Samuel L. Beranbaum

Angiographic Studies of Benign and Malignant Cystadenoma of the Pancreas

Benign and malignant cystadenomas of the pancreas are very rare lesions (1, 7, 8), only about 75 cases having been reported in the worlds literature (7, 13). Lichtenstein in 1934 reported the first authenticated case of a malignant cystadenoma of the pancreas in America (6). Various workers have reviewed the literature and added one or two personal cases. P. Kent Cullen, Jr., et al. reviewed the literature to 1963 and collected 86 cases, 42 of which were malignant (4). Their analysis of almost 2.5 million admissions at the Mayo Clinic disclosed that a very small fraction of one per cent showed either benign or malignant cystadenoma of the pancreas. Thus, few cases are available for study at anyone institution. It has been our privilege to have studied four such cases angiographically and to have correlated our findings with surgical and/or autopsy material. Three cases were benign and one malignant. Clinical Findings Females predominate in a ratio of approximately 8: 1 (2–4). The lesions may be encounter...

Mycotic infection of the paranasal sinuses. Radiographic manifestations.

In the past few decades the incidence of mycotic infection of the paranasal sinuses has increased considerably, primarily because of the expanded use of antibiotics and chemotherapeutic agents, such as folic acid antagonists and nitrogen mustards. Clinical awareness of the existence of mycotic infection and advancement in the knowledge and technic of fungus identification also account for the rising incidence. When interpreting a roentgen examination of the paranasal sinuses, the radiologist may see mucous membrane thickening, clouding of the sinuses, and bone destruction. These changes may occur in malignant tumors and in bacterial or mycotic infection. Case Reports Case I: A. B., a 68-year-old white man, was admitted to Bellevue Hospital on Aug. 4, 1959, with a history of recent bloody discharge from the left nostril, associated with erythematous swelling and tenderness over the left maxillary and orbital regions. There was a long history of poorly controlled diabetes. The only significant laboratory st...

Routine Gastrointestinal Series with a 70-mm. Sequence Camera

Sophistication of cinefluorographic equipment has led to the adaptation of a 70-mm rapid sequence camera which permits individual exposures as well as sequence exposures, ranging from 1.5 to 10 per second. This camera has great versatility and may be used for individual exposures in spot-films, with detail approaching that of a standard radiograph. In addition, motion may be studied by the sequence features of the camera. In view of these two aspects it lends itself uniquely to upper gastrointestinal tract study. Janker in 1956 (4) was the first to report a 70-mm. record through an image intensifier. Feddema, in 1961 (1), at the Third Rochester Symposium on Cinefluorog-raphy, presented his experience making single exposures with 70-mm. fluorography on a remotely controlled ring stand utilizing a 9-in. intensifier. The present camera is an adaptation which permits sequence studies as well as individual exposures. Stauffer et al. (8) and Simon and Greenberg (6) have also reported their experiences with indi...

Roentgen exploration of the afferent loop.

Clinical problems attributable to afferent loop abnormalities in postgastrectomy patients are varied and poorly understood. The surgeon recognizes acute and chronic forms of obstruction; the internist uses the nebulous terms “chronic biliary vomiting” and “afferent loop syndrome.” The value of roentgenologic investigation in these problems has been consistently minimized. A number of authors have claimed that x-ray studies provide little information (1, 2, 6). It is our purpose to emphasize the value of detailed roentgen examination and to present our findings in 37 cases, of which 34 were symptomatic and 18 surgically proved. While much attention is currently focused on anatomic abnormalities subsequent to surgery, many of our cases are directly ascribable to other factors. Analysis of our findings indicates the desirability of reassessing the radiologic approach to afferent loop abnormalities and of providing a classification that includes more than surgically created causes of obstruction. Many authors...

