Aaron S. Weinstein

Defects of the Renal Collecting Systems in Patients Receiving Anticoagulants

Four patients receiving oral anticoagulants had symptoms including flank pain and gross hematuria suggesting renal calculi. Excretory urography revealed diffuse infundibular narrowing and intramural filling defects of the renal pelvis and proximal ureters. In all cases the urograms returned to normal and the symptoms were remitted after the prothrombin activity level was increased. The changes probably represented submucosal hemorrhage. The major importance of this entity is its recognition as a relatively benign and easily remediable complication of anticoagulant therapy.

Case report 768

A 29-year -o ld m a n presen ted with a 3 -month h i s to ry o f increas ing pa in and stiffness o f the neck. There was a decrease in range o f m o t i o n u p o n f lexion and extens ion o f the neck bu t no neuro log ica l deficits were noted . P la in r a d i o g r a p h s o f the cervical spine were o b t a i n e d and revealed an expand ing lesion involv ing the spinous process o f C2 (Fig. 1). The rest o f the cervical spine was normal . C o m p u t e d t o m o g r a p h y (CT) o f this reg ion was p e r f o r m e d and conf i rmed a lytic des t ruc t ive lesion involv ing the sp inous process o f C2 wi th irregu la r i ty o f c o n t o u r and an assoc ia ted soft t issue mass (Fig. 2). The l amina o f C2 was pa r t i a l ly involved. Par t i a l des t ruc t ion o f the sp inous process o f C3 was also seen due to the enc r o a c h m e n t o f the mass at C2. A p reope ra t i ve w o r k u p for exc is ional b iopsy o f the lesion i n c l u d e d a n o r m a l bone survey. A bone scan showed an a rea o f increased u p t a k e in the p r o x i m a l e n d o f the r ight t ibia. R a d i o g r a p h s o f the t ib ia a t the site o f t ake -up were negat ive and the pat ient was a s y m p t o m a t i c at this locat ion.

Acropachy in lymphatic leukemia.

Bone lesions in adults with leukemia are not common, and the presence of bone destruction, clubbing, and edema of overlying soft tissues, termed leukemic acropachy (acros = extremity, pachus = thick), is rare indeed. Schittenhelm first described this entity in 1925 (12), and only one similar case (1) has been found in the literature since that time. The case of leukemic acropachy described below differs from the other two in that the patient has shown clinical and radiographic reversal of the abnormalities after drug therapy. Case Report A 41-year-old Negro male entered the Cincinnati Veterans Administration Hospital in March 1964. In November 1963 rhinorrhea and painful swelling of the fingertips of both hands developed. In February 1964, biopsy of an indurated area of the left palm was diagnosed as lymphoma cutis. Physical examination revealed a healthy-appearing male with normal vital signs. The tip of the spleen was palpable. There was no lymphadenopathy or hepatomegaly. All of the fingers were clubbe...

Advantages of Three-Phase Spot-Film Radioqraphy

Most radiologists give considerable thought to the selection of a spot-film device. Their choice is usually based on mechanical convenience and mobility. There is evidence, however, that many other factors involved in spot-film radiography receive only slight consideration. This paper will deal with the possibilities of improving spot-film quality by utilizing 3-phase generators and controls. The usual fluoroscopic-radiographic unit in use in the United States is powered by a single-phase generator. Design of the control and a comparative lack of efficiency in the generators used in the single-phase systems present several handicaps in producing spot-films of highest quality and sharpness of detail. No choice of focal-spot size is permitted for making a spot-film. Fluoroscopy is done on the small focal spot, and spot-filming is permitted on the large focal spot only. In most cases the large focal spot is 2 mm. in diameter. Focal Spot To demonstrate the effect of focal-spot size on sharpness of detail, thr...

PROGRAMMED LEARNING IN RADIOLOGY: A PRELIMINARY EVALUATION.

The teaching and learning methods now employed in our medical schools are currently receiving critical scrutiny by many educators. Drastic changes in the curriculum are being contemplated or have actually been initiated, and new teaching technics have evolved. One of these, novel to medicine, is programmed instruction. Its development, application, and acceptance have moved at a rapid pace in business, industry, government, and undergraduate education (2, 3). Its employment in medicine up to the present time, however, has been limited in the main to a few preclinical subjects. At Dartmouth Medical School a course in parasitology has been programmed and tested, and programs in other basic sciences are being prepared (1, 4). In other institutions a few disciplines have been experimenting with medical programs. The magazine Spectrum is publishing a series of programs for the practicing physician. Programmed learning embodies the Socratic method of advancing by easy stages from the simple to the more complex,...

Case report 470

Fig. 1 A, B. Conventional anterioposterior and lateral radiographs of the left knee and upper leg show a large, expanding, lytic metadiaphyseal lesion in the upper end of the fibula. Some linear and flake-like fragments of bone are noted within and at the margins of the expansile lesion. The transition margins of the head and diaphysis of the fibula are irregular and frayed. Some permeative lytic changes are noted for a very short distance beyond the transition margin in the diaphysis.