Clinical and radiographic features of pulmonary tuberculosis in non-AIDS immunocompromised patients.

SETTING: Department of Chest Diseases, Istanbul Faculty of Medicine, Istanbul University. OBJECTIVE: To determine the clinical and radiographic presentation of pulmonary tuberculosis in non-AIDS immunocompromised patients (ICP). DESIGN: A retrospective review of medical records of 143 patients (63 immunocompromised patients and 80 immunocompetent patients) with pulmonary tuberculosis from 1992 to 2001. RESULTS: In ICPs, fever was more frequently observed (84.1% vs. 40%, P = 0.0000002), tuberculosis was more frequently disseminated (23.8 vs. 3.8%, P = 0.0008), and lung infiltrations were more often lobar or segmental consolidation (20.6% vs. 0%, P = 0.00007) and miliary lesions (17.5 vs. 3.8%, P = 0.014) than in the control patients. Hilar and/or mediastinal adenopathy was also more frequently documented in ICPs (14.3% vs. 2.5%, P = 0.01). CONCLUSION: Fever, atypical chest radiograph and disseminated disease are common findings of pulmonary tuberculosis in ICPs.

Evaluation of undergraduate training on tuberculosis at Istanbul Medical School.

SETTING: Undergraduate training on tuberculosis at Istanbul Medical School. OBJECTIVE: To assess whether tuberculosis-related questions asked in chest medicine examinations comply with the World Health Organization's (WHO) learning objectives for tuberculosis training, and to investigate students' skills in interpreting radiology and smears with respect to tuberculosis. DESIGN: Tuberculosis questions set for 4th year medical students (n = 838) were compared with WHO objectives (n = 23): 122 students were each asked to interpret 10 chest X-rays which had been read by three experts as 'typical tuberculosis lesions', 'normal' or 'non-tuberculosis lesions'; 114 students were also each given five smears which had been interpreted by an expert as 'negative' or 'positive' with respect to acid-fast-bacilli (AFB), and were asked to interpret them. RESULTS: Questions covered only nine of the WHO objectives. Among 117 types of questions, 91 (77.8%) were about clinical-radiological findings, treatment and drugs; 334 (65.1%) of 513 X-rays with typical tuberculosis lesions, 77 (21.1%) of 364 normal X-rays and 87 (25.4%) of 343 X-rays with non-tuberculosis lesions were identified as tuberculosis (kappa 0.45). Of 369 AFB-positive smears, 149 (40.4%) were evaluated as false negative, and of 185 AFB-negative smears, 48 (25.9%) were evaluated as false positive (kappa 0.49). CONCLUSION: Examination questions set on tuberculosis at Istanbul Medical School do not adequately reflect WHO learning objectives. Students' skills in interpreting radiology and smears suggest that their practical training on tuberculosis is insufficient.

CT and MR evaluation of pericardial constriction: a new diagnostic and therapeutic concept.

Eighty patients with pericardial constriction confirmed by catheter data were studied by CT (n = 79), MR imaging (n = 24), or both. To determine the validity of these imaging methods for subsequent treatment, 30 patients' studies were evaluated retrospectively (1980-1984) and 50 (1985-1991) prospectively. Twenty patients from the first group and 30 patients from the second group underwent pericardiectomy. By systematic analysis of CT scans and MR images it was possible to characterize the morphology of pericardial constriction (n = 80); to identify global (n = 27), right-sided (n = 46), left-sided (n = 2), annular (n = 2), effusive (n = 2), and epicardial (n = 1) forms of pericardial constriction; and to define parameters of myocardial atrophy and fibrosis (n = 17). Seventeen patients had myocardial atrophy, fibrosis, or both. Seven of them underwent pericardiectomy; all died of acute myocardial failure (100%). Four (9.3%) of 43 patients without myocardial atrophy or fibrosis died as a consequence of other complications. The method of thoracotomy and periepicardiectomy was continuously adjusted to the preoperative CT and MR findings. Thus, the clinical use of CT and MR imaging in patients with known or suspected pericardial constriction is based on (a) exclusion of patients with restrictive hemodynamics from diagnostic thoracotomy, (b) preoperative determination of the method of thoracotomy and extent of pericardiectomy, and (c) exclusion of patients with myocardial atrophy or fibrosis from pericardiectomy.

[Determination of length, width and height of the human skull by critical use of roentgenologic craniometry methods]. / Zur Bestimmung von Länge, Breite und Höhe des menschlichen Schädels unter kritischer Anwendung der Methoden der röntgenologischen Kraniometrie.

X-ray craniometry has gained in importance for scientific and clinical examination. It enables accurate measurement of shape and structure of the human skull, its characterisation and an accurate description of the type and cause of changes of its shape and components. Roentgenological craniometry is closely related to craniometry of anatomists and anthropologists, but in a few essential points it does differ from it--rather fundamentally, in fact. On using the roentgenological method, the general laws of x-ray imaging must be strictly observed and measurements must be effected only if they are conducted from such points which are roentgenologically clearly defined. Measurements must be definite, repeatable at any time and suitable for comparative purposes. The influence exercised by these conditions becomes noticeable already on determining the three principal dimensions of the cranium. Whereas the x-ray determination of the length and breadth of the cranium is easy to perform and does not present any problem, determination of the "height" of the cranium causes considerable difficulties that are mainly based on the statement of suitable points of measurement. Detailed studies and deliberations have shown that the distance between the vault and the base of the skull can supply a suitable measure for assessing the height of the skull. On lateral x-ray film the distance between the "endobregma" and the "bony floor of the hypophyseal cavity" is a suitable criterion, whereas on the sagittal x-ray films of the skull the criterion is the distance between "bregma" and "hypophyseal basis". The "lateral hypophyseal height of the skull" and the "sagittal hypophyseal height" are largely equal, clearly defined and always repeatable.(ABSTRACT TRUNCATED AT 250 WORDS)

An unusual radiographic finding in pulmonary parenchymal endometriosis.

Thoracic endometriosis is an uncommon disorder. In most cases, the diagnosis is based on history alone and radiographic findings depend on the menstrual cycle. CT findings include ill-defined or well-defined opacities, nodular lesions, cavities, cystic changes and bullous formation. We report a case of pulmonary parenchymal endometriosis with an unusual radiographic finding.