Radiology
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A retrospective study of 5,134 consecutive pediatric patients undergoing computed tomographic (CT) evaluation from January 1983 through December 1985 was conducted to analyze the need for sedation in a pediatric population; the safety, efficacy, and efficiency of various sedation regimens; and the pediatric radiologists' changing preference for certain sedatives. A marked preference for intravenous administration of pentobarbital sodium (Nembutal) evolved over the 3-year period analyzed. ⋯ Recovery times were reduced, and patient convenience was augmented. There were only two sedation failures in the 419 patients sedated with intravenous Nembutal, and there were no sedation-related complications.
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Pneumothorax in the critically ill patient may be difficult to detect when the air does not rise to the apex of the thorax. Several radiographic signs have been previously described to help recognize this condition. Air in the minor fissure, a previously unreported radiographic finding, is an additional sign of right-sided pneumothorax.
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The computed tomographic (CT) and conventional radiographic appearances of the acetabulum are correlated for assessment of acetabular fractures according to the Judet and Letournel classification system, a system widely used by orthopedic surgeons performing fracture reduction and external fixation of the acetabulum. A desiccated pelvis was marked along the acetabular borders with lead solder, and anteroposterior (AP) and oblique radiographs were obtained. The solder was then replaced by barium-impregnated string, and the acetabulum was scanned by CT. Radiographic-CT correlations of acetabular landmarks should aid the orthopedist by providing a useful interpretation of acetabular fractures according to the Judet and Letournel system.
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Radiographic measurements of the cardiothoracic ratio in four adult victims of blunt thoracic trauma with pneumopericardium demonstrated a sudden, substantial decrease in the size of the cardiac silhouette, which was accompanied by pathophysiologic effects of cardiac tamponade. The sudden decrease in cardiac size could not be attributed to a decrease in intravascular volume or to changes in positive airway pressure. Following surgical relief of tension pneumopericardium, the cardiac size was restored to baseline dimensions and the hemodynamic effects of tamponade resolved. In the presence of pneumopericardium, the "small heart" sign may alert one to the presence of tension pneumopericardium and impending cardiac tamponade.
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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.