Richard J. Steckel

Changes in Lymph Node Size Induced by Lymphangiography

We have been impressed on follow-up x-ray studies by a slow shrinkage in opacified pelvic and retroperitoneal nodes following lymphangiography. This change takes place over a period of one to nine months, and it occurs both in patients with abnormal lymphangiograms who have received no radiation or chemotherapy and in patients with normal lymphangiograms (Figs. 1 and 2). It is important to distinguish such “spontaneous shrinkage” of lymph nodes on serial films from changes caused by specific therapy. While dramatic shrinkage of opacified abnormal nodes can unquestionably be induced by therapy (as in some lymphomas), it is possible that unwarranted inferences of a therapeutic response are sometimes made from modest changes on follow-up films when these same lymph node changes might have occurred even in the absence of specific therapy! In an attempt to elucidate a cause for “spontaneous” changes in lymph node size, we performed unilateral hind-limb lymphangiography on dogs and then removed both popliteal n...

Catheterization of the Trachea and Bronchi by a Modified Seldinger Technic: A New Approach to Bronchography

On occasion, a technic developed in one field finds unexpected application in another and thereby satisfies a need which for many years has remained unmet. It is believed that the Seldinger technic of catheterization, until now applied exclusively to angiography (1), may ultimately find an important application in bronchography. Specifically, a modified Seldinger technic has been employed to introduce a radiopaque catheter through the cricothyroid membrane and then to maneuver it into various primary and secondary bronchi under fluoroscopic control. The technic is safe, relatively easy to perform, comfortable for the patient, and capable of producing selective bronchograms of superior quality. Method The pharynx is first lightly anesthetized to prevent coughing, which may result if radiographic contrast material flows back through the glottis during filling of the upper lobes. The patient is then placed in the supine position with the head well extended (Fig. 1). The notch between the lower border of the ...

Prevention of radiation nephritis with renal artery infusion of vasoconstrictors. Experimental and preliminary clinical studies.

Numerous radiobiologic experiments have documented the validity of the original observations (1, 2) that the state of oxygenation at the time of irradiation markedly influences radiation response. Clinical attempts to exploit this so-called “oxygen effect” have taken a number of forms. These include efforts at increasing tumor oxygenation by respiration of oxygen under hyperbaric (3) as well as ambient conditions (4, 5). A similar objective was approached by the intra-arterial infusion of hydrogen peroxide (6). Conversely, the reduction of normal tissue toxicity by production of ischemia was the design of tourniquet application proximal to the irradiation site for soft-tissue sarcomas and bone neoplasms in the extremities (7, 8). The present study is an attempt to attenuate the radiosensitivity of the normal kidney by creating hypoxia during irradiation with the intra-arterial infusion of a vasoconstrictor agent. Preclinical experiments in dogs, previously reported in part (9), have demonstrated a signifi...

The Seldinger Catheter in Radiation Therapy

The skill of the diagnostic radiologist in manipulating a percutaneous arterial catheter might be applied to clinical radiation therapy in a technic currently under investigation. A dose of 2,300 rads is the practical limit for radiation fields encompassing both kidneys; higher amounts lead to delayed radiation nephritis in a significant proportion of cases (1, 6). It is thought that catheterization of the renal artery with infusion of a radioprotective agent during therapy might provide protection to the kidney against radiation damage. In this way, a much higher radiation dose could be delivered to overlying tumor tissue without the risk of late radiation nephritis. Several methods have been used clinically to create or to enhance a difference in radiation sensitivity between tumor and normal tissues. Tissue oxygenation is the single most important (and the most easily altered) factor in determining local tissue radiosensitivity (2, 4). Attempts have been made to employ hyperbaric oxygen to effect a mor...

Usefulness of extremity arteriography in special situations.

Cerebral and renal arteriography are well established clinical procedures in the diagnosis of malignant tumors, and arteriography of other retroperitoneal and intraperitoneal viscera is “coming-of-age.” It is surprising that vascular studies of extremity tumors, one of the first areas of investigation to which arteriography was applied, are not yet routine even in many of the more advanced clinical centers (1, 3). The literature which does exist on this subject suggests that arteriography might be very helpful in differentiating benign from malignant extremity lesions, in selecting biopsy sites, and in defining the extent of tumors (3, 5–7, 15, 18, 19). In our experience with arteriography of peripheral tumors, we have come to feel that these assertions are valid within certain limitations. Furthermore, it has been suggested that arteriography might give early objective evidence of a response to therapy when vascular malignant tumors of the extremities are treated by irradiation (3, 14, 15, 18, 19). Selec...

Beam Localization in Cobalt and Megavoltage Therapy during Treatment

Dupont Adlux film has been found useful for making portal films with Co60 and 2 MV x-rays during irradiation (Figs. 1 and 2). Exposure is continuous during the entire treatment and the image represents the position of anatomic structures under the actual conditions of therapy. The low sensitivity and the wide latitude of this film produce densities which are useful over a wide range of individual treatments. Since the patient is not moved, as is frequently necessary for the usual portal film technics, this procedure gives a more accurate indication of the beam orientation. The film is placed in standard cardboard film-holders without screens. Because the holders are thin, discomfort to the patient is minimal. Adlux film has a thinner base than the usual x-ray films. This makes it undesirable for automatic processing units, and for this reason we develop it by hand-processing in conventional radiographic solutions. It has been reported that with ordinary Scotch tape, it can be attached to a leader of stand...

Multiple Coarctations of the Pulmonary Arteries with Associated Infundibular Pulmonic Stenosis

Coarctation of the pulmonary artery and its branches is a congenital anomaly which is being recognized more and more frequently. The English literature records at least 120 cases in which right-heart catheterization and angiocardiography confirmed the diagnosis, and in at least 6 cases a second cardiac catheterization was performed (1–7). This paper is the case history of a young woman with a loud systolic heart murmur. Cardiac catheterization and angiocardiography performed thirty-seven months apart established the diagnosis of infundibular pulmonic stenosis and multiple coarctations of the pulmonary artery. The stability of the pressures, radiographs, and electrocardiograms and the clinical course in this case suggest that the natural history of the disease may be more benign than has been previously believed. Case Report When first observed at the University of California at Los Angeles Center for the Health Sciences, this 17-year-old Caucasian girl complained of easy fatigability and mild shortness of...

Clinical method for evaluation of radiopotentiation with oxygen inhalation: a preliminary note.

Since the observation was reported that in experimental systems the degree of oxygenation at the time of irradiation markedly influences radiation response (1–3), a number of clinical trials have been undertaken in hopes of exploiting the so-called “oxygen effect.” A current evaluation of hyperbaric oxygen inhalation during radiotherapy is difficult because of the absence of suitable controls in the published clinical reports (4–6). An additional approach is suggested by an experimental study employing spontaneous mammary adenocarcinomas in mice (7). In this investigation, the radiation-potentiating effect resulting from inhalation of 95 per cent oxygen-5 per cent carbon dioxide at atmospheric pressure was comparable to that obtained with hyperbaric oxygen. This communication describes the preliminary results of a clinical method which may prove suitable for studies of this type. Materials and Methods Patients with discrete bilateral pulmonary metastases were selected for study. The lung lesions were meta...