First-year medical students' attitudes toward radiology.

To explore the perspectives of entering medical students, a questionnaire was completed anonymously by 171 students in September of their first year of medical school. The authors investigated their attitudes toward radiology relative to other specialties and their perspective concerning which factors would influence their eventual choice of a specialty. Upon entering medical school, 33.3% of the students indicated that they had chosen a specialty, and 7.4% of these students had selected radiology. Radiology was perceived as a well-paid specialty with a pleasant lifestyle. These are factors that were perceived as very important regarding influence on eventual choice of specialty. However, radiology was believed to have an undesirably low level of patient contact and was perceived as not being intellectually exciting. We plan to follow this group of students prospectively through medical school to see whether their attitudes change toward radiology as a career.

Carpo-metacarpal growth disturbance and the assessment of carpal narrowing in children with juvenile rheumatoid arthritis.

Second metacarpal length (M2), radio-metacarpal length (RM), and intermetacarpal width (W) were measured on 96 radiographs in 52 children with polyarticular juvenile rheumatoid arthritis (JRA), and compared with body height and skeletal maturation in order to: (1) differentiate between processes resulting in retardation of bone growth and those producing delay in skeletal maturation; (2) assess the severity and progression over time of such retardation; and (3) assess the impact of retardation of the second metacarpal on the assessment of carpal narrowing in children with JRA. All measurements were converted into z scores (the units of standard deviation above or below the normal mean for each measurement) based on published norms. Retardation of M2 (mean z scores -0.91) began earlier and was more severe compared with retardation of height (mean z score -0.25). This disproportion widened with increasing duration of disease. That this primarily represents a disturbance in M2 growth rather than a secondary effect due to altered maturation is suggested by the bone ages being normal (mean z score 0.14) and the absence of premature closure of the metacarpal physes. Z scores for RM/W (mean -3.53) were at least 1 Z more negative than for corresponding measurements of RM/M2 (mean -2.41) in 47 (90.4%) children and the mean difference between the z scores for RM/W was -1.12. This discrepancy between RM/W and RM/M2 was eliminated by correcting for the reduction in M2.

Concurrent hydromyelia and diastematomyelia.

Hydromyelia was discovered in six of 13 patients with diastematomyelia. In one patient, hydromyelia affected only the segments of spinal cord above the diastematomyelia. In five patients, hydromyelia extended downward from the single cord into one or both hemicords. Because hydromyelia and diastematomyelia occur simultaneously, because they may produce very similar clinical changes, and because simultaneous or sequential surgical correction of both conditions may be necessary to achieve the best clinical result, the possibility of hydromyelia should be evaluated specifically in each patient demonstrated to have diastematomyelia.

Radiographic lung disease and response of persistent pulmonary hypertension to mean airway pressure and alkalosis.

Persistent pulmonary hypertension of the newborn (PPHN) is associated with multiple cardiopulmonary diseases. Therapy often includes hyperventilation/alkalosis despite little evidence as to its efficacy in diverse conditions. To determine (1) if part of the improvement of arterial oxygen tension (PaO2) attributed to alkalosis is actually related to increased mean airway pressure (P(aw)) and (2) if the presence of radiographic pulmonary disease predicts the response to alkalosis or mean airway pressure, we reviewed records of 19 newborns with well-documented PPHN. Arterial blood gases and corresponding ventilator settings were recorded during the first day of life. To adjust for lower FiO2, corrected PaO2 (cPaO2) was calculated when the FiO2 < 1.0, such that cPaO2 = calculated arterial/alveolar oxygen ratio x (713 - PaCO2/0.8). Regression equations were obtained and mean slopes of these were compared for P(aw) vs. cPaO2, and pH vs. cPaO2 by one group t-tests (with assumed population slope of zero). There was no correlation between P(aw) and cPaO2 (mean slope +/- SD = -8.4 +/- 30.8, P = 0.25), but there was a moderate correlation between pH and cPaO2 (mean slope = 333.1 +/- 480.5, P = 0.007). Patients were then classified by chest radiographs as having severe or minimal/no lung disease. Relationships of P(aw) and pH to cPaO2 were then re-examined. No correlation was present between P(aw) and cPaO2 in 11 patients with PPHN and severe radiographic disease (mean slope = -7.4 +/- 26.9, P = 0.38) or in eight patients with PPHN and minimal/no lung disease (mean slope = -9.8 +/- 37.5, P = 0.48).(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation of ultrasound with postmortem neuropathologic studies in neonates.

