Evaluation of postoperative osteomyelitis of the sternum comparing CT and dual Tc-99m MDP bone and In-111 WBC SPECT.

This article reports on a retrospective study of 32 patients who underwent CT and combined Tc-99m MDP and in-111 WBC SPECT between 1988 and 1991 for post-operative sternal osteomyelitis. Of these 32 patients, 7 patients (Group 1) underwent evaluation for possible sternal osteomyelitis due to persistent fevers, leukocytosis, or changes in the sternal incision; 12 patients (Group 2) had surgically proven osteomyelitis, and in 13 patients (Group 3) there was definite clinical evidence of sternal wound infection (however, surgical specimens of the sternum were not submitted). There was considerable overlap between the CT findings in the soft tissues adjacent to the sternum in Group 1 and Group 2 patients. Severe demineralization was seen in two patients, and erosion of the sternum was seen in five patients with proven osteomyelitis. Combined Tc-99m MDP bone and in-111 WBC SPECT was positive for osteomyelitis in 11 of 12 patients in Group 2. One patient with osteomyelitis had negative scintigraphy; however, this patient had a four-week course of IV antibiotic therapy prior to the study. All seven patients in Group 1 had negative SPECT scans and were treated successfully with oral antibiotics and minimal soft tissue debridement. Three patients in Group 3 had negative SPECT scans and were treated successfully with antibiotics and limited debridement. Ten patients with positive SPECT scans were treated with a combination of antibiotics and aggressive surgical intervention. In conclusion, CT findings in the soft tissues offer little specificity in distinguishing soft tissue inflammation from osteomyelitis of the sternum.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the anchoring strengths of the Kopans and Hawkins II needle-hook-wire systems.

To determine whether needle-hook-wire anchoring strength is a factor in accidental repositioning of a hook wire, 5-cm Kopans and Hawkins II hook wires were placed axially (n = 9) and coronally (n = 5) in mastectomy specimens. The tension required to pull the hook wires 1, 2, 3, and 5 cm and to increase the barb angle to 90 degrees and 180 degrees were compared. The average anchoring strength of the Hawkins II hook wire was greater than that of the Kopans hook wire, by 2.6 times (P less than .001; all distances, both angles) with the wires in the axial plane and by 1.6 times (P less than .06; intervals and angles combined) in the coronal plane.

MR findings in the brains of compressed-air tunnel workers: relationship to psychometric results.

Cranial MR imaging was performed in 30 subjects who had been involved in compressed-air tunnel projects in and around Milwaukee, WI. Nineteen of these subjects had been exposed to various degrees of hyperbaric air as calculated by an exposure index (average PSI pressure gauge multiplied by the number of years exposed), while 11 of the subjects were age-matched controls who belonged to the same labor union but had not been exposed to hyperbaric air. All MR scanning was done on a 1.5-T unit, and axial, sagittal, and coronal T1, proton density, and T2-weighted images were obtained. Ventricular size was measured objectively. Foci of increased T2 intensity within deep white matter tracts were evaluated as to number and location, and psychometric testing was performed on both groups to exclude preexisting organic brain disease. The 19 subjects in the experimental group had a statistically higher number (p = .05) of white matter lesions (more than 152) than the control group (22 lesions), and 37% of the experimental group had more than 20 white matter lesions each (seven of 19 subjects) while only 18% of the control group had 10 or 11 lesions each. The experimental group had a five times higher risk than the control group of having high-grade lesions, and a high statistical correlation (p = .02) was found between the number and severity of lesions in the experimental group as compared with the control group when linear trend analysis was performed. No correlation was found between exposure index, MR grade or number, or aseptic necrosis. Ventricular size was normal in all subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Does dysbaric osteonecrosis progress in the absence of further hyperbaric exposure? A 10-year radiologic follow-up of 15 patients.

