Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment.

STUDY DESIGN: This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period. OBJECTIVES: The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments. SUMMARY OF BACKGROUND DATA: The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3. METHODS: The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed. RESULTS: Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome. CONCLUSIONS: Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.

Effects of inhaled hexachlorobenzene aerosols on rat pulmonary host defenses.

Pulmonary bactericidal activity, macrophage phagocytic activity, alveolar macrophage (AM) enzyme activity, and T- and B-cell mitogenesis of lymphocytes from lung associated lymph nodes (LALN) or mesenteric lymph nodes (MESLN) were assessed in Sprague-Dawley rats exposed 4 hr/d, 4 days/wk for 1, 4, or 16 days to hexachlorobenzene (HCB) aerosols. Pulmonary bactericidal activity was depressed after 1 or 4 but not 16 exposures to 35 mg/m3 of HCB. AM phagocytosis of 51Cr-RBC in vitro was increased after 4 but not 1 or 16 exposures to HCB, and no effect was observed in peritoneal macrophages. HCB significantly enhanced mitogenesis in MESLN to the B-cell mitogen Salmonella typhimurium lipopolysaccharide (STM) after 4 exposures; LALN STM mitogenesis and LALN and MESLN mitogenesis to phytohemagglutinin (PHA) were not affected. After 16 exposures, however, the PHA responses in LALN and MESLN were significantly increased and decreased, respectively.

Chest wall after mastectomy. Part I. CT appearance of normal postoperative anatomy, postirradiation changes, and optimal scanning techniques.

The computed tomographic (CT) scans of patients with breast carcinoma treated by surgery with and without radiation therapy were reviewed and correlated with clinical status. The optimal techniques of patient examination and the post-therapy findings were analyzed. The brachial injection of intravenous contrast material produced significant artifacts that limited interpretation of the ipsilateral chest wall in all cases and did not give additional information. Scans obtained with the patients' arms placed at their sides resulted in more clearly interpretable scans, especially when arm weakness or lymphedema precluded symmetric elevation of the arms out of the CT gantry. Radiation therapy produced both acute and chronic changes with characteristic CT appearances. The postoperative anatomy varied markedly depending on the previous surgery. Careful clinical correlation with referring physicians was the key to proper scan evaluation.

Chest wall after mastectomy. Part II. CT appearance of tumor recurrence.

The postoperative computed tomography (CT) scans of 19 patients with breast cancer and suspected local or regional recurrence were reviewed. Recurrence was documented by percutaneous biopsy in 15 and by overwhelming clinical evidence in two. CT correctly identified the sites of recurrence in all 15 biopsy-proved cases. In two patients, suspected areas on CT scans proved to be residual pectoralis muscles. In most cases, the CT findings of recurrence to the skin, subcutaneous fat, pectoralis muscle, axilla, and brachial plexus can be differentiated from the postoperative and postirradiation anatomy.

Improved survival with early CT diagnosis of pancreatic abscess.

Until recently pancreatic abscess was often a lethal complication of acute pancreatitis. A major factor contributing to this high mortality has been delay in diagnosis. When combined with diagnostic needle aspiration, computed tomography (CT) has greatly enhanced the early detection of pancreatic abscesses. In the past 5 years at our institutions 23 patients with proven pancreatic abscesses were evaluated early in their clinical course by CT. In follow-up ranging from 4 months to 4 1/2 years there were only 4 deaths: a mortality rate of 17%. Many of the surviving patients had a long and protracted clinical course (mean length of hospitalization, 58 days) and reoperation for recurrent abscess or gastrointestinal complications was required in 9 patients (39%). Computed tomography proved helpful both in localizing the site of de novo or recurrent pancreatic abscess and in detecting postoperative complications. An aggressive approach to early CT scanning with diagnostic needle aspiration appears to be a factor in the improved survival of these patients.

Perirectal inflammatory disease: CT findings.

