Contact thermography of spinal root compression syndromes.

A thermographic technique is described that uses cholesteric liquid crystals that change color in response to variations in surface temperature. The crystals are embedded in elastic flexible sheets that conform to the contours of the torso and extremities. The technique is well suited to temperature measurement of individual skin dermatomes and myotomes. Typical heat patterns emanating from the torso and extremities have been observed and correlated with root compression syndromes at low cervical and low lumbosacral levels. The imaging results correlate well with clinical and surgical findings, particularly when the extremity dermatomes are included. The technique objectively documents the subjective complaint of pain and approaches myelography in accuracy. It was in agreement with myelography in 86% of cases and with surgery in 95% of cases. Liquid crystal thermography may, therefore, effectively screen patients of myelography and can complement it in identifying clinically significant abnormalities.

Liquid crystal thermography of the spine and extremities. Its value in the diagnosis of spinal root syndromes.

Cholesteric liquid crystals are special compounds that display specific color changes in response to variations in temperature. Their responses can be graphically demonstrated by means of color thermography. A new color contract thermographic technique is described utilizing liquid crystals embedded in elastic flexible sheaths. These sheaths, when inflated, conform to the varied contours of the torso and extremities and, therefore, the new thermographic technique is especially well suited to the study of the skin dermatomes and myotomes. Typical heat patterns have been observed in root compression syndromes and particularly at the S-1, L-5, L-4, C-6, C-7, and C-8 levels. A high degree of anatomic accuracy can thus be achieved, comparable to or better than can be achieved by electromyography or myelography. Liquid crystal thermography can serve to screen patients for myelography and can complement myelography in identifying clinically significant abnormalities. The imaging technique correlates well with clinical and surgical findings, and constitutes one of the first attempts by means of a concomitant study of the body dermatomes to objectively document the subjective complaint of pain.

Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success.

Caustic material ingestion, either accidental or intentional, may result in tissue and organ destruction leading to a wide range of complications, including loss of speech and the ability to eat. The esophagus can be reconstructed successfully, but reopening the larynx and upper airway poses a significant therapeutic dilemma. External reconstruction may put the neoesophagus at risk. Loss of the normal swallowing mechanism and the protective supraglottic structures often results in fatal aspiration. The authors present three cases of successful endoscopic laser recannulation of the larynx with esophageal replacement. The discussion includes surgical technique and the tools used to determine the success of the reconstruction, including computed tomographic scanning, modified barium swallow, placement of an upper esophageal anastomosis, psychologic support, and speech and swallowing therapy.

Thermography in posttraumatic pain.

Posttraumatic pain is often associated with complex disturbances of the sympathetic nervous system which also controls microcirculation of the skin. Circulatory skin changes are in turn reflected by altered superficial thermal emission, which can be reliably imaged by thermography. Examples of classic thermographic patterns associated with commonly occurring injuries and detected along cutaneous distributions of peripheral nerves or spinal root dermatomes are presented. Thermographic abnormalities may also occur in ondermatomal distributions to involve an entire hand, foot, or extremity as observed in reflex sympathetic dystrophy. Such thermographic findings often appear before skin or roentgenographic changes become manifest and lead to earlier diagnosis. Prompt and more effective treatment, particularly in reflex sympathetic dystrophy, may thereby be initiated so that full blown, difficult to manage, chronic disability may be averted. The diagnosis of malingering may also be strengthened or suspected if thermographic studies together with other examinations are normal.

Nonprolapsing atrial myxoma; clinical, echocardiographic, and angiographic correlations.

The auscultatory features typical of myxoma were absent in a patient with nonprolapsing left atrial myxoma. Angiocardiographic and echocardiographic findings including B-mode cross-sectional scanning are presented.

Kidney cassettes for intraoperative radiography.

