Showing papers in "American Journal of Roentgenology in 1973"
TL;DR: The roentgenographic evaluation of choledochal cyst with special emphasis on cholangiography is presented and the surgical implications of this anomaly are suggested.
Abstract: 1. A new concept of the etiology of choledochal cyst is presented. The etiology of this entity is based on an anomalous relationship between the common bile duct and the pancreatic ducts.2. This anomaly allows reflux of pancreatic juice into the common bile duct. Pancreatic juice leads to cholangitis and dilatation of the common duct.3. The roentgenographic evaluation of choledochal cyst with special emphasis on cholangiography is presented.4. The surgical implications of this anomaly are suggested.
262 citations
TL;DR: It is concluded that deposition and growth of secondarily seeded neoplasms in the abdomen are dependent upon the natural flow of ascites within the peritoneal recesses.
Abstract: The distribution of intraperitoneal malignant seeding clearly correlates with the pathways of flow of ascitic fluid.Four predominant sites of seeded metastases are identified: (1) the pouch of Douglas at the rectosigmoid level; (2) the right lower quadrant at the lower end of the small bowel mesentery; (3) the left lower quadrant along the superior border of the sigmoid mesocolon and colon; and (4) the right paracolic gutter lateral to the cecum and ascending colon. It is at these sites that the preferential, repeated or arrested flow of intraperitoneal fluid occurs.It is concluded that deposition and growth of secondarily seeded neoplasms in the abdomen are dependent upon the natural flow of ascites within the peritoneal recesses.
211 citations
192 citations
TL;DR: It is evident that the presently available pretesting techniques serve no useful purpose and should be abandoned.
Abstract: Thirty-two thousand, nine hundred sixty-four consecutive patients were studied with reference to the incidence and clinical characteristics of reactions to a single urographic contrast medium. Mild side effects were recorded in 5.1 per cent and acute reactions in 1.72 per cent. Severe reactions occurred in 0.09 per cent with 1 death from cardiac arrest.Acute reactions are unpredictable on the basis of history or any known pretesting technique. Pretesting itself is hazardous and gives a false sense of security to both physician and patient. As a consequence of these facts, it is evident that the presently available pretesting techniques serve no useful purpose and should be abandoned.The first 9,934 patients were studied with special reference to an association between a history of "allergy" or "hypersensitivity" and acute reactions. Reactions were 2.5 times (3.0 per cent as compared to 1.2 per cent) more frequent in patients with a positive history of "allergy." No increase in severity of reactions was no...
187 citations
TL;DR: Compared to re-operation or attempts of stone dissolution, extraction under roentgenologic control in the ambulatory patient is the method of choice for the treatment of retained biliary tract stones.
Abstract: Our experience with 20 cases of nonoperative retained biliary tract stone extractions is presented.†An improved instrumentation technique through a steerable catheter under roentgenologic control is described.A second surgical intervention for stone removal became unnecessary in all but 1 of our 20 patients undergoing this new roentgenologic technique.All 19 patients have remained asymptomatic after stone removal.The technique was unsuccessful in 1 patient due to our inability to catheterize a tortuous T-tube drain tract.Compared to re-operation or attempts of stone dissolution, extraction under roentgenologic control in the ambulatory patient is the method of choice for the treatment of retained biliary tract stones.
172 citations
TL;DR: The middle cerebral artery has been noted to demonstrate anomalies less frequently than the other major intracranial arteries.
Abstract: The middle cerebral artery has been noted to demonstrate anomalies less frequently than the other major intracranial arteries.The cerebral angiograms and brief case histories of 7 patients with anomalies involving the middle cerebral artery are presented. Three cases of accessory middle cerebral artery, 2 cases of duplication of the middle cerebral artery, and 2 cases of early bifurcation of the middle cerebral artery are reported.
169 citations
TL;DR: It is found thatSinusoidal congestion, parenchymal atrophy, and subintimal fibrous thickening of the central veins are early histologic manifestations of liver injury, whereas dense fibrous occlusion of the vein lumina is a late effect.
