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Books > Medicine > Other branches of medicine > Medical imaging > Ultrasonics
The primary purpose of this book is to bridge the gap be tween the practice of clinical medicine and diagnostic radi ology. It is intended primarily for utilization by medical students in training and by nonradiologist physicians. In this world of rapidly expanding knowledge in the many specialties of medicine, it is becoming increasingly difficult for many physicians to stay abreast of the newer and constantly changing modalities of diagnosis as well as the therapeutic regimens of the common as well as the less common disease processes within their realm of practice. This book will enable the busy clinician to utilize the consultative services offered by his or her colleagues in diagnostic radiology with maximum effectiveness. The most common clinical applications of the more recent imag ing modalities (i. e. , nuclear medicine, ultrasound, comput erized tomography, and magnetic resonance imaging) have been categorized and condensed into a format that will be both comprehensible and useful on a daily basis for those physicians routinely requesting these diagnostic examina tions for their patients. For simplicity, the book is divided, whenever feasible, into organ systems and subdivided into the multiple classifications of pathologic states (i. e. , con genital, trauma or iatrogenic, inflammatory, and neo plasm). In addition, there are brief comments related to the vii specific advantages and disadvantages as well as the cost effectiveness of each modality.
Twenty years ago, the enzyme superoxide dismutase which uses the superoxide radical anion as its specific substrate was reported. With this discovery was born a new scientific field, in which oxygen, necessary for aerobi c 1 ife on thi s planet, had to be cons i dered also in terms of its toxicity and stresses. This stimulated the search for knowledge of active oxygen species in biology and medicine. Superoxide and other reactive oxygen species are now implicated in many disease processes. Major advances have been achieved during these past years with respect to free radical generation and mechanisms of free radical action in causing tissue injury. In parallel, the possibil ity of influencing free radical related disease processes by antioxidant treatment was studied in various in vitro and in vivo systems. This was the unique theme of a conference organized in Paris by the Society for Free Radical Research (December 9-10, 1988) which brought together experts from basic sciences and clinicians in order to evaluate the current status of antioxidant therapy. The conference emphasized fundamental processes in antioxidant action. Among the major topics were superoxide dismutase (SOD) and low molecular weight substances with such activity, called SOD mimics. Other antioxidant enzymes were also considered. Antioxidant vitamins, in particular vitamins E and C, other naturally occurri ng antioxidants and vari ous synthet i c antioxidants were included in the presentations as there is now a rapidly developing series of compounds with potentially interesting clinical applications.
For this Workshop, the organizers have attempted to invite experts from all known centers which are engaged in neutron beam development for neutron capture therapy. The Workshop was designed around a series of nineteen invited papers which dealt with neutron source design and development and beam characterization and performance. Emphasis was placed on epithermal beams because they offer clinical advantages and are more challenging to implement than thermal beams. Fission reactor sources were the basis for the majority of the papers; however three papers dealt with accelerator neutron sources. An additional three invited papers provided a summary of clinical results of Ncr therapy in Japan between 1968 and 1989 and overviews of clinical considerations for neutron capture therapy and of the status of tumor targeting chemical agents for Ncr. Five contributed poster papers dealing with NCT beam design and performance were also presented. A rapporteurs' paper was prepared after the Workshop to attempt to summarize the major aspects, issues, and conclusions which resulted from this Workshop. Many people contributed to both the smooth functioning of the Workshop and to the preparation of these proceedings. Special thanks are reserved for Ms. Dorothy K.
The investigation of the brain by means of ultrasound has acquired increasing importance in the last years because it permits insight into the spatial relationships within the intact human skull in a short time without endangering the patient. The road from the first ultra sonic investigations on the exposed brain to the detection of intracranial midline shifts on the intact skull, the registration of echo pulsations and recently, to ultrasonotomography has been a long one already. However, this development is by no means at an end. Following the suggestion of numerous colleagues concerned with echo-encephalography in this country and abroad, the Neurosurgical Clinic of the University of Erlangen-Nuremberg organized an "International Symposium on Echo-Encephalography" on April 14th and 15th, 1967. Here there was an open exchange of experience on the results obtained up to the present. The limitations of the method and sources of error as well as the directions of future development of the ultrasonic echo procedure were discussed."
