Robert J. Reeves

Fat Absorption from the Human Gastrointestinal Tract in Patients Undergoing Radiation Therapy

The effect of ionizing radiation on the gastrointestinal tract was first noted by Walsh in 1897 (1). The circumstances under which the irradiation was given and the amount are unrecorded. Since that time, many studies as to the effect of radiation on the digestive tract have been carried out. These have been directed toward a morbid anatomical evaluation or a physiological evaluation, or both. Excellent studies of the anatomical changes in the small bowel after irradiation in varying amounts may be found in papers by Warren (2, 3), Martin (4), and Senn (5). Their observations have been substantiated by many other workers. The changes have consisted primarily of a loss of the intestinal epithelium, beginning with that in the crypts and progressing to the villi. Ulcerations then appear, extending through the submucosa and sometimes into the serosa. The extent of these lesions and the rapidity with which the process develops depend to a large extent upon the tissue dose received by the area. It has also been...

The Retention of Thorium Dioxide by the Reticulo-endothelial System

SINCE thorium dioxide solution was first used clinically by Radt (1), little has been learned about its rate of elimination from the body. We have been able to determine by roentgenograms that the liver and spleen retain some qualitatively large portion of the compound, but it is most logical that the radio-activity of the thorium series, which has engendered much of the prevalent suspicion of its physiological effects, should be chosen as an indicator for actual measurement of retention by the organism. The Geiger-Muller counter offers a sufficiently sensitive, simple, and rapid method for measuring such small intensities of radiation directly from the patient. Experimental work was, therefore, undertaken with this type of instrument to determine the average retention of intravenously administered thorium dioxide in the human organism. The absolute intensity of gamma radiation from fresh commercial thorotrast has been determined, in the course of our preliminary calibrations, to be equivalent to approxim...

Fungous Infection of Bone

The bacteriologic and roentgenologic aspects of fungous disease of bone are well known to the many physicians interested in mycotic infections. The criteria for the roentgen diagnosis have been described and effectively correlated with the pathological observations. Often, however, in spite of all the information available, those who are called upon to give opinions on cases of fungous disease find it impossible to offer a definite interpretation or are even led into making a wrong diagnosis. It is for this reason that a review of the subject seems timely. So much has been written on the various phases of fungous infection and the morphological and cultural characteristics of the various organisms that a further account is not necessary here. Figure 1 will serve as a general description. In our series of 40 cases of fungous disease of bone, blastomycosis predominated, accounting for 23; actinomycosis accounted for 16, and cryptococcosis for 1. Luck (4), on the other hand, has found blastomycosis of much l...

The roentgen diagnosis of Whipple's disease (intestinal lipodystrophy), with emphasis on improvement following antibiotic therapy.

Only in the past three or four years has it been recognized that Whipples disease (intestinal lipodystrophy) can be successfully treated with long-term administration of antibiotics. From the time of Whipples initial description in 1907 (17) until the past decade, the disease had been considered invariably fatal, although Paul-ley (11) as early as 1952 reported a case of Whipples disease which responded to tetracycline therapy. There were also a number of reports of long-term remissions attributed to cortisone (15). It was not until 1960 (5), however, that the very impressive results of long-term antibiotic therapy were reported. Subsequent articles (1, 14) have substantiated this observation, and it is our opinion that no one should die of Whipples disease if it is correctly diagnosed and treated. The major clinical manifestations of Whipples disease are diarrhea, steatorrhea, arthralgias, increased skin pigmentation, lymph node enlargement, and serous effusions. Although these symptoms obviously re...

Diffuse pancreatic calcification; an analysis of six cases.

It infrequently becomes the privilege of the roentgenologist to make an absolute diagnosis of pancreatic disease by its direct visualization. He is afforded this opportunity, however, upon demonstrating a pancreas outlined by a diffuse calcium deposition. Beling (2), in 1940, accumulated 12 such cases in a survey of the literature, and added one of his own. Two of the twelve have since been questioned (6). Several subsequent reports have been made (8, 11), and a recent report by Wirts and Snape (12), in 1947, showed a total of 24 cases, including the 2 which, they described. It would appear that diffuse pancreatic calcification is not so rare as it has been previously considered. Recently there have come to our attention several cases presenting diagnostic problems in which the finding of disseminated calcification by the roentgenologist served to confirm the impression of pancreatic disease. Because of this and the relative infrequency of the condition, it was our opinion that a discussion of the subject...

Right-Angle Scatter for X-Ray Beams of 0.14 mm. to 2.5 mm. Copper h.v.l.

