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Large experimental segmental bone defects treated by bone transportation with monolateral external distractors.

Monolateral frames were applied to five dogs and ten lambs for treatment of large segmental bone defects (LSBD) surgically induced in one of their femoral diaphyses. Reconstruction was attempted by bone transport, as developed by Ilizarov. Monolateral frames were used to minimize the draw-backs of Ilizarov's circular device. Radiographic, computed tomographic, and histologic studies were performed. The skin and soft tissues were not a major obstacle for the longitudinal migration of the screws during bone transport. Four months after the operations, healing and remodeling of the bone defect was always satisfactory. Histologically, the repair of the lengthened segment followed an intramembranous ossification pattern in its central areas and in the periphery as well. At the end of the experiment, the new induced bone had a virtually normal diaphyseal bone appearance. Bone transport for the treatment of experimental LSBD can be completed in monolateral frames.

Animals↗

[Report of 3 cases of adenoid cystic carcinoma of the palate. Clinical, histological and therapeutical considerations].

Three cases of adenoid cyst carcinoma of the palate are reported. In this study clinical features, pathological findings, treatment and prognosis are analyzed. In the 1st and 2nd cases we unfortunately verified that the course of the tumors based in a slow-continuous infiltrating spread. Moreover, in our first patient a late diagnosis of it made the prognosis become worse. In the 1st one, radical surgery is proposed for the adenoid cyst carcinoma diagnosed at an early stage without tumoral dissemination.

Aged↗

[Potentialities of some x-ray methods in sternal osteomyelitis].

X-Ray examination of 85 patients (63 with sternal osteomyelitis) carried out to plan a surgical intervention should be based on a complex of special methods including roentgenography in the lateral projection, spot roentgenography in oblique projection, and tomography with transverse direction of the x-ray tube movement. Employment of transverse direction of smearing in tomography helps imaging the sternum in the direct frontal projection, mapping the destructive changes, and comparing the results of other examinations with this map. X-Ray computer-aided tomography and osteoscintigraphy are advisable to assess the changes in soft tissues and the process activity. Such an approach appears to be the most useful in planning surgical strategy in patients with sternal osteomyelitis.

Humans↗

Sarcoidosis with nasal obstruction and septal perforation.

Although sarcoidosis is predominantly a pulmonary disorder, it often produces disease in the head and neck. For this reason, otolaryngologists should be comfortable in evaluating and treating the disease. The diagnosis of sarcoidosis often can be made with a biopsy of conjunctival or oral mucosa, even when disease manifestations are not apparent in those parts of the body. In a case of sarcoidosis involving the nose, a 54-year-old black man had a proliferation of small lumps on the tip of his nose. For many years, he had had daily epistaxis, anosmia and severe difficulty breathing through this nose. The bridge of his nose was deformed, and he had a large anterior septal perforation. Physical examination revealed palpable bilateral cervical lymphadenopathy. Laboratory test results were, for the most part, normal; however, fine-needle aspiration of one of the cervical lymph nodes showed multiple epithelioid granulomas with interspersed lymphocyte, and an incisional biopsy of the nasal tissue was highly suggestive of sarcoidosis. Unenhanced computed tomography also revealed widespread nasal inflammation and an abnormal soft tissue mass anterior to the maxilla consistent with chronic osteomyelitis. The patient's condition dramatically improved following treatment with oral prednisone; however, he considered undergoing reconstructive surgery for the noticeable nasal septal deformity.

Biopsy, Needle↗

[An epidural spinal abscess with caudal symptoms as a complication of Crohn's disease].

Progressive symptoms of caudal compression (flaccid paraparesis, sensory disorders), accompanied by severe pain and fever, developed over a few days in a 26-year-old man with Crohn's disease for 11 years. Spinal computed tomography, performed under the diagnosis of herniated disc, revealed intraspinal soft tissue, as well as gas in the spinal canal (L2-S3) and the paravertebral muscles. This led to the diagnosis of acute epidural abscess and a laminectomy was performed (at L4-S2). Intraspinally there was thickened, bluish fatty tissue; thick pus exuded between dura and the sacral roots. Suction-irrigation of the spinal canal was undertaken via an epidural drain. Postoperative contrast infusion into the colon demonstrated a fistula directed towards the sacrum. The postoperative course was complicated by severe respiratory impairment of which the patient died.--Epidural abscess is a rare complication of Crohn's disease. Because of its poor prognosis early diagnosis with magnetic resonance imaging or computed tomography should be undertaken in every patient with Crohn's disease who has back pain, fever or, particularly, symptoms of spinal compression.

Abscess↗

Reliability of soft-copy versus hard-copy interpretation of emergency department radiographs: a prototype study.

