Glassy carbon implant as a bone graft substitute: an experimental study on rabbits.

The purpose of this experimental investigation was to study the incorporation of porous glassy carbon in bone. Cylinders of porous glassy carbon were implanted in drill holes in diaphyses and metaphyses of rabbits tibia for 1, 3, 6, 12 and 24 weeks. Bone ingrowth into the glassy carbon implants was examined by radiographic, histologic, fluorocrome and microradiographic methods. The material caused no pathological reaction. Tissue ingrowth into pores was seen by all examination methods. The amount of bone in the pores increases with time. The ingrowth was most distinctive in those areas where the implant was in close contact with cortical bone or trabeculae of the cancellous bone. Porous glassy carbon can be used as bone substitute, although the small size of implant available is at the present a limitation for its clinical use.

Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis.

Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p < 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome.

Experimental osteotomy fixed with composite resins.

In connection with osteosynthesis carried out on the tibias of rats we compared acrylic and bis-GMA plastics (CMW and Silar) and acrylic emulsion and acrylic dispersion used as intermediary material. A total of 80 rats of both sexes were used. The rats were divided into four groups, in which different intermediary material combinations were tested. The observation times were 1, 3, 6, 12, and 24 weeks. Macroscopical, radiological, histological, oxytetracycline fluorescence, and scanning electron-microscopical studies were done. Histologically, the Silar proved to be the more reliable fixation material and acrylic dispersion the better intermediary material. Furthermore, the radiological results were better (P less than 0.05) when acrylic dispersion was used as the intermediary material and Silar as the plastic.

Manual of radiographic technique / by T. Holm, P. E. S. Palmer, E. Lehtinen

A manual developed for use in training operators of the WHO Basic Radiological System (BRS) unit, an inexpensive X-ray installation developed by six manufacturers in keeping with WHO specifications. The unit, which is easy to operate and to repair, produces high quality radiographs sufficient for at least 80% of the examinations needed at a university hospital. The manual offers step-by-step instructions for all phases of technical operation of the BRS unit. Readers are guided in the position of the tube, choice of cassette and its placement, collimation of the X-ray beam, and the setting of kV and mAs values. Instructions also cover the correct positioning of the patient and the proper appearance of the finished radiograph. The 100 projections featured were selected as representing virtually all radiological investigations required in a small hospital or primary care facility

Head injuries and skull radiography: clinical factors predicting a fracture.

Five hundred and ninety-eight cases were studied where the patients had been subjected to skull radiography because of a head injury. Concussion had been established in 231 patients and a more severe brain injury in 8. Forty-nine patients (8.2 per cent) had skull fractures. The relative frequency of fractures was the highest among those aged between 40 and 59 years (16 per cent). From among 16 variables, either clinical or pertaining to the history, 4 had clearly sustained a fracture of the skull, the statistically significant features being amnesia, unconsciousness for over 30 minutes, a wound and subcutaneous haematoma in the scalp and a reduced level of consciousness. On the basis of these signs the patients could be divided into two groups which differed in the frequency of skull fractures by a factor of five. The skull fracture was not observed to have influenced the patient's care or recovery, particularly if the patient had a concurrent brain injury. Based on the results, the indications for skull radiography in patients with head injuries can be identified and this can reduce the need for X-ray examinations to one-half and still reveal 80 per cent of skull fractures.

Television tomometry in intravenous cholangiography.

Out of 93 infusion cholangiographies carried out with a remote control stand, television tomometry could be applied to the tomographic cut localization in 79 cases. The accuracy of the method was considered very good in 86% and--including the former--sufficient in 95% of the cases. With certain exceptions the method was considered suitable in the routine intravenous cholangiography. The importance of training for successful operation is emphasized.

Microfiling and automatic filing of radiographs.

When advantage is taken of the newest qualities of microfilms and copy films and when using their special developers and developing machines, it seems today that the microfilming of radiographs on 35 mm film is successful. Equipment in the price range of 67 000 DM is available. It includes automated filming and developing, but slipping microfilms onto the punch card jackets is semi-automatic. The advantage of the equipment is its low price, its small size compared to the Delcomat system, and thus its smaller filing space need. Also, the automation of filing is possible with this system. The system seems to be quite suitable for at least creating and maintenance of teaching files.

[Errors in the radiological diagnosis of injuries of the cervical spine (author's transl)]. / Fehlbefundung in der Röntgendiagnostik der Halswirbelsäulenverletzungen.