The findings on computed tomographic (CT) scans were reviewed in 42 patients with perirectal inflammatory disease and suspected perirectal abscesses. CT was reliable for use in distinguishing perirectal abscesses from cellulitis and in localizing both supralevator and infralevator abscesses. CT allowed correct diagnosis of 13 surgically proved perirectal abscesses in ten patients, including three with residual abscesses after surgical drainage. In three patients with supralevator abscesses, the abscess was missed on initial surgical exploration. In patients without abscesses, CT was helpful in evaluating the extent of perirectal inflammation; however, it was not possible to determine its cause. The anatomy on CT scans of the pararectal spaces is reviewed, with emphasis on useful anatomic landmarks in the axial plane for distinguishing supralevator from infralevator abscesses.

Absence of hydrocarbon-induced nephropathy in rats exposed subchronically to volatile hydrocarbon mixtures pertinent to gasoline.

Ninety-day inhalation studies were conducted on 50:50 weight percent (wt %) mixtures of n-butane:n-pentane and isobutane:isopentane, respectively, and on a distillation cut boiling below 145 degrees F of a reference unleaded gasoline blend to assess the nephrotoxicity of these volatile mixtures. The mixtures of butanes and pentanes were selected because these four hydrocarbons are the most prevalent components of gasoline vapors encountered under typical occupational exposures. The 0-145 degrees F gasoline distillation fraction was tested because it reasonably approximates the composition of gasoline vapors measured under occupational settings. Male and female F-344 rats were exposed to 2 levels of each mixture, 6 hours per day, 5 days per week, for 13 weeks. The target concentrations for the butane:pentane mixtures were 4500 and 1000 parts per million (ppm), while 5200 and 1200 ppm were set for the gasoline distillation fraction. An interim sacrifice was conducted after 28 days. The rats were not significantly affected by the exposures, and there was no evidence of hydrocarbon-induced nephropathy in either sex at the termination of each study. However, at the 28-day interim sacrifice period for both butane:pentane mixtures, mild, transient treatment-related but not exposure-related kidney effects were observed in the male rats. These perturbations were absent at the interim sacrifice period for the gasoline distillation fraction.

The effects of inhalation of organic chemical air contaminants on murine lung host defenses.

The potential health hazards of exposure to threshold limit value (TLV) concentrations of acetaldehyde, acrolein, propylene oxide, chloroform, methyl chloroform, carbon tetrachloride, allyl chloride, methylene chloride, ethylene trichloride, perchloroethylene, benzene, phenol, monochlorobenzene, and benzyl chloride, compounds which may be present in the ambient or work room atmosphere were investigated. The effects of single and multiple 3-hr inhalation exposures were evaluated in mice by monitoring changes in their susceptibility to experimentally induced streptococcus aerosol infection and pulmonary bactericidal activity to inhaled Klebsiella pneumoniae. When significant changes in these parameters were found, further exposures were performed at reduced vapor concentrations until the no-measurable-effect level was reached. Multiple exposures on 5 consecutive days were then performed at this concentration. Significant increases in susceptibility to respiratory streptococcus infection were observed after single 3-hr exposure to TLV concentrations of methylene chloride, perchloroethylene, and ethylene trichloride. For methylene chloride and perchloroethylene, these exposure conditions also resulted in significantly decreased pulmonary bactericidal activity.

Evaluation of common bile duct diameter using high resolution computed tomography.

The visibility rate and mean diameter of the common bile duct (CBD) were determined in 172 patients scanned with a routine abdominal technique on a GE CT/T 9800. Ninety-two (53%) had visible CBDs with the mean diameter measuring 5.3 mm. The visibility rate varied from 45 to 66% in healthy and ill patients, although the CBD diameters were similar (4.5 and 5.1 mm). The CBD was visualized more often in patients after cholecystectomy (87%), and the mean diameter was larger (8.2 mm). Using high resolution CT it seemed that the CBD could be demonstrated more frequently than the previously reported 30%.

Sclerosing cholangitis associated with hepatic arterial FUDR chemotherapy: radiographic-histologic correlation.

