Detection of pericardial effusion by chest roentgenography and electrocardiography versus echocardiography.

To determine the sensitivity and specificity of chest roentgenography and electrocardiography in the detection of pericardial effusion, echocardiography was used as the diagnostic standard. Chest roentgenograms and electrocardiograms of 124 patients, 57 of whom had pericardial effusion, were read without knowledge of the echocardiographic interpretation. The sensitivity of roentgenographic diagnosis was low (20%), as was that of diagnosis from decreased voltage on the electrocardiogram (26%). The specificity of the chest roentgenogram was 89% and that of the low-voltage electrocardiogram 97%. The high specificity of the low-voltage electrocardiogram may have been due in part to the exclusion of obese and emphysematous subjects from the study. When cardiomegaly detected roentgenographically or a low-voltage electrocardiogram or both were considered as evidence of pericardial effusion, sensitivity improved to 82% but specificity declined to 29%. It is concluded the chest roentgenography and electrocardiography are unsatisfactory as screening investigations for the detection of pericardial effusion.     

Screening for occult lung cancer.

A pilot screening program for the early detection of lung cancer was carried out in Saskatchewan in 1968 using chest roentgenography and cytologic examination of sputum samples. The yield from 23 000 men aged 40 years and over was only 10 cases. Nine of the men had advanced disease. One had occult lung cancer. A period of 31 months elapsed between the discovery of malignant cells in this patient''s sputum and roentgenographic localization of the tumour. Following pneumonectomy he has survived with no discernible residual or metastatic tumour for 12 years. The morphologic changes in the resected lung provided a basis for discussing the preclinical phase of squamous cancer of the lung, the treatment of occult cancer and multicentric primary pulmonary tumours. The survey would have been more successful with a narrower target group and more frequent examination.     

Tuberculosis Contact Investigation Using Interferon-Gamma Release Assay with Chest X-Ray and Computed Tomography

Between September 2009 and January 2010, 6 members of the Japanese Eastern Army, who had completed the same training program, were diagnosed with active tuberculosis (TB) on different occasions. The Ministry of Defense conducted a contact investigation of all members who had come into contact with the infected members. The purpose of this study was to verify the efficacy of the TB screening protocol used in this investigation. A total of 884 subjects underwent interferon-gamma release assay (IGRA) and chest X-ray. The 132 subjects who were IGRA positive or with X-ray findings suggestive of TB subsequently underwent chest computer tomography (CT). Chest CT was performed for 132 subjects. Based on CT findings, 24 (2.7%) subjects were classified into the active TB group, 107 (12.1%) into the latent tuberculosis infection (LTBI) group, and 753 (85.2%) into the non-TB group. The first 2 groups underwent anti-TB therapy, and all 3 groups were followed for 2 years after treatment. Although one subject in the active TB group experienced relapse during the follow-up period, no patient in the LTBI or non-TB groups developed TB. IGRA and chest X-ray, followed by chest CT for those IGRA positive or with suspicious X-ray findings, appears to be an effective means of TB contact screening and infection prevention.     

Radiodiagnosis of a small amount of fluid in the pericardial cavity]

X-ray symptomatology of small pericardial effusions was studied on the basis of analysis of clinicoroentgenological and echocardiographic investigation of 173 patients with various chest diseases. Comparison of x-ray and USI results led to a conclusion of the effectiveness of polypositional roentgenography for the detection of small amounts of fluid in the pericardial cavity.     

X-ray characteristics of acute intestinal obstruction in middle-aged and elderly patients

The authors presented clinical and x-ray findings of 188 patients with mechanical intestinal obstruction (92 of them were middle-aged and advanced in years and 96 were under 60). A combined program of x-ray examination included 3 stages: panoramic polypositional roentgenography of the chest and abdominal cavity, dynamic x-ray control over the state of the abdominal cavity, and contrast study of the G.I. tract. A distinctive feature of the x-ray symptomatology of intestinal obstruction in middle-aged and old patients was the absence of classical x-ray symptoms in some cases during panoramic roentgenography of the abdominal cavity. In patients over 60, x-ray symptomatology was characterized by marked colon distension and intestinal distension of various degree in 77.1%     

The x-ray picture of pulmonary circulation in the course of acute myocardial infarct

A study was made of the time course of lesser circulation (LC) in 80 patients with acute transmural myocardial infarction and in 20 patients with chronic coronary heart disease with the help of chest x-ray. A possibility of preclinical detection of left ventricular insufficiency was confirmed. The capacity of roentgenography to reflect objectively the time course of LC disorder and its correlation with primary determination of a degree of changes, age, cardiac sizes, the expression of aortic atherosclerosis, pleurocardiac reactions and site of myocardial infarction were defined.     