A miniature vacuum cassette, contoured to conform to the kidney, has been used successfully in the operating room to visualize intraparenchymal calculi fragments. A low-dose technique using a single-emulsion film and high-definition intensifying screens has been developed. A vacuum system assures good screen-film contact. The vacuum cassette can be sterilized and reused.

The chewable barium tablet slow tracking of oral and pharyngeal swallowing dysfunction.

Dysphagia can be due to oral or pharyngeal dysfunction as well as to esophageal causes. Oral and pharyngeal disturbances, however, are more common in older people because of their attendant risks of laryngeal, tracheal, and pulmonary aspiration. To guide any dietary prescriptions it is important to establish whether the patient can best tolerate liquids, soft foods, solid chewable boluses, all, or none of these. It therefore becomes important to supplement liquid barium swallowing studies with soft and chewable boluses mixed with barium. Here I describe the novel introduction of chewable barium tablets in conjunction with routine swallowing studies. Chewable barium tablets, if used properly, are safe, supply needed information, and can shorten the evaluation of oral and pharyngeal dysfunction studies. Because of the granular appearance of the tablets, aspiration due to this solid chewable bolus can be distinguished from liquid aspiration. Moreover, if the barium tablets are swallowed whole, they can help delineate esophageal strictures if the oral and pharyngeal phases of swallowing are normal.

Vacuum contoured, liquid crystal, dynamic breast thermoangiography as an aid to mammography in the detection of breast cancer.

New thermographic equipment is introduced in the form of liquid crystals embedded in flexible, transparent, elastomeric sheaths which may be vacuum contoured to any breast. Dynamic thermoangiography, a new physiological method of performing thermography with these liquid crystal sheaths, is presented. Thermographic changes are recorded during active skin cooling and rewarming with liquid crystals in situ. The new system eliminates skin preparation previously required. Preliminary results appear to show good correlation with conventional telethermography. Vascular, as well as thermal pathology, is accentuated with rich, high contrast, thermographically calibrated colour patterns. The new system is relatively inexpensive, simple to operate, and may be suited to a programme for the detection of breast cancer.

Liquid crystal contact thermography of deep venous thrombosis.

A new thermographic technique for the diagnosis of deep venous thrombosis, liquid crystal contact color thermography using naturally occurring cholesteric crystals is described. Cholesteric crystals have the property of changing colors in consistent, predictable patterns in response to local temperature changes. The technique is reliable and reproducible. It has also been rendered simple by embedding the liquid crystals in elastic, flexible sheets. The sheets are inflated and readily adapt and contour to extremities of various sizes and shapes. Preliminary results have shown excellent correlation with ascending phlebography. The two methods were in agreement in 90% of cases with no false-negative liquid crystal thermograms. The technique shows promise as a noninvasive screening study for the diagnosis of deep venous thrombosis in high risk patients.

Diagnosis and management of complications of percutaneous nephrolithotomy.

The therapeutic management of the complications of percutaneous nephrolithotomy (PNL) depends on the early recognition of these complications. A review of 720 cases revealed the incidence of significant complications to be less than 4%. An algorithm was developed as a guideline for the diagnosis and management of complications of PNL. Early complications included transient bleeding (83 cases), extravasation of urine (52 cases), significant infection (11 cases [2 with septicemia and shock]), and migration of stone fragments into the retroperitoneum (7 cases). Nonrenal complications were present in less than 6% of these patients. These included pleural effusions or pneumothorax (24 cases) and lung atelectasis (19 cases). Late complications were seen in less than 2% of the patients. These included stricture of the ureter with obstruction (5 cases), A-V fistula with or without pseudoaneurysm (7 cases), and subcapsular hematoma (1 case). Therapeutic management included improvement of technique to the use of antibiotics to treat infection. The use of proper drainage and the placement of stent or catheter in the treatment and prevention of further complications has become an integral part of the algorithm for the treatment of complications of PNL. This algorithm recommends the proper diagnostic modality for the detection and evaluation of the extent of the complication. Once detected, the complications of PNL can be minimized with limited permanent changes.