Ulcerative Colitis in Association with Diverticular Disease of the Colon

Ulcerative colitis is now recognized as a disease involving all age groups. In older patients it may start de novo, or it may exist for a long time in the chronic stage with periodic exacerbations. One would therefore expect it to be associated with diverticular disease of the colon, which is prevalent in the later decades. Collins (3) reported 16 cases of ulcerative colitis engrafted on acute diverticulitis in a series of 1,140 consecutive cases of acute diverticulitis coli. He indicated a grave prognosis with a marked increase in morbidity and mortality. The roentgen recognition of this association therefore merits closer scrutiny. The x-ray manifestations of the two diseases vary when they are associated, depending upon the stage of each. Pseudo-diverticula may occur in the acute phase of ulcerative colitis and must be differentiated from the entity under consideration. True diverticula of the colon may be an incidental finding in ulcerative colitis (Figs. 1 and 2). They are lined with mucosa, which ma...

The indenture sign in acute exudative colitis

SummaryThe significance of the indenture pattern has been stressed as a sign of acute exudative colonic infection, regardless of etiology.

Small polypoid lesions associated with spastic diverticulosis

ConclusionsSpastic diverticulosis is defined and differentiated from diverticulitis. Persistence of the filling defect and constancy of its location are not essential for the diagnosis of a small polypoid lesion in an area of spastic diverticulosis.A single positive finding of an intraluminal defect in spastic diverticulosis is more significant than numerous negative findings. Discovery of an intraluminal defect in an area of spastic diverticulosis demands re-examination after antispasmodic therapy.Differentiation between a polypoid lesion in an area of diverticulosis and the intrinsic features of diverticulitis are discussed. Circumferential visualization of the colon is essential to differentiate a polyp from a diverticulum. Fecal defects in an area of spastic diverticulosis are comparatively uncommon, so that such a defect should be considered a polypoid lesion until its presence is disproved.

Radiographic Features of Ureterocele

Ureterocele, from the Greek (όυρητήρ and κήλη), literally means hernia of the ureter. It is the result of a congenital stenosis of the ureteral orifice and a concomitant weakness of the wall of the lower ureter so that there is a resultant ballooning of the terminal ureter into the bladder. This intracystic ballooning of the dilated ureter produces a characteristic defect on the cystogram, which is practically pathognomonic in the infant. The extent of the radiographic defect is proportional to the size of the ureterocele, which may vary from a centimeter in diameter to sizes which fill the bladder and may occasionally, in the female, prolapse through the urethra. Because of obstruction secondary to the ureterocele there is frequently an associated hydronephrosis on the affected side. Of the anomalies concomitant with ureterocele, double ureter is the most common. When this latter anomaly is present, the ureterocele usually affects the ureter draining the upper kidney. Ureteroceles may also contain calcul...

Roentgen features of non-malignant periappendiceal and Ileocecal lesions

The differential diagnosis between an inflammatory and neoplastic mass is extremely difficult, and at times impossible. An illustrative review of roentgen features of the numerous pathological manifestations is presented with the realization that the final diagnosis depends on a correlation with the clinical findings. In addition two cases of hypertrophy of the ileocecal valve and/or ileal prolapse are included.

Pirie's Bone

There is a general misconception regarding the significance of a small accessory ossicle located on the dorsum of the astragalus, just proximal to the astragaloscaphoid joint. A roentgenogram taken following a traumatic incident about the ankle joint will reveal this ossicle, at times with a somewhat irregular surface, adjacent to the main body of the astragalus. This repeatedly occurs in compensation cases with a misdiagnosis of a chip fracture. A. H. Pirie, in 1921, first focused attention on this ossicle, which now bears his name. At that time he had collected 14 cases, in 4 of which the condition was bilateral. Proof of the existence of the bone was obtained postmortem. Notwithstanding Piries report, there has been a paucity of comment on the condition in the medical literature, and it is usually omitted from standard textbooks, being mentioned only in Fergusons text. The distal end of the astragalus often exhibits developmental irregularities. The astragaloscaphoid ossicle is a frequent occurrence ...