Abstract: 1. Irradiation of the entire liver with doses of 2,450 to 2,920 rads given by the moving strip technique caused liver injury in 14 of 65 patients treated.2. The clinical picture of radiation hepatitis may consist of hepatomegaly, ascites, pleural effusion, and alteration in liver function. The response to the injury sustained is variable, and patients may die within a short time (Group I). The chronic form may be a continuation of the acute injury (Group II), or the patient may experience an abrupt onset of symptoms (Group III).3. Sinusoidal congestion, parenchymal atrophy, and subintimal fibrous thickening of the central veins are early histologic manifestations of liver injury, whereas dense fibrous occlusion of the vein lumina is a late effect.4. A safe dose to the entire liver with the moving strip technique has not been determined. Part of the liver is no longer included in the treatment field.
139 citations
TL;DR: Local tumor control was achieved in approximately one-half of the patients with supraglottic tumors treated initially by irradiation alone, while surgery after irradiation failure resulted in local control in 12 of 15 patients with resectable lesions.
Abstract: Two hundred and thirteen patients with carcinoma of the larynx were treated with the Stanford 4.8 mev. medical linear accelerator between 1957 and 1970. Included were 67 patients with supraglottic tumors and 146 with involvement of glottic structures. The 78 patients with carcinoma limited to a single true vocal cord had a 5 year actuarial survival of 90 per cent, with 4 of 5 radiation failures being salvaged by laryngectomy. There was only 1 tumor-related death in the 99 patients with T1 and T2 glottic lesions.Local tumor control was achieved in approximately one-half of the patients with supraglottic tumors treated initially by irradiation alone, while surgery after irradiation failure resulted in local control in 12 of 15 patients with resectable lesions. An additional 4 patients with planned preoperative irradiation were also controlled locally and are alive without evidence of disease.These cases are also analyzed according to presenting symptoms, complications, sites of metastases, quality of postir...
128 citations
108 citations
TL;DR: Analysis of 7,000 carotid angiograms over a period of 8 years has revealed a wide variety of pathologic conditions responsible for stenosis and occlusion of the internal carotids artery and its branches.
Abstract: Atherosclerosis is by far the most common cause of stenosis and occlusion of intracranial and extracranial arteries in the western world.With increasing use of cerebral angiography, other stenoses and occlusions will be encountered with greater frequency than heretofore.Analysis of 7,000 carotid angiograms over a period of 8 years has revealed a wide variety of pathologic conditions responsible for stenosis and occlusion of the internal carotid artery and its branches; 140 such cases have been classified.
107 citations
TL;DR: Twenty-six cases of hydrometrocolpos in infancy have been recognized during life or discovered at autopsy in this hospital since 1935, with imperforate hymen and all children with stenosis or atresia of the vagina or cervix had other congenital malformations, usually multiple and severe.
Abstract: Twenty-six cases of hydrometrocolpos in infancy have been recognized during life or discovered at autopsy in this hospital since 1935.There were 10 infants with imperforate hymen or low obstructing vaginal membrane, 13 with atresia or stenosis of the vagina, and 3 with cervical stenosis or atresia.Although imperforate hymen was not associated with other congenital anomalies, all children with stenosis or atresia of the vagina or cervix had other congenital malformations, usually multiple and severe. Fistulae, imperforate anus, bicornuate uterus, and renal hypoplasia were especially common.The resulting anatomic complexity necessitates individualization of the radiologic diagnostic approach. It is clearly worth-while to obtain as complete preoperative definition of the anatomy as the condition of the child allows.
TL;DR: A randomized mass screening program using mammography as well as clinical examination in women aged 40 to 64 years resulted in a higher proportion of breast cancer detected with no axillary lymph node involvement and subsequently a substantial reduction in mortality in a study group as compared to a matched control.
Abstract: A randomized mass screening program using mammography as well as clinical examination in women aged 40 to 64 years resulted in a higher proportion of breast cancer detected with no axillary lymph node involvement and subsequently a substantial reduction in mortality in a study group as compared to a matched control. Both clinical examination and mammography contributed independently to the yield. However, in women under 50 in this study, mammography led to detection of only a small proportion of additional cases, while at age 50 years and over omission of either modality would have led to substantially lower cancer detection rates. The particularly substantial contribution of mammography is underscored by a case fatality rate of only 2 per cent in cancers detected in mammography alone.It would be reasonable to conclude that further follow-up to determine long-term effect of the screening procedures is indicated.It would also seem useful to evaluate the contribution of newer improved methods of mammography...
