Lewis G. Jacobs

Myelography Demonstration of Cysts of Spinal Membranes

We have recently seen two cases in which cysts projecting from the subarachnoid space were filled at myelography. One of these was a congenital extradural meningeal cyst, the other a perineurial cyst. Although the two conditions are unrelated both clinically and pathologically, the somewhat similar pattern of the myelographic findings suggests reporting them together. Congenital Extradural Meningeal Cyst A rather rare cause of compressive symptoms referable to the spinal cord or its roots is the congenital extradural meningeal cyst. The clinical and roentgenological diagnosis preoperatively is usually cord tumor or disk herniation. Clinical Features: The similarity of the histories and neurological findings in the reported cases of extradural cysts is striking. The description of the syndrome supplied by Elsberg (4) on the basis of 3 cases of his own and 1 from another clinic leaves little to add. Because of its conciseness and because historically it is the first description of this rare condition, it se...

The Reversal of Advanced Bronchiectasis

Reversible bronchiectasis or pseudobronchiectasis has been reported by a number of authors. The cases have been limited largely to the acute and subacute phases of the disease, most often following an acute pneumonia; all have been of the cylindrical type. The reversal of mixed saccular and cylindrical bronchiectasis of considerable duration and chronic symptomatology, under medical management, has not to our knowledge been the subject of report. Such a case is recorded here. The mechanism of the production and reversal of the more acute types of bronchiectasis has been fully discussed by Mallory (4), and by Fleischner (2), who approached the problem from a theoretical point of view. Their discussion does not appear pertinent to our case, since it is based principally on the cylindrical type of disease. Finke (1) does indeed mention the observation of saccular changes in cases lacking microscopic evidence of destructive bronchial lesions, but he also notes his belief that this condition, once it has exist...

Isolated fracture of the pisiform bone; a case report.

Fracture of the pisiform bone without other carpal injury is apparently rather uncommon. The first report of a pisiform fracture, by Guibout (17) in 1847, was in a case complicated by fractures of the navicular, the capitate, and the radius, resulting from a fatal jump from a third-story window. The fracture was proved at necropsy. Jaeger (19), summarizing the literature in 1931, was able to find 11 cases, and reported one of his own. Since then there have been 5 additional reports (6, 8, 11, 12, 24), so that, including the present case, there are on record 18 examples of isolated pisiform fracture. In two instances the reports were in Russian journals which are not available to the author, so that verification of these (12,24) has not been made. Schnek (5), in an experience of six years in Bohlers clinic, found 13 pisiform fractures in 437 carpal injuries, but he does not indicate how many of these were isolated fracture of this bone. He states, by way of comparison, that during the same period 669 frac...

Unusual Case of Late Post-Irradiation Damage to the Ileum

Radiation damage to the ileum, first mentioned by Walsh (21) in 1897, is of two types: acute, usually observed during the course of irradiation or just following it, and late, generally developing six months to five years after therapy. Occasional cases are seen much later than five years, when they present diagnostic problems because of obscure bleeding, partial small-bowel obstruction, or vague symptoms suggesting psychoneurosis as a predominant feature. Sometimes recurrent neoplasm has been mistakenly diagnosed. Perforation of the ileum has been an occasional complication. The primary disease for which radiation was given in such cases was most often carcinoma of the cervix uteri, though testicular tumors (2, 5) (treated for involvement of retroperitoneal nodes or prophylaxis of this area), carcinoma of the corpus uteri (15, 16, 20, 24), carcinoma of the colon (10), carcinoma of the ovary (14, 20), and plasma-cell myeloma of the ileum (18) are also among the initial conditions. It might be anticipated ...

Intra-Abdominal Egg-Shell Calcifications Due to Silicosis

Intra-abdominal egg-shell calcifications due to silicosis are extremely rare. In a fairly extensive review of the literature only 1 case, reported by Riemer (5), was found. The case to be presented here is an example of extreme egg-shell calcification in the peri-aortic abdominal lymph nodes, unique in our experience. Of 41 patients at the Oakland Veterans Administration Hospital with a clinical diagnosis of pulmonary silicosis, 10 showed intrathoracic egg-shell calcification of varying degree, and 5 intra-abdominal calcification. In 3 of the latter, the calcification was of the mulberry type; 1 was of a rather indefinite amorphous character, and 1 was of the eggshell variety. In 17 cases no x-ray examination of the abdomen had been made. An additional 50 cases were listed in the x-ray cross index under silicosis, either for diagnostic or differential purposes. Nineteen of these patients were found not to have silicosis, and in 12 records were not available for review. Of the remaining 19, thoracic egg-sh...

