A simple radiologic aid in the diagnosis of small avulsion fractures of the knee

The diagnosis of knee injuries roentgenographically can present difficulties. Two illustrative cases demonstrate that simple medial and lateral oblique projections with standard radiographic techniques can contribute to increased detection of small avulsion fractures which can be missed on the standard radiographic projections.     

Surgical treatment of Oddi's sphincter tumors. Apropos of 56 cases

The records of 56 patients operated upon for ampullary tumors were reviewed in order to determine the best way to diagnose and treat these tumors. Thirty six males and 20 females, 30 to 89 years old, were operated upon between October 1970 and October 1985. Eighty six p. 100 had jaundice and 21 p. 100, anemia. In recent years, ultrasonography, duodenoscopy and ERCP appeared to be the most useful tests for diagnosis. Mean size of the tumors was 2.3 cm (0.5 to 5 cm). Five tumors were benign (8.9 p. 100) and 51 were malignant. According to the classification of Martin, 5 were grade I: 10, grade II: 18, grade III: and 18, grade IV. The correct histologic diagnosis was obtained on biopsy specimens taken during endoscopy in 7 of 12 patients. Nine patients underwent palliative choledocoduodenostomies: only one is alive at 3 years; 47 underwent resection of the tumor: 3 local excisions associated with sphincterotomy for small benign tumors, 6 ampullectomies (followed in 3 by a Whipple procedure for recurrence) and 41 Whipple procedures. After pancreatic resection, 3 patients died during hospital stay and 12 had reversible complications; overall 5 year survival was 41 p. 100. It was 75 p. 100 in grade I, 50 p. 100 in grade II, 40 p. 100 in grade III and 10 p. 100 in grade IV. Patients who received an ampullectomy were alive with a follow up of 1, 2, and 3 years. All patients operated upon for a benign tumor were alive except one who died of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radiographic evaluation of cervical spine injuries

This study involves an evaluation of specific radiologic patterns of various cervical spine injuries on plain radiographs in order to determine a rational approach for further radiologic investigation and resultant treatment. We retrospectively reviewed 236 patients with 319 cervical spine injuries. Fractures included 50 of the dens, 21 hangman, 4 Jefferson, 29 burst, 24 compression, 32 corner/teardrop, 65 facet, 24 lamina, and nine pedicle. Dislocations included one occipitoatlantal, two atlantoaxial rotatory, and 28 facet. Pleuridirectional tomography performed in 137 cases and computerized tomography was performed in 26. The cases were divided into three groups according to the significance of their radiographic findings: Group I: no additional information was added by the additional radiographic studies compared to the plain radiographs. Group II: the additional radiographic studies changed the extent or type of injuries seen on the plain radiographs. Group III: plain radiographs were negative. The abnormalities were only found on the additional radiographic studies. Results of 137 patients undergoing tomography: 62 were in group I, 64 were in group II, and 11 were in group III. Of the 26 patients undergoing computerized tomography, 13 were in group I, 13 were in group II, and no patients were in group III. Specific fracture types were reviewed according to the distribution of the three groups. We concluded that pleuridirectional tomography appears to be particularly advantageous in patients with injuries involving the facets. Computerized tomography appears to add the most additional information in patients with laminar and posterior element fractures and C1 fractures. We feel that timely and accurate diagnosis of cervical spine injuries is essential.(ABSTRACT TRUNCATED AT 250 WORDS)     

Radiologic evaluation of dens fracture. Role of plain radiography and tomography.

A retrospective study of 50 dens fractures was performed. In 47 of 50 cases (94%), plain radiographs disclosed the fracture. Initial cross-table lateral view alone showed the fracture in 43 cases. In the remaining four cases, routine plain films revealed the fracture: open-mouth view in three cases and lateral skull view in one case. In 3 of 50 cases (6%), plain films were negative, and fractures were seen only on tomography. Conventional circular tomography was performed in 26 cases; results were divided into 3 categories according to the significance of the findings: Category I, tomography confirmed plain radiographic findings, but added no further information; Category II, tomography detected additional findings or showed the extent of injury better than plain radiography; Category III, fracture was only seen by tomography. There were 19 cases in Category I, 4 in Category II, and 3 in Category III. Careful evaluation of plain radiographs remains the primary method for diagnosis of dens fractures. Tomography should be performed whenever plain radiographs or clinical symptoms are suspicious for dens fracture. In addition, tomography is useful to define the fracture level and pattern, which are important factors in the management of these injuries.     

Satisfaction of search in diagnostic radiology

A subset of underreading errors (false-negative responses) in radiology has been attributed to "satisfaction of search," which occurs when lesions remain undetected after detection of an initial lesion. This phenomenon has not been studied in the experimental laboratory. A primary goal of this study was to develop a procedure or paradigm to study satisfaction of search. The authors measured detection accuracy for native lesions in images before and after the addition of a simulated nodular lesion. Simulated and native lesions were not spatially superimposed and the native abnormalities were physically identical with and without the nodules. Only responses related to the native lesion were analyzed. Accuracy parameters of receiver operating characteristic (ROC) curves were estimated by the method of maximum likelihood and jackknife. The average perceptual accuracy of the individual ROC curves as measured by Az and de' was significantly reduced with addition of the nodules (t = 2.364, p = 0.025, t = 2.648, p = 0.017, respectively). Az and de' parameters of the pooled ROC curve showed a similar effect (t = 1.573, p = 0.080; t = 1.934, p = 0.047, respectively). The results indicated a substantial satisfaction-of-search effect, with diminished accuracy in perception of native lesions.     

Forearm and vertebral bone mineral in treated and untreated hyperprolactinemic amenorrhea

To determine whether women with PRL-secreting pituitary tumors have similar decreases in cortical and trabecular bone and to determine whether bone loss associated with hyperprolactinemia is reversible, we measured forearm and vertebral bone mineral in normal women and in amenorrheic women with treated and untreated hyperprolactinemia. The mean spinal bone mineral content in hyperprolactinemic women [130 +/- 23 (+/- SD) mg/mL] was 25% lower than that in normal women (167 +/- 28 mg/mL), while the mean forearm bone mineral content (0.71 +/- 0.04 g/cm2) was similar to that in normal women (0.73 +/- 0.05 g/cm2). Women with normal serum PRL levels and regular menses after transsphenoidal surgery had slightly higher mean spinal bone mineral content (149 +/- 28 mg/mL) than women who remained amenorrheic after surgery (129 +/- 19 mg/mL), but the mean value in the cured women remained significantly lower than that in normal women. In contrast, women who had undergone successful transsphenoidal pituitary surgery had mean forearm bone mineral comparable to that in normal women. There was no correlation between vertebral and radial bone mineral in hyperprolactinemic women and no correlation between bone mineral and serum PRL, serum estradiol, or duration of amenorrhea when age was taken into account. These findings suggest that hyperprolactinemia and/or decreased gonadal function in women with PRL-secreting pituitary tumors are associated with more prominent effects on trabecular bone in the spine than on cortical bone in the wrist. In addition, the abnormal spinal bone mineral content after successful treatment suggest that normalization of estradiol and PRL secretion is not sufficient to restore bone mineral content to normal, although it may be stabilized.     

Posterior atlantooccipital subluxation in Down syndrome

Three Down syndrome patients with posterior atlantooccipital (AO) subluxation are described. All are asymptomatic. The subluxation becomes manifest during active extension of the neck and reduces in flexion. Methods of assessing posterior AO subluxation are discussed. The abnormality is attributed to ligamentous laxity in patients with Down syndrome.