Radiology
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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.
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Fourteen children who experienced acute, profound central nervous system hypoxia secondary to near drowning, aspiration, or respiratory arrest underwent CT examination. During the first week after the episode, the most frequent finding was a loss of gray-white matter differentiation. ⋯ Subsequent CT scans obtained from two weeks to five months after the hypoxic episode showed progression of cerebral loss from cortical infarction with gyral hemorrhage and enhancement to global parenchymal atrophy. The prognosis is poor in these patients: seven children experienced severe neurologic deficits and seven died.
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Preoperative oblique hilar tomography was used to evaluate hilar lymph nodes in 150 patients with clinically resectable bronchogenic carcinoma. CT was also used in the evaluation of mediastinal lymph nodes in 50 of these patients. Subsequently, all patients underwent mediastinoscopy and/or thoracotomy. ⋯ The sensitivity of CT for evaluation of mediastinal nodal metastasis was 83% and the specificity was 90%. Thus patients with negative mediastinal CT need not undergo mediastinoscopy prior to thoracotomy, while mediastinoscopy and biopsy should be done in patients with enlarged mediastinal nodes on CT. Oblique hilar tomography is an accurate method for evaluation of hilar adenopathy and for predicting mediastinal involvement by extrapolation.
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Exclusive contracts between radiologists and hospitals may be more frequently scrutinized for antitrust violations because of the Hyde v Jefferson Parish Hospital District No. 2 case. In the Hyde case, the lower court decided antitrust law had been violated, and it was the first antitrust case about exclusive medical contracts to be reviewed by the U. S. ⋯ The case is a precedent for considering similar circumstances according to traditional business antitrust analyses such as per se violations, tying arrangements, group boycott, and market foreclosure. Areas that may be scrutinized for anticompetitiveness include hospital privileges when radiologists have exclusive contracts with the community's only hospital or provide services unique within an area, and physicians' access to scarce resources (e.g., computed tomography [CT], magnetic resonance [MR] imaging). Radiologists must understand antitrust implications of their hospital contracts; examine the terms of staff appointment, bylaws, and rights; and be able to guide their attorneys through contract negotiations.
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Two cases are described in which chest radiographic findings were typical of those reported as "pneumatocele in the pulmonary ligament" in adults. Analysis based on lateral chest radiography and computed tomography showed a loculated hydropneumothorax behind the pulmonary ligament. ⋯ Middle mediastinal air in the newborn, which appears quite different on the lateral chest radiograph, may extend into the pulmonary ligament, though this is unproved. There is probably no such entity as "pneumatocele in the pulmonary ligament" in the adult.