Showing papers in "Acta radiologica: diagnosis in 1969"

Submucosal perforation of the esophagus in the neonate.

Abstract: Excessive salivation, with choking, coughing and cyanosis on attempts at feeding in a newborn infant reasonably suggest esophageal atresia. Yet, other less common lesions may present the same signs. Of these, the simple esophagotracheal fistula, without atresia, is well known, while instances of congenital pharyngo-esophageal and true esophageal diverticula, with or without coexisting esophagotracheal fistulae, have only occasionally been reported (BRINTNALL & KRIDELBAUGH 1950, KNOX 1951, ROBB 1952 and GRANT & ARNElL 1959). An apparently even more rare disorder in the neonate with the same symptomatology is submucosal perforation of the esophagus. The clinical features and the radiologic appearances of this lesion on the basis of experience gained from two cases recently studied will be described in this communication. During its preparation, however, the records of a third case treated in another hospital became available and were included in the study. The radiologic features and the findings at operation of this third case well support the etiologic hypothesis for the disorder.

Thromboembolism of leg following percutaneous catheterisation of femoral artery for angiography. Symptoms and signs.

Abstract: Percutaneous catheterisation is now widely used, especially in diagnostic roentgenology. It would appear from the literature, however, that arterial catheterisation involves the risk of tromboembolism (MANDELBAUM & SCHUMACKER JR 1962, LANG 1963, MCGRAw 1963, HALPERN 1964, KOTTKE et coll. 1964, GREENSTONE et coll, 1965, BERGENTZ et coll, 1966, SEIDENERG & HURWITT 1966, MORTENSEN 1967). The term thromboembolism is used by the authors to denote occlusion of an artery by an embolus or by an obstructive thrombus. Thromboembolism is a serious complication and may sometimes even necessitate amputation of the affected limb (LUKE & MCGRAW 1963, SEIDENBERG & HURWITT). The figures given for the frequency of thromboembolism following catheterisation of the femoral artery vary between 0.2 % (SAUR 1964) and 8 % (KOTTKE et coll.), the corresponding range for amputation being 1: 364 (MCGRAW) to 6: 11402 (LANG). According to most investigators, thrombi occur more often than emboli.

Platelet adhesion and throms formation on vascular catheters in dogs.

Abstract: Vascular catheterisation is now widely used in diagnostic techniques (angiography, blood analysis, blood pressure recording) and in therapeutics (artificial cardiac pace-makers, intravenous and intraarterial drip). The most common serious complication of vascular catheterisation is thromboembolism. Though the causal mechanism is not properly understood, there is evidence that the risk varies with the area of the outer surface of the intravascular part of the catheter. This suggests thrombus formation to be stimulated by some reaction of the blood to the surface of the catheter (JACOBSSON & SCHLOSSMAN 1969a). I t has been demonstrated in vitro that platelets adhere to the surface of a catheter and aggregate (JACOBSSON 1969a). The initial phase of thrombus formation is characterised by a similar reaction of platelets to the vessel wall (HuGUES 1962, ZUCKER & BORRELLI 1962, HOVIG 1963, OWREN 1964, MUSTARD et colI. 1967). It was therefore thought worthwhile to investigate if platelets

Aneurysm of the splenic artery.

Abstract: Until some 20 years ago the roentgen diagnosis of aneurysm of the splenic artery was based on the demonstration of a characteristic calcification in the left hypochondrium. The first aneurysms of the splenic artery diagnosed by aortography were described by WAGNER (1946). Since then many calcified aneurysms detected by conventional roentgenography have been verified by aortography (SMITH et colI. 1952, and others). Uncalcified aneurysms have also been diagnosed angiographically in recent years, usually in association with the investigation of acute gastrointestinal haemorrhage or diffuse abdominal pain (SPITTEL et colI. 1961, ROSCH & BRET 1962, ROSCH 1967, BAUM et colI. 1965, OLIN & REUTER 1966, KUPIC et coIl. 1967, SMITH & HILL 1967). BOlJSEN & EFSING (1967) reported intrasplenic aneurysms following puncture for splenoportal phlebography in patients with portal hypertension. Their series included several patients with extrasplenic aneurysms of the splenic artery. Splenomegaly, especially when caused by portal hypertension, is sometimes associated with extrasplenic aneurysms of the splenic artery (OWENS & COFFEY 1953, SHEPS et coll. 1958). The frequency of aneurysms in patients with portal hypertension is unknown.

Cerebral Blood Flow in Occult Hydrocephalus Studied with Angiography and the Xenon 133 Clearance Method

Abstract: Occult hydrocephalus has received increasing attention during the last few years due to the reversibility of the serious, associated, symptoms, which include dementia and apraxia of gait. A vast number of these patients may be rescued by the insertion of an atrioventricular shunt or similar procedure. The often dramatic improvements following this relatively simple operation are well known although the nature of the underlying mechanism has not yet been agreed upon. Several theories have been offered. YAKOVLEV attributed the gait disturbances to stretching of the long paracentral fibres to the lower extremities. PENFIELD et colI. and KIBLER et colI. described periventricular demyelination and suggested a vascular cause. BREIG et coll, considered a general increase in cerebral blood flow to be the most plausible cause of the clinical improvement following a shunting procedure. Few clinical data are available however to support any of these theories. The cerebral circulation may now be studied in two ways: with angiography and through recording of the clearance curve by external counting after intra-

Thromboembolism of leg following percutaneous catheterisation of femoral artery for angiography. Predisposing factors.

