CT findings in acid lipase deficiency: wolman disease and cholesteryl ester storage disease.

Acid lipase deficiency leads to the abnormal accumulation of cholesteryl esters and triglycerides in many tissues. It is manifested clinically in two forms: Wolman disease, which is usually fatal in infancy, and cholesteryl ester storage disease (CESD), which is clinically milder. One case of each is presented.

Influence of glycogen on liver density: computed tomography from a metabolic perspective.

The liver is a metabolically active organ with a radiographic density that can be modified by its glycogen and fat content. In rhesus monkeys an increase in liver glycogen induced by glucose loading was accompanied by an increase in attenuation values on computed tomography and a decrease in total liver fat. Conversely, fasting depleted glycogen, increased fat, and decreased liver attenuation.

Use of the hazard rate to schedule follow-up exams efficiently. An optimization approach to patient management.

The problem of surveillance for metastasis in a cancer patient is modeled as an allocation problem. The hazard rate of metastasis appearing determines the efficient scheduling of follow-up exams. An optimal schedule of follow-up exams is shown to be dependent on the hazard rate, K, and D.

The radiographic follow-up of patients with Ewing sarcoma: a demonstration of a general method.

An analysis of the patterns of detectable tumor recurrence using the concepts of hazard rate, predictive value, and cumulative probability was undertaken to assess the appearance of metastases in Ewing sarcoma. This study comprises 107 patients who were seen between 1964 and 1977. The distribution of the sites of metastases indicates that repeated examinations of both lungs and bones are necessary for the effective surveillance of both truncal and extremity primary lesions.

Small-cell osteosarcoma.

Six cases of small-cell osteosarcoma, a tumor that resembles Ewing's sarcoma but produces osteoid matrix, are presented. The patients were young (6-31 years of age) and presented with symptoms of pain and/or swelling of 1-10 months duration. The lesions demonstrated a wide variation in radiographic appearance.

Computed tomography of the liver and kidneys in glycogen storage disease.

Glycogen, in concentrations encountered in von Gierke's disease, has computed tomography (CT) attenuation coefficients in the 50 to 70 Hounsfield unit (HU: 1,000 scale) range and accounts for the increased density of the liver. However, in eight patients with Type I glycogen storage disease, simultaneous hepatic infiltration with fat and glycogen led to a range of liver CT densities from 13 to 80 HU. Fatty infiltration may facilitate the demonstration of hepatic tumors in older patients with this disease.

A multidisciplinary approach to chronic low-back pain in Western Australia.

Fifty patients with chronic low-back pain were subjected to extensive medical, psychiatric, and psychosocial assessment by a comprehensive Low Back Pain Clinic. Most patients were found to have easily identifiable environment factors which influenced the persistence of the symptomatology. All patients were significantly functionally impaired, and whilst neurologic findings were uncovered in only 12 patients, most had restricted movement of the lumbar spine.

Ultrasonic evaluation of therapeutic response in tumors: its values and implications.

Not only may ultrasound demonstrate the presence of a tumor mass at various sites in the abdomen, but it may also be useful in measuring the size of the mass. The rate of tumor growth or regression was followed by ultrasound in 28 patients with ovarian carcinoma undergoing chemotherapy. The ability of ultrasound to make precise measurements of tumor size is discussed, and the value of these measurements is explored.

The first rib as the cause of a "pulmonary nodule" on chest computed tomography.

A protuberance arising from the first rib may simulate a pulmonary nodule on computed tomography of the chest. The typical location of this density should suggest its true nature, which may be confirmed by a frontal chest radiograph.

Electromyographic activity in paraspinal musculature in patients with idiopathic scoliosis before and after Harrington instrumentation.

Ten patients with idiopathic scoliosis underwent electromyographic (emg) examination before and after Harrington instrumentation and fusion. Each patient had a normal emg preoperatively. At 3 weeks all 10 demonstrated spontaneous activity consistent with denervation, and voluntary activity was absent or markedly reduced.

Evaluation of bupivacaine nerve blocks in the modification of pain and pulmonary function changes after thoracotomy.

Thirty-one patients undergoing thoracotomy were prospectively randomized to receive (1) no nerve blocks (n = 12), (2) placement of percutaneous catheters for intermittent nerve blocks with bupivacaine (Marcaine) (n = 10), or (3) bupivacaine nerve blocks intraoperatively (n = 8). One patient refused postoperative evaluation and was not included in this study. All patients received similar preoperative, intraoperative, and postoperative medications.

Effects of benoxaprofen and indomethacin on platelet function and biochemistry.

Benoxaprofen did not impair platelet function or platelet prostaglandin synthesis in vivo or in vitro in contrast to indomethacin, a known prostaglandin synthesis inhibitor. Platelet cyclic AMP levels were not changed by either drug in vivo or in vitro. The results of routine tests for hemostatic function (template bleeding time and blood clotting assays) were not changed by either drug.

The displaced crus: a sign for distinguishing between pleural fluid and ascites on computed tomography.

Fluid collections in the lower pleural cavity and upper abdominal cavity may sometimes appear similar on computed tomography. Lateral displacement of the diaphragmatic crus and interposition of fluid between the crus and vertebral column indicate an intrapleural component. Demonstration of fluid anterior to the crus establishes an intraperitoneal component.

Radionuclide determination of cardiac chamber flow/volume characteristics.

The flow/volume characteristics of an externally monitored radionuclide dilution curve may contain valuable information about specific cardiac chamber abnormalities. a simplified method of obtaining this flow/volume ratio on a standard scintillation camera is presented. Preliminary clinical application to right-sided cardiac lesions has been undertaken.

Stablization of the spine in the surgical treatment of severe spinal tuberculosis in children.

This is a 5- to 10-year survey of 160 children, all with severe surgically-treated spinal tuberculosis. The treatment consisted of: anterior spinal fusion alone, anterior with posterior fusion, posterior fusion alone and posterior with anterior fusion. The results indicate that in the less severe cases, where an abscess is not evident on plain radiographs, psoterior fusion alone can be of value in the growing spine.

Paralytic pelvic obliquity. Its prognosis and management and the development of a technique for full correction of the deformity.

Thirty-nine patients with post-poliomyelitic scoliosis and pelvic obliquity were treated and followed for up to four years. The dominant pathological mechanism causing the pelvic obliquity was trunk-muscle imbalance. The natural history of untreated pelvic obliquity is progression, leading ultimately to dislocation of the hip.

Discography in paralytic scoliosis.

Observations are made on the progressive alterations of the intervertebral disc in paralytic scoliosis, demonstrated by discography.