The aim of this work was not an exhaustive review of all pediatric echo graphic problems but a presentation of our daily experience with ultrasonography in pediatric practice. Several teams of pediatric radiologists from France and Belgium have combined their experiences to produce a practical book. The different authors have been chosen for their specific experience and their special area of work. The different chapters express therefore personal opinions. Unresolved questions are posed and ultrasonographic examinations are used in the diagnosis of different diseases, while the discoveries and ideas of the individual authors are described. Some fields are not included, such as echocardiography. Gabriel Kalifa Contents Chapter 1. Antenatal Diagnosis by Ultrasonography . . . . . . . . . . . . . . 1 . . . Introduction ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Ultrasonography of a Normal Pregnancy ...................... 1 2.1 Timing of Successive Examinations. . . . . . . . . . . . . . . . . . . . . . . 1 2.2 Normal Fetal Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2.1 Central Nervous System .......................... 3 2.2.2 Chest........................................... 3 2.2.3 Abdomen....................................... 3 2.2.4 Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . .
The history of the use of ultrasound in medicine has been one of evolution of technology and innovative methods of applying this technology to imaging body structures. Many scientists and clinicians have contributed to this evolution. Ophthalmic ultrasound has become an indispensible tool in ophthalmic practice, with its own instrumentation and techniques. Ultrasound frequencies used in ophthalmology have generally been higher than those used in general medicine because of a requirement for higher resolution and a lesser need for deep penetration. Most ophthalmic diagnostic equipment uses frequencies in the 10 MHz range. The use of ultrasound frequencies in the 50-100 MHz range is a relatively new development in ultrasound imaging of the eye. This technique has been developed in our laboratories over the past several years. We have progressed from the theoretical description of the basic science required, past the first in-vitro experiments in eye bank eyes, to the construction of an instrument capable of clinical application. We have gained broad clinical experience with this instrument in normal patients and patients with ocular disease. A commercial instrument based on our original clinical scanner has recently become available, allowing other clinicians to apply this tool to ophthalmic research and clinical practice. We have applied the term ultrasound biomicroscopy to this new imaging technique because of similarities to optical biomicroscopy, i. e. , the observation of living tissue at microscopic resolution.
Surgery an essentially manual exercise in its early days, has progressively grown richer in complementary techniques helping the surgeon to perfect his movements and increase efficiency. This is particularly the case with digestive surgery, which has been thoroughly transformed by radiology, endoscopy and extemporaneous examinations effected during surgical intervention. Such methods make it possible for surgeons to develop subtle nuances in operative techniques and to specify indi cations more and more precisely. Ultrasonography must now be included among such techniques. It supplements them and can sometimes even replace them. For these reasons, this work devoted to the use of ultrasound by the surgeon during surgical intervention is of great interest. Two general conditions had to be met before ultrasonography could be em ployed in abdominal surgery: the method and apparatus had to be adapted to its surgical utilization, and the surgeon had to adapt to a nonsurgical technique. The first condition has been fulfilled for all purposes. Intraoperative sonograms can be generated at a very high rate and are proving to be more and more useful. The miniaturization of probes permits their application almost everywhere with opti mal results. Of course, the costs are still high, but one can expect them to decrease.
For doctors and students who wish to learn ultrasonography concisely yet comprehensively. The authors present the subject both systematically and practically, and with the facility of quick reference in mind, making generous use of flow-charts, tables and teaching-points. All general aspects of diagnostic ultrasound are covered, concentrating on those disorders encountered in the daily routine of scanning, but also referring to rarer conditions which need to be considered in differential diagnosis.