During a 2-year period, cholangiography was performed on 17 patients with clinical evidence of cholestasis who were receiving hepatic intraarterial floxuridine (IA-FUDR) infusions for treatment of metastatic colorectal adenocarcinoma. The development of cholestasis was associated with persistently elevated alkaline phosphatase, but serial CT examinations of the liver showed no progression of the tumor. All patients had cholangiographic abnormalities (by endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or operative cholangiography) of the biliary ductal system similar to those in idiopathic sclerosing cholangitis. Certain features, however, appear specific to IA-FUDR-induced cholestasis. All patients studied had segmental involvement at the common hepatic duct bifurcation. The cystic duct and gallbladder were often involved, but the distal common bile duct was spared. Histologic features of periportal and periductal fibrosis were present in specimens obtained from percutaneous liver biopsy in three patients, cholecystectomy in four patients, and autopsy in two patients. When clinical signs of hepatic dysfunction occur in the absence of tumor progression, biliary sclerosis must be suspected.

Effects of toluene inhalation on pulmonary host defenses of mice.

The potential hazards of exposure to vapor-phase toluene on pulmonary host defenses were evaluated. Mice exposed to concentrations ranging from 2.5-500 ppm, including the threshold limit value level of 100 ppm, exhibited increased susceptibility to respiratory infection with Streptococcus zooepidemicus. The no-measurable-effect level for single, as well as for 5 exposures was 1 ppm. Significantly decreased pulmonary bactericidal activity was observed after single exposures to 500, 250, 100 and 2.5 ppm toluene, and after 5 daily 3-h exposures to 1.0 ppm of toluene. A 20-exposure study with toluene at 1 ppm produced no changes in either of the 2 assays.

Effects of arsenic trioxide inhalation exposure on pulmonary antibacterial defenses in mice.

The effects of single and multiple (5 and 20) 3-h inhalation exposures to aerosols of arsenic trioxide on the pulmonary defense system of mice were investigated. Arsenic trioxide mist was generated from an aqueous solution and dried to produce particulate aerosols of 0.4 micron mass median aerodynamic diameter. Aerosol mass concentration ranged from 125 to 1000 micrograms As/m3. Effects of the exposures were evaluated by determination of changes in susceptibility to experimentally induced streptococcal aerosol infection and in pulmonary bactericidal activity to 35S-labeled Klebsiella pneumoniae. Significant increases in mortality due to the infectious challenge and decreases in bactericidal activity were seen after single 3-h exposures to 270, 500, and 940 micrograms As/m3. Similarly, 5 or 20 multiple 3-h exposures to 500 micrograms As/m3 produced consistently significant increases in mortality and decreases in pulmonary bactericidal activity. At 125 or 250 micrograms As/m3, a decrease in bactericidal activity was seen only after 20 exposures to 250 micrograms/m3. Results from earlier studies with an arsenic-containing copper smelter dust were compared to these data. The possibility of the development of adaptation during multiple exposures to arsenic trioxide is also considered.

The effects of intratracheally administered coarse mode particles on respiratory tract infection in mice.

Because coarse mode particles are rarely studied in their existing size ranges (greatest mass about 5-7 microns, aerodynamic diameter), we investigated the effects of four such particles, quartz, ferric oxide, calcium carbonate, and sodium feldspar, on host defenses against bacterial pulmonary infection. Mice which received intratracheal instillations of 10, 33, and 100 micrograms/mouse were exposed within an hour to aerosols of viable Streptococcus, and pneumonia-induced mortality was measured. At 33 and 100 micrograms/mouse, all particles significantly increased mortality. At the lower dose, only Fe2O3 caused a significant increase in mortality. To evaluate potential delayed effects, mice were challenged with the bacteria 24 h after exposure to 100 micrograms particles/mouse. Delaying the challenge did not significantly alter the response, except for the sodium feldspar group for which a partial recovery was observed. When mice exposed to 100 micrograms particles/mouse received aerosols of Klebsiella pneumoniae 24 h later, there was no significant effect on pulmonary bactericidal activity. For the model system used, it appears that Fe2O3, CaCO3, and sodium feldspar have effects roughly equivalent to quartz.