TL;DR: Interstitial gamma-ray therapy still is an important modality of irradiation for oral tongue and floor of the mouth lesions but computer dosimetry and careful dental hygiene result in a high control rate with few complications.
Abstract: Interstitial gamma-ray therapy still is an important modality of irradiation for oral tongue and floor of the mouth lesions.Computer dosimetry and careful dental hygiene result in a high control rate with few complications.
TL;DR: This group of 22 children has illustrated the unusual nature of congenital and acquired cerebral aneurysms versus those found in adults, and current selective angiographic techniques promise an increased incidence and accuracy in the diagnosis and demonstration in infants and children.
Abstract: This group of 22 children has illustrated the unusual nature of congenital and acquired cerebral aneurysms versus those found in adults.The identification of cerebral aneurysms in the first decade of life has resulted from the increased use of cerebral angiography in children.The unexpected large size of our congenital aneurysms is contrary to the expected small size dictated by accepted pathogenetic concepts.The anatomic distribution of congenital aneurysms is different from those of adults, and only the internal carotid bifurcation can be implicated as a common point of origin.Current selective angiographic techniques promise an increased incidence and accuracy in the diagnosis and demonstration of cerebral aneurysms in infants and children.
TL;DR: Angiographic examinations were made of 9 patients who had complete occlusion of the basilar artery and a direct relationship is indicated between patency of collateral pathways and prognosis.
Abstract: Angiographic examinations were made of 9 patients who had complete occlusion of the basilar artery. Six are alive 3 months to 5 years after diagnosis.In 7 of the patients the diagnosis was not suspected prior to angiography. The commonest site of occlusion was just distal to the origins of the posterior inferior cerebellar arteries. Various patterns of collateral flow were observed.A direct relationship is indicated between patency of collateral pathways and prognosis.
TL;DR: The precise anatomic pathways and roentgenologic findings are described and illustrated and the lesions produced range from transient spasm to the development of obstructive strictures and remote exudative abscesses.
Abstract: 1. Pancreatitis extends along the mesenteric planes of the transverse mesocolon to the large intestine and via the small bowel mesentery to the jejunum, ileum and cecum.2. In the large intestine, the transverse colon and particularly the splenic flexure are most commonly involved. The distal ascending colon may be involved by way of a duodenal fistula.3. In the small bowel, the inflammatory process may selectively involve jejunal loops or may progress down the length of the mesentery to localize in the ileocecal area. Malabsorption may result from the effects of pancreatitis on the small bowel.4. The precise anatomic pathways and roentgenologic findings are described and illustrated. The lesions produced range from transient spasm to the development of obstructive strictures and remote exudative abscesses.
TL;DR: A benign cartilaginous tumor that arises near the triradiate cartilage in a young male has an excellent prognosis and should be treated with conservative surgical measures.
Abstract: Benign chondroblastoma often presents with a typical roentgenographic appearance. When the radiologist encounters this lesion in the tubular bones, he will be able to suggest the correct diagnosis in most cases. Unfortunately, when the lesion arises in flat bones (as with many bone tumors), the diagnosis is considerably more difficult. Even in this situation, the radiologist occasionally may be able to suggest the diagnosis of chondroblastoma. For example, a pelvic lesion that appears to be benign, that has a thin sclerotic rim, and that arises near the triradiate cartilage in a young male would certainly cause one to consider chondroblastoma as a possibility.The present study revealed the following:1. This benign cartilaginous tumor has an excellent prognosis and should be treated with conservative surgical measures.2. Sixty per cent of the lesions occur in patients who are in the second decade, and another 20 per cent occur in those in the third decade.3. Approximately two-thirds of the lesions occur in...
TL;DR: An aggressive approach to the treatment of testicular seminomas, utilizing super-voltage techniques, has resulted in 95 per cent survival for all stages.
Abstract: An aggressive approach to the treatment of testicular seminomas, utilizing super-voltage techniques, has resulted in 95 per cent survival for all stages.For the carcinoma group the sandwich technique has resulted in a sharper segregation of the Stage I and II cases with respect to survival with 100 per cent survival resulting in Stage I.Adjunctive chemotherapy may well be warranted in Stage II, where about one-third to one-half of the patients develop relapse or die.The value of analyzing such data by means of probability of disease-free survival is emphasized.
