Leslie Preger

A model for the cinefluoroscopic and manometric study of chronic intestinal obstruction

NFANTS BORN WITH INTESTINAL atresia have considerable dilatation of the bowel proximal to the obstruction, and the distal bowel is collapsed. When the dilated proximal intestine is anastomosed to the distal bowel, persistent functional obstruction occurs even though the anastomosis is widely patent. Contrast roentgenograms show abnormal peristalsis with a churning, to-and-fro, flow of contrast medium which is not propelled beyond the dilated part. This functional obstruction of the bowel is the most common cause of death in infants treated for jejunal atresia.’ Many investigators have studied the physiology of normal intestinal motility in the human by measuring changes in intraluminal pressure and by roentgenographic techniques. An historical summary of these methods is recorded by Hightower.’ In the small bowel, two types of intestinal contraction have been described which were derived from a correlation between intraluminal pressure changes and cinefluoroscopic observations. Type I waves are simple monophasic increases in pressure lasting less than 8 set with an amplitude of 13~ 60 cm of water pressure. These waves have been associated with eccentric contractions of the bowel wall which travel less than a few centimeters, and seem to have a mixing action on the intestinal contents. Type I waves account for 85”,, to 90”, of the wave activity in the intestine. Type III waves have a complex pattern characterized by a prolonged elevation above baseline pressure, on which are superimposed monophasic spikes similar to, but shorter in duration than Type I waves. Type III waves have been correlated with concentric contractions of the intestine which travel along the bowel wall and propel luminal contents aborally. These waves may occur every 10 set to 8 min, and have an amplitude of 5- to 30-cm water pressure. We have attempted to clarify the physiologic changes in intestinal motility after chronic small bowel obstruction. We wanted an experimental model which might be comparable to intestinal atresia, and which could be evaluated by radiologic and manometric studies. The intestinal obstruction would have to exist for several weeks or months without producing fluid or electrolyte de

Pulmonary Alveolar Proteinosis

Since the original description of pulmonary alveolar proteinosis in 1958 (19), more than 100 cases have been reported. This article indicates the wide spectrum of roentgenographic changes (other than the well known batwing appearance) by reference to 5 patients in the San Francisco area who were examined recently. The classic butterfly pattern formed by infiltrates radiating from the hili and suggestive of pulmonary edema is not seen in as many patients as the earlier case reports suggested. When present, its differentiation from pulmonary edema is based on much less dyspnea in patients with pulmonary alveolar proteinosis (PAP), normal size of heart, and caliber of pulmonary vein. Also, Kerleys B lines or pleural effusion are absent. In patients with longstanding PAP, cor pulmonale may supervene. This adds further diagnostic problems by the presence of cardiomegaly and pleural effusions. The butterfly appearance may resolve almost completely within a week (18), but the overnight clearing seen in some pat...

Roentgenographic Roentgenographic Features of the Neutrophil Dysfunction Syndromes

The neutrophil dysfunction syndromes comprise a group of rare, often fatal disorders, usually beginning in infancy. Common to all these syndromes is an impairment of the ability of peripheral blood neutrophils (3, 14, 15, 17, 26) and monocytes (12) to kill ingested, opsonized bacteria. Although the syndromes bear diverse patterns of inheritance (14), their clinical manifestations are strikingly similar. A proposed classification by Douglas, Davis, and Fudenberg (14) includes three syndromes whose roentgenographic features are here presented (Table I). Recognition of a specific constellation of these features permits the roentgenologist to assume a key diagnostic role. The roentgenographic findings in the neutrophil dysfunction syndromes are characterized by their great diversity, reflecting involvement of multiple organs. The unusual chronicity of many of the changes may result from the persistence of viable intracellular bacteria within granulomatous lesions. The pulmonary findings include chronic and re...

Short Hard Palate in Newborn: Roentgen Sign of Mongolism

The hard palate in mongolism is short (2). Studies with measurements, however, have been few and are limited to school-age and adult mongoloids (6, 7). To our knowledge, no series has been reported of short hard palate in the newborn. Because the diagnosis may yet be in need of confirmation at this age (5), we have examined lateral roentgenograms of the skull to determine length of the hard palate in the newborn period as a sign of mongolism. Materials and Methods Records of newborn infants from 1955 through 1967 were reviewed at the University of California Medical Center, San Francisco, and at the Childrens Hospital Medical Center, Oakland. These revealed 10 patients with proved mongolism on whom lateral roentgenograms of the skull had been obtained with routine technic during the first month of life. On these roentgenograms the hard palate was readily observed. We have defined its length as extending from the anterior maxillary process to its posterior termination, both clearly defined endpoints (Fig....

The Hurler syndrome without abnormal mucopolysacchariduria.

The hurler syndrome is characterized by dwarfism, hepatosplenomegaly, skeletal deformities, coarse facial features, mental retardation, and corneal opacities. The biochemical manifestations of this genetic disorder include excessive urinary excretion of acid mucopolysaccharides (AMPS) and accumulation of mucopolysaccharide in various tissues, leading to morphologic and functional changes. Both the radiologic characteristics and the excessive urinary mucopolysaccharides aid in the diagnosis of this disorder. We report two siblings with clinical and radiologic signs of the Hurler syndrome in whom the excretion of urinary AMPS was normal. Case Reports Case I: This 7-year-old girl (Fig. 1) was born in June 1959 after a thirty-seven-week pregnancy which was complicated by hyperemesis gravidarum during the first five and one-half months. Birth was spontaneous by breech presentation, with the legs extended in front of the face. The infant weighed 2,472 g at birth. The child appeared normal immediately after deli...

Extraosseous osteogenic sarcoma of the chest

Summary Two primary intrathoracic osteogenic sarcomas that simulated a mesothelioma are presented. The tumours arose either from pleura or from non-osseous chest-wall structures. The possibility of osteoblastic transformation of the mesothelial cell is discussed.

Intrarenal pheochromocytoma Preoperative angiographic diagnosis

This report documents the angiographic, urographic, and tomographic findings in a patients with a pheochromocytoma within the renal capsule and separate from a normal adrenal gland.

Width of Azygos Vein Related to Central Venous Pressure

Enlargement of the azygos vein is a well known anomaly in roentgenograms of patients with congestive heart failure (3). A report correlating the width of the azygos vein with venous pressure could not be found in the English literature. Since roentgenographic assessment of central venous pressure (CVP) would be useful in many clinical circumstances, we decided to determine the predictive value of this measurement. Materials and Method Initially, anteroposterior and oblique portable roentgenography of the chest was attempted on patients in the Intensive Care Unit (ICU) at the time CVP was recorded. An elective oblique roentgenogram and an additional overpenetrated anteroposterior view were necessary for better demonstration of the azygos vein. Because the maneuvers for these caused the patient much discomfort, the procedures were discontinued. Instead, anteroposterior films of patients in whom the CVP was measured within an hour of roentgenography were studied retrospectively. This study comprises a total ...