Ulnar artery occlusion in mountain bikers.

We report two cases of the hypothenar hammer syndrome, diagnosed with digital angiography, which occurred in mountain bikers. To our knowledge, the association between mountain bike enthusiasts and ulnar artery occlusion has not been reported in the literature.

Interstitial microwave-induced hyperthermia and iridium brachytherapy for the treatment of obstructing biliary carcinomas.

In a phase I clinical study, 10 patients with obstructive biliary carcinomas were treated with single-antenna interstitial microwave hyperthermia and iridium-192 brachytherapy. For each patient a standard biliary drainage catheter was implanted percutaneously through the obstructed common bile duct. This catheter accommodated a single microwave antenna which operated at 915 MHz, and one or two fibreoptic thermometry probes for temperature measurement. Under fluoroscopic guidance the microwave antenna and temperature probes were positioned in the CT-determined tumour mass. The 60-min heat treatment achieved a central tumour temperature of 45-55 degrees C while keeping temperatures at the proximal and distal margins at 43 degrees C. Immediately following the hyperthermia treatment the microwave antenna and temperature probes were removed, and a single strand of iridium-192 double-strength seeds was inserted to irradiate the tumour length. A dose of 5500-7900 cGy calculated at 0.5 cm radially from the catheter was administered over 5-7 days. Upon removal of the iridium a second hyperthermia treatment was performed. A total of 18 hyperthermia treatments were administered to the 10 patients. In two cases the second hyperthermia treatment after brachytherapy was not possible due to a kink in the catheter, or bile precipitation in the catheter. All patients tolerated the procedure well, and there were no acute complications. To evaluate the volumetric heating potential of this hyperthermia method, specific absorption rate (SAR) values were measured at 182 planar points in muscle phantom. Insulated and non-insulated antenna performance was tested at 915 MHz in a biliary catheter filled with air, saline, or bile to mimic clinical treatments. The insulated antenna exhibited the best performance. Differences between antenna performance in saline and bile were also noted. In summary, this technique may have potential for tumours which obstruct biliary drainage and are accessible to percutaneous decompression using standard diagnostic radiological procedures.

Angiographic management of retroperitoneal hemorrhage from renal angiomyolipoma in polycystic kidney disease.

Angiographic management of bilateral angiomyolipomas complicated by hemorrhage in autosomal dominant polycystic kidney disease is presented. The patient had mild stigmata of tuberous sclerosis, and a family history of tuberous sclerosis and autosomal dominant polycystic kidney disease. The radiographic features at diagnosis, and those present during and after embolization are described. Radiological criteria for diagnosis and successful control of bleeding with intra-arterial selective embolization are discussed. Radiographic features before, during and after embolization are exhibited.

Limited field of view spin echo MR imaging.

Several groups have reported using a method of limiting the field of view (FOV) where the slices excited by the 90 and 180 degree pulses are perpendicular. However, only one slice can be excited during each repetition time, so multislice imaging is not possible. We present a modification of this method that allows multislice imaging. The slices excited by the 90 degrees and 180 degrees pulses are at a small angle; the field of view is limited and multislice imaging is possible. The modifications also allow the center of the FOV to be offset to any position. We describe the conditions that yield optimal images for the given FOV, slice thickness, and interslice gap. Representative images demonstrating the features of the technique are presented. The technique can be used to reduce the number of phase-encoding steps resulting in reduced imaging time, or it can be used to increase the spatial resolution without increasing the imaging time.

Objective tinnitus of vascular origin with hearing improvement after treatment.

Objective tinnitus occurs as a result of muscular contraction or vascular pulsations. The literature is reviewed and we present two case reports of vascular objective tinnitus and its diagnostic and therapeutic modalities. One patient was treated with embolization alone; the other, with embolization and surgical ligation. Both patients achieved an improvement in sensorineural hearing thresholds in their affected ears; one patient experienced an improvement in speech reception threshold of 30 decibels. Measures useful to diagnosis and evaluation of therapy and reasons for the observed improved hearing thresholds are discussed.

Atelosteogenesis type III: a distinct skeletal dysplasia with features overlapping atelosteogenesis and oto-palato-digital syndrome type II.

