P. Ruben Koehler

The effect of computed tomography viewer controls on anatomical measurements.

Newer computed tomography (CT) scanners provide a means for direct measurement of the size of normal and abnormal body structures from the viewing screen. Because tissue densities within the brain tend to fall in a narrow range, viewer control settings (window width and window center) are used in a relatively stereotyped fashion when studying head scans. In contrast, CT body scan images usually include tissues of widely different densities and require much broader use of the control settings for complete examination. Studies of the effect of changing the control settings have uncovered wide differences in how these controls should be set when measuring structures directly from the CT scan.

A Critical Evaluation of Lymphangiography

Lymphangiography has been widely practiced during the past several years. As a result of our early experience with this procedure in a significant number of cases (10, 12), we felt much concern about its diagnostic accuracy, its possible complications, and its proper place in patient care. A systematic study was therefore instituted, directed toward the pathologic and clinical correlation of our roentgen findings. The results of this study and our present ideas regarding the value of this method in diagnostic radiology will be presented. Clinical Material Lymphangiography was performed on 141 patients, 90 males and 51 females, ranging in age from five to ninety years, with 95 per cent between thirty and seventy. The method used was the intralymphatic injection of an oily contrast material (12). Eight studies were unsuccessful. The remaining patients were followed for periods extending up to twenty-nine months (Table I). The cases have been subdivided into the following groups: I. Lymphovascular: Under the...

Ultrasonic "B" scanning in the diagnosis of complications in renal transplant patients.

B-mode ultrasonography has been used in the evaluation of complications following renal transplantations. The main indications for examining the patient are decreased renal function, clinically suspected abscesses, or suggestions of a mass in the region of the transplant. In most patients, worsening renal function is due to rejection. In 10 of 50 patients, however, lesions such as lymphoceles, postoperative hematomas, abscesses, and urine leakage were diagnosed. Ultrasonography proved to be a noninvasive and reliable method for the assessment of these complications.

The Roentgen Diagnosis of Renal Inflammatory Masses—Special Emphasis on Angiographic Changes

Radiographic findings in 20 patients with renal inflammatory masses are reviewed. Angiographic findings depend on the degree of involvement and mode of spread of the disease. There is an increase in size and number of capsular vessels, abnormal intrarenal circulation manifested by slow and diminished blood flow, stretching of intralobar branches, loss of corticomedullary border, and loss of kidney outline. In the nephrographic phase multiple lucencies are seen in the cortex. In others, lines of increased densities alternate with strips of decreased densities. Correct diagnosis can be reached when findings on plain radiographs, intravenous urograms and angiograms are assessed.

Body Distribution of Ethiodol Following Lymphangiography

Since 1955, when Kinmonth and his co-workers (8) described a practical method for the intralymphatic injection of contrast substance, lymphangiography has come into widespread use. The procedure is being employed in diagnosis, in radiotherapy, and in the study of the physiology of the lymphatic system in various diseases (1, 4, 6, 7, 9, and 11). Despite this extensive use of Ethiodol in the procedures mentioned, there has been little detailed investigation of the metabolic fate of the medium in either man or animals. This problem became of interest when the frequent radiographic appearance of oil in the lungs was noted after diagnostic procedures (2, 13). Because of this, it was concluded that the oil did not remain confined to the lymphatic system and possibly was widely distributed throughout the body. Knowledge of its distribution became of more practical significance with the advent of the therapeutic use of the medium (1, 12). It was believed that studies with radioactive tracer technics in dogs unde...

Massive Extra-enteric Gastrointestinal Bleeding: Angiographic Diagnosis

Two patients with massive gastrointestinal bleeding are reported. One bled from an aneurysm of a branch of the left hepatic artery, the blood reaching the bowel through communication with the biliary tree. The second had an aneurysm of a branch of the splenic artery which communicated with the pancreatic duct. This type of bleeding is intermittent and, consequently, actual extravasation of contrast media is not always seen. Therefore, if one sees an aneurysm of a visceral artery, even if it does not directly supply the enteric tract, one should consider the possibility that it is the origin of the hemorrhage. Pathogenesis, diagnostic modalities, and therapeutic implications are discussed.

Angiographic Localization of Unknown Acute Gastrointestinal Bleeding Sites

The radiographic demonstration of gastrointestinal bleeding sites through the use of arteriography has been described by Baum and others (1–5, 14, 15). Despite their convincing results, this method of examination has not gained its deserved place in the work-up of acute gastrointestinal bleeders. In the past year we had the opportunity to examine four patients in whose diagnoses and management this procedure proved extremely helpful. The case histories and a discussion of this mode of identifying the site of gastrointestinal bleeding are presented below. Case I: A. E., a 69-year old white male, had undergone total cystectomy and ileal loop urinary diversion nine years previously. His present admission to the hospital was because of fever, chills, and hematuria. Intravenous urography showed no function of the left kidney. The patient stated that he noted several dark bowel movements and had an episode of rectal bleeding after taking castor oil. On admission the hemoglobin level was found to be 10.1 g. Guai...

Renal Arteriography in Experimental Renal Vein Occlusion

Renal vein thrombosis is a serious disease afflicting mainly children and young adults (5). The condition is frequently not recognized and may be more common than the relatively few documented cases would imply. There is ample experimental data to demonstrate spontaneous recovery from renal vein occlusion (2). The roentgen diagnosis is made rarely and with difficulty. Renal venography is the most direct and accurate way to demonstrate the abnormality but carries the risk of dislodging portions of the thrombus (4, 7). The procedure of percutaneous transrenal venography is not applicable to all patients nor is it always successful (1). It was therefore decided to investigate the feasibility of establishing this diagnosis by means of selective renal arteriography. Crummy and Hipona have previously reported on the value of renal arteriography in renal vein occlusion (3). The results of the experimental work will be presented in a condensed form in this communication. A more detailed discussion of the clinical...

Lymphatic Complications Following Renal Transplantation

Lymphatic complications following renal transplantation have not been previously described. Complications, resulting from the transection of lymph trunks during the preparation of the vascular pedicle, include Iymphocysts, abscesses, sinus tracts, and pelvic masses. The origin of the fluid in these spaces can be demonstrated by lymphography. Clinical signs of lymphatic complications include pain, swelling, a feeling of fullness in the area of the incision, and edema of the external genitalia and extremities. Late complications include obstructive uropathy, uremia, and fistula formation. Treatment involves aspiration and drainage; but, to prevent infection, puncture should be avoided if there is the possibility of spontaneous regression.

Diffuse Gastrointestinal Polyposis with Ectodermal Changes: Cronkhite-Canada Syndrome

Three patients with Cronkhite-Canada syndrome are described. This syndrome consists of generalized gastrointestinal polyposis associated with alopecia, onychotrophia, and skin pigmentation. The characteristics which distinguish Cronkhite-Canada syndrome from other cO!lditions associated with polyposis are late onset, lack of family history, and unique ectodermal changes. The patients are usually seriously ill and have abdominal pain associated with severe diarrhea, dehydration, electrolyte imbalance, and (in late stages) anemia and edema.