↗

PubMed1991

Massive intrapelvic synovial cyst as a complication of total hip replacement arthroplasty: a case report.

The authors report a case of massive intrapelvic synovial cyst complicating total hip arthroplasty in a 35-year-old woman with rheumatoid arthritis. The clinical presentation raised the possibility of a coincidental soft-tissue malignant tumour. This was ruled out by ultrasonography, computed tomography, fine-needle aspiration with examination of cells and culture and, ultimately, by image intensification in the operating room during aspiration of the cyst and injection of the adjacent hip joint with Hypaque. The authors conclude that perforation of the acetabular floor at total hip arthroplasty was likely the precipitating event. After 1 year there was no indication for surgical excision of the cyst.

Adult↗

PubMed1989

Magnetic resonance imaging in the diagnosis of anterior tibialis muscle herniation.

Magnetic resonance imaging (MRI) can be employed to successfully image the fascial compartments of the leg. Herniated muscle tissue and fascial discontinuity can each be unequivocally identified. Both the extent of fascial splitting and the size of the muscle herniation can be demarcated and quantified. MRI is favored over computed tomography because of its superior ability to distinguish soft-tissues structures, making it possible to see both muscle and fascia separately.

Hernia↗

PubMed1988

Orbital inflammatory pseudotumor associated with multifocal systemic neoplastic immunoincompetence.

A 52-year-old man developed proptosis from an orbital mass which was documented histopathologically to be an inflammatory orbital pseudotumor. When the lesion failed to resolve after six months of adrenocorticosteroid treatment, a second biopsy showed an inflammatory mass with nests of eosinophilic granuloma. The patient soon developed a lymphoma of the soft palate and a glioblastoma multiforme which led to the patient's rapid demise. Eosinophilic granuloma is known to represent the more benign end of the spectrum of histiocytic disorders in which a proliferation of Langerhans' cells and an abnormality of T-suppressor cells occur. Our case represents the first report of multifocal tumor immunoincompetence occurring with eosinophilic granuloma in an orbital inflammatory pseudotumor.

Adrenal Cortex Hormones↗

PubMed1985

Tenosynovial osteochondroma of the hand. A case report and brief review.

A 61-year-old man presented with a slowly growing, painless mass over the dorsum of his right hand. Roentgenography, computed tomography, and a radionuclide bone scan revealed a soft-tissue mass with mineralization but no bone or joint involvement. Routine laboratory tests and a chest roentgenogram were negative. A biopsy was inconclusive. The mass was removed en bloc and was diagnosed as synovial osteochondroma arising from the extensor tendon sheaths. The patient has been symptom-free 16 months postoperation. The literature indicates that these tumors occur almost exclusively in the hands or feet and are thought to develop by metaplasia from the mesenchymal cells of the synovial membrane; mineralization and ossification of the tumor are secondary. The actively growing tumor is often cellular and may show atypical cytologic features. Such microscopic characteristics should not be interpreted as evidence of a low-grade chondrosarcoma. A review of the literature failed to disclose a case with malignant transformation, although several lesions had recurred, some more than once. For this reason, complete removal of the involved synovia is of great importance.

Chondroma↗

PubMed1983

Radiology of sacrococcygeal chordoma. Difficulties in detecting soft tissue extension.

Plain radiographs of seven patients with sacrococcygeal chordomas showed sacral destruction, enlarged sacral neural foramina, and, usually, a presacral mass. Conventional tomograms clarified these bone abnormalities, which were often poorly visible on the plain radiographs. Two radionuclide bone scans showed increased peripheral uptake around the lesion, and one showed decreased uptake in the area of destroyed bone. Angiograms demonstrated only vessel displacement, and barium enemas showed only displacement of bowel by large soft tissue masses. Five myelograms were normal. Adequate surgical treatment of sacral chordomas requires a wide radical resection that avoids contaminating the wound with tumor. Therefore, thorough preoperative radiologic evaluation of the anatomic extent of a chordoma is essential. Although computed tomograms in three patients provided the best delineation of the total extent of bone and soft tissue involvement, tumor extension into gluteal muscles and other tissues eluded radiographic detection. The widespread infiltrative growth pattern along soft tissue planes and nerves and into vessels, undetectable by the above listed studies, mandates a cautious approach and a wide surgical margin, to prevent wound contamination and subsequent recurrence.

Aged↗

PubMed1994

[Magnetic resonance imaging in 80 cases of orbital tumors].

Magnetic resonance imaging (MRI) is a new medical imaging technique which has been used in evaluating ocular and orbital diseases in recent years. Owing to the high resolution of soft tissues and lesions, it is superior to ultrasound and computed tomography in the localization and characterization of an orbital tumor in diagnosis. In this paper, we analysed 80 cases of MR images of orbital tumors by which all the lesions were detected. Benign or malignant disorders were recognized in 59 cases and complete tumors with accurate localization were shown in 79 cases. The principles of MRI, signal intensity of various tumors and the indications of MRI were discussed.

Dermoid Cyst↗