The frequency of fractures of the cervical spine has increased with the rise in traffic accidents, but the radiological diagnosis of fractures at the initial examination remains unsatisfactory. A false negative diagnosis in the accident department was made in 25 out of 86 patients (29%) by a surgeon and in 12 patients (14%) by a radiologist. Poor radiographic quality was an important source of error, particularly for the diffult fractures in the cranial and caudal parts of the cervical spine. Half the fractures of the arch of the atlas and of the odontoid were missed initially. There was also difficulty in diagnosing fractures of the articular processes, evulsion fractures of the vertebrae and unilateral subluxation. Since the late results of missed vertebral fractures may be fatal, it is necessary to make more use of those signs which may indicate a fracture. Widening of the pre-vertebral soft tissues was seen in 33 out of 100 patients and an increased distance between articular facets on the A. P. projection in 19 out of 100 patients. Angled A. P. projections are useful for the diagnosis of fractures of articular facets in bed-ridden patients. Fractures in the lower cervical spine are well seen on oblique supine views. In larger accident departments, tomography and immediate radiological consultation should be available.

Radiation dose in hysterosalpingography: modern 100mm fluorography vs. full-scale radiography.

Radiation doses of modern 100mm fluorography and full-scale radiography were compared experimentally and applied to hysterosalpingography. It was determined that 100mm fluorography reduced the doses by 28-29% per exposure and 37-47% per examination compared with full-scale radiography performed with fast tungstate screens in identical conditions (70-80 kV, 400 mA). The dose during one minute of videofluoroscopy was equivalent to the doses produced by one exposure in full-scale filming and three to four exposures in 100mm filming. Although electronic magnification in 100mm fluorography increases the doses by two or threefold, these are still less than the doses in full-scale radiography.

Radiologic demonstration of Meckel's diverticulum.

A case of bleeding Meckel's diverticulum with a positive barium meal examination, selective mesenteric arteriography and 99mTc-pertechnetate scanning is presented. Complementary radiologic examinations are needed in the visualization of Meckel's diverticulum due to difficulties in making the correct diagnosis.

Calcification in cervical arteries in life and at autopsy.

In the clinical part of the study routine neck PA radiographs taken with the mouth open were compared with soft tissue films with the mouth closed for detection of calcification in the carotid arteries. Only 5.5% of 90 hospitalized patients showed foci of calcification in routine films. But foci of calcification were seen in 22% of the soft tissue radiographs of the whole series. In the autopsy part of the study large foci of calcification were found at the carotid bifurcations in 12 out of 20 cadavers by radiography. In an additional five cases contact radiographs also showed smaller foci of calcification. The vascular endothelium over the calcification was often ulcerated. The significance of the large arterial foci of calcification demonstrated in the neck radiographs as a sign of atherosclerosis and as a source of cerebral thromboembolism is discussed.

[The reliability of arthrography of the knee joint via medium format technique (author's transl)]. / Die Zuverlässigkeit der Kniegelenksarthrographie mit Mittleformattechnik.

Reports on 217 arthrographies of the knee joint with operative control. Partly or entirely erroneous roentgen diagnoses were made in 4.8-16.3% of the cases, depending upon the technique by which the patients had been examined. Lateral meniscus lesion was wrongly diagnosed three times as often as the medial lesion. The lowest incidence of wrong diagnoses occurred when examining via the medium format technique.

[On the meaningful filing period for x-ray films (author's transl)]. / Die sinnvolle Archivierungsdauer von Röntgenaufnahmen.

A total of 19,577 x-ray films made from 5,092 patients was examined, subdivided into 94 different kinds of examination. The following observations were made: The time since the last x-ray examination of the patient up to Jan. 6 1973 was less than 2 years in 30.1% and less than 5 years in 63.8% of the patients. These figures are due to the fact that the hospital is still very young. The period between two successive x-ray examinations was less than 2 years in 88.2% and less than 5 years in 95.8% of the patients. It is obviously not necessary to file roentgenographs for more than 5 years, since after that time only 4.2% of the patients return for a follow-up examination, and only a fraction of these can probably be regarded as really remarkable (Brolin).

[Direct pernodal lymphography (an alternative technique) (author's transl)]. / Direkte pernodale Lymphographie bei Kleinkindern (Eine andere technische Möglichkeit).

A lymphographic technique via direct injection into superficial inguinal lymphnodes is described which has proved useful in infants.

[Micro-computerised x ray generator, its advantages in clinical use (author's transl)]. / Mikrocomputergesteuerter Röntgengenerator und dessen Vorteile im klinischen Gebrauch.

The uses of the micro-processor are increasing in various fields. The micro-computer as part of an X ray generator has so many advantages for production, service, medical and economy, that it will soon be generally used. Experience with micro-computerised generators during 2.5 years routine use have been very positive. In productive total systems the experience has been the same.