Since the pioneering work of Donald and his first Lancet paper in 1958, the use of ultrasound in obstetrics and gynaecology has evolved rap idly. The introduction of grey scale techniques enhanced our ability to identify different tissues on the basis of their texture. However, it was the introduction of the linear array real-time scanner in the mid seven ties that changed ultrasound from being an "eccentric art form" to a readily available and usable technique. This led to the first reports of the diagnosis of neural tube defects using ultrasound by Campbell, as well as the establishment of fetal biometry. In the midst of this activity the parallel development of the transvaginal probe by Kratochwill went almost unnoticed by most gynaecologists. Yet the application of this technique has since had a major impact on many areas of gyna ecological practice, and on infertility in particular. Since the demon stration of transvaginal follicle aspiration, the vaginal route has become standard for most invasive ultrasound guided gynaecological procedures. The relatively new technical advance of transvaginal colour Doppler may potentially have just as great an impact. The introduction and use of transvaginal colour flow imaging has facili tated the study of vascular changes within the pelvis.
The second E. C. Workshop on Ultrasonic Tissue Characterization was organized for the assessment of research goals and plans as the basis to a grant proposal for a "Concerted Action" which will be forwarded to the European Commission. It should, therefore, not only be considered as a work in progress exhibition which succeeded the former activities within the E. C. (Inventory on Tissue Characterization in Europe and first Workshop). The Steering Group invited a 1 imited group of Institutes to send its group leader and a research fel low in the entitled field, who should expose the overall research program, as wei 1 as the more specific work on tissue characterization by RF signal analysis and spectroscopy. The ultimate goal of the Workshop has been the formulation of schemes of interaction among the Institutes and individuals and the definition of cooperative research programs. The remainder of the groups and some of the groups present are working in the field of analysis and processing of cl inical A- and B-mode echograms (i. e. video signals). Because this work is more closely related to the cl inical diagnostics it was decided that for that reason no preparatory workshop was needed. In the final proposal for the Concerted Action this work wi 1 1 get ample attention. Although not many clinicians were present, their positive interest in the sophisticated analysis techniques and their contribution to the dis cussions again have been a most valuable and stimulating experience."
Alfons Staudach has been a long-time member of the Anatomic Institute of Karl Franzens University in Graz, where he has devoted particular atten tion to the deeper understanding, appreciation and visualizion of gross ana tomic details. In this work the author has achieved correspondence between sonograms and anatomic sections with a consistency and persuasiveness unequaled in all the previous literature on diagnostic ultrasound. The various planes of section andtheir characteristic features, and indeed the entire format of the text, are designed to provide even the less experienced sonographer with a valuable basis for conducting his examinations. The more experienced reader will find essential information on topographic relations and organ development that is not available in any other work dealing with fetal ana to y. I am certain that my high estimation of this volume will prove justified, and that it will provice its readers with a useful and stimulating resource. Univ. -Prof. Dr. Walter Thiel (Chairman of the Anatomic Institute of the University of Graz) Foreword Anyone setting this book down after an initial perusal must wonder why such a reference was not available ten years ago. The meticulous and fas cinating juxtaposition of gross anatomic sections with sonograms, together with explanatory drawings and many practical guidelines, should enable even the novice accurately to identify details and interpret sonographic findings with precision."
It has often surprised me that in order to study the subject of obstructive uropathy, it is necessary to search through various sections of several urological, surgical and radiological textbooks rather than turn to one work on the subject. It is also true that, even now, many descriptions tend to concentrate on the causative conditions rather than their relationship to the proximal outflow tract, in a way which is predominantly structural and anatomical rather than functional and urodynamic. The subject of obstructive uropathy has changed radically in recent years. Inspired research from several centres has given us great insight into the mechanisms of obstruction and its effects on the outflow tract and nephron. It has been accompanied by the development of new methods of investigation in both the experimental and the clinical field. This book is an attempt to update and distill the subject of obstructive uropathy in one volume. For the purpose of the work, obstructive uropathy is taken to include any condition involving the outflow tract of the kidney, from minor calyces to urethra, which results in obstruction to the flow of urine. Emphasis is on physiology and pathophysiol ogy, function and urodynamics. These considerations should not be thought of as purely theoretical. Far from it. They hold the key to subsequent decisions on diagnosis and management and form the basis for a practical approach to the patient with obstruction. The only details the reader will not find here are descriptions of surgical technique."
