Mark S. Bankoff

Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid.

Twenty-five patients had Russe anterior corticocancellous bone-grafting between 1973 and 1984 for twenty-six symptomatic established non-unions of the scaphoid. The mean duration of follow-up was eleven years (range, seven to eighteen years). Twenty-one (81 per cent) of the twenty-six scaphoid bones united. We developed two rating scales to evaluate the results of the operation. One scale, based on objective findings, included the radiographic appearance of the wrist, the range of motion, and strength; the other scale, based on subjective findings, comprised function, pain, perception of a decrease in performance because of limitation of motion or strength, and satisfaction. These scales were used to compare the objective and subjective results in patients who had a malunion of the scaphoid in which the lateral intrascaphoid angle was more than 45 degrees convex dorsally between the proximal and distal poles (a so-called flexion or humpback deformity, which results in extension of the proximal fragment of the scaphoid at the radiocarpal joint) with the results in patients who had no such deformity. The lateral intrascaphoid angle was more than 45 degrees in thirteen (50 per cent) of the twenty-six wrists. Although the difference in the objective results between the wrists that had a malunion and those that did not have a malunion was highly significant (p = 0.001), there was no significant difference in the subjective results between the two groups, including satisfaction of the patient (p = 0.39). Twenty-three patients (92 per cent) returned to full-time employment and twenty-two (88 per cent), to sports activities. Twenty-three patients (92 per cent) reported that they had pronounced relief of pain and that the procedure had improved their quality of life. The presence of this deformity of the scaphoid after bone-grafting for a symptomatic non-union was not predictive of a poor long-term subjective outcome.

Determination of the Chemical Composition of Urinary Calculi by Computerized Tomography

The clinical management of renal calculi would be aided if a direct in vivo determination of stone chemical composition could be made. We investigated the possibility of obtaining this information by a quantitative analysis of the computerized tomography scan images of 80 urinary calculi. Our results show that by using an appropriately calibrated computerized tomography scanner the differentiation of stone chemical composition can be made on the basis of 3 parameters, namely, absolute computerized tomography value at a single x-ray energy, the difference between computerized tomography values measured at 2 different x-ray energies, and computerized tomography value-frequency histograms (pixel patterns) of the stones. Uric acid stones were differentiated from all other stones at a significance level of p less than 0.001. Cystine was differentiated from calcium oxalate and brushite at the same significance level. Using pixel patterns cystine and struvite were separated from each other correctly with 70 per cent accuracy. Struvite stones of low or moderate calcium phosphate content were identified correctly with 80 per cent accuracy. Struvite stones of high calcium phosphate content could not be differentiated from calcium oxalate or brushite. Calcium oxalate and brushite could not be separated. The minimum stone size that allowed chemical identification was established for each stone type. In addition, we demonstrated that all the urinary calculi examined were visible on computerized tomography scan regardless of chemical composition or size.

Computed tomography in the diagnosis of pericardial heart disease

Abstract To evaluate the use of computed tomography (CT) in the diagnosis of pericardial heart disease, 53 patients were prospectively studied by computed tomography of the chest and cardiac ultras...

Cystic lymphangiomas: CT diagnosis and thin needle aspiration

Cystic lymphangiomas of the retroperitoneum are rare benign tumours (Castellino & Finkelstein, 1975) which have previously been difficult to diagnose by conventional radiographic techniques (Hamilton & McInerney, 1981). These tumours have been evaluated by several modalities: computed tomography, ultrasound, thin needle aspiration, and lymphangiography and in one case a correct diagnosis was suggested preoperatively (Radin et al, 1983). We describe two cases of cystic lymphangioma of the retroperitoneum demonstrated and diagnosed by computed tomography and thin needle aspiration. The first case was proven to be a cystic lymphangioma at surgery. The second case, after its CT demonstration and thin needle aspiration, was managed conservatively and followed by computed tomography. In the appropriate clinical setting, conservative management of these benign tumours might well be considered.

Differentiation of constrictive pericarditis from restrictive cardiomyopathy by computed tomographic imaging

Differentiation of restrictive cardiomyopathy from constrictive pericarditis is notoriously difficult. Evaluation of such patients by noninvasive means including physical examination, electrocardiography, chest x-ray examination, and echocardiography has been shown to be unreliable.‘e7 Even cardiac catheterization may not be decisive in determining whether impaired diastolic filling is due to a cardiomyopathic process as opposed to thickening of the pericardium,“” and thoracotomy may be required to establish the diagnosis.*“* l3 Recent experience with computed tomographic imaging of the heart suggests that this diagnostic modality provides accurate definition of pericardial thickness.**-lfi We therefore undertook the present study to determine whether computed tomographic imaging of the chest could accurately differentiate patients in whom impaired ventricular diastolic filling was due to constrictive pericarditis from those with a restrictive cardiomyopathy.

Asymptomatic large coronary artery saphenous vein bypass graft aneurysm: a case report and review of the literature.

Relatively few cases of saphenous vein graft (SVG) aneurysms have been reported since the introduction of saphenous vein coronary bypass grafting in 1968 by Favaloro. 1,2 The majority of reports are descriptions of true aneurysms of the body of the SVGs or pseudoaneurysms located at or near the anastomosis sites. 3-37 We report an unusual case of a large SVG aneurysm that presented as an asymptomatic mediastinal mass. To our knowledge, this is the largest reported asymptomatic true aneurysm of a saphenous vein aortocoronary bypass graft.

Fine Needle Aspiration Biopsy in the Diagnosis of Renal Angiomyolipoma

Exclusive reliance on radiographic techniques for the diagnosis of renal angiomyolipoma can lead to misdiagnosis when the histological status is atypical, computerized tomographic findings are equivocal or renal cell carcinoma coexists. We report our experience and those of others in combining fine needle aspiration biopsy and radiological imaging to identify renal angiomyolipoma. Fine needle aspiration biopsy is safe and provides accurate histological diagnosis of renal angiomyolipoma.

A comparative study of magnetic resonance imaging versus computed tomography for the evaluation of maxillary and mandibular tumors

The relative value of magnetic resonance imaging (MRI) versus computed tomography (CT) for imaging benign and malignant lesions of the maxilla and mandible was studied in a group of 16 patients. The imaging methods were evaluated for their ability to detect the lesion and define lesion margins, soft tissue extension, and bone involvement. The abnormality was identifiable with both imaging methods. For benign cystic lesions of either the maxilla or mandible (50%), MRI was overall equal to or better than CT. Magnetic resonance imaging was superior to CT in the evaluation of lesion margins and soft tissue extent of disease, whereas it was equal or slightly inferior to CT in lesion detection and in the evaluation of bone involvement. In the imaging of malignant neoplasms (50%), MRI was overall superior to CT in all four categories reviewed. Magnetic resonance imaging also had the highest rate of correlation with clinical findings, either from physical examination or at the time of surgery.

Gas collections in the spinal cord on computed tomography.

Two examples of gas collections within the spinal canal, noted on computed tomography, are presented. A probable etiology is suggested and possible misinterpretations of such a finding are discussed.

Computed tomography in tarsal coalition.

The limitations of routine radiography of the feet in demonstrating tarsal coalitions are well known. Even with the use of multiple projections of the foot, tarsal coalitions may escape detection. Computed tomographic examinations of the feet were performed in persons suspected of having tarsal coalitions. The CT images were obtained in both the longitudinal and axial axes of the foot. Results of these examinations suggest the longitudinal projection to be most helpful in demonstrating talonavicular coalitions and the axial projection in demonstrating talocalcaneal coalitions. The history, pathology, and other imaging modalities of tarsal coalitions are reviewed.