Radiology
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The diagnostic usefulness, limitations, and adverse reactions associated with computed tomographic myelography using metrizamide were assessed for broad outpatient application. The initial approach was to examine inpatients (n = 38) with low-dose metrizamide (100 mgI/ml). This low dose was believed less likely to be associated with side effects. ⋯ Subsequently, this technique was extended to 42 outpatients, 38 (90.5%) of whom remained asymptomatic. For comparison, 170 mgI/ml was used in another 25 outpatients, who evidenced more symptoms. The potential medical, economic, and therapeutic benefits of obviating hospitalization by safer outpatient CT myelography seem clear.
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Scapulothoracic dissociation represents a closed traumatic forequarter amputation associated with major neurovascular injury. Radiographic findings consist of lateral displacement of the scapula on a well-centered plain film of the chest. Associated abnormalities include disruption of the acromioclavicular joint or, as in our two cases, distracted fractures of the clavicle. Persons in whom scalpulothoracic dissociation is diagnosed should undergo emergency angiography and surgery.