Patterns of preventive practice in New Brunswick

A survey of active general practitioners was conducted in New Brunswick to ascertain their patterns of preventive practice with respect to cancer of four anatomic sites: the breast, the cervix, the colon and rectum, and the lung. Ninety-two percent of the physicians reported that they taught breast self-examination to their female patients, 98% that they performed breast examinations, 98% that they did Papanicolaou smears routinely, and 97% that they provided counselling against smoking. Few of the physicians reported that they submitted women aged 50 to 59 years to annual mammography (3%) or examined stool samples from asymptomatic patients over 44 years of age for occult blood (20%). Many (77%) said they still routinely performed chest roentgenography for early detection of lung cancer; an estimated 49% of the physicians said they performed cytologic screening of sputum samples for the same purpose. Preventive practices, when used, were usually carried out during major encounters with patients, such as general check-ups. The potential for prevention through this clinically based approach is still largely unrealized.     

A standardized x-ray examination of mandibular fractures

Proceeding from an x-ray examination of 143 patients with mandibular fractures, the most informative methods and projections as well as the order of their use with account of the site of a fracture, were determined. The most informative method in all fracture sites was orthopantomography; panoramic roentgenography was indicated only in fractures of the frontal part. If panoramic tomography cannot be done, roentgenography or electroroentgenography in the frontal-nasal projection is recommended. If panoramic roentgenography cannot be done, extraoral roentgenography is indicated in the diagnosis of fractures of the frontal part of the mandible.     

Physique types and the skeletal mineral saturation of young men and women

The term "massiveness of the skeleton" does not reflect the amount of the mineral component in bones. As demonstrates application of the standard linear x-ray densitometry, in a more "massive" skeleton amount of mineral salts per a volume unit of the osseous tissue is less than in a thin "gracile" skeleton of the thoracal type of constitution. The muscular type of constitution concerning the mineral saturation occupies an intermediate position between the thoracal and digestive constitutional types.     

Distribution and subtype determination ofβ-receptors in the spinal cord of the adult rat

1. We determined the number of beta-receptors in the whole spinal cord of the adult rat and in the cervical, thoracal, and lumbal/sacral parts. 2. The undivided spinal cord contains 47 +/- 10 fmol/mg beta-receptors (KD = 2066 +/- 982 pmol/liter), and the cervical part of the spinal cord contains 53 +/- 8 fmol/mg protein (KD = 3224 +/- 1775 pmol/liter). The thoracal part shows 40 +/- 1 fmol/mg protein (KD = 3229 +/- 104 pmol/liter), and the lumbal/sacral spinal cord contains 48 +/- 8 fmol/mg protein (KD = 3610 +/- 1610 pmol/liter). 3. Competitive inhibition studies with l-practolol, dl-atenolol, and ICI 118,551 were performed and we calculated by a computer program in the whole spinal cord the following ratio of beta-receptor subtypes: 80 +/- 5% Beta 1-receptors and 20 +/- 5% beta 2-receptors. 4. The basal and (-)-isoproterenol- and NaF-stimulated activity of adenylate cyclase was highest in the cervical part of the spinal cord and equally distributed between the thoracal and the lumbal/sacral parts. 5. The whole synaptosomal protein of the cervical part of the spinal cord contained 132 +/- 20 fmol, the thoracal part 117 +/- 3 fmol, and the lumbal/sacral part 133 +/- 22 fmol.     

Roentgenomorphological correlations in the diagnosis of pneumonias in patients with combined, craniocerebral, thermal injury and exogenous poisonings]

The clinical roentgenological and postmortem morphological data were analyzed and correlated in 219 patients with combined (60), craniocerebral (38), thermal (46) injury and exogenous poisonings (75), who developed pneumonias in the course of the treatment. All the patients underwent chest roentgenography in the anteroposterior projection and in the supine position. The rate of intravital identification of pneumonias accounted for 73.3% in combined, 63% in craniocerebral, 65.2% in thermal injury, and for 77.3% in exogenous poisonings. The roentgenological and morphological characteristics common to the development of pneumonias in different injuries were revealed and the causes of diagnostic discrepancies were analyzed.     

