A. Franklin Turner

Computer Diagnosis of Pneumoconiosis

The advent of increased government involvement in occupational health maintenance with compensation for affected individuals is requiring new approaches to medical decision making. One aspect of this involvement will perhaps include the automatic mass diagnostic screening of medical films for the detection of a specffic abnormality with an occupational etiology. The results of two complementary approaches for performing diagnostic screening for presence and profusion of coal workers pneumoconiosis from the routine posterior-anterior chest radiograph are presented. The first is a digital approach utilizing the measurement of image texture, while the second uses hybrid optical-digital methods involving the optical Fourier tramsform. Both approaches yielded classification results comparable to experienced radiologists.

Diagnostic features of right ventricular myxoma

The clinical diagnostic features of right ventricular myxoma are described in a recent patient and related to the 15 cases previously reported. The presence of a pulmonic systolic ejection murmur with a delayed (120 to 140 msec.) and accentuated pulmonic second sound, or calcification in the region of the right ventricular outflow tract should suggest this lesion. Cardiac catheterization with angiocardiography in diagnostic. Ga scanning may assist in the diagnosis and followup after surgical removal of the myxoma. Early surgical removal will avoid the possibility of sudden death.

Pulmonary artery to vein shunts in obstructive pulmonary disease

Abstract Forty-six patients with chronic respiratory disease were studied; all but two had obstructive pulmonary disease. In none were intracardiac shunts or pulmonary arteriovenous fistulas detected. In four patients with obstructive pulmonary disease a direct pulmonary artery to vein connection was identified by peripheral pulmonary wedge arteriography. The findings in these four patients (history, physical examination, electrocardiography, chest roentgenography, cardiac catheterization, pulmonary function studies and angiography), compared with those in the remaining patients in whom no shunt was visualized, revealed no discriminating differences. All patients with pulmonary artery to vein connections had moderately severe obstructive pulmonary disease and moderate degrees of pulmonary hypertension. Pulmonary vascular resistance was significantly increased. When measured, the arterial blood pO 2 at the end of a twenty minute period of oxygen breathing was significantly decreased. However, many patients without definitely identifiable shunts showed similar degrees of abnormality. Since many of the latter had arterial blood pO 2 of from 134 to 350 mm. Hg during 100 per cent oxygen breathing, it is likely that arteriovenous shunts were present but not identified by the method of pulmonary arteriography employed.

The Valsalva Maneuver in the Diagnosis of Left Ventricular Aneuryem1

ONE OF THE most common and serious complications of myocardial infarction is the development of a ventricular aneurysm. Within three to five years, 76 to 88 percent of patients with this complication die (1, 14). Although infrequently diagnosed before death, ventricular aneurysm is now recognized as a significant cause of refractory heart failure in patients with arteriosclerotic heart disease (10). Cardiac aneurysm may be defined as an abnormal bulge of the ventricular wall secondary to increases in intraluminal pressure (4). This bulge may be seen throughout the cardiac cycle or only during systole and, according to Gorlin, may occur in an area varying in thickness from a paperthin scar to full thickness muscle (3). The radiological diagnosis of ventricular aneurysm depends upon the demonstration of such a bulge along one of the margins of the left ventricle. Unfortunately, this can be done in only 10 to 20 percent of the cases in which conventional radiologic technic is employed (3, 13). The Valsalva m...

Arthrography in penetrating injuries

Arthrography in cases of trauma to joints may provide valuable information about joint disruption as well as the location of foreign bodies. Allergy to contrast agents and bleeding diathesis are the only contraindications. Four cases are presented that demonstrate the usefulness of this technique.

Neonatal fibrous dysplasia.

Summary The first known case of neonatal fibrous dysplasia is reported. The differentiation from congenital pseudarthrosis and simple bone cyst is discussed. Discovery of a case of neonatal fibrous dysplasia supports the theory that fibrous dysplasia represents a congenital disorder of development of the skeleton.

