Robert N. Berk

Carcinoma in the porcelain gallbladder.

Two cases of carcinoma in porcelain gallbladders are presented, bringing the total number of cases recorded in the literature to 26. While the exact frequency with which these two diseases occur together is impossible to determine, the association is sufficiently common to warrant prophylactic cholecystectomy for porcelain gallbladder if the patient is a suitable surgical candidate.

Cholerheic enteropathy as a cause of diarrhea and death in radiation enteritis and its prevention with cholestyramine.

Cholerheic enteropathy, a syndrome of diarrhea due to the effects of excessive bile salts in the colon, occurs when bile salt absorption from the terminal ileum is impaired. Cholestyramine, a nonabsorbable anion-exchange resin, prevents diarrhea by binding the bile salts, thus rendering them inactive. Evidence that cholerheic enteropathy has a significant role in the pathogenesis of diarrhea and death from radiation enteritis is reviewed, and experiments with rats treated with cholestyramine prior to abdominal irradiation are described.

The Body Cast Syndrome

The body cast syndrome consists of acute gastric dilatation associated with the application of a plaster hip spica or body jacket. The syndrome is heralded by pernicious vomiting which is often sudden, unexpected, and copious. Aspiration, complete airway obstruction, and cardiac arrest or gastric perforation with peritonitis may occur if the cast is not promptly removed.

Altered Concepts of the Mechanism of Nonvisualization of the Gallbledder

Several observations made in the course of routine clinical cholecystography in recent months have rekindled an interest in our department in the basic mechanisms that determine whether or not visualization of the gallbladder will occur. The first such observation concerns the instance in which good opacification is apparent, but surgical extirpation reveals marked sclerosis of the gallbladder wall to an extent that suggests possible interference with the organs ability to concentrate contrast material. The second observation is the instance in which initial examination with contrast material fails to reveal a gallbladder shadow, and yet repeat examination with a similar dose on the following day demonstrates good opacification (Fig. 1). In Rosenbaums series of 450 consecutive patients examined by cholecystography (1), in 66 visualization was initially absent or inadequate without evidence of gallstones. Findings were normal in 10 per cent of those with initial nonvisualization and in 64 per cent of tho...

The Role of the Y and Z Hepatic Proteins in the Excretion of Radiographic Contrast Materials

The Y and Z proteins, found only in the liver and the mucosa of the small intestine, bind bilirubin, bromosulfophthalein, and certain other organic anions and may be responsible for the preferential hepatic uptake and biliary excretion of these compounds. Experiments show that two cholecystographic contrast media, iopanoic acid and iodipamide, bind to the Y and Z proteins, while iothalamate, a representative urographic contrast agent, does not, indicating that these proteins may be important in determining the pathway of excretion of contrast material.

Intra-abdominal Chicken-Bone Abscess

An accurate diagnosis of an intra-abdominal abscess due to perforation of the gastrointestinal tract by an ingested chicken bone can be made by identification of the bone on abdominal films. The first report of 2 cases with preoperative radiographic diagnoses is presented.

Lymphoma of the Esophagus

Abstract A case of direct involvement of the esophagus by lymphoma is presented. The radiographic features were those of a diffuse intramural submucosal tumor, in contrast to the 6 previously reported cases.

Echographic-Radiological Documentation of Spontaneous Rupture of a Pancreatic Pseudocyst into the Duodenum

A case of spontaneous rupture of a pancreatic pseudocyst into the duodenum is added to the 3 already described in the literature. This is the first such case in which the rupture was diagnosed by echographic examination.

An Angiographic Study of the Pre- and Postoperative Hemodynamics in Patients with Side-to-Side Portacaval Shunts

Hepatic panangiography was performed in 17 patients before and after side-to-side portacaval shunts. Preoperatively, a direct correlation existed between the diameters of the hepatic arteries and the severity of the patients cirrhosis. Postoperatively, the splenic artery and vein and the hepatic artery dilated further in most patients, reflecting increased blood flow. The greatest increase occured in those patients with less severe cirrhosis. The liver shrank postoperatively in most patients. The corrected sinusoidal pressure dropped significantly in all patients. A unique pattern of sinusoidal filling at wedged hepatic venography was observed postoperatively in many of the patients.

The late gastrointestinal manifestations of cystic fibrosis of the pancreas.

The gastrointestinal manifestations of cystic fibrosis which occur in older children and young adults are numerous. When recognized radiographically, they allow the radiologist to make the diagnosis of the disease in the absence of the typical pulmonary changes. The findings of meconium ileus equivalent, an adherent fecalith, splenomegaly, esophageal varices, unusual gallbladder abnormalities, and pneumatosis coli are suggestive of cystic fibrosis and its complications. The hyperplastic-looking cobblestone appearance of the colonic mucosa observed in many older patients is distinctive. Nodular mucosal changes in the small intestine may also be present.