Current approach in the management of patients with foreign bodies in the maxillofacial region.

The aim of the present study was to describe and discuss the gamut of current diagnostic and therapeutic modalities regarding impacted foreign bodies in the head and neck region, addressing xeroradiography, magnetic resonance imaging, computed tomography, and ultrasonography as diagnostic aids and stressing the importance of a multidisciplinary team in the treatment of such injuries. Considerations are also offered on the different types and forms of presentation of foreign bodies that may be impacted in the maxillofacial region and specific treatment methods.

Calciphylaxis in a patient with normal renal function: response to treatment with sodium thiosulfate.

Calciphylaxis is a rare, life-threatening cause of skin necrosis. The condition is primarily reported in patients with end-stage renal disease, and is associated with significant morbidity and mortality. Treatment has mainly been empirical. We report a case of calciphylaxis in a patient with normal renal function and hypoparathyroidism, who responded to treatment with sodium thiosulfate. To our knowledge, this is the first reported case of the use of sodium thiosulfate to treat calciphylaxis in a patient with normal renal function.

A comparative study between xerographic, computer-assisted overlay generation and animated-superimposition methods in bite mark analyses.

This study was to compare the suitability and precision of xerographic and computer-assisted methods for bite mark investigations. Eleven subjects were asked to bite on their forearm and the bite marks were photographically recorded. Alginate impressions of the subjects' dentition were taken and their casts were made using dental stone. The overlays generated by xerographic method were obtained by photocopying the subjects' casts and the incisal edge outlines were then transferred on a transparent sheet. The bite mark images were imported into Adobe Photoshop® software and printed to life-size. The bite mark analyses using xerographically generated overlays were done by comparing an overlay to the corresponding printed bite mark images manually. In computer-assisted method, the subjects' casts were scanned into Adobe Photoshop®. The bite mark analyses using computer-assisted overlay generation were done by matching an overlay and the corresponding bite mark images digitally using Adobe Photoshop®. Another comparison method was superimposing the cast images with corresponding bite mark images employing the Adobe Photoshop® CS6 and GIF-Animator©. A score with a range of 0-3 was given during analysis to each precision-determining criterion and the score was increased with better matching. The Kruskal Wallis H test showed significant difference between the three sets of data (H=18.761, p<0.05). In conclusion, bite mark analysis using the computer-assisted animated-superimposition method was the most accurate, followed by the computer-assisted overlay generation and lastly the xerographic method. The superior precision contributed by digital method is discernible despite the human skin being a poor recording medium of bite marks.

Measurement of skin thickness: a comparison of two in vivo techniques with a conventional histometric method.

Two in vivo techniques which are rapid, inexpensive, and reproducible have been investigated. The first is a standardized radiological (xerographic) technique which we have shown is capable of detecting small degrees of dermal atrophy after the application of topical corticosteroid preparations for only one month. The second technique employs the Harpenden Skinfold Caliper used in an unconventional manner so as to exclude subcutaneous fat. We have shown that this too is capable of detecting dermal atrophy from the application of topical corticosteroids and that there is a strong correlation between the two techniques (r = 0.82, p less than 0.001). Histometric techniques, on the other hand, give inaccurate and erroneous results for dermal thickness.

Comparison of xeroradiographic and ultrasound detection of corticosteroid induced dermal thinning.

A pulsed ultrasound technique was shown to have a high degree of correlation with the established xeroradiographic method for the determination of dermal thickness both in normal skin and corticosteroid treated skin, although xeroradiography consistently gave a higher value than ultrasound. Using the pulsed ultrasound technique, an early onset of dermal thinning could be detected 2 days following treatment with creams containing 0.05% clobetasol propionate and 0.1% beta-methasone 17-valerate. The amount of dermal thinning produced by the clobetasol propionate preparation was significantly greater than that produced by cream base, clobetasone butyrate 0.05% cream and hydrocortisone 1% cream as determined by both techniques. The pulsed ultrasound technique is an accurate, noninvasive and safe method for determining dermal thickness.

Xeroradiographic determination of Achilles tendon thickness in familial hypercholesterolemia confirmed by tissue cultures.

Twenty-three patients with familial hypercholesterolemia (FHC) confirmed by tissue cultures of skin fibroblasts (2 homozygotes, 21 heterozygotes) and 3 patients with sporadic hypercholesterolemia were evaluated for Achilles tendon (AT) thickness by xeroradiography. Both homozygotes had thick ATs and coronary heart disease (CHD), 20 heterozygotes had thick ATs, but only 8 of them had CHD. One heterozygote had a small AT value, but CHD for a long time. The 3 patients with sporadic hypercholesterolemia, one with CHD, had small AT. There was no correlation between serum cholesterol concentration and AT thickness, between age and AT thickness, nor between AT thickness and CHD.

Lethal post-transplantation calcinosis.

