Quantitative dual-energy radiographic absorptiometry (DRA) and dual-photon absorptiometry (DPA) were compared to determine the best means of assessing bone density. Both methods were used to evaluate the lumbar spine in 107 women (aged 35-84 years [mean, 64 years]) referred for evaluation of osteoporosis risk. High correlation was documented between measurements derived by the two techniques, with a .95 linear regression coefficient for the total spine density measurement. Age-related regression equations were similar in slope but manifested different intercepts. Bone mineral density values derived with DRA were consistently lower than those obtained with DPA (conversion equation: DPA density = [1.067 X DRA density] + 0.163). Besides the inherent imperfections of each system, it was found that inaccurate identification of intervertebral spaces on the low-resolution DPA images introduced errors in patient data. DRA may replace DPA as the dedicated projectional densitometric procedure of choice for technical reasons, but at present a conversion equation must be used to compare DRA data to DPA data.
A 14-year-old boy presented to an outside emergency department with an expanding right neck mass after he had been struck by an elbow to the neck 4 days earlier during a basketball game. On initial examination in the emergency department, a soft, minimally tender, cystic mass was visible and easily palpable in the right posterior cervical triangle. Despite considerable growth of the mass after the injury and a substantial cosmetic deformity, the patient exhibited no neurologic signs, respiratory compromise, or voice changes. Computed tomography (CT) of the neck with intravenous contrast showed a hypodense, 7.3 × 6.3 × 3.6-cm mass in the right posterior cervical space with anterolateral displacement of the sternocleidomastoid muscle (fi gure 1).A review of the patient's history revealed that when he was a young child, a mass in this area of his neck had been diagnosed; it was smaller than 1 cm at that time. The mass was believed to be benign, and further intervention was discouraged. The patient had experienced no problem related to the mass until the night of the basketball injury.In view of concern over the expanding nature of the mass, the patient was transferred to the Children's Figure 1. Contrast-enhanced CT shows the large mass in the right posterior cervical space.
Etiology of tracheoesophageal fistula is commonly congenital due to failure of proper embryonic lung bud branching, resulting in lateral septation of the foregut into the esophagus and trachea. Clinically, tracheoesophageal fistula (TEF) severity relates to oxygenation and aspiration pneumonia from gastric reflux. Acquired TEF is rare. Battery ingestion has recently increased in incidence, presenting asymptomatically or with nonspecific symptoms of fever, poor feeding, and dyspnea. The battery establishes an electrical circuit within the esophagus producing hydroxide ions at the negative pole forming alkali burns that perforate the esophagus and create a TEF. 1 Treatment of battery swallow-induced TEF requires immediate surgery, preferably within two hours to minimize friability, tissue necrosis, fistula enlargement, tracheobronchial contamination, sepsis, and nutritional problems. 2 We discuss the diagnosis, anesthetic approach, and surgical corrections of battery swallow-induced TEF (Figure 1) in a pediatric patient.
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