Multiple level spinal injuries: importance of early recognition.

Patients with severe trauma may simultaneously sustain more than one level of spinal injury. Often, the second or third levels of injury are not recognized early enough to prevent clinically significant extension of the neurologic deficit, pain pattern, spinal instability, and/or deformity. A review of 710 spinal injury patients admitted to the Midwest Regional Spinal Cord Injury Care System yielded 4.5% multiple noncontiguous vertebral injuries. Thirty cases were studied in respect to location and type of primary and secondary injury. Of the secondary lesions, 40% occurred above and 60% below the primary lesion. In half of the patients, there was a mean of 52.6 days delay in diagnosis of the secondary lesion. Three major patterns of injury emerged from this analysis. Knowledge of these patterns and careful total spine radiography in patients with severe trauma may be a significant aid in early recognition of multiple level injuries and possible prevention of their complication.     

Bacteria-specific IgE in patients with nasal polyposis. A preliminary report

Sixty-one patients exhibiting chronic nasal polyposis had their conditions evaluated by radioallergosorbent tests to determine the presence of bacteria-specific serum IgE. Fifty-nine patients exhibited positive serum IgE to at least one of 11 bacteria tested. There are several implications of the collected data.     

The role of imaging in infertility management

In a retrospective review of 211 female infertility patients receiving ovulation induction agents, the role of sonography in infertility management is defined. Sonography is used to determine imminence of ovulation for timing of insemination and in vitro fertilization. It is also used to diagnose ovarian hyperstimulation syndrome. To identify characteristics of the ovarian follicles of women able to conceive that might differentiate them from those unable to become pregnant, patients were assigned to "pregnant" (30.8%) or "nonpregnant" subgroups. In 259 sonographically monitored cycles reviewed, follicular size and configuration were not different for the two groups. The cumulus oophorus was seen in 28% of pregnant patients (8/28) and in only two nonpregnant patients. Low-level echoes were seen in the mature follicles of 11 patients but not in the large follicles of nonpregnant patients. Low-level intrafollicular echogenicity may be a prognostic indicator of fertility and may represent a periovulatory state, optimal, in the appropriate clinical setting, for artificial insemination or in vitro fertilization.     

The role of allergy in manifestations of respiratory disease in adult cystic fibrosis.

BACKGROUND: Variability is present in the expression of the clinical phenotype in cystic fibrosis (CF). Part of this variability may be explained by the coexistence of allergy in CF. OBJECTIVE: To determine the rate of allergy in adult CF and evaluate the association between allergy and the manifestations of upper and lower airway disease. METHODS: We performed a cross-sectional study of consecutive patients enrolled in a university hospital adult CF clinic. Allergen specific IgE was determined by radioallergosorbent and skin prick tests to common aeroallergens. We characterized features of upper and lower airway disease by clinical evaluation of rhinitis and spirometry before allergy testing. RESULTS: The study population consisted of 55 patients. Allergen specific IgE was present to at least 1 aeroallergen in 67% by skin prick testing and 80% by radioallergosorbent testing. Rhinitis occurred in 50% of the population and was associated with immediate-type hypersensitivity to aeroallergens other than molds. The frequency of rhinitis increased when there was sensitization to a greater number of aeroallergens and rarely occurred in the absence of allergic sensitization. There was no detectable difference in lung function between those with and without allergic sensitization. CONCLUSIONS: Immediate-type hypersensitivity to aeroallergens commonly occurs in adult CF. The coexistence of allergy in CF is associated with clinical features of rhinitis. Because allergic manifestations of CF warrant appropriate therapy, individuals with CF should be evaluated for coexistent allergy.     

Lumbar fracture-dislocation related to range-of-motion exercises.

Range-of-motion exercises are an established and widely accepted therapeutic modality in the treatment of the person with spinal cord injury and are usually uneventful. Occasionally, however, accidents do occur; among them are fractures and dislocations of limbs. An unusual "slice" fracture of L4, related to range of motion exercises, occurred in a young man who was a quadriplegic and converted him from upper to lower motor neuron bowel, bladder and sexual function. This iatrogenic fracture, although extremely rare, can be prevented if symptoms are properly interpreted.     

Thoracic and lumbar spine fusion: postoperative radiologic evaluation

A retrospective review of 206 consecutive thoracic and lumbar fusions revealed a variety of surgical procedures performed for instability and malalignment after severe trauma. Stabilization procedures included insertion of 103 Harrington distraction and 15 Harrington compression rods, 84 Weiss spings, six Luque rods, and 10 miscellaneous plates and wires as single or multiple devices in combination with anterior and/or posterior fusions. Complications of surgical fusion included nine unhooked rods, six fatigue fractures of rods and springs, five overdistractions of vertebrae, four cases of severe kyphosis, and two failures of reduction. A meaningful postoperative radiologic evaluation can be accomplished only when indications for surgical techniques, their radiologic appearance, and possible complications are known.     

The reconstructed esophagus.

Reconstruction of the esophagus has been used for more than half a century. Benign as well as malignant diseases are treated in this manner. Viscera used for reconstruction are: colon, jejunum, and stomach. The different modalities of surgical intervention have been briefly summarized. Complications have been enumerated with the major ones stressed in more detail. The exact nature of surgical procedure should be known before attempting to evaluate roentgenologically a reconstructed esophagus. Preoperative roentgen evaluations, including barium study and angiography, are indicated for better postoperative results. Postoperative roentgen studies are needed to detect most of the postoperative complications.     

Adenocarcinoma in tubular duplication of the sigmoid colon.

A rare case of mucus-secreting adenocarcinoma in a tubular duplication of the sigmoid colon is presented. The pertinent radiographic manifestations were: a calcium containing soft tissue mass located at the blind end of a 20 cm barium filled tubular duplication originating at the sigmoid colon.     

Radiologic manifestations of iatrogenic changes of the esophagus

The review of the roentgen manifestations of iatrogenic changes in the esophagus permits their grouping into two major categories of intentional and nonintentional alterations. In the first group, iatrogenic changes are encountered following reconstructive or other types of surgery, radiotherapy, and their respective complications. Nonintentional changes of the esophagus include injuries induced during diagnostic procedures, life-saving measures, and drug therapy. The knowledge of the spectra of possible iatrogenic alterations is important for accurate radiologic evaluation of the patients and the recognition of complications.