George J. Baylin

Metastatic Fat Necrosis and Lytic Bone Lesions in a Patient with Painless Acute Pancreatitis

A case of painless acute pancreatitis and the syndrome of metastatic fat necrosis is presented. The patient demonstrated nodular skin lesions, eosinophilia, arthritis; and rapidly progressive lytic bone lesions. Other radiographically demonstrable bone changes associated with pancreatic diseases are reviewed.

The Evaluation of Pancreatic Function by Use of I131 Labeled Fat

Summary A study using an I 131 labeled fat meal has been carried out on 30 patients with proven pancreatic disease. Measurements were made of the per cent of blood radioactivity at four, five, and six hours following the test meal, and on a subsequent 48-hour collection of feces. The test yielded information of diagnostic value in 10 of 12 patients found to have chronic relapsing pancreatitis, in 17 of 18 patients with pancreatic carcinoma. In the absence of small bowel disease, pyloric obstruction, or gastric surgery, an impairment of fat absorption using this technique is strongly suggestive of pancreatic disease. The method can further be used as a laboratory aid in evaluating substitution therapy in patients with pancreatic insufficiency.

I131 blood levels correlated with gastric emptying determined radiographically. I. Protein test meal.

Conclusions 1. A characteristic and reproducible curve of radioisotope blood levels was obtained in normal humans and normal dogs following an I131 labeled protein test meal. 2. Radiographic determination of gastric emptying is necessary for the proper interpretation of data. 3. Delayed gastric emptying significantly altered the radioisotope blood levels. 4. Fainting and change in position may alter radioisotope blood levels.

Fat Absorption from the Human Gastrointestinal Tract in Patients Undergoing Radiation Therapy

The effect of ionizing radiation on the gastrointestinal tract was first noted by Walsh in 1897 (1). The circumstances under which the irradiation was given and the amount are unrecorded. Since that time, many studies as to the effect of radiation on the digestive tract have been carried out. These have been directed toward a morbid anatomical evaluation or a physiological evaluation, or both. Excellent studies of the anatomical changes in the small bowel after irradiation in varying amounts may be found in papers by Warren (2, 3), Martin (4), and Senn (5). Their observations have been substantiated by many other workers. The changes have consisted primarily of a loss of the intestinal epithelium, beginning with that in the crypts and progressing to the villi. Ulcerations then appear, extending through the submucosa and sometimes into the serosa. The extent of these lesions and the rapidity with which the process develops depend to a large extent upon the tissue dose received by the area. It has also been...

RADIOISOTOPE-DILUTION CURVES AS AN ADJUNCT TO CARDIAC CATHETERIZATION.

Abstract A method of recordin externally monitored radioisotope-dilution curves at cardiac catheterization has been described. It was found to be reliable and had marked practical value as a routine procedure in the detection and localization of the site of left to right shunts. The geometry of the detection system was defined and correlated with the anatomic structures viewed by the heart and lung probes. Standards for normal curves were established in a series of patients without shunts. Radioisotope curves were compared with arterial dye-dilution curves and blood oxygen data for the detection and localization of the site of left to right shunts. All three methods detected shunts which comprised greater than 25 per cent of total pulmonary blood flow. The isotope and dye methods were found to be equally sensitive in the detection of small shunts if the indicator was injected into the pulmonary artery. All shunts detected by arterial dye-dilution curves were also detected by radioisotope-dilution curves. The reliability of the method was established and its practical usefulness shown. The major advantages of the radioisotope technic without blood sampling were found in severely ill young infants in whom the technic provided a quick and reliable method for the detection and localization of the site of the shunt.