Sonography is an ideal real-time imaging technique for the evaluation of muscles and tendons of the extremities, and this book is a useful reference for both the technique of examination and normal ultrasound anatomy. The first part considers technical aspects of the examination such as sonographic equipment, water-path systems, and dynamic maneuvers. The basic sonographic patterns of normal muscles, tendons, and other components of the extremities are then presented. Emphasis has been placed on pitfalls and artifacts. The other available imaging techniques for muscles and tendons are also discussed. The second part comprises an atlas of normal ultrasound scans of shoulder, arm, elbow, forearm, wrist, hand, thigh, knee, leg, ankle, and foot, with accompanying explanatory line drawings.
Since the beginnings of diagnostic ultrasound in the 1950s, each decade has seen significant advances in this technology. Commer cialization of ultrasound occurred during the 1960s with the introduction of many of the clinical uses that are in existence today. The 1970s showed the most dramatic changes with the commercial introduction of gray-scale and real-time ultrasound. In the 1980s many new advances were introduced, including color Doppler, as well as a wide variety of endoluminal approaches, including endorectal, endovaginal and transesophageal. The decade of the 1990s promises even more significant advances with further transducer miniaturization, three-dimensional ultra sound, and the introduction of a variety of ultrasound contrast agents. With such rapid changes occurring, it becomes important to disseminate knowledge in as rapid a fashion as possible, thus it was quite appropriate that a meeting such as this be held to provide an in-depth review of the many new areas of ultrasound imaging that show promise for the future. Emphasis was on the new uses of ultrasound in gastrointestinal diseases. Many of these advances will, of course, also have applications in many other areas of the body. It is hoped that those in attendance will acquire a much broader understanding of where ultrasound is now and where it is headed in the not too distant future.
It is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.
Over a mere 5 years, neonatal cranial sonography has evolved from an obscure and largely experimental imaging possibility to the modality of preference in the examination of the young brain. The almost immediate acceptance of the ultrasound examination of the neonatal brain was based on a number of coinci dent factors, the most important of which was the emergence of a burgeoning population of premature neonates who were, for the first time, surviving be yond infancy. These delicate patients were beginning to withstand the rigors of extrauterine life when not fully prepared for it; pulmonary, cardiac, and infec tious diseases no longer claimed most of them. With survival, a new specter reared its head: Would the eventual mental and neurologic status of these same children be worth the expense and time needed to bring them through their first months? This issue became increasingly pressing as evidence mounted through the 1970s that very premature neonates were at a high risk for intracranial hemor rhage and posthemorrhagic complications. An imaging modality that could evaluate the premature brain was sorely needed. The CT scanner with its proven ability to diagnose intracranial hemorrhage was of little value in this regard. So too were static gray-scale or waterpath ultrasound units. These modalities all had the same limitation, lack of portability. As neonatal intensive care units proliferated, so did the technology that would soon allow cribside neonatal neuroimaging, the real-time sector scanner."
Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.
Only a few years ago, most treatises on sonography covered all the diagnostic applications of ultrasound, de scribing organs from the brain down to the placenta. Dr. Bruneton and his associates must be thanked for pre senting this book devoted to the spleen. It probably offers the most complete presentation of details and the richest images available in its field. This book will thus become the ultimate reference in most libraries of books on son ography. March 1988 F. Weill The authors wish to thank Christine Rostagni, Fran ise Fein, and Bernard Fontaine for their assistance in the preparation of this book. Contents 1 Sonographic Anatomy of the Normal Spleen, Normal Anatomic Variants, and Pitfalls B. Senecail . . . . . . . . . . . . . . . . . . . . . . 1 1. 1 Anatomy of the Spleen. . . . . . . . . . . . . . . . 1 1. 1. 1 Morphology and Structure . . . . . . . . . . . . . 1 1. 1. 2 Location and Relations of the Spleen. . . . . . . . 3 1. 1. 3 Average Dimensions of the Cadaver Spleen . . . . 5 1. 1. 4 Congenital Anomalies and Normal Variants. . . . 5 1. 1. 4. 1 Fissured Spleen. . . . . . . . . . . . . . . . . . . . 5 1. 1. 4. 2 Lobulated Spleen. . . . . . . . . . . . . . . . . . . 5 1. 1. 4. 3 Spleen with Two Hili. . . . . . . . . . . . . . . . . 5 1. 1. 4. 4 Wandering or Ectopic Spleen . . . . . . . . . . . . 6 1. 1. 4. 5 Numeric Anomalies . . . . . . . . . . . . . . . . . 6 Ultrasonography of the Spleen . . . . . . . . . . . 1. 2 6 1. 2. 1 Equipment . . . . . . . . . . . . . . . . . . . . . . 6 1. 2. 2 Patient Examination . . . . . . . . . . . . . . . . . 7 1. 2. 3 Scanning Technique . . . . . . . . . . . . . . . . . 7 1. 3 Sonographic Features of the Normal Spleen. . . . 7 1. 3. 1 Splenic Contour . . . . . . . . . . . . . . . . . . . 7 1. 3. 2 Echo Pattern of the Splenic Parenchyma. . . . . ."
