Efficacy of daily bedside chest radiography as visualized by digital luminescence radiography

To determine the diagnostic impact of daily bedside chest radiography in comparison with digital luminescence technique (DLR; storage phosphor radiography) and conventional film screen radiography, a prospective randomized study was completed in 210 mechanically ventilated patients with a total of 420 analysed radiographs. The patients were allocated to two groups: 150 patients underwent DLR, and 60 patients underwent conventional film screen radiography. Radiological analysis was performed consensually and therapeutic efficacy was assessed by the clinicians. There was no statistical significant difference between the frequency of abnormal findings seen on DLR and conventional film screen radiography. In total, 448 abnormal findings were present in 249 of 300 DLR and 97 of 120 conventional film screen radiographs. The most common findings were signs of overhydration (41%), pleural effusion (31%), partial collapse of the lung (11%) and pneumothorax (2%). One hundred and twenty-three of 448 (27%) of these abnormal findings were thought to have a considerable impact on patient management. The high rate of abnormal findings with significant impact on patient management suggests that the use of daily bedside chest radiography may be reasonable.

["Phtisis atra"--a now seldom disease picture as a special disease course of silicosis]

Progressive massive fibrosis (PMF) of the lung is caused by coalescence of fibrotic nodules. The center of the PMF often displays necrotic areas. If the necrosis gets in contact to the bronchial system cavitation may occur. We report on a 68 year old patient suffering from severe silicosis of the lung and metastatic spread of a histologically proven lung cancer into the brain. The patient who was administered to the hospital under the intention of cerebral radiotherapy showed a colliquative PMF in the right upper lobe with cavitation and expectoration of large amounts of black-stained sputum (melanoptysis).

[Virtual bronchoscopy in the child using multi-slice CT: initial clinical experiences]

PURPOSE

Virtual bronchoscopy of the pediatric patient has been reported to be more difficult because of artifacts due to breathing or motion. We demonstrate the benefit of the accelerated examination based on multislice spiral CT (MSCT) in the pediatric patient which has not been reported so far.

MATERIAL AND METHODS

MSCT (tube voltage 120 kV, tube current 110 mA, 4 x 1 mm Slice thickness, 500 ms rotation time, Pitch 6) was performed on a CT scanner of the latest generation (Volume Zoom, Siemens Corp. Forchheim, Germany). In totally we examined 11 patients (median age 48 months, range 2-122 months) suspected of having tracheoesophageal fistula (n = 2), tracheobronchial narrowing (n = 8) due to intrinsic or extrinsic factors or injury of the bronchial system (n = 1).

RESULTS

In all patients we obtained sufficient data for 3D reconstruction avoiding general anesthesia. 6/11 examinations were described to be without pathological finding. A definite diagnosis was obtained in 10 patients. Virtual bronchoscopy could avoid other invasive diagnostic examination in 8/11 patients (73%).

CONCLUSION

Helical CT provides 3D-reconstruction and virtual bronchoscopy in the newborn as well as the infant. It avoids additional diagnostic bronchoscopy in a high percentage of all cases.

A pilot study on the effects of exercise in patients with systemic lupus erythematosus

OBJECTIVE

A pilot study was designed to assess the efficacy and safety of different exercise therapies on patient-reported fatigue and functional status.

METHODS

Ten patients with systemic lupus erythematosus (SLE) were randomly placed in either an aerobic exercise group (group 1: n = 5) or a range of motion/muscle strengthening (ROM/MS) exercise group (group 2: n = 5). Outcome measures assessed at baseline and the end of the study were fatigue, functional status, disease activity, cardiovascular fitness, isometric strength, bone mineral density (BMD) of the lumbar spine and femoral neck, and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation, respectively.

RESULTS

Both aerobic and ROM/MS types of exercise were safe and did not worsen SLE disease activity. Patients in both exercise groups showed some improvement in fatigue, functional status, cardiovascular fitness, and muscle strength. Both groups showed increased bone turnover, but BMD was unchanged. Eighty percent of the patients met the compliance standard for the study.

CONCLUSIONS

This pilot study shows the feasibility of exercise for SLE patients. The potential value of this approach shows promise in the routine management of these patients.

[Computerized tomography detection of portal vein air accumulation in severe gastroenteritis during chemotherapy]

Portal venous gas is caused by various pathological processes, both iatrogenic (complications of endoscopy) and non-iatrogenic (bowel ischemia, obstruction, perforated gastric ulcer, septicaemia). We report an immunocompromised patient suffering from metastatic cancer of the breast who developed severe gastroenteritis. Plain radiographs of the abdomen showed branching tubular lucencies that extended from the porta hepatis widely over the liver. A computed tomography performed to exclude air in the biliary tract demonstrated portal venous gas. Although the finding of portal venous gas has been associated with a high mortality rate and usually necessitates surgery, our patient survived without surgical intervention.