The case studies of four patients with post-transplantation calcinosis are presented. Three of the four patients died of inanition and sepsis secondary to infection of extensive soft tissue ulcers and diffuse cutaneous vascular calcification with gangrene. The fourth patient survived following removal of all four parathyroid glands and autografting of approximately one-half of one gland. Common to the patients was secondary hyperparathyroidism, elevated mean serum calcium levels after transplantation, and radiographic evidence of small and medium vessel calcification. No other differences could be found between these patients and other patients with post-transplantation hyperparathyroidism without calcinosis. In the face of apparently minor complaints of lower extremity discomfort, elevated parathyroid hormone levels (PTH) and positive xerography may indicate subtotal parathyroidectomy regardless of the serum calcium level.

Breast scintigraphy with 99mTc-pertechnetate and 67Ga-citrate.

Radionuclide breast scintigraphy was evaluated as a noninvasive tumor-localizing modality. Technetium-99m-pertechnetate (99mTcO4) demonstrated good correlation between malignancy and postive scintigraphy (88% accuracy in 16 cases of breast carcinoma). The high false-positive rate (29% of proven benign breast disease) limits the use of 99mTcO4 as an aid to differential diagnosis. Gallium-67-citrate (67Ga) is limited as a diagnostic adjunct (localizing in only five of ten breast malignancies). Refined techniques of positioning, shielding, gamma camera imaging, and computer assistance have helped in visualizing abnormal radionuclide accumulation.

Skeletal histopathology in fetuses with chondroectodermal dysplasia (Ellis-van Creveld syndrome).

Chondroectodermal dysplasia (CED) is an uncommon autosomal recessive disorder and one of the short rib polydactyly syndromes (SRPS). It is characterized by acromelic and mesomelic shortness of limbs, postaxial polydactyly, small chest, ectodermal dysplasia, and in many cases, congenital heart defects. Controversy exists over possible changes in the growth plate. With the advent of ultrasonographic examination, increasing numbers of fetuses with osteochondrodysplasias are examined by pathologists. Since histopathologic examination of the skeletal system is useful in defining various osteochondrodysplasias and it has not been described in the fetus with CED, we herein describe 3 cases of fetal CED with emphasis on skeletal histopathology. All 3 pregnancies were terminated at 22-23 weeks because of ultrasonographic demonstration of short limbs and growth retardation. Radiologically, each fetus had acromelic and mesomelic shortness of long bones with smooth round metaphyses, vertically short iliac bones, short ribs and normal vertebrae. These findings are similar to those described in the larger newborn infant with CED. Histopathologically, the cartilage of the long bones showed chondrocytic disorganization in the physeal growth zone. The findings are dissimilar to those of larger infants and older children in whom chondrocytic columnization has been seen in the central physis and disorganization in peripheral physis. Furthermore, a variable degree of chondrocytic disorganization was also seen in the central physeal growth zone of vertebrae in these fetuses. Other findings noted at fetopsy were: polydactyly in all 3 cases, congenital heart defect in 2 and an abnormal frenulum in one case. The foregoing phenotypic and radiographic manifestations and skeletal histopathology help separate CED from other SRPS.

Ultrasonographic prenatal diagnosis and fetal pathology of Langer mesomelic dwarfism.

In a family at risk for Langer mesomelic dwarfism, we document the onset of disproportionate growth in the second trimester by sonographic biometry. Midtrimester pathologic correlation of this condition demonstrates primary changes in the growthplate in the regions of proliferating cartilage and hypertrophic and degenerative chondrocytes.

Xerotomography of peripheral lung lesions.

Xerotomography was compared to conventional tomography in 72 patients with peripheral lung lesions. The xerotomogram was superior to the conventional tomogram in 41 patients, and yielded no additional information in 31. Details of lesions were better displayed, especially the margins: cavitations, air bronchogram and bronchiectasis, and calcification. Differentiation between benign, inflammatory and malignant lesions was facilitated. The xerotomographic process improved the image detail of lesions due to the edge enhancement property and the greater recording latitude of contrast of the xeroradiographs. Xerotomography is recommended only in selected patients for a few tomographic cuts because of the high radiation dosage.

Xerotomographic diagnosis of central bronchogenic carcinoma.

Xerotomography was used to examine 14 patients with substantial pulmonary opacities, in whom the diagnosis of bronchogenic carcinoma had been suspected. Xerotomography was valuable because it provided excellent delineation of the tracheobronchial tree, which assisted in differentiation of benign from malignant lesions. Malignancy was suggested by: 1) amputation, 2) eccentric narrowing of the bronchus, 3)irregularity of the bronchial wall, 4)presence of an intraluminal mass. Mediastinal and hilar node enlargement could also be assessed. The use of these criteria allowed a correct preoperative diagnosis in 12 of 14 patients. Due to the high radiation dosage, this method is not suitable for use as a screening procedure.

Improved image quality and examination procedures in xeroradiographic peripheral angiography: an experimental study.

