Charles M. Nice

The Roentgen Findings in Primary Hepatoma in Infants and Children An Analysis of Eleven Cases

Primary Hepatoma is of relatively rare occurrence in infants but, in spite of its low incidence, it is one of the commonest neoplasms of the liver seen in infancy and early childhood. Although numerous articles have been written about its pathology, clinical aspects, and therapy, no study could be found in which there was an attempt to establish roentgen criteria for the diagnosis. This paper will deal with roentgen findings in 11 cases of primary hepatoma in infants and young children. It is significant that the cases to be presented, despite their relative rarity, were hitherto unreported. This may serve to indicate that such tumors are not really as rare as the isolated case reports (with reviews of all the previously recorded cases) would suggest. Steiner (18) found only 77 cases (including 2 of his own) in children under sixteen years in which he considered the diagnosis justified. Bigelow and Wright, in 1953, assembled 95 proved cases and added 1 of their own (2). Still another case was added by Tom...

Irradiation Therapy in Hodgkin's Disease

The study of Hodgkins disease includes many interesting pathologic and clinical ramifications. One of the most consistent observations in this disease has been that, although the lesions appear radiosensitive, the mortality rate is high. Previous reports from this institution (34, 35) have outlined the general therapeutic approach and given the survival figures obtained in the past. It is the present purpose to bring up to date the results of irradiation therapy in Hodgkins disease at the University of Minnesota Hospitals and to review fundamental concepts on the nature of this disease and its therapeutic management. Historical Data Historical reviews of Hodgkins disease can be found in numerous publications and here will be limited largely to references (2, 16, 17, 18, 22, 26, 32, 38, 40, 49–53, 55, 56). A particularly accurate histologic description of the characteristic cells was given by Reed (40), in 1902. Many suggestions as to the cause of Hodgkins disease have been made, but none has been subs...The study of Hodgkins disease includes many interesting pathologic and clinical ramifications. One of the most consistent observations in this disease has been that, although the lesions appear radiosensitive, the mortality rate is high. Previous reports from this institution (34, 35) have outlined the general therapeutic approach and given the survival figures obtained in the past. It is the present purpose to bring up to date the results of irradiation therapy in Hodgkins disease at the University of Minnesota Hospitals and to review fundamental concepts on the nature of this disease and its therapeutic management. Historical Data Historical reviews of Hodgkins disease can be found in numerous publications and here will be limited largely to references (2, 16, 17, 18, 22, 26, 32, 38, 40, 49–53, 55, 56). A particularly accurate histologic description of the characteristic cells was given by Reed (40), in 1902. Many suggestions as to the cause of Hodgkins disease have been made, but none has been subs...

Primary Adenoid Cystic Carcinoma (Cylindroma) of the Trachea

Two cases of adenoid cystic carcinoma of the trachea, and a review of the literature, are presented. This unusual and often undiagnosed tumor closely mimics asthma and chronic bronchitis. Although many patients die within 2 to 3 years of the onset of symptoms without appropriate treatment, adequate therapy should lead to survival of 10 years or more. The radiologist should make the initial diagnosis by noting the tumor, which is frequently located posterolaterally and in the middle third of the trachea.

The use of dionosil in bronchography; a preliminary report.

The search for ideal agents to be used in contrast roentgenography is a continuous one, and in no field is their need more keenly felt than in bronchography. For that procedure it is highly desirable that the following objectives be met: (1) The degree of irritation produced by the medium should be of sufficiently low degree that bronchography may be performed with a minimum of effort and with the least possible post-bronchographic complications. (2) The contrast agent should so outline the bronchial tree and provide such roentgenographic contrast that maximum diagnostic utility is attained. (3) While the above criteria are probably most important, it is also desirable that the contrast medium be removed or absorbed so that later roentgen diagnostic study of the chest may be of maximum benefit. In our experience the above criteria have been fulfilled best by N-propyl 3:5-di-iodo-4 pyridone-N-acetate (propyliodone), which is manufactured under the trade name of Dionosil. It is the purpose of the present pa...

Irradiation of bone lesions in the presence of metallic intramedullary fixation.

THE TREATMENT of pathologic fractures of the long bones, especially the femur, has been greatly forwarded by the use of the intramedullary nailing method of Kuntscher (1940). The operation is simple, fixation is maintained without supplementary apparatus, immediate activity is usually possible, and there is a tremendous decrease in morbidity. Experience abroad has been confirmed in this country. A recent editorial by Cave (1949) acknowledges the great value of intramedullary fixation in stabilizing painful pathologic fractures of the femur. Pathologic fractures of the long bones resulting from both primary and secondary bone tumors have been treated satisfactorily by intramedullary nailing (Table I). It has been suggested that in the presence of bone lesions where spontaneous fracture appears to be imminent, intramedullary nailing be carried out as a prophylactic measure (Griessmann and Schuttemeyer, 1947). The majority of patients treated in this manner have received no further therapy. Occasionally irra...

