Folke Knutsson

The Instability Associated with Disk Degeneration in the Lumbar Spine

ISSN: 0001-6926 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/iaro20 The Instability Associated with Disk Degeneration in the Lumbar Spine Folke Knutsson To cite this article: Folke Knutsson (1944) The Instability Associated with Disk Degeneration in the Lumbar Spine, Acta Radiologica, 25:5-6, 593-609, DOI: 10.3109/00016924409136488 To link to this article: http://dx.doi.org/10.3109/00016924409136488

The Roentgen Appearance in Ureteritis Cystica

In some respects it may be said that the radiography of the ureter constitutes a new diagnostic field for it is only in quite recent years that we have been able to take methodical radiograms of the ureter. Even if the routine method of pyelography earlier practised with a catheter ·pushed up into the ureter often resulted in a satisfactory opaque filling of it, the opaque fluid just as often ran back into the bladder, thus giving no shadow of the ureter. It was only with the introduction of intravenous urography that greater possibilities were obtained for examining the ureter with a contrast agent. The best method for examining by roentgen the morphology of the ureter has however been advanced by CHEVASSU. By his method the olive-shaped point of a catheter is introduced only into the very mouth of the ureter after which the fluid is injected. The return of the fluid is thus prevented by the point of the catheter and complete filling of the ureter obtained. By this technique we have been given the chance of carrying out a methodical roentgen examination of the ureter and thus made ourselves independent of the capricious method of contrast filling offered us by the catheter pyelography of earlier days. In this paper two cases are described with changes in the relief of the ureters typical for ureteritis cystica. Changes of this nature have been recorded exceedingly sparingly for the simple reason that the necessary method of examination is relatively new. Formerly well-known changes consist of new growths, concretions, constrictions and dilatations whereas changes in the mucous membrane relief signify a diagnostic novelty. In ureteritis cystica multiple epithelial cysts are present in the ureteral wall. Similar formations also occur in the renal pelvis (pyelitis cystica)

Closed Perforating Ulcer Manifesting Itself by Subhepatic Gas-Bubble

Most cases of perforating ulcers manifest themselves by a clinical picture that does not present any diagnostic difficulties whatever. On the other hand it is often difficult to settle the diagnosis in more obscure cases. Since roentgen examination was adopted in these acute abdominal cases a new valuable roentgenological sign has been added to our diagnostic facilities by demonstrating free gas in the abdomen in cases of perforating ulcers. This roentgenological phenomenon was first observed by WIELAND in Germany 1915, and is really nothing but a refinement of the old method of establishing by percussion the absence of normal liver dullness. The positive finding of this roentgenological sign is almost pathognomonic of perforating ulcer while, on the other hand, the absence of free gas does not exclude such a possibility. In more than half the number of all cases of perforating ulcer free gas can probably be demonstrated in the abdomen. From the point of view of differential diagnosis it must be remembered that perforation of any part of the intestinal tract can of course give rise to escape of air in the abdomen (perforation of a gangrenous appendix, cancer with perforation and so on, but perforation of a duodenal or gastric ulcer is incomparably so much more common that for practical purposes no heed need be taken to this more general possibility. Nor must it be forgotten that free gas may escape into the abdomen for some other reason, e. g. by air forcing its way through the female genitalia, a condition observed after vaginal lavage. A great many different observers have emphasized the great value of this roentgenological sign. The technique adopted has been similar on all hands. The patient has thus been examined in sitting and left-sided reclining position. In so doing the escaped air has collected below the diaphragmatic dome and been demonstrated by screening or radiography.