Progression of dysbaric osteonecrosis of the femoral and humeral heads was evaluated in 15 caisson workers. All patients had dysbaric osteonecrosis but had had no further exposure to hyperbaric pressures for a minimum of 10 years. The original and follow-up radiographs were compared in each case. Of 24 normal articular heads (nine humeral and 15 femoral), one (4%) humeral head developed new subcortical sclerosis. Of the 36 juxta-articular lesions, seven (four humeral and three femoral) showed major changes in the 10-year interval. Of these seven, two (one humeral and one femoral) had new articular fractures and three (two humeral and one femoral) with articular fractures showed progressive osteoarthritis. We conclude that caisson workers can develop lesions in previously normal areas and experience worsening of previously known lesions in the absence of further exposure to hyperbaric pressures.

Toluidine blue dye as a breast localization marker.

We compared the efficacy of toluidine blue dye vs methylene blue as a visual marker for breast localizations in vitro and in vivo. In phase 1, the dyes were injected into 10 mastectomy specimens and allowed to diffuse for 24-48 hr. In phase 2, the breasts of four premastectomy patients were injected with the dyes and the dyes were allowed to diffuse for 3 3/4, 12, 24, and 47 hr before mastectomy. In phase 3, the breasts of 18 women in whom 20 breast localizations were performed before excisional biopsy were injected with methylene blue or toluidine blue up to 2 hr 10 min before the biopsy. All excised stained breast tissue was evaluated blindly. The amount of pain associated with injections of the dye was recorded. The 22 women in phases 2 and 3 had had mammograms before, and the parenchymal patterns had been classified according to Wolfe. In the patients injected 3 3/4, 12, 24, and 47 hr before mastectomy, more intense staining with less diffusibility was seen with toluidine blue than with methylene blue. In the 20 localization procedures before excisional biopsy, no difference in intensity of staining or radius of diffusion was seen between methylene blue and toluidine blue with maximal diffusion times of 2 hr 10 min. Breast parenchymal pattern did not correlate with stain intensity or diffusibility. The six patients in whom both methylene blue and toluidine blue were injected and the 18 patients in whom either dye was injected felt less discomfort at the time of injection of toluidine blue than of methylene blue. Our results suggest that toluidine blue causes less discomfort and produces a more intense stain with a smaller diffusion radius than methylene blue regardless of breast parenchymal pattern.

Evaluating EMP with computed tomography.

Extramedullary plasmacytomas (EMP) of the nasopharynx are rarely associated with osseous destruction, and when destruction does occur, only minimal erosions have been found. More extensive bony involvement and intracranial extension in neoplasms of the head and neck usually suggest the presence of a more aggressive tumor such as carcinoma. We report computed tomographic (CT) findings in a nasopharyngeal EMP showing extensive intracranial involvement and severe bony destruction.

Coronary angiography in atrial myxoma: findings in nine cases.

We report the findings on selective coronary angiography in nine patients with atrial myxomas. The angiograms were obtained because the patients were suspected of having coronary artery disease. In each case, the diagnosis of myxoma had been made earlier by echocardiography. Coronary angiography in five (55%) of the nine patients showed neovascularity in the tumor without calcification. In one patient, the angiogram showed a varix of the myocardium at the base of the tumor. The angiograms in three (33%) of the nine patients did not show neovascularity but showed tumoral calcification. Six (67%) of the nine patients had significant coronary artery disease that required coronary artery bypass grafting along with resection of the myxoma. These data suggest that the incidence of neovascularity in atrial myxomas is higher than previously reported. Furthermore, a significant number of this older population presented with operable artery disease as well as atrial myxoma.

Early CT findings after interstitial radiation therapy for primary malignant brain tumors.

The CT findings after interstitial radiation therapy for brain tumors have not been extensively described. We evaluated retrospectively the CT scans of 13 patients who were treated with brachytherapy for malignant glioma. We found no typical CT appearance that differentiates recurrent tumor from radiation effect. After undergoing brachytherapy, eight of the 13 patients scanned demonstrated enhancement of brain tissue beyond the margins of the original enhancing tumor mass. In most cases, the pattern of enhancement diminished and extended more peripherally from the central necrotic area with time. We also report a new CT finding of focal calcification developing at the site of the radioactive implant.