Nathaniel Finby

Reactions from Intravenous Organic Iodide Compounds: Pretesting and Prophylaxis

Pretesting and prophylactic measures in contrast roentgenography are utilized to anticipate reactions and, in particular, to avoid fatality. For practical purposes, it is important to separate minor and major reactions to intravenous organic iodide compounds. The minor reactions, such as urticaria, sneezing, arm pain, rhinitis, nausea, vomiting, and headache, are usually mild and transient, responding quickly to mere reassurance and symptomatic therapy. The frequency and intensity of the less serious reactions depend upon the condition of the patient, type of examination, the contrast medium, and the skill and experience of the physician. Many patients are ill and are naturally apprehensive about the examination if the physician allows his own fears to become apparent or indicates by his questions that he is planning a dangerous examination, the patient responds by becoming reactive and ill at ease. If there is added an awkward or painful needle puncture, one may anticipate a large number of reactions. Th...

Clinical Manifestations of the Unperforated Aortic Sinus Aneurysm

There are no diagnostic features for the recognition of unperforated aortic sinus aneurysms except for a grade 3 to 4 cardiac murmur. Linear or massive calcifications in the intracardiac portion of the root of the aorta continuous with the linear calcifications of the ascending aorta sometimes occurs in syphilitic aortic sinus aneurysms. Accordingly, a high index of suspicion and angiocardiography are advocated in order to establish the diagnosis during life. Surgical repair of a localized congenital aortic sinus aneurysm through the right atrial approach seems feasible if there are no serious complicating aortic or cardiac lesions. The diffuse unruptured aneurysmal congenital and syphilitic aortic sinus aneurysms are better left alone. If rupture occurs, surgical repair, even though heroic, should be attempted.

Congenital aneurysm of the right aortic sinus associated with coarctation of the aorta and subacute bacterial endocarditis; ante-mortem report of a case.

ANEURYSMS of the aortic sinus (of Valsalva) are rare. Jones and Langley,1 in their classic paper, reviewed the literature in 1949 and reported a total of 43 cases proved by autopsy and added 4 of t...

Roentgen aspects of pleural mesothelioma.

Mesothelioma of the pleura is a neo-plastic disease which develops from the lining cells of the pleura. Its origin has long been in dispute, but the recent tissue culture studies of Stout and Murray (1), confirmed by Sano, Weiss, and Gault (2), have established the mesothelial char-acter of the tumor. The controversy regarding mesothelioma has led to more than thirty designations (3) , due to the fact that mesothelial cells may assume different histologic forms. The term endothelioma has frequently been used (4) because it was believed that the tumor originated from endothelial structures. Robertson (5) prefers the term pleural sarcoma, while Saccone and Coblenz (6), in order to avoid the controversy of cell origin, called the condition a pleuroma. Two groups of mesothelioma have been recognized, the localized and the diffuse. Clinical differentiation is important be-cause of the surgical and prognostic implications. Twelve cases of mesothelioma, 5 of the localized and 7 of the diffuse type are herein rep...

Intramural diverticulosis of the gallbladder; Rokitansky-Aschoff sinuses.

Intramural diverticulosis of the gallbladder has been described under numerous and varied titles. Rokitansky (1) in 1861 and Aschoff (2) in 1905 studied the mucosal outpouchings in the gallbladder wall and described them as “false diverticula.” Halpert (3) in 1927 pointed out the distinction between “true Luschkas ducts” (i.e., aberrant bile ducts not related to the diverticula) and the diverticula which he in turn labeled Rokitansky-Aschoff sinuses. Robertson and Ferguson (4) in 1946 made an extensive pathological study of this condition and surveyed the literature to that time. Hernia-like protrusions of the gallbladder mucosa through the muscular layer can occur because of the lack of a muscularis mucosa and the loose arrangement of the muscular bundles. This is most likely to occur in the presence of chronic inflammation and increased intraluminal pressure. In their study at the Mayo Clinic, Robertson and Ferguson found 383 cases of cholecystitis; only 33 of these did not exhibit intramural diverticu...

Hypotonic duodenography with glucagon. A clinical comparison study.