Deficiency of intestinal gas in infants with diarrhea; a presentation of three cases.

The presence of moderate amounts of air in the small bowel loops is a normal finding in infants. The newborn infant swallows air with its first breath, and gas can be demonstrated by roentgenograms in the sigmoid colon usually in two to five hours (6, 14, 15). Complete absence of gas in the small bowel, or in the stomach and small intestine, as shown roentgenographically, is commonly interpreted as a sign of high obstruction and of grave significance. There is little in the literature to indicate that complete absence of gas in the infant bowel occurs under any other circumstances. In 3 cases to be presented here this finding was associated with severe diarrhea and dehydration without any mechanical obstruction. Severe diarrhea with resulting dehydration is not a true disease of infants, but rather a sign accompanying disease. In many instances it can be attributed to specific bacterial or viral causative agents (2–5, 7, 10, 13). As is well known, however, it may be due to parenteral infection elsewhere i...

The relationship of the left atrium to the opacified esophagus in upright and recumbent positions.

It has long been recognized that the close apposition of the posterior surface of the left atrium to the anterior wall of the thoracic esophagus is of diagnostic significance in evaluating enlargement of this cardiac chamber. Earlier investigators (4, 6, 7, 10, 11) have demonstrated adequately the importance of examination of the barium-opacified esophagus, not only in diseases of the heart and aorta but also in differentiating lesions of the right and left sides of the heart. Mitral valvular disease—stenosis, incompetence, or both—is the most common cause for left atrial enlargement. Dilatation of the left ventricle, auricular fibrillation, patent ductus arteriosus, and interventricular septal defect may produce functional changes which enlarge the left atrium. The above conditions do not always cause sufficient left atrial enlargement to produce esophageal deviation in the upright patient (2). Kjellberg (3) believes that lesser degrees of enlargement may become manifest with the patient prone, since in ...

Fundamental Aids in Roentgen Diagnosis, Emphasizing Spot Filming and Fluoroscopy

Parts of this book previously appeared in the authors early work, Fundamentals of Clinical Fluoroscopy . The purpose of this monograph is also to give the reader an intelligent approach to the study and application of roentgenologic diagnosis, with emphasis on fluoroscopy and spot filming. Whenever a roentgenogram can give the same information as a fluoroscopic examination, taking the roentgenogram is preferable. After the roentgenogram has been reviewed it is frequently observed that the patient may benefit from a fluoroscopic examination. Very properly, the author begins with a discussion of the mechanics of production of fluoroscopic images and the need for protective measures in radiology. Following this are chapters on examination of the lungs, the heart, and the entire gastrointestinal system. A special chapter discusses intestinal obstruction, which is a very important clinical problem, and there are many ways in which the roentgenologic examination may assist in the diagnosis and management

The Chest Film in Massive Pulmonary Embolism

Embolism refers to blockage of an artery, whereas infarction denotes necrosis of the pulmonary tissue resulting from inadequate blood supply. Embolism is associated with a minimal pulmonary physical finding and very few roentgenographic findings other than the loss of vascular pattern in the region involved. Embolism and infarction occur in different clinical settings, although the two may coexist. A suggestion is raised that a relatively small pulmonary embolism may cause sufficient arteriospasm to give rise to anxiety and dyspnea, thus mimicking a larger occlusion. Embolism of one of the main pulmonary arteries is less common than multiple lobar or smaller occlusions. When one of the main pulmonary arteries contains a large embolus, usually there are emboli in the other lung and it is the latter episode which results in death. One might argue that this small monograph could easily have been condensed into a rather large single article in a

EXOCRINE GLAND DYSFUNCTION (MUCOVISCIDOSIS) IN ADULTS.

Since the original description by Fanconi et al. in 1936 (12), with further elaboration by Andersen in 1938 (1), the association of bronchial infection with cystic fibrosis of the pancreas in children has been well known. That this syndrome might persist into adult life was indicated in 1949 by Pugsley and Spence (23), who reported a case of cystic fibrosis of the pancreas concomitant with chronic pulmonary disease and cirrhosis of the liver in a white male who died at seventeen years of age. In 1953, Darling et al. (7) demonstrated that heat casualties with fibrocystic disease were associated with excessive salt loss in the sweat. Because of studies indicating that renal mechanisms of salt retention are normal in these patients, that the gastrointestinal tract is not the avenue of excessive salt loss, and that no primary adrenal dysfunction is present, these authors concluded that the cause of excessive salt loss in the sweat probably lies in the sweat glands themselves. Extending the studies of this gro...