Showing papers in "American Journal of Roentgenology in 1974"
620 citations
TL;DR: The general rules of the TNM system were adopted in this investigation and were undertaken under the auspices of the Task Force on Lung Cancer and the American Joint Committee on Cancer Staging and End Results Reporting.
Abstract: I 30 S TAGING of neoplastic disease is the procedure of assigning a simple coded designator to a patient in accordance with an established set of rules. Its purpose is to classify patients and group them with respect to the anatomic extent or biologic severity of their disease. Clinical staging is based only on those measures of disease extent which are available from diagnostic or evaluative studies undertaken prior to instituting therapy. This classification of patients into relatively homogeneous groups, with respect to estimates of their prognosis, is essential if different modalities of treatment are to be compared and if results are to be communicated in meaningful terms. The central problems in designing a meaningful staging system are: (I) to identify and give proportionate weight to those factors which will reliably and validly predict survival; and (2) to develop rules which, when applied to these factors, will permit assignment of an index of disease extent. The essential character of such an index is that patients within any stagegroup who survive equivalent treatment will demonstrate a generally similar ageadjusted life expectancy. A major constraint on any system of classifying the extent of disease is that it must be easily understood and remembered; therefore, it must be based on relatively few predicting factors. Only a relatively uncomplicated system will lend itself to widespread utilization. Among the systems of classification proposed by international organizations and 8 10, 14, 17 and mdi viduals6 are classification schemes applicable speci ficalby to lung cancer.”2 Some of these have been found wanting,5’9”3 and none have achieved wide acceptance to date. The TNM classification scheme, first proposed by Denoix,4 meets many of the criteria and constraints noted above, and its principles are well established internationally.’6 Therefore, the general rules of the TNM system were adopted in this investigation, undertaken under the auspices of the Task Force on Lung Cancer2 of the American Joint Committee on Cancer Staging and End Results Reporting. When using the TNM system, the letter T represents the primary tumor with appropriate subscripts to describe increasing sizes of tumor and/or the involvement by direct extension. The letter N represents regional lymph node involvement with appropriate subscripts to describe the absence of involvement or increasing degrees of such involvement. The letter M represents distant metastasis with appropriate subscripts to describe the absence of such metastasis or increasing degrees of such dis_
298 citations
TL;DR: Percutaneous transhepatic decompression of the biliary system, a new therapeutic method, may provide a lasting solution on at least temporary relief of the misery of the patient and improve upon the failing condition of the liver.
Abstract: The prognosis, following multiple unsuccessful surgical reconstructions of an obstructed biliary system, used to be very disappointing, because of the recurrent hepatitis, increasing jaundice and hepatic failure, which led to eventual coma and subsequent death.Percutaneous transhepatic decompression of the biliary system, a new therapeutic method, may provide a lasting solution on at least temporary relief of the misery of the patient and improve upon the failing condition of the liver.In patients having malignant obstructive lesions this therapeutic method has very limited value.Under benign conditions TBD may offer the only life saving treatment with such a satisfactory clinical recovery that patients prefer the inconvenience of an indwelling tube to another surgical repair.
193 citations
144 citations
115 citations
TL;DR: The classic roentgenographic and clinical features of the battered child syndrome were not present in most of the patients, and skull fractures and spread of the cranial sutures, either alone or in combination, were quite common.
Abstract: The classic roentgenographic and clinical features of the battered child syndrome were not present in most of our patients. The well known epiphyseal-metaphyseal long bone fractures, usually considered the classic findings in these infants, were less common in our series than were spiral and transverse fractures of the long bones. Multiple skeletal injuries were also less common than expected. It is not known whether these data merely represent an isolated experience, or a more universal, but as yet unappreciated phenomenon. However, because of our findings it has caused us to place more emphasis on, and be more suspicious of single, ordinary long bone fractures, especially when clinical correlation is less than plausible.Skull fractures and spread of the cranial sutures, either alone or in combination, were quite common. These findings are obviously significant both in respect to early diagnosis and associated intracranial complications. Often skull fractures, or simple spreading of the sutures, served t...
109 citations
TL;DR: The hydatid cysts of the lungs were commonly solitary, well circumscribed, polycyclic, unruptured, at the lung bases, and at the posterior segments, and they exhibited different rates of growth in the same patient with a maximum growth of 7 cm.
Abstract: Roentgen analysis of 50 cases of hydatid disease of the lungs is presented.The hydatid cysts of the lungs were commonly solitary, well circumscribed, polycyclic, unruptured, at the lung bases, and at the posterior segments.They exhibited different rates of growth in the same patient with a maximum growth of 7 cm. in 7 months. The presence of 2 or more large well circumscribed masses were found to be virtually pathognomonic of simple hydatid cysts. Characteristics of multiple small cysts are presented.The roentgen manifestations of rupturing and ruptured hydatid cysts included the classical roentgen signs; i.e., the crescent sign, the double arch sign, and the water lily sign. The "membrane" sign on bronchography and tomography and the "daughter cyst" sign are described and illustrated.Included also are cases showing: empty pericyst; pericyst effusion; hydatid lung abscess; pleural reaction; pleural effusion; and empyema. Accompanying types of pneumonitis included the peri-pericyst allergic and bacterial p...