Measurement of impulsivity: construct coherence, longitudinal stability, and relationship with externalizing problems in middle childhood and adolescence

This study focused on the assessment of impulsivity in nonreferred school-aged children. Children had been participants since infancy in the Bloomington Longitudinal Study. Individual differences in impulsivity were assessed in the laboratory when children were 6 (44 boys, 36 girls) and 8 (50 boys, 39 girls) years of age. Impulsivity constructs derived from these assessments were related to parent and teacher ratings of externalizing problems across the school-age period (ages 7-10) and to parent and self-ratings of these outcomes across adolescence (ages 14-17). Consistent with prior research, individual measures of impulsivity factor-analyzed into subdimensions reflecting children's executive control capabilities, delay of gratification, and ability or willingness to sustain attention and compliance during work tasks. Children's performance on the main interactive task index, inhibitory control, showed a signficant level of stability between ages 6 and 8. During the school-age years, children who performed impulsively on the laboratory measures were perceived by mothers and by teachers as more impulsive, inattentive, and overactive than others, affirming the external validity of the impulsivity constructs. Finally, impulsive behavior in the laboratory at ages 6 and 8 predicted maternal and self-ratings of externalizing problem behavior across adolescence, supporting the long-term predictive value of the laboratory-derived impulsivity measures.

CTF-guided puncture of an unenhanced isodense liver lesion during continuous intravenous injection of contrast medium

CT fluoroscopy (CTF) facilitates guidance of percutaneous biopsies and other interventional procedures. We wished to demonstrate the usefulness of CTF for the puncture of an unenhanced isodense liver lesion during continuous injection of intravenous contrast medium. We performed CTF-guided puncture of a 2-cm lesion in the liver of a patient suffering from lung cancer. CTF enables puncture of liver foci even if they are unenhanced and isodense with the surrounding parenchyma.

First experiences in percutaneous arterial chemoembolization of malignant liver lesions by means of real-time CT fluoroscopy

Computed tomography fluoroscopy (CTF) allows real-time display (continuous imaging) and has been increasingly used in interventional procedures. We wished to demonstrate the usefulness of CTF in chemoembolization of the liver. Twenty-one patients with primary or secondary malignant lesions of the liver underwent CTF-guided chemoembolization after angiographic positioning of a catheter in the hepatic artery. Embolization materials such as Lipiodol and mitomycin C were administered under continuous CT scanning. CTF led to a change of the method (correction of catheter position, application of norepinephrine) in nine of 21 cases. There were no fatal complications.

[Rothmund-Thomson syndrome and osteosarcoma]

Until now less than 200 cases of Rothmund Thomson syndrome (RTS) also called Poikiloderma atrophicans have been reported. RTS is an autosomal recessive dermatosis characterized by athropy and teleangiectasia of the skin, juvenile cataract, hypogonadism and sceletal abnormalities. These osseous disorders include cortical hyperostosis mimicking rickets or chondrodysthropy and may mask early signs of malignant disorders. This seems to be a problem due to the fact that there is an association between osteosarcoma and RTS. The radiologic findings of both RTS and osteosarcoma in a 7 year old female are discussed.

Retroviral risk factors in patients with autoimmune disease

OBJECTIVE

Retroviruses can cause immunoregulatory disturbances and may play a role in the pathogenesis of autoimmune disorders. Little is known about the frequency of behavioral risk factors for exogenous retroviral infections in patients with autoimmune diseases. We compare the frequency of recognized risk factors for retroviral infections among patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and controls.

METHODS

Patients with SLE and RA from a university rheumatology clinic and control patients were enrolled in this study. The presence of retroviral risk factors (intravenous drug use, prostitution, increased number of sex partners, sexually transmitted diseases, high risk sex partners, blood transfusion) was determined by a self-administered questionnaire.

RESULTS

We surveyed 81 patients with SLE and 117 with RA and 100 healthy controls. Patients in all groups reported similar exposure to all risk factors surveyed for retroviral infection except sexually transmitted disease, which was reported more often in patients with SLE (25% of SLE versus 11% of RA and 11% of controls, p = 0.013).

CONCLUSION

Self-reported retroviral risk factors were generally not increased in patients with autoimmune disease compared to healthy controls; the role of exogenous retroviruses in the pathogenesis of SLE and RA remains unclear.