Vascular diagnostics traditionally rely on x-ray angiography. This approach remains even today essential in the clinical work-up of patients with vascular pathology. Recently, however, newer imaging modalities have been intro duced to assess vascular disease. Among these the color Doppler flow and magnetic resonance imaging appear the most promising. Due to their noninva sive character both methods are ideally suited for screening as well as serial follow-up of vascular patients. The emergence of color Doppler flow and magnetic resonance vascular imaging coincides with new concepts in vascular medicine. Today, vascular prevention and percutaneous interventions are becoming the leading compo nents in modern vascular care. It is in this new and exciting environment of novel vascular concepts where the demand for reliable noninvasive vascular imaging is becoming a high priority. Color Doppler flow and magnetic reso nance vascular imaging are well on the way to satisfy this demand. This textbook provides the long awaited information on vascular imaging by color Doppler flow and magnetic resonance. The text covers the essentials of vascular anatomy, physiology and noninvasive imaging technology before providing a state-of-the-art review of their current clinical applications. All chapters are written by competent scientists and clinicians in a clear, conscise and yet thorough and exhaustive manner. The coherent and didactic composi tion of the textbook allows the reader an easy access to the elementary as well as the advanced principals and clinical applications of the modern noninvasive vascular imaging.
Congenital hip dysplasia and dislocation are common diseases of newborns and small infants, with frequently severe consequences if orthopaedic therapy is not initiated at an early stage. Therefore many clinicians have been looking for a simple method for the investigation of the hip joint in the early neonatal period. Up to 1980 the diagnosis of hip dysplasia could usually not be made before the 3rd month of life, by means of pelvic roentgenography. Only incomplete or complete unilateral dislocations were diagnosed in the neonatal age group. In 1980, however, Graf, an Austrian orthopaedic surgeon, began using ultrasound investigation ofthe hip joint in newborns and small infants in order to make an early diagnosis and to avoid radiation exposure. The intention of the present study was to compare ultrasound of the hip joint with other established diagnostic procedures and to establish whether it is suitable as a screening procedure in newborns. 2 Incidence of Congenital Hip Dysplasia and Dislocation In 1972 Barlow reported that 90 % of hips which are unstable at birth develop to normal joints spontaneously without any therapy. Visser (1984) thus suggested determining the percentage of hip dislocations after the 2nd - 3rd month of life so that children with spontaneous stabilisation would be excluded.
Sonography is a noninvasive diagnostic method that has gained an established place in many branches of medicine. Although the inability of ultrasound to penetrate bone delayed its application in the orthopedic field, the successful work of R. Graf in the early detection of pediatric hip disorders with ultra sound has served as an impetus for the increasing use of sonogra phy to detect and evaluate abnormalities of the musculoskeletal system. It is certain that further advances in this modality will be forth coming, and that sonography will be applied to new lines of inves tigation in orthopedic diagnosis. In Arthrosonography the authors use concise text and copious illustrations to demonstrate the potential applications of articular ultrasound, its diagnostic capabilities, and technical aspects of the ultrasound examination. Potential pitfalls are also explained. This book is the logical outcome of the application of diagnos tic ultrasound in orthopedics and rheumatology. It covers all basic practical aspects of arthrosonography and will be a valued re source for those concerned with the evaluation of the musculo skeletal system. HANS RETTIG Contents Introduction . . . . . . . . . . . . . 1 The Piezoelectric Effect - The Basis of Modem Sonography . . . . . . 1 Ultrasound Techniques. . . . . . . . . . . 1 General Principles of Diagnostic Ultrasound 2 Landmarks for Arthrosonography 6 Artifacts ........ . 6 Reverberations . . . . . 7 Hyperbolic Artifacts . . 7 Acoustic Mirror Image . 8 Special Phenomena in Arthrosonography 8 "Wandering Echo" Phenomenon . ."