101 citations
96 citations
TL;DR: A study of 621 patients with glottic carcinoma treated by megavoltage radiation therapy was made and the results of treatment according to the status of the mobility of the involved cord and the extent of the mucosal surface spread are presented.
Abstract: A study of 621 patients with glottic carcinoma treated by megavoltage radiation therapy was made. The results of treatment according to the status of the mobility of the involved cord and the extent of the mucosal surface spread are presented.More than two-thirds (69 per cent) of the patients survived without disease (absolute rate) and over three-quarters (78 per cent) were cured (determinate rate) by radiation therapy alone for 5 or more years with preservation of useful voice.For lesions with normal cord mobility, the 3 year and 5 year NED rates of approximately 90 per cent were achieved.For lesions with impaired cord mobility, the 3 year and 5 year NED rates deteriorated to approximately 65 per cent.For lesions with completely fixed cord, the 3 year and 5 year NED rates were approximately 25 per cent following radiation therapy.Over two-thirds of radiation failures (70 per cent) were cured by subsequent surgery without postoperative complications.Treatment policies for this disease are outlined. Based...
95 citations
TL;DR: Differences in neurotoxicity of 8 contrast media that are derivatives of benzoic acid are correlated with differences in their specific octanol/water partition coefficient.
Abstract: Neurotoxicity of x-ray contrast media used in cerebral and spinal cord angiography is related to 2 factors.The specific factor is the lipid solubility, or octanol/water partition coefficient of the contrast medium anion, which determines its passage through membranes of cerebrovascular endothelial cells of the blood-brain barrier.The nonspecific factor is solution osmolality, which opens tight junctions between the cells through which the contrast media then can enter the brain.Differences in neurotoxicity of 8 contrast media that are derivatives of benzoic acid are correlated with differences in their specific octanol/water partition coefficient. Brain uptake depends on the partition coefficient and on pKa, which determines the proportion of dissociated and undissociated form of the acid in blood. Systemic LD50 of the benzoic acid derivates also depends on octanol/water partition and on pKa.
93 citations
TL;DR: Difficulty in obtaining angulated views of the coronary vessels in a single transverse plane can be overcome by the systematic use of additional views in a sagittal plane, angulated approximately 25° either in a cranial or caudal direction or both.
Abstract: It has been a standard practice during selective coronary angiography to obtain multiple angulated views of the coronary vessels in a single transverse plane.These views usually provide an excellent definition of the longitudinally oriented right coronary artery and middle and distal segments of the left coronary artery. However, the proximal branches of the left coronary artery are more transversely oriented and can be parallel to the axis of the x-ray beam in this plane of rotation. This results not infrequently in superimpositions and incomplete tangential views of these segments. Therefore, stenoses in these areas can be overlooked or underestimated.We have found that these difficulties can be overcome, in most instances, by the systematic use of additional views in a sagittal plane, angulated approximately 25° either in a cranial or caudal direction or both.
TL;DR: "Condensing osteitis" of the clavicle, a previously undescribed entity, is characterized by pain along the top of the shoulder, which is aggravated by abduction of the arm, and is alleviated by surgical excision of the involved end of the bone.
Abstract: "Condensing osteitis" of the clavicle, a previously undescribed entity, is characterized by pain along the top of the shoulder, which is aggravated by abduction of the armRoentgenographically, there is increased bone density of the medial end of the clavicle and, histologically, there is an increased quantity and thickness (reinforcement) of normal cancellous bone and sometimes expansion with associated periosteal reactive bone These changes are felt to be the result of increased or altered mechanical stress across the sternoclavicular jointThe symptoms are alleviated by surgical excision of the involved end of the bone
TL;DR: The results have been encouraging with substantial local tumor control and no late urinary or rectal disturbances in the 49 patients who have been followed from 6 to 30 months.
Abstract: A technique involving a pelvic lymphadenectomy and a retropubic implantation of the prostate with iodine 125 encapsulated sources is under investigation at Memorial Hospital. This technique is simple and applicable to patients with localized cancer of the prostate, clinically stage B or C. It has increased the accuracy of staging, carries no mortality and has low morbidity. The results have been encouraging with substantial local tumor control and no late urinary or rectal disturbances in the 49 patients who have been followed from 6 to 30 months.
TL;DR: 1. Colonic diverticulosis is the most common cause of acute rectal bleeding in the middle-aged or elderly adult and results in precise preoperative diagnosis and rational surgery.