Air trapping on chest CT is associated with worse ventilation distribution in infants with cystic fibrosis diagnosed following newborn screening

Background

In school-aged children with cystic fibrosis (CF) structural lung damage assessed using chest CT is associated with abnormal ventilation distribution. The primary objective of this analysis was to determine the relationships between ventilation distribution outcomes and the presence and extent of structural damage as assessed by chest CT in infants and young children with CF.

Methods

Data of infants and young children with CF diagnosed following newborn screening consecutively reviewed between August 2005 and December 2009 were analysed. Ventilation distribution (lung clearance index and the first and second moment ratios [LCI, M₁/M₀ and M₂/M₀, respectively]), chest CT and airway pathology from bronchoalveolar lavage were determined at diagnosis and then annually. The chest CT scans were evaluated for the presence or absence of bronchiectasis and air trapping.

Results

Matched lung function, chest CT and pathology outcomes were available in 49 infants (31 male) with bronchiectasis and air trapping present in 13 (27%) and 24 (49%) infants, respectively. The presence of bronchiectasis or air trapping was associated with increased M₂/M₀ but not LCI or M₁/M₀. There was a weak, but statistically significant association between the extent of air trapping and all ventilation distribution outcomes.

Conclusion

These findings suggest that in early CF lung disease there are weak associations between ventilation distribution and lung damage from chest CT. These finding are in contrast to those reported in older children. These findings suggest that assessments of LCI could not be used to replace a chest CT scan for the assessment of structural lung disease in the first two years of life. Further research in which both MBW and chest CT outcomes are obtained is required to assess the role of ventilation distribution in tracking the progression of lung damage in infants with CF.     

Pulmonary Changes in Lung Purpura and Some of the Other Collagen Diseases

The physician who specializes in pulmonary diseases has a most helpful aid in the form of chest roentgenography. This examination is secured routinely in many hospitals and clinics today. The roentgenogram is very accurate in finding pulmonary lesions. Accuracy in determining the type of lesion depends on the experience of the physician who is studying the patient.Pulmonary lesions occur in many systemic diseases. They may occur in some of the collagen diseases and at times they may be the first and also the most striking findings noted during the examination of a patient. For this reason, attention is called to some of the pulmonary findings encountered in certain of these diseases. Some of the clinical, roentgenologic and pathologic manifestations of necrotizing alveolitis, periarteritis nodosa, glomerulonephritis, disseminated lupus erythematosus, rheumatoid arthritis, and scleroderma are described.     

Quantitative analysis of the postnatal axon growth in the dorsal funiculus of rats

The dorsal funiculus in cervical spinal cords of rats from birth to 120 days postnatally has been studied on order to document the axon growth. Within the dorsal funiculus the cuneate and gracile fasciculi have been examined and within the gracile fasciculus the distinct cervical, thoracal and lumbar areas. Light microscopy and morphometry on the day of birth and 15, 20 and 120 days postnatally show an axon growth stagnation between the 15th and 20th day of maturation. The stagnation phase seems to induce the myelinization. A comparison between Goll's and Burdach's tracts shows an earlier and faster growth of the axons in Burdach's tract. Consequently, the epicritical sensibility of the upper extremity is developed earlier. It has been found out that within Goll's tract a caudocranial maturation takes place. The lumbar area of the fasciculus gracilis is matured earlier than the thoracal and the cervical ones.     

Radiation diagnosis of involutional osteopenia]

160 patients with involutive osteopaenia were investigated. The diagnostic possibilities of roentgenography, magnetic resonance imaging and computed tomography were evaluated. There was determined that roentgenography gives the possibility to determine the common localisation and the expressiveness of the pathologic process. MRI and CT give a valuable additional information on early stages of osteopaenia and it's complications.     