TL;DR: In this paper, the authors found that one-half of patients with suspected sinusitis have abnormal roentgenograms consisting of one alone or a combination of mucosal thickening, opacity, fluid and polyps.
Abstract: 1. Fifty-one per cent of patients with suspected sinusitis have abnormal roentgenograms consisting of one alone or a combination of mucosal thickening, opacity, fluid and polyps.2. Similar abnormal roentgenograms are found in 57 per cent of children without sinusitis and in 75 per cent of children who have an upper respiratory infection, but without sinusitis.3. Only 6 of 120 patients with suspected sinusitis had acute sinusitis, but the roentgen finding had no diagnostic or therapeutic significance.4. Specific treatment for sinusitis caused the roentgen findings to disappear in 4 of 6 patients with acute sinusitis and in only 2 of 8 with suspected sinusitis.5. Mucosal thickening, opacity, fluid and polyps have little diagnostic significance relative to sinusitis and appear to be associated with upper respiratory infection in most patients.6. If sinus roentgenograms are to be utilized in the evaluation of the sinuses in children, the omnipresence and relationship of the roentgen pathology to upper respira...
TL;DR: Four patients with extensive, unresectable desmoid tumors were treated with definitive radiation therapy and three are free of disease 2 years after treatment; the tumor of the fourth has decreased to 20 per cent its former size 1 year after therapy by irradiation.
Abstract: Four patients with extensive, unresectable desmoid tumors were treated with definitive radiation therapyThree are free of disease 2 years after treatment; the tumor of the fourth has decreased to 20 per cent its former size 1 year after therapy by irradiationThe authors feel that surgery is the treatment of choice in cases of small lesions, but radiation therapy should be attempted in the more extensive tumors Radical amputation should be reserved for only those patients in whom desmoid tumors failed to respond to radiation treatment
TL;DR: The case of partial absence is unique in that it is felt to represent the first known case of demonstration of a vascular etiology of primary cerebral hemiatrophy in a living patient.
Abstract: Unilateral congenital absence of the internal carotid artery, either partial or total, has been rarely demonstrated. We are presenting 1 case of each entity.The case of partial absence is unique in that it is felt to represent the first known case of demonstration of a vascular etiology of primary cerebral hemiatrophy in a living patient.The case of unilateral total absence of the internal carotid was associated with contralateral absence of the external carotid artery and persistence of the stapedial artery which were incidental findings in a patient who presented with a subdural hematoma following head trauma.
TL;DR: The thymolipoma usually begins in young individuals and, being virtually asymptomatic, may attain huge proportions before discovery, and well penetrated chest roentgenograms will usually demonstrate the outlines of the underlying heart and diaphragms, since these structures are always of greater roent genographic density than the fatty tumor.
Abstract: 1. The thymolipoma usually begins in young individuals and, being virtually asymptomatic, may attain huge proportions before discovery.2. The smaller lesions cannot be distinguished roentgenographically from other benign anterior mediastinal masses.3. The large tumors tend to slump toward the diaphragms, leaving the anterior superior mediastinal space lucent, an unusual finding in the majority of large mediastinal tumors. Often the large mass simulates cardiomegaly, but a normal position of the esophagus on the lateral roentgenogram is evidence against significant cardiac enlargement.4. Well penetrated chest roentgenograms will usually demonstrate the outlines of the underlying heart and diaphragms, since these structures are always of greater roentgenographic density than the fatty tumor. This finding is virtually pathognomonic and will obviate the need for angiocardiography or pneumomediastinum.5. The thin periphery of the tumor may be considerably more lucent than the bulky center—a suggestive finding.
TL;DR: In this article, retrograde portal blood flow was demonstrated in 1 cirrhotic patient with primary liver cell carcinoma during celiac arteriography in 5 patients with hepatoma, the portal flow was to-and-from, the direction depending upon the force of the contrast medium injection.