Abstract: 1. Arteriography is the diagnostic method of choice in acute rectal hemorrhage and results in precise preoperative diagnosis and rational surgery. The potential for selective therapy through the catheter is also evident.2. Colonic diverticulosis is, by far, the most common cause of acute rectal bleeding in the middle-aged or elderly adult.3. Most bleeding colonic diverticula are located to the right of the splenic flexure.4. Carcinoma is a rare cause of rectal hemorrhage.5. The bleeding point is occasionally located outside of the colon.6. A history of trauma or previous surgery should suggest the possibility of arteriovenous fistula.7. Arteriovenous malformations of the right colon should be diligently searched for in elderly patients with aortic stenosis and recurrent hemorrhage.8. Hemorrhage from duodenal ulcer may present as rectal hemorrhage and lead to diagnostic confusion.
TL;DR: A barium enema examination performed in each patient showed identical roentgenographic findings, and this entity was shown not to be Hirschsprung’s disease.
Abstract: 1. Twenty infants with symptoms and roentgenographic signs of low colonic obstruction are presented.2. A barium enema examination performed in each patient showed identical roentgenographic findings.3. This entity was shown not to be Hirschsprung’s disease. Surgery is contraindicated. The only procedure required is diagnostic barium enema examination, this being also curative.4. This entity is not the "meconium plug syndrome," although plugs have been removed in a few instances.5. A highly significant correlation exists between this syndrome and maternal diabetes.
TL;DR: Four cases are reported to demonstrate the value of an ultrasonically guided aspiration of the suspected abscess in selected patients.
Abstract: Ultrasonic examination can reliably diagnose intra-abdominal or retroperitoneal abscesses in the majority of patients. Some cases in which the diagnosis is unsure or a precarious clinical condition contraindicates exploratory surgery can be definitively diagnosed by an ultrasonically guided aspiration of the suspected abscess.The discomfort and risk are minimal.Four cases are reported to demonstrate the value of such aspiration in selected patients.
TL;DR: Percutaneous needle aspiration biopsy of pulmonary lesions is a simple, safe, practical, and acceptable diagnostic procedure and the diagnostic yield of this procedure exceeds that of any other method, other than open thoracotomy.
Abstract: Percutaneous needle aspiration biopsy of pulmonary lesions is a simple, safe, practical, and acceptable diagnostic procedure. The diagnostic yield of this procedure exceeds that of any other method, other than open thoracotomy. With the use of No. 16 or No. 18 thin-walled needles, image amplifier guidance, and needle guidance instruments, all lesions, either in central or peripheral portions of the lung, are accessible for biopsy.Four hundred and ten needle aspiration biopsies were carried out on 350 patients. Of 290 confirmed cases, 190 were proven to be malignant by needle biopsy and 44 were proven to be benign. Two hundred and thirty-four patients out of 290 were diagnosed by needle biopsy—a biopsy success rate of 81 per cent. A second or third biopsy will significantly increase the number of satisfactory biopsies. The complications of a pneumothorax are of no consequence and can be immediately handled by the radiologist using a pneumothorax catheter. Other complications of subcutaneous emphysema, hemo...
TL;DR: The protean features of aortograms in aortic dissection are discussed in detail and the three dimensional approach to a precise anatomic assessment is emphasized.
Abstract: The protean features of aortograms in aortic dissection are discussed in detail.The three dimensional approach to a precise anatomic assessment is emphasized.Problems in angiographic diagnosis of aortic dissection are also included.
TL;DR: Although the mechanism of gallium 67 accumulation in pulmonary sarcoidosis remains to be determined, its measurement may prove to be a useful new index of disease activity before, during and after therapy.
Abstract: Twenty-nine patients with biopsy proven pulmonary sarcoidosis in various clinical stages of activity were studied with gallium 67 citrate scans.If the chest roentgenogram was normal, we were not able to demonstrate any abnormal pulmonary accumulation of gallium 67, regardless of the patient’s subjective complaints. Eight patients had abnormal gallium 67 accumulation in the hilar region with no roentgenographic evidence of hilar lymphadenopathy. Gallium 67 uptake in the pulmonary parenchyma or hilar regions correlated poorly with clinical activity.Large doses of steroids decreased the uptake of gallium 67 in the pulmonary parenchyma and hilum in 3 patients. Although the mechanism of gallium 67 accumulation in pulmonary sarcoidosis remains to be determined, its measurement may prove to be a useful new index of disease activity before, during and after therapy.
TL;DR: Eighty-six cases of thoracic foregut cysts were histologically selected and classified as either respiratory (bronchogenic or bronchial) or entenic, and the neurenteric cysts should be very characteristic because of their associated vertebral body anomalies.
