AJR. American journal of roentgenology
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AJR Am J Roentgenol · Oct 1991
ReviewPercutaneous procedures for the diagnosis and treatment of lower back pain: diskography, facet-joint injection, and epidural injection.
This review discusses the indications, techniques, complications, and results of three percutaneous procedures used to evaluate and treat lower back pain: diskography, facet-joint injection, and epidural injection. Diskography, performed by injection of contrast medium into the nucleus pulposus, is a technique used to determine the cause of lower back pain in patients in whom findings on other imaging studies are normal or conflicting. Injection of steroids and anesthetic into the facet joints of the lumbar spine is useful to diagnose or treat patients with facet syndrome (back pain caused by abnormalities of the facet joints). Injection of steroids and anesthetic agents into the epidural space provides short-term relief, and can sometimes provide permanent relief, of lower back pain.
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AJR Am J Roentgenol · Oct 1991
Indications for radiography in patients with acute ankle injuries: role of the physical examination.
A prospective study was performed to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred one patients were seen in the emergency department for acute ankle trauma and referred to the department of radiology for ankle radiographs. Radiology residents performed a brief but thorough physical examination of the ankle in all 201 patients. ⋯ In only one of these patients was a fracture seen on radiographs. The radiograph in this case showed a small avulsion fracture of the dorsal aspect of the talus that was clinically insignificant (no cast or surgery was required). Our results suggest that a brief but thorough physical examination can eliminate the need for a large percentage of radiographs ordered in patients with acute ankle trauma.
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AJR Am J Roentgenol · Oct 1991
Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT.
The usefulness of lymphangiography and CT in the diagnosis and localization of laceration of the thoracic duct was evaluated in 12 patients with chylothorax or chylous ascites after surgery. Bipedal lymphangiography was performed in all 12 patients. The last four patients studied also had CT after lymphangiography. ⋯ One patient with normal findings on lymphangiography had an alternative diagnosis established at surgery. Laceration of the thoracic duct was accurately diagnosed and localized with lymphangiography, which allowed definitive surgical repair. CT was of little additional value in diagnosing these injuries.
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AJR Am J Roentgenol · Aug 1991
Carotid duplex sonography: bisferious pulse contour in patients with aortic valvular disease.
Characteristic systolic and diastolic pulse contours occur in the carotid Doppler waveforms of patients with aortic valvular disease that have not previously been described in publications concerning carotid duplex sonography. The purpose of this study was to evaluate the presence and characterize the nature of these carotid duplex waveform abnormalities in patients with known aortic valve disease and to correlate these changes with the severity of valve dysfunction. The study group consisted of 26 patients with aortic regurgitation or combined aortic regurgitation and aortic stenosis. ⋯ These patterns are reversible after aortic valve replacement. While echocardiography remains the study of choice in the evaluation of suspected valvular dysfunction, up to one third of patients with aortic regurgitation may not have a detectable murmur. Therefore, identifying these patterns on carotid duplex examinations may provide clinically useful information and serve as a clue to previously unsuspected cardiovascular disease.
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AJR Am J Roentgenol · Jul 1991
Comparative StudyRadiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media.
Nephropathy is an established untoward event associated with intravascular administration of conventional high-osmolality contrast media (HOM). It has not been shown previously that lower-osmolality contrast media (LOM) are less nephrotoxic in a clinical setting. We evaluate the ability to replace HOM with LOM (in lower-extremity angiography) to reduce the incidence of nephropathy. ⋯ When all patients are considered, the incidence of contrast-induced nephropathy for LOM vs HOM (defined as an increase in serum creatinine level greater than 0.3 mg/dl and greater than 20% on day 1, 2, or 3 and on day 5, 6, or 7, is 7% vs 26% (p = .001). When only patients with preangiography azotemia are considered, the incidence of contrast-induced nephropathy for LOM vs HOM is 10% vs 41% (p = .017); for diabetic patients, regardless of preangiography creatinine level, the incidence is 10% vs 31% (p = .012). Although contrast-induced nephropathy may develop even in a patient with no risk factors who receives LOM, LOM is associated with a decreased incidence of this condition, to various degrees, depending on the presence of risk factors.