OBJECTIVE: The purpose of this study was to compare the diagnostic reliability of hard-copy and soft-copy interpretation of radiographs obtained in the emergency department using a methodology for evaluating imaging systems when independent proof of the diagnosis is not available. MATERIALS AND METHODS: We collected radiographs from a stratified sample of 100 patients seen in the emergency department. The images were obtained using computed radiography, and the digital images were printed on film and stored for display on a workstation. A group of seven experienced radiologists reported the cases using both film and the workstation display. The results were analyzed using mixture distribution analysis (MDA). RESULTS: The reliability expressed as the percentage of agreement of a typical observer relative to the majority was computed from the MDA. The result was 90% for both hard copy and soft copy with bootstrap confidence intervals of 86-94%. CONCLUSION: We conclude that, in the emergency department, soft-copy interpretation is as reliable as hard-copy interpretation. The strength of this conclusion depends on the validity of the MDA approach as well as the extent to which the observer sample and case sample are representative of the emergency department.

Diagnosis, Differential↗

Computed tomography diagnosis of macrodystrophia lipomatosa.

Isolated congenital macrodactyly, termed macrodystrophia lipomatosa, is a rare entity. It may be confused with plexiform neurofibroma, hemangioma, or lymphangioma. Computed tomography provides an ideal methodology to verify the fatty proliferation of soft tissue that accompanies bone overgrowth and distinguishes this lesion from the others in the differential list.

Adipose Tissue↗

Intraaortic growth of hydatid cysts causing occlusion of the aorta and of both iliac arteries: case report.

A woman who had been operated on previously for a paraspinal hydatid cyst presented with claudication of the lower limbs. Computed tomographic and magnetic resonance images showed multiple cysts in the soft tissues of the back, retroperitoneum, and lumen of the aorta and iliac arteries. Occlusion of the aorta and iliac arteries by recurrent hydatid cysts after previous surgery was confirmed with angiography and subsequent surgical exploration. The authors present the imaging findings of this unusual manifestation of cystic echinococcosis.

Adult↗

Comparison of survey radiography with ultrasonography and x-ray computed tomography for clinical staging of subcutaneous neoplasms in dogs.

A study of 26 dogs (examined consecutively) with infiltrative subcutaneous neoplasms (mastocytoma, n = 11; soft tissue sarcoma, n = 13; and adenocarcinoma, n = 2) was conducted. Dogs were evaluated by physical examination, survey radiography, ultrasonography (US), and x-ray computed tomography (CT) prior to surgical excision of the tumor. The purpose of the evaluation was to accurately define gross neoplastic margins before surgical excision and to determine whether a difference could be observed between routine clinical staging (physical examination and survey radiography) and more detailed clinical staging (US and CT imaging). The clinical stage of 5 of 26 neoplasms assessed by US and of 17 of 26 neoplasms assessed by CT was determined to be more advanced because of previously undetected neoplasia, greater neoplastic size, or greater tissue invasiveness. Preoperative imaging of infiltrative subcutaneous neoplasms, using US and CT, is highly recommended to accurately determine gross neoplastic margins.

Adenocarcinoma↗

Radiology of giant cell tumors of bone: computed tomography, arthro-tomography, and scintigraphy.

Radiologic studies of 50 giant cell tumors of bone in 48 patients were useful in assessing the anatomic extent for planning surgical treatment. Contrast-enhanced computed tomography (CT) provided the most useful and complete evaluation, including soft tissue extent and relationship to major vessels. Angiography was useful when the extraosseous extent and vascular relationships were not entirely clear on CT. Arthro-tomography was the best way to evaluate tumor invasion through subchondral cortex and articular cartilage. Reactive soft tissues, with edema and hyperemia, were difficult to distinguish from tumor tissue on CT and angiograms. Bone scintigrams often showed intense uptake beyond the true tumor limits.

Adolescent↗

CT and MRI features of low-grade fibromyxoid sarcoma in the shoulder of a pediatric patient.

We report the computed tomography (CT) and magnetic resonance imaging (MRI) features of a 10-year-old boy with low-grade fibromyxoid sarcoma (LGFMS) in the shoulder and correlate them with the clinicopathological features. LGFMS, a rare soft tissue sarcoma with bland histological features and paradoxically aggressive behavior, tends to occur in superficial regions and in children more than previously recognized. To date, few imaging studies have been reported, particularly in pediatric patients. In this case, precontrast CT showed a low- to isodensity mass and punctate calcification. On contrast-enhanced CT, heterogeneous enhancement was seen. MRI findings correlated well with the pathological features of the tumor. The myxoid area showed high signal intensity on T2-weighted MR images and heterogeneous enhancement after administration of contrast material; the hypercellular area demonstrated lower signal intensity on T2-weighted MR images and slight enhancement.

Child↗

Magnetic resonance imaging of extremity masses.

Twenty-seven adults with extremity masses were examined by magnetic resonance imaging (MRI). In 26/27 cases, computed tomography (CT) scans were available for comparison. Imaging with multiple pulse sequences is necessary to optimize diagnosis by MRI. Advantages of MRI include direct sagittal and coronal imaging, demonstration of vessels without contrast and superior soft tissue contrast. CT better demonstrates cortical destruction and small calcifications, which may be important in some cases. For noncalcified masses without bone involvement, MRI is equivalent or superior to CT. In those cases with calcification or bone involvement, MRI plays a role complementary to CT.