Abstract: Eighty-six cases of thoracic foregut cysts were histologically selected and classified as either respiratory (bronchogenic or bronchial) or entenic. Most are homogeneous water density masses which are located in the mediastinum and frequently are based around the carina. There is a tendency for the carina-based group to extend either posteriorly or inferiorly into the retrocardiac area. These masses tend to be right-sided and partially obscured by surrounding normal structures. The simple enteric cysts are not always distinguishable from the respiratory cysts, but they do tend to be larger and more posterior. In contrast with the simple enteric cysts, the neurenteric cysts should be very characteristic because of their associated vertebral body anomalies.The intrapulmonary cysts may present as either a mass or cavity and such an appearance may be nonspecific. However, when the diagnosis is considered either preoperatively or on histologic grounds, signs of an underlying inflammatory process, such as surro...
TL;DR: Recurrent acute oliguric renal failure developed in 8 patients after catheterization angiography without bilateral renal arteriography after the cause for this complication remains obscure.
Abstract: Acute oliguric renal failure developed in 8 patients after catheterization angiography without bilateral renal arteriography.The cause for this complication remains obscure. Severe dehydration, shock, overdose of contrast medium, or multiple myeloma could not be implicated. From retrospective analysis of these cases, multiple factors seem to be operative in these generally severely ill patients.Early recognition and adequate management may prevent life-threatening effects of this infrequent, but potentially serious angiographic complication.
TL;DR: One hundred and forty patients with chromophobe adenomas were treated by radiation therapy, decompression, or surgical decompression followed by radiation treatment as mentioned in this paper, and the initial response of the visual fields was the same for each form of therapy, but the long-term control rates at all intervals from 2 to 20 years were much greater when irradiation was given.
Abstract: One hundred and forty patients with chromophobe adenomas were treated by radiation therapy, surgical decompression, or surgical decompression followed by radiation therapy. The initial response of the visual fields was the same for each form of therapy. The long-term control rates at all intervals from 2 to 20 years were, however, much greater when irradiation was given. At 10 years the absolute control rate was 71 per cent for radiation therapy, 79 per cent for decompression plus irradiation, but only 9 per cent for surgery alone. It is probable that results for the irradiated groups would have been better if the doses had been higher in the earlier patients. After 10 years no patient without irradiation was free of recurrence.No major complication could be attributed to irradiation. Surgical procedures, on the other hand, yielded a 7 per cent mortality rate, and 5 per cent of those operated experienced major damage to optic nerves or chiasm.It is the author’s opinion that selected cases of presumed chro...
TL;DR: Three cases of soft tissue calcification secondary to subcutaneous extravasation of an intravenous infusion of calcium gluconate are reported.
Abstract: Three cases of soft tissue calcification secondary to subcutaneous extravasation of an intravenous infusion of calcium gluconate are reported.Histologic changes consist of thickening of the subcutaneum and calcification in the subcutaneum, and the fascial planes. Vascular calcification may also be seen.Roentgenologic recognition and awareness of this diagnosis is important, as the clinical picture is variable and the etiology of the presenting inflammatory response or mass is often unknown.
TL;DR: Stomach and small bowel tonicity and motility were significantly decreased following atropine sulfate and propantheline bromide at 10, 30, and 60 minutes as compared to placebo.
Abstract: Twelve asymptomatic subjects cooperated in each of 2 studies. In Study I glucagon was compared to placebo and to atropine sulfate 1 mg. In Study II glucagon 2 mg. was compared to placebo and to propantheline bromide 30 mg. Drugs were given intramuscularly, double-blind, and crossover.When the subjects received glucagon, the radiologist reported that motility and tonicity were decreased and that the drug effect was significantly (p<0.001) greater at 10 and 30 minutes than when placebo was given. Sixty minutes after receiving glucagon the tonicity and motility of the stomach and duodenum differed little from that seen with placebo. Small bowel motility was also significantly (p<0.05) less after glucagon than after placebo.Stomach and small bowel tonicity and motility were significantly (p<0.05) decreased following atropine sulfate and propantheline bromide at 10, 30, and 60 minutes as compared to placebo. Tonicity and motility of the duodenal bulb at 60 minutes and duodenal loop at 30 and 60 minutes were al...
TL;DR: Two cases of ALL (acute lymphocytic leukemia), both in long-term remission, developed a gyriform pattern of brain calcification during treatment for CNS (central nervous system) complications, on a treatment regimen which included: prednisone, vincristine, methotrexate and irradiation.
Abstract: Two cases of ALL (acute lymphocytic leukemia), both in long-term remission, developed a gyriform pattern of brain calcification during treatment for CNS (central nervous system) complications, on a treatment regimen which included: prednisone, vincristine, methotrexate and irradiation.Cerebral angiography and brain biopsy were obtained in one. The calcium was closely related to vascular structures.