3.2 Technique ............. '. . . . . . . 123 3.3 Drainage Catheters: Materials and Selection . 139 3.4 The Loop Catheter . . . . . . . . . . 141 4 Aspiration of Pancreatic Pseudocysts 145 E. Concluding Remarks 149 151 References " Subject Index . 158 VII List of Contributors BURGER, H. R, Dr. med., Oberarzt, Institut fur Pathologie, Univer sitiit Zurich, SchmelzbergstraBe 12, CH-8091 Zurich EINIGHAMMER, H.J., Dipl. Phys., Dr. rer. nat., Neurologische Uni versitatsklinik, MoorenstraBe 5, 0-4000 Dusseldorf HAUKE, R, Dipl., Phys., Dr. rer. nat., Gesellschaft fur Medizin. Techn. Informationssysteme, MarienstraBe 2,0-7910 Neu-Ulm PEmo, G., Professor Dr. med., Leitender Arzt, Abteilung fUr Zytolo gie, Institut fur Pathologie, Universitatsspital, CH-8091 Zurich " ... so it is not good for men to fear all that is not already known and settled, and thus feel that it is bad and harmful to strive for a greater perfection than already exists." Holderlin to his mother, 16. November 1799 A. Introduction 1 General The modem cross-sectional imaging methods of sonography and computed to mography, developed in the early 1970s, have contributed greatly to noninva sive studies of the parenchymatous organs and permit the evaluation of patho logic changes in areas that were previously accessible only to invasive, indirect, or inadequate examination."
It will be a long time before the quality of this profusely illustrated book is overtaken and the present spate of books on the subject of obstetric ultrasound may, as a result, suffer a numerical set-back - especially with translation into English which will "deliver the milk on everyone's doorstep". Two of the authors studied in our department in Glasgow and worked like If there are any rewards for teaching, then we humble Scots who demons. have had the privilege have had more than our share as a result of the pride with which we regard our pupils. In my own old age and looking back over the last thirty years, the innumer able difficulties, set-backs and disappointments have been more than compen sated for by those who have turned the subject from a laughable eccentricity (as I have at one time experienced) into a science of increasing exactitude. This transformation has come about, not by any efforts of mine, but by the enthusiasm and ingenuity of those who would probably have achieved as much on their own if given the encouragement which I ultimately received in Glasgow University life. Limbo must be the expected lot of most of us ordinary mortals but the work lives on. And so, in this reminiscent and philosophical mood I beg leave to quote a little poem which I wrote at an age when young men do that sort of thing.
Owing to the anatomic complexity of the neck and the diver sity of pathologic entities affecting it, the cervical region has long been of great semiological interest. Physical examination is an easy means of evaluating the size and origin of a solitary cervical mass, yet valid interpretation can prove difficult when the normal morphology of the neck has been altered; excellent examples are patients with extensive fibrosis or scarring secondary to previous irradiation or surgery. Like wise, physical examination cannot assess the relations of a pathologic process to adjacent structures - e. g., invasion can not be distinguished from simple displacement -and it is un suitable for monitoring therapeutic efficacy, such as the re sponse of metastatic nodes to medical management. Between physical examination, which remains fundamental, and exploratory surgical procedures, which are often the only means of obtaining indispensable anatomic proof for diagno sis, lie a number of recent imaging techniques including com puted tomography and magnetic resonance imaging using surface coils that provide invaluable information for the in vestigation of cervical pathologies. Real-time ultrasonogra phy occupies a privileged position because of its noninvasive ness, rapidity, and reliability, especially when performed by a specially trained examiner." |
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