John F. Healy

Does tongue size differ between patients with and without sleep-disordered breathing?

Objectives/Hypothesis To determine whether there is a difference in the tongue size of patients with and without sleep‐disordered breathing (SDB) and to evaluate whether tongue volume correlates with body mass index (BMI), neck circumference, age, Epworth Sleepiness Scale score, or apnea‐hypopnea index (AHI).

Metallic spinal artifacts in magnetic resonance imaging.

Study Design. The magnetic resonance artifact susceptibility of traces of surgical aluminum, titanium, and stainless steel in a human spine model was investigated. Metallic filings were deposited in noncontiguous disc spaces in five human thoracic spines before magnetic resonance imaging with spin echo and gradient echo sequences. Objectives. Spin echo and gradient echo sequences were used to quantitate and compare void artifact produced by commonly used surgical metals. This was compared to a liquid paraffin control. Summary of Background Data. No significant susceptibility artifact was seen with any metal in all spin echo sequences, including T1 (TR 600, TE 12), T2 (TR 2000, TE 30), proton density (TR 2000, TE 80), and fast T2 scanning (TR 3800, TE 96, Ef). Methods. Sagittal magnetic resonance imaging permitted void artifact quantification and comparison between different metallic alloys. Two neuroradiologists, working on a blinded basis, evaluated all data and rated the void susceptibility artifact on a scale of 1 (least) to 4 (greatest). Results. In general, the magnitude of an imaging artifact during magnetic resonance imaging correlated with the magnetism of the metal. Nickel, found in a larger concentration in 316L than in 304 stainless steel, decreases the magnetic resonance artifact of specific metals because of its ability to stabilize iron in a nonmagnetic state. Therefore, the 316L stainless steel yielded less artifact production than 304 stainless steel on gradient echo imaging. Conclusion. If upon gradient echo imaging in the postoperative period significant artifact production is noted, stainless steel deposition should be suspected as the causative agent. In this situation, spin echo techniques should be the first approach for attempting optimal visualization of the spinal cord and soft tissue structures. [Key words: artifact production, ferromagnetic, gradient echo, magnetic resonance imaging, metal alloys] Spine 1994;19:1237–1242

Dermoid cysts and their complications as manifested by computed cranial tomography

Abstract Rupture of a dermoid cyst intracranially is well demonstrated by cranial computed tomography. This complication was previously thought to have very grave consequences. Two cases are presented with rupture of cyst contents into the ventricle and subarachnoid space. One patient had a history of “aseptic meningitis”. Both patients had hydrocephalus. Both patients did well after surgery.

Cranial computed tomography in the detection of dural, orbital, and skull involvement in metastatic neuroblastoma

Abstract Computed tomography is a superior radiographic modality in detecting the presence and evaluating the extent of neuroblastoma metastases to the skull, orbit, and extradural space. Pathologic correlation can be excellent.

Renal Devitalization Using 95 Per Cent Ethyl Alcohol

Preoperative embolization of renal arteries with solid material before nephrectomy is a standard procedure for the treatment of renal cell carcinoma. However, it often is difficult to use these materials and sometimes special equipment is required. We have used 95 per cent ethyl alcohol in 3 patients to devitalize kidneys with tumors. Our results show 95 per cent ethyl alcohol to be safe, effective and easy to use. When combined with epidural anesthesia alcohol embolization is well tolerated by the patient, and its destructive effect is complete and limited to the selected organ.

Pathologic basis of computed tomographic and angiographic findings in a giant ninth nerve neuroma

Abstract Close radiologic-pathologic correlation in the case of a large ninth nerve neuroma reveals the probable tissue basis of cranial computed tomographic and angiographic findings found in the radiological investigation of this tumor.

Lateral thoracic meningocele demonstrated by computerized tomography

Abstract Posterior mediastinal masses are common in patients with neurofibromatosis. Most are lateral meningoceles rather than solid neurogenic tumors. Computed tomography best demonstrates the extent and the nature of posterior mediastinal masses and defines associated bony erosion. Introduction of Metrizamide into the subarachnoid space and subsequently into the mass with demonstration of a CSF-Metrizamide fluid level confirms the diagnosis of meningocele.

Computed tomography of orbital trauma

Ten cases of trauma to the orbit and orbital region are presented to illustrate the efficacy of computed tomography in the radiologic evaluation of these injuries. CT was able to detect subarachnoid hemorrhage, retrobulbar hematoma, orbital cellulitis, foreign bodies, intraglobal and intraorbital air, dislocated lens, blowout, and tripod fractures in these patients.

Computed tomographic demonstration of enlarged, ectatic basilar artery associated with obstruction of the anterior third ventricle

Abstract Ectasia of the vertebrobasilar system can be diagnosed on cranial computed tomography. It may be associated with hypertension, but often is of no clinical significance. Previous reports have implicated vertebrobasilar ectasia as a cause of cranial nerve syndromes. We wish to report a patient in whom vertebrobasilar ectasia appeared to obstruct the anterior third ventricle causing obstructive hydrocephalus.

Embolic stroke complicating Staphylococcus aureus endocarditis circumstantially linked to rectal trauma from foreign body: a first case report

BackgroundDiagnostic and therapeutic instrumentation of the lower gastrointestinal tract has been reported to result in bacteremia and endocarditis. No such case has been reported in persons with a history of rectal foreign body insertion despite its potential for greater trauma.Case presentationA 58-year-old male was admitted with confusion and inability to speak. His past history was notable for hospitalization to extract a retained plastic soda bottle from the rectosigmoid two years prior. On examination, he was febrile, tachycardic and hypotensive. There was an apical pansystolic murmur on cardiac examination. He had a mixed receptive and expressive aphasia, and a right hemiparesis. On rectal examination he had perianal erythema and diminished sphincter tone. Magnetic resonance imaging of the brain showed infarction of the occipital and frontal lobes. Transesophageal Echocardiography of the heart revealed vegetations on the mitral valve. All of his blood culture bottles grew methicillin sensitive Staphylococcus aureus. He was successfully treated for bacterial endocarditis with intravenous nafcillin and gentamicin. The rectum is frequently colonized by Staphylococcus aureus and trauma to its mucosa can lead to bacteremia and endocarditis with this organism.In the absence of corroborative evidence such as presented here, it is difficult to make a correlation between staphylococcal endocarditis and anorectal foreign body insertion due to patients being less than forthcomingConclusionThere is a potential risk of staphylococcal bacteremia and endocarditis with rectal foreign body insertion. Further studies are needed to explore this finding. Detailed sexual history and patient counseling should be made a part of routine primary care.