We present 5 cases of a short-limb dwarfism syndrome whose manifestations overlap those of atelosteogenesis and oto-palato-digital syndrome Type II. Clinical, radiographic, genetic, and histologic data are presented which demonstrate differences between our patients and previously reported cases of these other conditions. We conclude that the disorder seen in these children represents a distinct chondrodysplasia for which we propose the name atelosteogenesis Type III.

Case report and delineation of the congenital hypothalamic hamartoblastoma syndrome (Pallister-Hall syndrome).

We report one new case of congenital hypothalamic hamartoblastoma syndrome (Pallister-Hall syndrome) and one case of a diencephalic nodule associated with craniofacial malformations. Based on a review of 11 cases of Pallister-Hall syndrome documented by pathological examination, two cases presumed by phenotype, three cases of hypothalamic hamartoma with craniofacial anomalies only, and several cases of related interest, we delineate the clinical, neuroradiologic, and neuropathologic manifestations which aid in differential diagnosis. Clinical manifestations in infants with Pallister-Hall syndrome included postaxial polydactyly with nail dysplasia, short nose with flat nasal bridge, apparently low-set, posteriorly angulated ears, kidney and lung anomalies, congenital heart defects, imperforate anus, and micropenis with undescended or hypoplastic testes in males. These manifestations were associated with varying degrees of panhypopituitarism and pituitary aplasia. In three cases of hypothalamic hamartoma associated with craniofacial anomalies only, the face resembled that of holoprosencephaly. Other cases of hypothalamic hamartoma have had associated palate or heart defects or presented with precocious puberty. Of the infants with a hypothalamic hamartoblastoma at autopsy, neuropathologic findings were consistent with a primitive neuroectodermal tumor. Surgical tissue from our sole survivor suggested such tumors might mature, and the tumor has not recurred. Neuroradiologic diagnosis may be difficult but should be attempted in infants with these clinical manifestations; due to the need for prompt initiation of appropriate therapy.

Offset electrocardiographic electrode simulating a pulmonary nodule on radiographs.

A recently developed type of electrocardiographic (ECG) monitoring electrode may simulate a pulmonary nodule on chest radiographs. The artifact results from the offset design of the electrode, which contrasts with the configuration of conventional electrodes. Awareness of this potential artifact is important to prevent misdiagnosis.

Comparison of local versus central tumor measurements in a multicenter cancer trial.

Four hundred nineteen solid tumors from 92 patients were measured by a local team consisting of a physician and nurse oncologist or physician's assistant, and centrally by one radiologist. The central radiologist also remeasured 137 tumors on 30 patients to assess intraexaminer agreement. Tumor measurements at specific points in time as well as changes in tumor measurements over time were evaluated. When signed differences were calculated, there was little overall difference between local and central examiners, although three of the eight centers did show a significant difference. However, when absolute differences were calculated, the relative errors of the width times length products ranged from 35 to 55%. Although local and central examiners agreed 75% of the time on change in disease, there was only 42% agreement on the subset of patients who had a remission. In general, the intraexaminer agreement was slightly better than the interexaminer agreement. This study suggests that solid tumor measurements are not particularly reliable, and that survival time remains the most satisfactory endpoint in a cancer clinical trial.

Digital deformity: an effect of frostbite in children.

Two young children, aged 2 1/2 and 3 1/2, were briefly exposed to temperatures of -20 degrees F (-29 degrees C) without adequate hand protection. Hand contact with snow and metal doorknobs also occurred. Second and third degree frostbite of the cold injured digits ensured. Within six months, and progressing thereafter, the fingers developed a stubby appearance and demonstrated distal angulation and weak extension. Roentgenograms revealed undermineralization of the phalanges and coarsening of the trabecular pattern. The epiphyses of the middle and distal epiphyses were absent or atrophic. The metaphyses were irregularly convoluted. The pathogenesis of this deformity appears to be the direct effect of freezing and of ischemia on the most metabolically active site in the digit--the growth plate.

Acute esophageal food impaction treated by gas-forming agents.

Impacted meat obstructing the esophagus was successfully treated in 8 patients by oral administration of tartaric acid and sodium bicarbonate. This acid-base mixture produces carbon dioxide, which distends the esophagus and propels the meat into the stomach. The authors have had a 100% success rate with no complications and recommend that this procedure be the first treatment attempted for meat impaction in the esophagus.

A systematic technique for comprehensive evaluation of the temporal bone by computed tomography.

