Radiology
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Nineteen patients who had foreign bodies in the distal esophagus were examined prospectively to determine the efficacy of intravenous glucagon in relieving the obstruction. The administration of glucagon resulted in clearance of the impacted food in seven patients. Although the success rate is relatively low, the risk is minimal and justifiable. Use of intravenous glucagon is a safe, worthwhile initial step in the treatment of distal esophageal foreign bodies.
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Thirty-nine cases of intracranial vascular malformations in children were reviewed. All patients underwent preoperative computed tomography (CT) and 35 had complete preoperative angiographic work-ups. ⋯ Among the 39 patients, there were 30 parenchymal arteriovenous malformations, four dural arteriovenous malformations, three cavernous angiomas, and two venous angiomas. Combined CT and angiography allowed a highly specific diagnosis in 77% of the cases.
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Comparative Study
Dissecting aortic aneurysms: accuracy of computed tomographic diagnosis.
During a three-year period, fifty patients were evaluated for the possibility of dissecting aortic aneurysm using high-resolution computed tomography (CT). The diagnosis of dissection was made if two contrast-medium-filled channels were identified within the aortic lumen. Eighteen patients were diagnosed with CT as having dissecting aortic aneurysms. ⋯ Follow-up was obtained in all patients. There were no known false-negative diagnoses and one false-positive diagnosis. High-resolution CT offers an accurate, noninvasive means to evaluate patients for suspected dissecting aortic aneurysms.
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Three hundred patients who had sustained blunt abdominal injury were evaluated with computed tomography (CT). The images showed areas of hemorrhage by varying attenuation coefficients (average, 45 Hounsfield units; exceeding 30 Hounsfield units in all cases except in those patients with bleeding more than 48 hours old). Small hematomas tended to accumulate near the site of origin while free intraperitoneal bleeding most frequently accumulated in the Morison pouch, paracolic gutters, and pelvis. ⋯ Only one false-negative and two false-positive CT interpretations occurred, and each was potentially avoidable in retrospect. CT is sensitive and specific for the diagnosis of hemoperitoneum and can estimate the extent and probable source of bleeding. This information may obviate the need for a peritoneal lavage and laparotomy in many instances.
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Testicular salvage rates are improved markedly when surgical correction of a ruptured tunica albuginea is performed within 72 hours after a scrotal injury. The authors studied 11 patients who had suffered various types of blunt or penetrating trauma to the scrotum. The importance of ultrasound for the evaluation of the traumatized scrotum and detection of a testicular rupture is stressed. The spectrum of abnormalities that may be present after a scrotal injury is described.