Abstract: Several reports of thromboembolism following percutaneous catheterisation of the femoral artery have been published. The frequency of the complication varies from one series to another; SAUR (1964), for example, reported 0.2 % while KOTTKE et coll, (1964) gave a figure as high as 8 %. Such discrepancies are probably due to differences in the criteria used in the diagnosis of the condition, in the examination technique and in the composition of the clinical material. The complication often produces only vague symptoms and is therefore readily missed. Even palpation of the pulse is not always conclusive. These difficulties in the diagnosis of thromboembolism following catheterisation of the femoral artery was the subject of the preceding article in this journal. In many investigations into the cause of the complication, interest has been focused on the examination technique and only secondarily on the condition of the patient. As to the performance of the examination, the following details have been stressed as important: puncture technique (HALPERN 1964), the length of the catheter and the volume of contrast medium used (KOTTKE et coll.), duration

Microvascular effects of topically applied contrast media.

Abstract: The toxicology of roentgen contrast media has received much attention in recent years and has been the subject of several investigations. Side effects such as nausea, vomiting and urticaria are not uncommon after the intravenous and intraarterial injection of contrast media; the latter often also produce a more or less severe local burning sensation. Clinical observations have even indicated more serious effects. Coronary angiography is sometimes followed by electrocardiographic abnormalities (Ross 1963, JACOBSSON & PAULIN 1967). Circulatory changes such as alterations in the minute volume, blood pressure, hematocrit and plasma volume and osmolality have been reported (BROWN et colI. 1965, FODA et colI. 1965, and ISERI et coIl. 1965). In the presence of reduced renal function damage to the kidneys, as reflected in an increased NPN, has been demonstrated after nephroangiography (BAUDISCH & BAUMANN 1964). Albuminuria following urography has been described (KIRKLAND & HASLOCK 1961). INGVAR (1957) and GREITZ & WEISS (1959) during cerebral angiography with moderate amounts of contrast medium registered only a few changes in the EEG, whereas LUNDERVOLD & ENGESET (1967), using larger doses of medium, frequently observed such changes.

Angiographic demonstration of collaterals to the coronary arteries in patients with angina pectoris.

Abstract: Intercoronary and extracardiac anastomoses to the coronary arteries may be demonstrated by various methods of coronary angiography (SONES et colI. 1959, PAULIN 1964, ARVIDSSON & MOBERG 1966, BJORK 1966, and others). Successful results of operative procedures to increase the vascularization of the myocardium may also be documented by angiography (see accompanying illustration). It must be emphasized however that it is essentially the anatomy of the arteries that is demonstrated by these angiographic methods, and it is well known from vascular studies using peripheral and renal angiography that it is difficult to correlate the anatomical findings at angiography with disturbances of function. It is only to be expected that the same would apply to the myocardium and the anatomy of the coronary arteries as seen at coronary angiography. To investigate these factors, a study was made of 65 patients referred for surgical treatment of angina pectoris. Electrocardiograms with standard and various precordial leads were obtained in all these patients, and the physical work capacity was determined by means of a bicycle ergometer (HALLEN 1964).

Primary malignant lymphoma of the lung.

Abstract: Malignant lymphoma, confined to a single organ, is a rare disease. Primary lymphomatous lesions most commonly involve the stomach or the intestine (MCSWAIN & BEAL 1944 and THORBJARNARSON et coll. 1956). Primary sites of lymphomatous lesions may, however, be present in the lungs and about 100 cases have been reported (SALTZSTEIN 1963). Most of the lesions were lymphocytic lymphomas (about 60 %) but cases of Hodgkin's disease and reticulum cell sarcoma in the lungs have been encountered (BECK & REGANIS 1951, AHREN & ZETTERGREN 1963). Primary lymphomas with the exception of Hodgkin's disease of the lung remain restricted to the lungs and grow very slowly. Wide-spread dissemination throughout the reticuloendothelial system from a primary lymphoma of the lung of this type has not been reported. On the other hand, secondary pulmonary involvement is not unusual in cases of disseminated malignant lymphomas. ROBBINS (1953) found evidence of spread of malignant lymphomas to the lungs in 25 % of autopsies in such cases. The diagnosis of primary pulmonary lymphoma is based on roentgenographic examination and the histologic characteristics of the lesions. The roentgenologic features of primary pulmonary lymphomas have been described by ROBBINS (1953), VAN HAZEL & JENSIK (1956) and STERNBERG et colI. (1959).