Roentgenography of the Second Cervical Vertebra by Ottonello's Method

SINCE the description, in 1930, of a method of producing roentgenograms of the entire cervical spine in posterior projection on a single film by Ottonello (1), no information on its use was found in a search of the American literature. As, however, the value of this procedure is considerable, a brief descriptive note, with some suggested modifications, seems warranted. Ottonellos view consists of a roentgenograph taken with the jaw in constant motion vertically, i.e., by opening and shutting the mouth, the other factors being approximately the same as for the ordinary posterior view of the cervical spine. Several complete motions of the jaw must be made, open and shut, during the exposure, and an even, rhythmical motion is essential. In positioning the head, hyperextension of the neck is very important. If the head is flexed, the upper teeth will prevent the proper visualization of the topmost vertebrae. The study is best made in the recumbent position, with as great an F.S.D. as possible. In order to sec...

Carcinoma of the Ovary

CARCINOMA of the ovary being one of the most radiosensitive epithelial tumors, it is highly important to know what results are obtained by radiation treatment of this disease. While practically every patient in the series here presented had some surgical procedure—ranging from laparotomy and biopsy to attempted excision—it was not felt that the probability of cure was good in any of the cases if surgery alone was used; in many of them, since the primary tumor was not removed, the only benefit traceable to surgery was that a definite diagnosis was made available. Consequently, we feel that the principal treatment in these patients was with radiation. This is made more explicit when we state that of the 15 patients now living (for various periods), eight had definite metastases at the time of the first irradiation, while the other seven had none mentioned in the available records (but it is not known with certainty that they did not have metastases). Exact evaluation of the original clinical condition is no...

An Improved Method for the Treatment of Cancer Statistics

IN presenting cancer statistics it has become customary to state results as the percentage of so-called five-year cures. The hope that a patient who has lived five years without recurrence will be in no further danger of one is partly justified by the observation that about 95 per cent of recurrences make their appearance within a five-year period; however, this measure does disregard an appreciable proportion of the late recurrences. Moreover, the five-year-cure rate fails to account for the patients who die of causes other than cancer, and without evidence of recurrence. The common practice of listing such patients separately amounts to no more than transferring the statistical burden from the author to the reader, without helping in any way to solve the problem. Then, too, many authors publish data in terms of cure rates for other periods than five years. At present the only method of comparison between such data is reference to the original articles, and these often do not give sufficient details to p...

Cardiac Mensuration as Applied to Survey Films (4 × 5-Inch Photoroentgenograms)1

The roentgen mensuration of heart size has assumed considerable importance medically since the pioneer work of Bardeen (1) and of Hodges and Eyster (2). In general, the problem has been to pick those hearts showing as small a degree as possible of enlargement above true normal. Many methods of measuring the heart shadow have been proposed, and most of them may be classified into three groups: those in which some diameter or diameters are used, those in which an area estimation is used, and those in which a volumetric reconstruction is used. It is particularly noteworthy that no one has attempted to see how accurately the shadow measurement can be reproduced by the same or by another observer; either it is tacitly assumed, and incorrectly so, that the results are reproducible, or the error involved is grossly underestimated. The standard to which these measurements are compared is usually anthropometric, a combination of height and weight being the most common, although various other measurements have been...

A Simple Calculator for Therapy Exposure Times

Nomographs for making various calculations are no novelty, but since the technic of constructing this form of chart is not known to many physicians, a nomograph for calculating therapy exposures is here presented. This chart will give the correct exposure time for any dose within its range for various technics, which may be almost unlimited in number, and for various focus-skin distances. The most important advantage of such a chart is the protection it affords from errors in arithmetic, since it supplants all other calculations and requires only a single setting of a sliding scale and a stretch of a string across from the dose scale through the distance scale to the time scale, where the answer may be read. Figure 1 shows a completed nomograph arranged for the technics and distances used in this office. The arrow is set to point to the technic in use, and the string carried on stretch from the dose to be given through the distance used2 to the time scale, where the exposure time is read. While the theory...