Adolescent↗

Imaging body armor.

This study examined the feasibility of performing radiographic studies on patients wearing standard-issue body armor. The Kevlar helmet, fragmentation vest, demining suit sleeve, and armor plate were studied with plain film and computed tomography in a simulated casualty situation. We found that the military helmet contains metal screws and metal clips in the headband, but diagnostic computed tomographic images can be obtained. Kevlar, the principal component of soft armor, has favorable photon attenuation characteristics. Plate armor of composite material also did not limit radiographic studies. Therefore, when medically advantageous, patients can be examined radiographically while wearing standard military body armor. Civilian emergency rooms should be aware of these observations because law enforcement officers wear similar protective armor.

Extremities↗

Strain imaging of coronary arteries with intraluminal ultrasound: experiments on an inhomogeneous phantom.

In coronary arteries, knowing the relative stiffness of atherosclerotic lesions can help physicians select the most appropriate therapeutic modality. Because soft material supports larger strains than hard, measurements of this quantity can distinguish tissue of differing stiffness. In a previous paper, we described techniques for computing displacements and strains in coronary arteries using an integrated angioplasty and imaging catheter. Here, we demonstrate that hard and soft materials in a tissue-mimicking phantom can be differentiated with this device. Because tissue motion cannot be distinguished from catheter motion a priori, we perform all computations in the coordinate system centered at the balloon's geometric center. This reference frame depends only on balloon shape and is independent of catheter motion. A specialized correlation-based, phase-sensitive speckle tracking algorithm has been developed to compute strain. Maximum phantom displacement was about 25 microns, and the maximum radial, normal strain was about 1.5 percent.

Catheterization↗

Three-dimensional imaging for evaluation of head and neck tumors.

OBJECTIVE: To determine the usefulness of three-dimensional imaging in addition to computed tomography in presurgical examination of patients with head and neck tumors. DESIGN: Two-dimensional computed tomographic information from 31 patients with oral facial tumors was converted to three-dimensional images. SETTING: University teaching hospital. PATIENTS OR OTHER PARTICIPANTS: A consecutive sample of 31 patients with oral facial tumors. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Improved treatment planning with the use of three-dimensional images used in conjunction with computed tomographic scans. RESULTS: The three-dimensional images from patients with minimal tumor invasion of bone or with massive soft-tissue tumors allowed easy appreciation of tumor dimensions, an important factor in treatment planning. In patients with small soft-tissue tumors with no evidence of bone involvement on two-dimensional scans, massive tumors with complete bone destruction, and recurrent tumors, the three-dimensional representations added little to the obvious presentation of the two-dimensional scans. CONCLUSIONS: Three-dimensional imaging is a useful adjunct to diagnosis and treatment planning in patients with minimal tumor invasion of bone or with massive soft-tissue tumors.

Color↗

Computer assisted tomography in experimentally induced orbital pseudotumor.

Induction of an entity that is comparable to pseudotumor of the orbit in humans has been performed successfully in the rabbit. Injection of a retrobulbar antigen in a previously sensitized rabbit produced a profound inflammatory mass. Proptosis, soft tissue swelling, and an orbital mass effect were grossly visible after a short interval. Computer assisted tomography disclosed dense orbital mass and uveoscleral thickening. Exenteration specimens confirmed as inflammatory cell mass similar to the histology associated with pseudotumor of the human orbit.

Animals↗

Intracortical chondroblastoma mimicking intra-articular osteoid osteoma.

We report a case of intra-articular intracortical chondroblastoma of the femoral condyle which radiologically appeared to be osteoid osteoma. A 19-year-old woman presented with a 3-year history of gradually increasing pain in the right knee and had been on nonsteroidal anti-inflammatory drugs for pain relief. Laboratory data were within normal limits. Radiographs showed a well-demarcated lucent lesion in the medial condyle of the right femur. A nidus-like lesion with calcifications and a sclerotic rim located in the cortex was imaged by computed tomography scan. Magnetic resonance imaging revealed bone marrow edema and soft tissue swelling around the lesion, with low signal intensity of the nidus-like lesion on both T1- and T2-weighted images. The lesion was excised en bloc and the histological diagnosis of chondroblastoma was made. A mild inflammatory reaction was observed in the bone marrow and synovium around the tumor. The chondroblastoma cells were shown to express cyclooxygenase-2 with immunohistochemistry.

Adult↗

Endometriosis mimicking soft tissue tumors: diagnosis and treatment.

The clinical manifestations, the radiologic appearance and the treatment of four women with extragenital endometriosis of the abdominal wall are presented. In two patients endometriosis was found adherent with the structures of the inguinal canal and in the other two the tumors infiltrated structures of the abdominal wall. Symptoms included cyclical pain and palpable subcutaneous masses fixed to the surrounding tissues. Computed tomography and magnetic resonance imaging failed to differentiate the lesions from other soft tissue tumors. Resection to healthy tissue margins is the treatment of choice, in order to avoid local recurrence.

Adult↗