We examined the correlation between cranial sonogram and postmortem examination neurodiagnoses in 51 infants (30 boys and 21 girls) who underwent cranial sonogram before death. The mean gestation of the infants at birth was 32 weeks 6 days; the mean birth weight, 1,992 gm; and the mean survival, 27 days. Most infants had several postmortem examination neurodiagnoses; therefore the postmortem examination diagnosis considered to be most significant in terms of clinical management and long-term neurologic function was chosen for each infant and designated as the primary diagnosis. The ability of the cranial sonogram to diagnose the primary diagnosis was then evaluated. The accuracy of the cranial sonogram in defining primary diagnoses was 59%. There were 21 cases (41%) in which cranial sonogram failed to define the primary diagnosis; nine of these could be explained on the basis of the timing of the ultrasound in relation to the age of the lesion or to the microscopic nature of the lesion. In 12 patients the factors causing the failure of cranial sonogram to define primary postmortem examination diagnoses could not be identified. The positive predictive value of a cranial sonogram diagnosis was 77%; the negative predictive value was 19%.

Medical students' attitudes toward radiology: comparison of matriculating and graduating students.

RATIONALE AND OBJECTIVES: To determine graduating medical students' perceptions of radiology and to document changes in their perceptions since they entered medical school. MATERIALS AND METHODS: A survey questionnaire was distributed to 213 graduating students. Questions were similar to those answered by the same group of students as they entered medical school nearly 4 years earlier. RESULTS: The survey was anonymously completed by 140 students. Seventy percent of students changed their choice of medical specialty since entering medical school. Factors with a major or important influence on specialty choice included intellectual excitement (96%), high patient contact (86%), opportunity for a good family life (72%), and regular hours (57%). Radiology was perceived to be a well-paid (89%), "high-tech" (86%) specialty with a healthy lifestyle (82%), regular hours (99%), and good family life (92%), but it was not perceived to offer high patient contact (1%) and was intellectually exciting to only 33% of students. This perception was unchanged from freshman year. CONCLUSIONS: This 4-year longitudinal study of a medical student class documents surprisingly little change in the perception of radiology throughout medical school. High patient contact and intellectual excitement, both factors of major or important influence on specialty choice, were thought to be lacking in radiology.

Performance on the radiology component of a critical clinical skills examination.

RATIONALE AND OBJECTIVES: Clinical competence certification is now required in some specialties in medicine. A Comprehensive Clinical Assessment (CCA) was created to test mastery of critical skills by students at the end of the 3rd year of medical school. METHODS: The CCA is a series of stations that test skills the faculty consider important for all medical students (eg, breast examination, electrocardiogram reading, chest pain assessment, ophthalmology photographs). The radiology station was designed to evaluate imaging skills believed to be taught and learned in the core 3rd-year rotations. RESULTS: External measures (National Board Examinations, grade point average, and overall score) of clinical performance of the 608 medical students who completed the CCA examination between 1991 and 1993 were found to be correlated with the radiology station scores. CONCLUSION: The radiology station in the CCA examination is a reproducible measure of clinical performance.

Resolution of splenic injury after nonoperative management.