Cerebral circulation time and cerebral blood flow

Abstract: Cerebral circulation in man has been investigated mainly by angiography and by determination of the cerebral blood flow. Cerebral angiography, although primarily introduced for morphologic studies, has proved to be of great value in the study of the physiologic features of the circulation. Serial angiography makes it possible to demonstrate the transportation of contrast media through the vessels of the brain and thus to determine the mean circulation time (GRElTZ 1956). The cerebral circulation time (CCT) reflects important physiologic aspects of the circulation. These aspects do not seem yet to have been properly utilized since determination of the cerebral circulation time appears to have been restricted mainly to the differential diagnosis of neoplasms. Introduction of the isotope clearance method, permitting quantitative measurement of the cerebral blood flow (CBF) expressed in ml/100 g brain tissue/ min has opened up new possibilities for studying the cerebral circulation and has stimulated further research activity in this field.

Isotope scanning of spinal cord cysts.

Abstract: It has been possible to diagnose cystic lesions in the cervical part of the medulla by examining the patient with Pantopaque myelography in supine position and gas myelography in sitting position (CONWAY 1961, 1967, HEINZ et colI. 1966). Similarly, volume variations suggesting the presence of cysts in the cervical spinal cord have been demonstrated by gas myelography and encephalography (WICKBOM & HANAFEE 1963, GARDNER 1965). The technique for lumbar gas myelography, recently introduced, has now made it possible to diagnose cystic changes in all parts of the spinal cord (WESTBERG 1965, 1966). Long flaccid cysts can be distinguished from other types of cystic intramedullary lesions (WESTBERG 1966). The demonstration of a flaccid cyst by gas myelography is sufficient justification for making a diagnosis of syringomyelia with complete certainty. On the other hand, this roentgen finding is not indispensable to the diagnosis of syringomyelia, since the cyst may disappear and leave a spinal cord atrophy (ELLERTSSON 1969a). Most cases of syringomyelia can be distinguished from other types of intramedullary cyst by their clinical manifestations, by findings in the examination of the cerebrospinal fluid and the cyst fluid, and by roentgen observations (ELLERTSSON 1968, 1969b). Communication between the cyst and the cerebrospinal fluid space occurs in syringomyelia but not in other types of intramedullary cyst (ELLERTSSON & GREITZ 1969).

Lumbar myelography with water-soluble contrast media. With special reference to the appearances of root pockets.

Abstract: The report by MIXTER & BARR in 1934 that sciatica may be caused by disc herniation and that its removal may relieve the symptoms of the patient produced a wave of enthusiasm for this kind of surgery throughout the world. The diagnosis is often made with great accuracy from the symptoms and signs and by careful neurologic examinations (NORLiN 1944). However, disc herniation is not always responsible for the symptoms and, if present, its correct spinal level may be difficult to determine. A great number of negative surgical explorations have been performed over the years and illustrate the fact that sciatica is not synonymous with disc prolapse. Furthermore, a negative finding at one level necessitates the exploration of several interspaces. Often the surgeon has to accept the possibility of a concealed disc or faces the problem of evaluating minor deformations of the posterior aspect of the disc which may be unassociated with the prolapse although they may lead to excision. This is naturally less favourable to the patient than the removal of a true prolapse (FRIBERG & HIRSCH 1946).

Vertebra plana due to histiocytosis X: serial studies.

Abstract: Osseous lesions are the hallmark of histiocytosis X since the skeleton represents the most common involved organ system and furthermore usually presents a characteristic radiographic appearance. This enables clinicians to identify a disease entity that is often mistaken for an infectious or metabolic disorder. In those cases of histiocytosis X without bone lesions, the diagnosis is often in doubt and only becomes established when the typical bone lesion occurs. A review of the accumulated clinical experience at the University of Minnesota Hospitals since 1950 comprises some 48 patients with generalized or localized histiocytosis X. Lesions were found in the vertebral column in ten patients. Characteristic radiographic findings include a variable degree of compression of the vertebral body, either symmetrical or asymmetrical, preservation of the intervertebral disc, and absence of associated soft tissue mass. The most severe degree of compression is termed vertebra plana. Serial radiographic studies over periods varying from 6 months to 11 years reveal some restoration of vertebral height in nearly all cases. Complete recon-

Effect of secretin in celiac and superior mesenteric angiography.

Abstract: Pancreatic angiographies are usually performed with the pancreas at rest as a result of fasting and premedication. Inactivity implies low oxygen consumption of the pancreas during the examination. Oxygen uptake in the pancreas can be increased by the intravenous administration of secretin (JORPES 1966, JORPES & MUTT 1959, LAGERLOF et coll, 1967). During recent years pure crystalline secretin has been successfully produced, and since 1966 synthesis is possible. Secretin acts as a catalyst in the production of bicarbonate and water by the pancreatic cells, as well as in the production of enzymes, though to a lesser degree. One clinical unit of secretin per kg body weight administered intravenously increases the oxygen uptake in the pancreas from the state of rest to 4 or 5 times within 3 minutes. The secretion from the pancreas to the duodenum, following its intravenous injection, starts at 3 minutes, to become maximal at lO to 30 minutes. The greater oxygen consumption of the pancreas is associated with an increase in blood flow. TAYLOR et call. (1966), in pancreatic angiography with administration of intra-arterial secretin in three normal cases reported that the pancreatic arteries were well demonstrated. BENNET et call. (1967) in an investigation of 33 patients,