John R. Hodgson

Roentgenologic Features of Lymphoid Hyperplasia of the Small Intestine Associated with Dysgammaglobulinemia

In 1966 Hermans and his co-workers (1) reported eight cases of dysgammaglobulinemia associated with nodular lymphoid hyperplasia of the small intestine. Characteristically, these patients demonstrated an unusual susceptibility to infection, chronic or intermittent diarrhea, reduced concentration of gamma globulins, and roentgenologic evidence of nodular defects in the intestine. Since that report, two more patients have been observed with this combination of findings. The present report is primarily concerned with the roentgenologic appearance of these nodular defects in 10 patients. These tiny, nodular, filling defects are usually evident on films of the upper part of the small intestine and are located primarily in the duodenum and jejunum, although they may also be seen in the terminal part of the ileum and the right colon. Clinical Study All the 10 patients (6 men and 4 women) gave a history of either unusual susceptibility to infection or chronic diarrhea which had persisted for various periods. The ...

THE ROENTGENOLOGIC DIAGNOSIS OF PRIMARY GASTRIC LYMPHOMA.

Malignant lymphoma originating in the stomach is an uncommon but important lesion; it accounts for about 2 per cent of all gastric malignant neoplasms. Patients with lymphoma localized to the stomach and perigastric nodes are well known to have a more favorable prognosis than those with carcinoma of this organ. Much has been written about the radiologic findings in cases of malignant lymphoma of the stomach (7, 8). While many authors conclude that a specific roentgen-ographic diagnosis of this lesion is usually not possible (1, 6, 9, 10, 12, 13), they stress that radiographic examination of the stomach will reveal its presence, site, and extent, and usually will also indicate its neoplastic nature. The present study is based on 72 cases of primary gastric lymphoma collected from the files of the Mayo Clinic from 1951 through 1960. In all, the diagnosis was established by surgical exploration and the histologic study of either surgical specimens or biopsy material. In every instance the medical records and...

Primary lymphoma in the small intestine: problems of roentgenologic diagnosis.

Primary malignant tumors of the small intestine are uncommon, and 40 per cent of these are lymphomas (2). In an earlier report from the Mayo Clinic, Faulkner and Dockerty stated that 65 per cent of the roentgenograms obtained in their series of 33 surgically treated patients with small intestinal lymphoma demonstrated “positive evidence of pathology” (3). The purposes of the current communication are (a) to describe the roentgenographic alterations demonstrated in histologically verified primary malignant lymphoma of the small intestine and (b) to determine if such findings are reliable in establishing specific roentgen criteria either for diagnosis of the disease or for differential diagnosis between malignant lymphoma and other small-bowel lesions. To these ends, the authors reviewed the available roentgenograms from 46 patients with histologically verified primary malignant lymphoma of the small intestine seen at the Mayo Clinic in the twelve-year period 1951 through 1962. Survival data were calculated...

The effect of premedication with chlorpheniramine on reactions to methylglucamine iodipamide

Abstract In 1,830 cholangiographic examinations in which methylglucamine iodipamide was given at the Mayo Clinic, premedication with chlorpheniramine, in doses of 6 to 10 mg. given intramuscularly 5 minutes prior to intravenous injection of the contrast medium, reduced the incidence of reactions to 6 per cent from the rate of 24 per cent in 854 such examinations without antihistaminic premedication. Methylglucamine iodipamide can and does produce toxic and anaphylactoid reactions as well as hypotension if given too rapidly. Studies of blood concentrations of histamine in 10 cases failed to substantiate the idea that methylglucamine iodipamide may be a histamine releaser, except in one case in which a reaction occurred. There the concentration of histamine increased to twice as much as that found before the injection. Adding epinephrine (in two tested quantities) to the chlorpheniramine for injection seemed not to enhance the effects of chlorpheniramine, but rather added annoying side effects. Premedication with an antihistaminic drug, though definitely helpful, does not appear to be the complete answer to the prevention of reactions following injection of contrast medium for cholangiography, but we do recommend its use for lessening these reactions.