This clinical double-blind study shows that glucagon (2 mg) is a valuable agent for hypotonic duodenography. Pro-Banthine (45 mg) is slightly more effective as a hypotonic agent, but there is no doubt that its use is associated with more side effects and subsequent patient discomfort; contraindications to its use are more commonly encountered in a general hospital population.

Spondyloepiphysial Dysplasia Tarda: Four Cases in Childhood and Adolescence, and Some Considerations Regarding Platyspondyly

SPONDYLOEPIPHYSIAL dysplasia tarda is an uncommon hereditary chondrodysplasia characterized by shortness of stature due to generalized vertebral flattening or platyspondyly. The peripheral skeleton is relatively unaffected, showing only secondary and nonspecific changes. A distinct familial incidence has been demonstrated, and the disease is known to be transmitted as a sex-linked recessive trait. The entity was first described by Maroteaux, Lamy, and Bernard in 1957 (12). In a recent paper Langer (10) described the appearance of the spine in adults suffering the dysplasia. In this report we will present 4 cases in male siblings of two families. All were seen during childhood and adolescence. It is also the purpose of this paper to trace concepts of platyspondyly from the original use of the term by Putti (14) in 1910 to our current understanding of diseases in which platyspondyly is an important manifestation. Platyspondyly is most frequently associated in the mind of the radiologist with Morquio-Brailsf...

Ninety per cent hypaque for rapid intravenous roentgenography; preliminary report.

Highly Concentrated iodinated contrast media are needed for rapid intravenous injection in angiocardiography and nephrotomography. The present study documents the use of 90 per cent Hypaque in 50 consecutive patients, with a detailed analysis of reactions and results. Chemistry and Pharmacology Hypaque is a white crystalline solid which contains 59.87 per cent iodine and is highly water-soluble. Chemically, it is sodium 3,5-diacetamido-2,4,6,-triiodobenzoate, which is related structurally to Urokon (sodium acetrizoate). The acetrizoate formula is the basis for a group of contrast agents which may be of value in radiologic investigation. Sodium Hypaque has been extensively utilized in 50 per cent solution for intravenous urography and has proved satisfactory for that purpose (1). An attempt to produce a more concentrated solution resulted in the development of 90 per cent Hypaque, which consists of 30 per cent Sodium Hypaque and 60 per cent Methylglucamine Hypaque. This product is not soluble at room tempe...

Percutaneous Transfemoral Renal Arteriography in Hypertension

Renal Arteriography finds its most important application in the study of renal hypertension. The modified Seldinger technic (1) of percutaneous transfemoral retrograde arteriography provides a precise and accurate demonstration of the anatomy and vascular pathology of the renal arteries and their intrarenal branches. In addition, a nephrography phase during the study reflects the status of the renal parenchyma. The radiologic demonstration of the anatomic-pathologic state of the renal vessels is mandatory for the surgical approach to remediable lesions. A recent study (2) in which aortography was used extensively in hypertensive patients demonstrated lesions of occlusive renal arterial disease in about 25 per cent of the total. The occlusive lesion was considered to be the primary cause of the hypertension in the majority. Occlusive renal arterial disease is listed as the most common cause of hypertension which is amenable to surgical correction, and at this time, 75 (3) to 82 per cent (4) of patients hav...

The Role of Angiocardiography in Myxedema Heart Disease

In 1918, Zondek (26) reported cardiac change in a number of patients with myxedema, emphasizing the increase in heart size as demonstrated by x-ray examination. In 1939, Scherf and Boyd (20) described 3 cases of pericardial effusion in myxedematous patients, offering this as a common cause of the enlarged cardiac silhouette. In recent years, there have been several reports of this association in the literature, usually in isolated cases (2, 3, 4, 6, 10, 12, 17, 21, 26). Most often, the diagnosis was established by pericardiocentesis (9); in other instances, by postmortem examination. Of interest is the report of Lerman et al. (14), who cited postmortem records showing 2 of 5 myxedematous patients to have pericardial effusions. In 1953, Marks and Roof (16) reviewed the literature on pericardial effusion in myxedema. In 13 of 44 cases of myxedema reported, there were associated pleural or peritoneal effusions, or both. The purpose of this paper is to show how angiocardiography may be decisive in documenting...