Catheter Tip Deflector System for Selective Bronchography

Percutaneous transcricothyroid membrane catheterization of the bronchial tree for bronchographic examination is simple and safe (5). For entrance into small subsegmental branches, catheters of various curvatures are required. It is often necessary to exchange various preshaped catheters when studying several subsegmental branches, thus prolonging the procedure and increasing the possibility of complications. The use of a catheter tip deflector system obviates the need for such substitution. Following the introduction of guides for angiography (4, 6), application of these technics for controlling catheters in bronchography was suggested (7). The use of a catheter tip deflector system2 is ideally suited for regulating and varying the curvature of any catheter following its percutaneous introduction through the cricothyroid membrane. The system consists of a tip-deflector handle and a short (35 cm) Teflon-coated wire (O.D. 1.14 mm). The tip-deflecting guide wire allows controlled curvature from 0 to 180° and...

Evaluation of Flow Rates of Cardiovascular Contrast Media Through the Catheters Usually Used in Pediatric Cardiac Catheterization and Angiocardiographic Study

a Associate Clinical Professor of Pediatrics, University of Southern California, Director of Cardiac Catheterization Laboratory, Los Angeles County General Hospital, 1200 North State Street, Box 121, Los Angeles, Calif. 90033. b Assistant Professor of Radiology, University of Southern California. Associated with Angio-Cardiology, Los Angeles County General Hospital. Angiocardiographic studies on infants and children, to be successful diagnostically, require the consideration of many factors. These may be grouped as follows: (1) the internal diameter, the length and type of catheter material; (2) the pressure of injection; (3) the iodine content, density and viscosity of the contrast media; (4) the osmolarity, sodium content and specific toxicity of the contrast material; (5) the general condition of the patient, such as the state of hydration, stability of his cardiac condition, hematocrit level, etc. Within recent years a number of iodine-containing compounds have been introduced as well as a great variety of catheters of different sizes, lengths and construction. This study was undertaken to assess the practical importance of some of these factors in pediatric angiocardiography. Flow rates of various catheters and opaque media had been studied previously by others. In 1959, Laws and Foxl compared the flow rates of several types of opaque media with that of water. They used large catheters and pressures below 140 pounds per square inch. They showed that flow rates increased with pressure and internal diameter of the catheter, and they felt that the most important factor was the wall thickness and size of the cardiac catheter.

Measurements Of Lung Vascularity For Early Diagnosis Of Pulmonary Edema

Cardiogenic pulmonary edema is a major cause of pulmonary edema. With methods presently available, pulmonary edema can only be detected clinically, late in its course, making prompt therapy of the developing condition virtually impossible. The detection of an early rise in pulmonary venous pressure could allow institution of therapy and possibly prevent pulmonary edema and its accompanying morbidity and mortality. It has been shown experimentally that as pulmonary venous pressures rise, there is a redistribution of blood flow in the lungs. A prototype optical-digital system for automatic processing of coal workers pneumoconiosis chest radiographs has been developed. With the optical system it is well known that high frequency information pertains to the amount of sharpness of edge information in an image. From experience with the prototype system, it was hypothesized that lung regions with more vascularity would generate more of this high frequency than a region of lung with few vessels, and that pulmonary vascular patterns could be extracted using the Fraunhofer diffraction pattern sampling unit. To examine the effect of the number of vessels in annular ring and wedge signatures, a study was made of straight line patterns which might simulate different categories of redistribution. Different patterns were characterized by plotting the normalized energies of the annular rings and wedges. An interactive, non statistical prediction was made on a test set of line patterns with an accuracy rate of 95%. Spatial frequency signatures were recorded using radiographs, carried out by removing an upper lung and lower lung region. These regions were rotated and interchanged and these signatures were recorded. Interactive, non statistical predictions were made on a test set of these radiographic sections with an accuracy rate of 90%. Derived features from a test set of 15 normal and 24 abnormal (2+ re-distribution) radiographs were submitted to a non-interactive stepwise discriminant analysis procedure (BMDO7M) which yielded an accuracy rate of 95% using three features. These preliminary results are encouraging and suggest that automatic processing of chest radiographs might yield estimates of the pulmonary venous pressure.