Origin of the Right Pulmonary Artery from the Ascending Aorta Unusual Cineangiocardiographic and Pathologic Findings

Origin of the right pulmonary artery from the aorta is a congenital malformation usually associated with serious symptoms in the first year of life and characterized by a poor prognosis. Sixty-five patients with this disorder have been reviewed in the literature, and 95% presented during the first year with signs of congestive heart failure. All had cardiomegaly by radiographic and electrocardiographic examination. An accurate diagnosis was established by cineangiography, and associated cardiovascular anomalies were present in 85%. Origin of the right pulmonary artery from the ascending aorta is much more common than origin of the left pulmonary artery from this vessel (8 to 1). Twenty-three patients were managed without operation with a 30% 1-year survival rate. Among those patients managed surgically, the survival rate was 84% at 1 year. It is now clear that operation should be done as early as possible to prevent irreversible changes occurring in the pulmonary arterial vasculature since microscopic features of pulmonary hypertension have been seen during the first month of life. One patient was operated on at 5 months with correction of the deformity. The pulmonary arterial pressure decreased to normal after operation. This child is now asymptomatic and his 10-year postoperative follow-up is the longest found in the literature.

Use of I131 Labeled Oleic Acid in Study of Gastrointestinal Function.

Summary and Conclusion 1. Constant and reproducible curves of blood radioactivity levels are found in normal humans and dogs after an oleic acid test. 2. Following pancreatectomy and induced pancreatitis in dogs, the curves obtained with oleic acid test were within normal range while those obtained with triolein were depressed.

A common denominator in the etiology of adult respiratory distress syndrome

The initiating factor in ARDS is a matter of controversy. Some investigators relate ARDS development to diffuse pulmonary microemboli after stress ranging from sepsis to non-thoracic and thoracic trauma. Others indicate hyperoxic exposure as the causative agent. This investigation looked for a common factor in ischemia and hyperoxic exposure in lung which could cause the genesis of ARDS. Studies of oxidative phosphorylation, succinate dehydrogenase activity and ATP level were performed on ischemic and 100% O2 exposed lung. Results in both showed decreased respiration rate below the basal rate, decreased SDH activity, followed by marked decrease in ATP levels in pulmonary tissue. Decrease in respiration (ATP production) capacity and ATP levels in ischemic lung were such that normal cell functions could not be sustained if returned to normal circulation. Hyperbaric O2 therapy would subsequently decrease energy metabolism in regions of normal circulation and in previously ischemic regions.

Right-Angle Scatter for X-Ray Beams of 0.14 mm. to 2.5 mm. Copper h.v.l.

The computation of shielding requirements due to scattered radiation from a therapeutic installation is dependent upon data available in the literature. It is impossible to calculate accurately with the Compton equation the distribution and magnitude of scatter at any given point away from a scattering medium such as the human body. This is because the x-ray spectrum is a continuous one and the exact spectral distribution is not known accurately for each machine. There are several reports in the literature relating right-angle scatter at 1 meter from the seatterer to the peak kilovoltage across the x-ray tube. Glasser et al. (1) give data compiled from several of these papers (2–5) relating right-angle scatter at 1 meter, in percentage of central beam dosage, for x-ray tube potentials of 75 kvp, 80 kvp, 200 kvp, and 1 Mvp, for selected port sizes. As indicated by the relatively small selection of data, the information in the literature is rather sparse. It was believed by the present authors that a practi...

Prognosis in Osteitis Condensans Ilii

The entity of osteitis condensans ilii is first mentioned in the English literature in 1936 (1). Since that time there have been several good reviews of the subject (2, 3). It has been impossible however, to settle upon a definite etiology or constant clinical picture. The few aspects which seem to be relatively established are the radiological picture, the age and sex incidence, and the pathological picture. The purpose of this paper is to contribute some clarifying information regarding the prognosis. Nineteen cases of osteitis condensans ilii seen at Duke University Medical Center, in the years 1940 to 1958, were obtained from the x-ray museum file. These did not represent all of the cases seen during the period but only those cases placed in the teaching collection because of their roentgen appearance. The radiological criteria for diagnosis were: (a) the presence of a homogeneous triangular area of increased density involving the ilium adjacent to the sacroiliac joint and located at the lower border ...