The significance of duodenal deformity in patients with extrahepatic portal obstruction.

The study to be considered here was undertaken because of the clinical impression that a significant percentage of patients with portal venous congestion due to an extrahepatic portal obstruction are reported by the roentgenologist as having a duodenal deformity. Such a finding might be misinterpreted as a sign of duodenal ulcer, especially if the patient has presented with upper gastrointestinal bleeding and if esophagogastric varices are not demonstrable at the time of the roentgen examination. Even if varices are visualized, confusion about the source of the bleeding can occur. It is generally accepted that patients with hepatic cirrhosis have a 15 to 20 per cent incidence of duodenal ulceration (1). Hence, the clinician is not surprised when the radiologist reports esophagogastric varices and duodenal ulcer in the same case. In reviewing the records of 63 cases of portal congestion due to extrahepatic obstruction studied by Hallenbeck and Adson (2), it was noted that the roentgenologist reported a def...

Hilgenreiner measurements of the hip roentgenograms in 247 normal infants 6 and 7 months of age. Follow-up of deviations from "normal".

Summary The Hilgenreiner measurements of roentgenograms of the hips were determined for a group of infants 6 and 7 months of age. Also, data on the presence or absence of the capital epiphysis were obtained, and follow-up studies of those infants whose measurements deviated from the “average” were made. It is suggested that Hilgenreiner measurements be used for interpretative purposes in relation to two standard deviations from the mean.

The Roentgen Diagnosis of Diverticulitis

The roentgen diagnosis of diverticulitis of the colon assumes greater importance with the growing number of elderly individuals in our society. Since diverticulosis and diverticulitis are more prevalent in the higher age groups, the greater life expectancy has increased the incidence of both diseases. Because earlier and better diagnosis is needed, a review of this subject was undertaken, with emphasis on the roentgen diagnosis of sigmoidal diverticulitis and on the relationship of the findings to the pathologic aspects of the disease. The pathologic anatomy of diverticulitis was first recognized and described by Cruveilhier (4) in 1849. Graser (7) in 1899 described the formation of diverticula of the intestine and stressed their frequency. In 1907, Mayo, Wilson, and Giffin (8) reported the first American series in which operation had been performed. The earliest complete treatise on diverticula of the colon was undertaken by Telling (11) in 1908. The first case demonstrated roentgenologically prior to op...

Polycystic Disease of the Liver, with Unusual Cholecystographic Manifestations: Report of a Case

Summary A case is presented in which polycystic disease of the liver produced extrinsic pressure on the gall bladder, causing distortion and irregularity of its outline.

Newer concepts in cholecystography and cholangiography.

Changes in cholecystography during the past decade include use of denser contrast mediums, variations in technics, and new methods of preparing the patient. Use of denser contrast mediums appears directly related to the more frequent roentgenologic diagnosis of polypoid lesions. Dihydroxy-phenylisatin was found effective in reducing obscuration by gas and fecal material. Cholangiography using intravenous injections of sodium iodipamide has been a widely used preoperative procedure. Tomography has increased the accuracy of the examination.

The Roentgen Diagnosis of Diverticulitis1

The roentgen diagnosis of diverticulitis of the colon assumes greater importance with the growing number of elderly individuals in our society. Since diverticulosis and diverticulitis are more prevalent in the higher age groups, the greater life expectancy has increased the incidence of both diseases. Because earlier and better diagnosis is needed, a review of this subject was undertaken, with emphasis on the roentgen diagnosis of sigmoidal diverticulitis and on the relationship of the findings to the pathologic aspects of the disease. The pathologic anatomy of diverticulitis was first recognized and described by Cruveilhier (4) in 1849. Graser (7) in 1899 described the formation of diverticula of the intestine and stressed their frequency. In 1907, Mayo, Wilson, and Giffin (8) reported the first American series in which operation had been performed. The earliest complete treatise on diverticula of the colon was undertaken by Telling (11) in 1908. The first case demonstrated roentgenologically prior to op...