James A. Nelson

Gossypiboma--the problem of the retained surgical sponge.

Commonly used surgical sponges and appliances all have standardized, readily recognized opaque markers visible on radiographs. When these markers are identified on postoperative radiographs, they should be assumed to represent retained surgical sponges or appliances. With the rare exception of thoracotomy dressings, these marked materials are seldom, if ever, used as external bandaging materials. AP and lateral radiographs should provide an immediate answer as to the location of any retained surgical device. The early recognition of these retained surgical sponges should eliminate most complications related to their presence.

Scattered radiation in chest radiography

Luminance scatter fractions were measured for patients and phantoms in various regions of the chest film. Scatter fractions were found to be highly variable, being quite high in the regions of the chest with a large equivalent tissue thickness (e.g. mediastinum, chest wall, and subdiaphragmatic areas). For example, approximately 90% of the radiation reaching the mediastinum region of the chest film was found to be scattered radiation when a grid was not used. Even with a 12:1 grid, less than 50% of the available primary beam contrast was being displayed in the mediastinum. In regions of the chest film with high scatter fractions, film latitude was also a problem, further reducing image contrast in these regions. Image contrast and scatter fractions in chest radiography were investigated for different scatter rejection techniques including air gaps, antiscatter grids, and slit radiography.

Intraperitoneal insulin administration produces a positive portal-systemic blood insulin gradient in unanesthetized, unrestrained swine

The present study was performed to evaluate the porto-systemic insulin gradient in response to (1) glucose feeding (2) intramuscular insulin administration, and (3) peritoneal insulin administration in unanesthetized swine. The experiment was designed to verify the hypothesis that intraperitoneal insulin administered might lead to a more physiologic portal vein insulin concentration than systemic administration of a similar insulin dose. Studies were performed in 4 domestic swine with chronic, indwelling catheters in the inferior vena cava and portal vein. Unpaired studied of the absolute portal venous and systemic venous insulin concentrations were performed in response to glucose prn(n = 4), 1 unit regular insulin/kg i.m.(n = 4), and 1 unit regular insulin/kg i.p.(n = 5). Timed blood samples were obtained and serum insulin concentrations determined by RIA. Portal and caval serum insulin concentrations following intramuscular insulin injection showed no significant difference. A significant portal vein insulin excess (p less than 0.001) was demonstrated following both feeding and intraperitoneal insulin.

Retractile Mesenteritis: Initial Presentation as Colonic Obstruction

Retroperitoneal fibrosis has been associated with a variety of sclerosing diseases. Among these is the variant known as retractile mesenteritis, which involves predominantly the mesentery of the small intestine and associated vessels; involvement of the mesocolon and the colon is less frequent. Two patients with a dominating clinical picture of colonic obstruction are described. The radiographic presentations were similar and should serve to remind radiologists and clinicians of this entity.

Jejunal diverticulosis and chronic pneumoperitoneum

A unique case of pneumoperitoneum, without peritonitis or perforation, associated with jejunal diverticulosis is presented. Pneumoperitoneum is documented over the course of many years, with recurrence after partial small bowel resection. Jejunal diverticulosis is one of the leading gastrointestinal causes of pneumoperitoneum without peritonitis or surgery. The distended diverticular mucosa may function as a semipermeable membrane allowing transmural gas equilibration.

Necrotizing enterocolitis in acute leukemia: Radiographic findings

Acute gangrenous appendicitis or right lower quadrant necrotizing enterocolitis occurs with a high incidence in patients undergoing treatment for acute leukemia. In a series of 81 fully documented cases with complete charts and follow-up we identified seven surgically or pathologically proved cases of this syndrome. Plain radiographs of the abdomen were available in five of the seven cases, and a barium enema was performed on one. In three of the five cases the radiographic examination suggested or confirmed the nature of the right lower quadrant syndrome. Two of the seven patients were successfully treated by appropriate surgery. The radiographic findings in this series are reviewed and re-emphasized since an accurate diagnosis becomes important in appropriate management of this formerly uniformly fatal complication of acute leukemia and/or its therapy.

Investigations of moving-slit radiography.

The technique of moving-slit radiography for reduction of scattered radiation was investigated using a prototype moving-slit radiographic apparatus. Slit widths of 1-2 cm, when used in conjuction with an 8: 1 grid, were found to improve radiographic contrast by a factor of 2 in studies employing physical as well as anatomic phantoms. Use of the moving-slit technique at elevated kVps was found to provide radiographic contrast as good as or better than that obtained in conventional low-kVp full-field techniques, but with a substantial reduction of patient exposure (factor of 2-4). Considerations in the design of an optimal multislit apparatus are discussed. Excessive tube loading is shown not to be a factor in such a system.

Peritoneal lavage with low morbidity.

Peritoneal lavage has proven to be a useful tool for evaluating abdominal trauma. We developed a technique that avoids the complications associated with the standard dialysis trocar and the minilaporatomy. This technique has been utilized by 51 different physicians in 132 cases with a single avoidable complication. The bladder was entered when the rule of emptying the bladder first was violated.

Radiocolloid estimation of hepatic portal perfusion

Abstract We have developed a scintigraphic technique, which can be performed in conjunction with visceral angiography, for calculating the fraction of superior mesenteric venous (SMV) blood that bypasses liver sinusoids through extrahepatic and intrahepatic collaterals. Following sequential injections of 99m TC sulfur colloid (SC) and 99m Tc human serum albumin (HSA) into the superior mesenteric artery, time course of isotope appearance in the heart is monitored with a gamma camera-computer system. First pass time-activity curves for both substances are constructed and shunt index (SI) for SC determined as integral of SC counts divided by integral of HSA counts. SI was calculated in four dogs before and after end-to-side portacaval shunt. Total shunting of portal flow was considered to represent an SI = 1.00 and all other values were adjusted to this base-line (corrected SI). Seven preoperative determinations averaged 0.19 ± 0.05 SD (0.12 to 0.26) and the mean of four postshunt measurements was 0.99 ± 0.13 (0.85 to 1.16; P r = 0.62 ( P

Peritoneal Lavage with Low Morbidity

Peritoneal lavage has proven to be a useful tool for evaluating abdominal trauma. However, morbidity levels associated with the technique have inhibited its wide acceptance. A technique has been developed that avoids the complications associated with use of a standard dialysis trocar or a mini-laparotomy. The technique uses an 18 gauge needle, a wire guide with soft tip and a number 9 French Teflon catheter. The test can be completed in 20 to 30 minutes and has been done in as little as seven minutes. This technique has been used by 51 different physicians in 132 cases with a single avoidable complication which occurred when one of the contraindications was violated.