A systematic method for comprehensive visualization of the temporal bone structures using thin-section, high-resolution computed tomography (CT) was developed. In relation to the anthropologic baseline (0 degrees), four separate tomographic planes of 0 degrees, 30 degrees, 70 degrees, and 105 degrees were each found to optimize different aspects of temporal bone evaluation with significant reduction in the radiation dose to the lens. Virtually all patients were able to maintain the necessary head positioning that allows for both direct coronal and axial sections. It is concluded that in the majority of cases, thin-section, high-resolution CT can replace polytomography, although the examinations may be complementary in the evaluation of certain abnormalities.

Early diagnosis of septic arthritis of the sacroiliac joint by use of computed tomography.

Two cases of suspected septic arthritis of the sacroiliac joint with normal radiographs and nuclide scans were investigated by computed tomography. Bone and soft tissue abnormalities consistent with septic arthritis were found. Diagnosis was confirmed by needle aspiration of the sacroiliac joint. Computed tomography may be useful in the early diagnosis of the sacroiliac joint when plain radiographs and nuclide scans are normal.

Intracranial aneurysms: characteristics of aneurysms by site, with special reference to anterior communicating artery aneurysms.

Data are presented from an unselected series of 212 aneurysm patients for aneurysms at three major sites: the internal carotid-posterior communicating artery junction, the anterior communicating artery, and the middle cerebral artery. More than 70% of the anterior communicating artery aneurysms occurred as single aneurysms; less than 30% of the middle cerebral artery aneurysms were single. Anterior communicating artery aneurysms showed a right-side predominance in males but not in females. Both males and females had significantly higher mean systolic and diastolic blood pressures for left-sided anterior communicating artery aneurysms than for right-side aneurysms. A brief review of factors relevant to anterior communicating artery aneurysms is presented.

Rheumatoid arthritis: failure of daily heat therapy to affect its progression.

Seventeen volunteers with symmetrical rheumatoid arthritis (RA) applied heat to 1 hand twice daily for 2 years. Joint swelling, joint tenderness and grip strength were measured at intervals. The proliferative aspect of the disease was assessed by roentgenograms using a scoring system. There was no difference between experimental hand and control hand in any of the factors measured. The patients found the heat soothing and comforting. Thus, daily heat therapy did not accelerate the proliferative lesion in RA and may remain as an adjunct to therapy.

Intracranial aneurysms. Age, sex, blood pressure, and multiplicity in an unselected series of patients.

All cases of intracranial aneurysm, arteriovenous malformation, and subarachnoid hemorrhage of undetermined etiology seen at one hospital over a 13-year period were reviewed to assess relationships between age, sex, systolic and diastolic blood pressure, and number of aneurysms. There were 350 patients, of whom 212 had aneurysms. The major findings were as follows: 1) Hypertension was not significantly more prevalent in the aneurysm population than in the age-matched general population, except for females aged 18 to 54 years (systolic pressure elevation of 10 to 15 mm Hg). 2) Under 55 years of age, both male and female hypertensive patients were twice as likely to have multiple aneurysms as normotensive patients. 3) Females were more likely than males to have multiple aneurysms. 4) For females but not males, increasing age, higher systolic pressure, and higher diastolic pressure all correlated with an increasing number of aneurysms. Hypertension appears to be more prevalent in certain subgroups of the total aneurysm population, although the individual relationships between hypertension, atherosclerosis, and aneurysms cannot be determined from either the present or previous studies. The possible role of familial factors, as well as implications for both diagnosis and further research, are briefly noted.

A computerized exposure system.

An application of computer technology to radiographic technique formulation and selection was developed. By proper monitoring and organizing of the immense number of variables associated with technique formulation, through computer program control, the resultant program can readily calculate a complete technique exposure system for virtually all standard radiographic generators in any number of diagnostic radiology installations. This results in significant saving of film cost and time in the preparation and continued maintenance of an exposure system, less exposure to the patient as a result of fewer repeat radiographs, and uniform film quality.

Angiography of high cervical extramedullary tumours.

Vertebral angiography was performed in two cases of extramedullary tumour of the upper cervical spine. The technical feasibility and relatively low risk of catheter vertebral angiography makes it a useful procedure to be performed in addition to myelography in the pre-operative evaluation of such lesions. The information thus obtained includes the relationship of the tumour to the vertebral arteries and other vital structures, demonstration of the blood supply, and evidence as to tumour type.