Ten dogs were used to compare conventional peripheral angiography and xeroradiographic angiography using three different concentrations of contrast material. Serial angiograms were produced in order to determine maximum arterial filling time, and a xeroradiograph was made at the predetermined maximal arterial phase. Xeroradiographic angiography consistently provided better imaging of the peripheral vessels and soft tissue. Reduction of the concentration of contrast material resulted in the loss of an image of diagnostic quality using conventional angiography, but vascular definition was maintained using xeroradiography. These studies indicate that xeroradiographic angiography not only improved peripheral vascular imaging, but is also successful at a lower concentration of contrast material, thus reducing toxic systemic effects and pain associated with the procedure.

The utilization of xeroradiography for radiography of cross-section of thin cadaveric slices.

Although xeroradiography has had many medical applications, its utilization and the advantages it offers in the study of cadaveric sections has not previously been fully explored. It was our purpose to determine possible advantages or disadvantages this modality might have for this purpose. The edge enhancement which xeroradiography allows is a distinct advantage since the various anatomic structures become more clearly defined. On the other hand, the hollow viscera and the lumina of blood vessels are not enhanced, but rather blend with the walls of these "hollow" structures. Also, there is some loss of detail in the depiction of some of the glandular structures, such as the seminal vesicles. An artist's assistance to define these by comparison with the gross specimen gives us an optimum result. An x-ray enhanced image is thereby attained which exceeds the usual line drawing or artist's depiction of the cross-sectional specimen, and both can be similarly labeled for study.

Chest xerotomography: evaluation of calcification within lung nodules.

Through the use of a chest phantom and beeswax nodules containing calcium, xerotomography is shown to be a valuable tool in the evaluation of calcifications within lung nodules. The technique gives superior definition of calcium, especially fine calcifications in the 1-2-mm, or less, range. Our results suggest that clinical trials should follow and clinicopathologic correlation be obtained.

The pediatric tracheostomy: III). An appraisal of xerography.

Comparatively new in the roentgen evaluation of infants and children, xerography would appear to be ideal for portraying the pediatric airway. Since the radiation dose of xerography is higher than conventional radiography, its image quality is the subject of careful scrutiny in a pediatric setting here described in 23 infants and children with tracheostomies. In this appraisal three pediatric radiologists independently compared each child's xeroradiograph with an accepted control, conventional radiography. The principal conclusion: the xerographic image of the pediatric airway is slightly superior to standard radiography in most studies (40 of 47 paired studies, 85.1%). In all but two comparisons, however, the tracheal morphology is correctly perceived, described, and interpreted in both the standard radiograph and the xeroradiograph. The main role of xerography, then, is its verification of tracheal detail as first depicted by the preliminary radiography. This confirmation is important in this particular pediatric problem, the tracheostomy, which has inherent difficulties in correct roentgen diagnosis.

Localization of peripheral catheter emboli with xeroradiography.

There is an increasing incidence of venous catheter emboli coincident with the prolonged use of both peripheral and central venous cannuli. Difficulty in localizing embolized catheter fragments frequently has been a problem, especially in the pediatric patient in whom nonradiopaque catheters are used. A case of catheter embolus in a 4-week-old infant is reported and the use of xeroradiography to localize the catheter in the soft tissue of the extremity is described. Xeroradiography offers excellent definition of soft tissue architecture and therefore may be of value in a variety of situations where localization of a foreign body proves difficult.

Mass screening for breast disease. Results, problems, and expectations.

The first 18 months' experience of the Breast Diagnostic Center of Jefferson Medical College have been reviewed. Almost 14,000 patients were screened for breast disease, using a combination of clinical examination. Xeroradiography, and thermography. In this group of 14,000 women, 106 cases of cancer were discovered, in incidence of almost 8 per 1000 women screened. Of these 106 cases of cancer, 45.3% were clinically occult or not recognized by clinical examination, and within this group at the time of mastectomy only a small percent had any evidence of axillary lymph node metastases. The combination of several technics of examination is proving to be more reliable for the early detection of breast cancer than any of the technics alone, and programs such as these may make a significant difference in the death rate from breast cancer.

The addition of mammography to breast carcinoma screening in a general gynecology practice. One year's experience.

Obstetrician-gynecologists must be in the vanguard of the effort to reduce the death rate from breast carcinoma for it is they who regularly examine a large number of American women. Routine mammography was incorporated into a general gynecologic practice and was recommended for all women over 30. Of 750 women clinically examined, 524 had mammography, and there were 8 carcinomas detected in this group. Six of these were detected by mammography, 5 by mammography alone. Four of these 5 were in situ lesions. In 2 cases the clinical examination was suspicious and the mammography negative. Only 2 of the 8 patients with cancer fell into the commonly cited "high-risk" groups. Based on this experience, suggestions are made for incorporation of mammography into the routine gynecologic examination.