The computation of shielding requirements due to scattered radiation from a therapeutic installation is dependent upon data available in the literature. It is impossible to calculate accurately with the Compton equation the distribution and magnitude of scatter at any given point away from a scattering medium such as the human body. This is because the x-ray spectrum is a continuous one and the exact spectral distribution is not known accurately for each machine. There are several reports in the literature relating right-angle scatter at 1 meter from the seatterer to the peak kilovoltage across the x-ray tube. Glasser et al. (1) give data compiled from several of these papers (2–5) relating right-angle scatter at 1 meter, in percentage of central beam dosage, for x-ray tube potentials of 75 kvp, 80 kvp, 200 kvp, and 1 Mvp, for selected port sizes. As indicated by the relatively small selection of data, the information in the literature is rather sparse. It was believed by the present authors that a practi...

The Roentgen Treatment of Leukemia, with Report of a Pregnancy in a Case of Lymphatic Leukemia

Leukemia was first described in 1845, by Virchow and Hughes Bennett, who independently discovered the disease but did not describe the difference in the cell types. In 1891, Ehrlich described the different cell types which distinguish the myeloid from the leukemoid form of the disease. Since its discovery, cases of leukemia have been met with in increasing numbers as diagnostic methods have been improved. Various methods of treatment have been used for the relief of this condition. Among the drugs used are arsenicals, Fowlers solution, arsylene “Roche” and arsacetin, iron and benzol, and tuberculin. Vaccines and serums have been used with some success and are advocated by Curschmann (2) and Coley (3). Artificial pyrexia has also been used in its treatment, and transfusions are of great value as a supportive measure. All of these methods have definite value and are still used as supportive measures, especially in locations where roentgen rays are not available. At the present time, roentgen rays are the u...

The Treatment of Hypotonic Megacolon by Administration of Pancreatic Tissue Extract

SINCE Hirschsprung described the congenital megacolon in 1886, much has been written concerning treatment, both surgically and by the use of various drugs for stimulating the parasympathetics and producing peristalsis. Megacolon may be classified as congenital and acquired. The congenital type, as described by Hirschsprung, is associated with hypertrophy and the thickening of all the layers of the colon wall. The acquired type is subdivided into those produced by mechanical obstruction and by idiopathic dilatation. It is this latter group with which we wish to deal. Sheldon and Kern (1) attempted the use of parathormone, but their conclusions do not appear to be lasting in effect. It was their opinion that the patients might have a low grade chronic parathyroid deficiency. Our studies have not borne this out. Bonar (2) believes the etiology of idiopathic megacolon to be neuromuscular, due to failure of the pelvi-rectal flexure to relax with oncoming peristaltic waves. By means of rectal injections of a sa...

Treatment of radiation sickness with trasentine and trasentine-phenobarbital; preliminary report.

It is well known that x-ray therapy injures healthy as well as malignant cells. According to Kallet and Thorstad (10), this injury is anatomically manifested by an initial edema as a result of damage to connective tissue and blood vessels. With further trauma, an endarteritic process develops, with thickening of the walls and a gradual decrease in the size of the lumen of the intestine. The most distressing symptoms which follow intensive irradiation are nausea (sometimes vomiting) and diarrhea, frequently accompanied by pain and evidence of urinary bladder irritation. Such symptoms are seen particularly in those patients receiving radiation to the pelvic area, because of the anatomic proximity of the lower intestine to the uterus and the frequency with which x-ray therapy is employed for the treatment of carcinoma in or about the latter organ. The cause of these sequelae remains an enigma, although it seems possible that they may be due to a direct action of the x-rays on the rectum and/or sigmoid colon,...

Sarcoma of the Stomach

SARCOMA of the stomach is seldom encountered, if one may judge by the reports in the literature. Approximately 200 cases have been reported and they seem to be of more frequent occurrence than individual experience would lead one to infer. In the Berlin Pathological Institute, for instance, there is but one example of sarcoma of the stomach in the 840 specimens. In this discussion I have excluded lymphosarcoma, which is a fairly frequent finding. Frazier, in 1914, quotes Bruch as being the first to record a case of sarcoma of the stomach, in 1847. Virchow, in 1864, referred to three cases. Baldy, in 1893, reported the case of a patient who came to him complaining of a mass in the abdomen, which was accompanied by progressive weakness and loss of weight. Physical examination disclosed a large irregular mass filling the entire abdomen from the symphysis to the ensiform cartilage. A small hard mass, the size of a walnut, was found in the umbilicus. There had been no gastro-intestinal symptoms. Operation disc...