Numerous studies have demonstrated success with nonoperative management of splenic injuries in pediatric patients. However, the resolution of the splenic injury has not been previously evaluated. The records of 50 pediatric patients with splenic injuries from blunt trauma treated nonoperatively between 1984 to 1992 were reviewed retrospectively. Abdominal computed tomography (CT) was performed at the time of injury and 6 weeks postinjury in 25 patients. These scans were reviewed and categorized by a modification of a previously reported grading system for parenchymal injury. All patients had healing of the splenic injuries, with complete resolution of the healing process observed at 6 weeks postinjury in 44%. Even those with shattered spleens (n = 6) had consistent improvement in splenic architecture, with resolution of fractures and/or contusions and return of splenic perfusion. Ten (77%) of 13 grade 1 and 2 injuries were completely resolved by the 6-week follow-up examination, whereas only one (8%) of 12 grade 3 to 5 injuries showed radiological resolution of splenic injuries. None of the 25 follow-up CT scans affected clinical decision-making or led to a deviation from the established protocol, which included a 3-month period of reduced activity. All 50 patients did well, without evidence of morbidity, mortality, or complications after return to full activity 3 months postinjury.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of sonography in the diagnosis of bronchopulmonary sequestration.

Sonography in six patients with pulmonary sequestration demonstrated findings associated with and indicative of that diagnosis. The most useful feature, which was seen in three cases and is diagnostic of sequestration, is the identification of an anomalous systemic artery arising from the aorta.

Radiographic imaging of airway obstruction in pediatrics.

The authors review techniques available to image the airway, normal radiographic airway anatomy, pitfalls in imaging the airway, and radiographic findings in various pathologic processes that may cause airway obstruction. A brief discussion of the application of imaging in the child with sleep apnea is included.

Postintubation granuloma of the anterior subglottic larynx.

We present an unusual case of a granuloma in the subglottic laryngeal airway of a 6-week-old infant with a history of previous endotracheal intubation. Postintubation granuloma formation in this region has not been previously reported in infants.

Scintiangiographic demonstration of parasitization of systemic blood supply by inflammatory lung disease.

An unusual case in which a computed tomogram demonstrated abnormal, enlarged vessels in the right lower lobe of the lung and suggested an arteriovenous malformation is presented. A scintiangiogram showed abnormal systemic supply to this area in the aortic phase. Contrast angiography demonstrated hypertrophy of the right inferior phrenic artery with abnormal systemic supply to the pleura and parenchyma of the right lower lobe, presumably on the basis of old infection.

Indium-111 leukocyte uptake in a patient with osseous metastatic Ewing's sarcoma.

A case of increased uptake of in-111 labeled leukocytes in osseous metastasis from Ewing's sarcoma is presented. Bone scan and MRI findings were concordant with the indium scan, and biopsy confirmed Ewing's metastasis. Although relatively specific for infection, indium infrequently does demonstrate abnormal bone uptake in several malignancies. This case report is the first to describe indium uptake in osseous metastatic Ewing's sarcoma. Possible mechanisms of indium leukocyte localization are discussed.

Ileal duplication cyst: repeated spontaneous decompression delays diagnosis.

A duplication cyst of the ileum was initially observed in a fetus at 26 weeks gestation on prenatal ultrasonography. Repeated spontaneous resolution of the cyst by decompression into the adjacent bowel lumen delayed diagnosis and management until the child was 9 months of age. The child experienced two episodes of hemorrhage from the cyst as a result of the delay in diagnosis.

Enlarged common hepatic duct secondary to morphine in a neonate.

A neonate with reversible, nonobstructive common hepatic duct enlargement secondary to intravenous morphine administration is presented.

Elliptical cricoid cartilage: a unique type of congenital subglottic stenosis.

An elliptically shaped cricoid cartilage, a specific type of congenital subglottic stenosis, is described, and the laryngoscopic and radiographic findings in three cases are discussed. An "hourglass" deformity of the subglottic laryngeal airway on an anteroposterior airway radiograph is suggestive of this diagnosis.

Pericardial effusion presenting as an anterior mediastinal mass.

The authors present a case of pericardial effusion in a patient with previous cardiac surgery. Because the pericardium is opened and not reclosed during surgery, fluid can extend superior to the normal upper reflections of the pericardium and simulate an anterior mediastinal mass.