Computed tomography in the diagnosis of degenerative diseases of the spine

CT and roentgenography were used for the investigation of 78 patients with the radicular syndrome. The state of the intervertebral disks, intervertebral joints and cerebrospinal canal in degenerative vertebral diseases was assessed. CT permits the detection of hernia, protrusion of the intervertebral disks, deformity of the intervertebral joints, and the narrowing of the cerebrospinal canal as a result of degenerative changes, as well as establishing the cause of the affection of neural structures in the cerebrospinal canal, radicular holes. CT possesses some advantages over roentgenography in the diagnosis of degenerative vertebral diseases and can be recommended as the principal method together with roentgenography for investigation of patients with lumbar pains.     

Esophageal duplication cyst containing a foreign body

About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended.     

Familial Fibrocystic Pulmonary Dysplasia: Observations in One Family

At least 31 cases of familial fibrocystic pulmonary dysplasia, within 10 families, have been described in the world literature. The mode of genetic transmission of this disease, however, has been uncertain until now. The author observed three unequivocal and five probable cases of familial fibrocystic pulmonary dysplasia among 56 members of one family. Diagnostic criteria included progressive dyspnea and cyanosis, digital clubbing, pulmonary hypertension, negative sweat tests, polycythemia, arterial hypoxia and hypocapnia, chest radiographs showing diffuse bilateral pulmonary fibrosis, and diffuse fibrocystic pulmonary dysplasia at postmortem examination (two cases). Among the three unequivocal cases one father-to-son transmission was observed. Non-sex-linked dominant transmission of familial fibrocystic pulmonary dysplasia is thereby proved for the first time. One patient also developed a bronchial carcinoma in addition to fibrocystic pulmonary dysplasia; this is considered to be a cause-and-effect relationship and not a coincidental complication.     

Quantification of overdiagnosis in randomised trials of cancer screening: an overview and re-analysis of systematic reviews

The degree of overdiagnosis in common cancer screening trials is uncertain due to inadequate design of trials, varying definition and methods used to estimate overdiagnosis. Therefore, we aimed to quantify the risk of overdiagnosis for the most widely implemented cancer screening programmes and assess the implications of design limitations and biases in cancer screening trials on the estimates of overdiagnosis by conducting an overview and re-analysis of systematic reviews of cancer screening. We searched PubMed and the Cochrane Library from their inception dates to November 29, 2021. Eligible studies included systematic reviews of randomised trials comparing cancer screening interventions to no screening, which reported cancer incidence for both trial arms. We extracted data on study characteristics, cancer incidence and assessed the risk of bias using the Cochrane Collaboration’s risk of bias tool. We included 19 trials described in 30 articles for review, reporting results for the following types of screening: mammography for breast cancer, chest X-ray or low-dose CT for lung cancer, alpha-foetoprotein and ultrasound for liver cancer, digital rectal examination, prostate-specific antigen, and transrectal ultrasound for prostate cancer, and CA-125 test and/or ultrasound for ovarian cancer. No trials on screening for melanoma were eligible. Only one trial (5%) had low risk in all bias domains, leading to a post-hoc meta-analysis, excluding trials with high risk of bias in critical domains, finding the extent of overdiagnosis ranged from 17% to 38% across cancer screening programmes. We conclude that there is a significant risk of overdiagnosis in the included randomised trials on cancer screening. We found that trials were generally not designed to estimate overdiagnosis and many trials had high risk of biases that may draw the estimates of overdiagnosis towards the null. In effect, the true extent of overdiagnosis due to cancer screening is likely underestimated.     

Effects of obtaining a blood culture on subsequent management of young febrile children without an evident focus of infection.

To assess the effects of obtaining a blood culture on the subsequent diagnostic and therapeutic management of young febrile children without an evident focus of bacterial infection, we carried out a randomized controlled clinical trial of this procedure in 146 children 3 to 24 months of age who presented to our emergency department with an unexplained temperature of 39.0 degrees C or higher. Random assignment to either have (67 children) or not have (79) a blood sample taken for culture resulted in groups equivalent in age, sex, weight, socioeconomic status, temperature at enrolment and laboratory test results. No differences were detected in the rates of subsequent hospital admission, outpatient visits, determination of complete blood count or other blood tests, urinalysis or urine culture, chest or other roentgenography, or administration of antibiotics or other medications. Knowledge of the absence of such differences should be helpful in evaluating the relative benefits and costs of blood culture for young febrile children.