Abstract: Angiographic studies were carried out on 49 cases of liver cirrhosis and 47 cases of primary liver cell carcinoma.An unequivocal retrograde portal blood flow was demonstrated in 1 cirrhotic patient. The portal vein was visualized during celiac arteriography in 5 patients with hepatoma, In 1, the portal flow was to- and-from, the direction depending upon the force of the contrast medium injection. In 4 hepatoma patients in whom retrograde portal flow was seen, there were tumor thrombi in the portal vein, and in 1 patient, in the collateral veins.Thus, retrograde portal flow does occur in cirrhosis of the liver, but very rarely, and it occurs more often in primary liver cell carcinoma, probably due to arterial neovascularization and arteriovenous communications.
TL;DR: Hematogeneous osteomyelitis caused by Pseudomonas aeruginosa and Klebsiella aerobacter is a newly recognized complication of intravenous drug abuse.
Abstract: Hematogeneous osteomyelitis caused by Pseudomonas aeruginosa and Klebsiella aerobacter is a newly recognized complication of intravenous drug abuse.
TL;DR: Carotid artery catheterization through the femoral approach is highly successful even in elderly patients with atherosclerotic disease and can be achieved with relative ease and safety.
Abstract: A series of 2,000 consecutive femorocerebral angiographic studies is presented and the rate of success for carotid artery catheterization is calculated. Special emphasis is placed on patients above 50 years of age.1. The results are as follows:a. Left carotid artery. Total rate of success is 99 per cent with no difference between males and females. In patients over 50 years of age (1,042 examined carotid arteries) the rate of success is 98 per cent. The lowest rate of success is in the 8th decade in males 95 per cent.b. Right carotid artery. Total rate of success is 98 per cent with very slight difference between males and females. In patients over 50 years of age (1,028 examined carotid arteries) the rate of success is 96 per cent. The lowest rate of success is in the 8th decade in females—91 per cent.Carotid artery catheterization through the femoral approach is highly successful even in elderly patients with atherosclerotic disease and can be achieved with relative ease and safety.2. Successful cathete...
TL;DR: Transient, nonobstructive intussusceptions are reported for the first time, occurring in 17 per cent of the cases reviewed and an explanation for these changes based on the histopathology of the disease is proposed.
Abstract: A strikingly narrowed intervalvular distance, disproportionate for the degree of dilatation, is distinctive of scleroderma of the small bowel. It occurs in oven 60 per cent of the cases.Transient, nonobstructive intussusceptions are reported for the first time, occurring in 17 per cent of the cases reviewed.An explanation for these changes based on the histopathology of the disease is proposed.
TL;DR: An abnormal location of the chondrification center, with subsequent hypoplastic cartilaginous development of the arch is postulated as the likely cause.
Abstract: Four examples of an absent posterior arch of the atlas are described.Most patients with this anomaly have a small ossification posteriorly.An abnormal location of the chondrification center, with subsequent hypoplastic cartilaginous development of the arch is postulated as the likely cause.When this is an isolated anomaly, it is usually unassociated with neurologic abnormalities.
TL;DR: Adrenal venography in a series of 80 patients was useful in demonstrating the cortical tumors associated with Cushing’s syndrome and virilization and the lesion was correctly lateralized in all patients who had assay of adrenal venous blood performed.
Abstract: Adrenal venography in a series of 80 patients was useful in demonstrating the cortical tumors associated with Cushing’s syndrome and virilization. Eight of 17 patients with Cushing’s syndrome due to adrenocortical hyperfunction had roentgenographically enlarged glands.This technique was successful in roentgenographically demonstrating 6 of 10 tumors associated with primary aldosteronism. The lesion was correctly lateralized in all patients who had assay of adrenal venous blood performed.Phenochromocytomas may also be demonstrated by this technique but aortography and selective arteriography must also be performed since these tumors may be extraadrenal.
TL;DR: The course of ectopic bone formation in paraplegic patients was investigated by serial Sr85 or Sr87m scintigrams and differences in uptake on consecutive scintIGrams in the same patient were expressed by means of an uptake ratio between ectopic and normal bone.
Abstract: The course of ectopic bone formation in paraplegic patients was investigated by serial Sr85 or Sr87m scintigrams.Differences in uptake on consecutive scintigrams in the same patient were expressed by means of an uptake ratio between ectopic and normal bone.In most cases the uptake ratios tended to decrease with time.Surgical removal of ectopic bone, when indicated, was not followed by recurrence.In some rare cases, however, strontium uptake remained high over several years and the uptake ratios increased. In these cases removal of ectopic bone was followed by recurrence.