Sidney W. Nelson

Barium Suspensions vs. Water-Soluble Iodine Compounds in the Study of Obstruction of the Small Bowel

The purpose of the carefully controlled laboratory experiment to be reported here was to determine whether water-soluble iodinated compounds were superior to conventional barium suspensions for the radiographic examination of complete obstruction of the small bowel. The study was designed to evaluate, first, the physiologic response to each medium; second, the radiographic value of each medium; third, the magnitude of the oft cited danger of barium impaction when an obstruction exists in the small intestine. Method of Study High, complete, non-strangulating obstructions were produced surgically in the small intestine of 21 mongrel dogs. Each animal in a group of 7 controls received via nasogastric tube, 1 c.c. of normal saline per pound of body weight twenty-four hours after the obstruction was produced. A second group of 7 dogs received a water-soluble iodinated compound. Gastrografin2 was used because it seemed to be the most popular and palatable of the present group of water-soluble iodinated media. I...

Dangers and fallibilities of iodinated radiopaque media in obstruction of the small bowel

Summary In a controlled study of forty-two conditioned dogs with complete nonstrangulating obstructions of the small intestine it was learned that a barium suspension (Micropaque) was a superior radiographic contrast medium when compared to a water-soluble iodinated compound (Gastrografin). The barium suspension was better tolerated by the animals, resulted in more diagnostic roentgenographic studies, and showed no evidence of impaction at, or proximal to, the obstruction. Our studies also show small, but definite, deleterious change in blood electrolyte, hematocrit, and blood urea nitrogen levels which indicate that the concentrated water-soluble iodinated compounds can further aggravate an already existing hypovolemic state in the animal with a complete mechanical obstruction of the small intestine, whereas deleterious changes of such magnitude are not associated with the use of the barium sulfate suspension. We are now applying this knowledge clinically when a suspected obstruction of the small bowel necessitates the use of a radiopaque medium, i.e., a barium sulfate suspension is preferred to a water-soluble iodinated compound. (Fig. 7.) However, if an obstruction of the colon seems likely, a barium enema should be performed first, and if this is normal, a barium sulfate suspension can be safely ingested or injected through a nasogastric tube. We now discourage the use of water-soluble iodinated media and strongly recommend the routine use of orally ingested barium suspensions in examining patients with possible obstruction of the small bowel so that earlier and more accurate diagnoses can be made, as recommended many years ago by Frimann-Dahl [ 2 ]. However, we continue to favor the use of the aqueous iodinated media in those clinical situations in which a perforated viscus is obvious or suspected.

Barium sulfate and bismuth subcarbonate suspensions as bronchographic contrast media.

During the last five years several papers have appeared concerning the advantages and disadvantages of the various bronchographic contrast media which contain iodine as the radiopaque ingredient. While these media are relatively safe, as manifested by their extensive clinical use, it is nevertheless recognized that an occasional individual is dangerously sensitive to organic iodine compounds. Furthermore, the oily iodine-containing media are known to produce chronic lipoid pneumonia and granulomata in certain patients. Aqueous suspensions are available, but it has become apparent to us that these are more irritating to the tracheobronchial mucosa than are the oily media. In recent years sulfanilamide has been added to Lipiodol in order to hasten removal (absorption) of the iodine from the lung. However, the known hazards of sulfanilamide, when added to those of iodine, would seem to preclude the acceptance of such a medium as the ideal contrast material. On the other hand, aqueous suspensions of barium su...

An Automatic Inhalation-Actuated Aerosol Anesthesia Unit: A New Method of Applying Topical Aneshesia to the Oropharynx and Tracheobronchial Tree

Adequate topical anesthetization is vital to the success of bronchography or endoscopy of the larynx and tracheobronchial tree. Unfortunately, conventional methods of administering topical anesthesia to the respiratory tract cause apprehension, gagging, and coughing in the patient, an ordeal for both the physician and the subject. Some alleviation of these problems has attended the use of manual aerosol methods (1, 2) which, however, require considerable co-operation from the patient. A satisfactory positive pressure method has also been devised to administer an aerosolized anesthetic agent employing the Bennett valve (3), although much of the agent reaches the alveoli where it is not needed (no nerve endings) and where unwanted absorption into the blood stream can occur. For several years the authors have been striving to develop an automatic method of aerosolizing and administering topical anesthetic agents to the tracheobronchial mucosa during normal inhalation by means of breath-actuated valves. It is...

Transcarotid coronary arteriography in man with emphasis on intercoronary arterial anastomosis.

At the annual meeting of the Radiological Society of North America in 1957 we demonstrated the technic and the results of transcarotid aortic valvulography based on a series of 51 injections in 49 patients (1). On that occasion, and in subsequent publications, attention was called to the incidental satisfactory, although inconstant, visualization of the normal coronary arteries in these cases (2, 3). It became evident that, after certain modifications, the method (4) could be utilized for the direct visualization of the coronary arteries in those patients in whom clinical findings and electrocardiography failed to establish a diagnosis. Experimental studies, including approximately 300 injections in 50 mongrel dogs, helped us to introduce the changes in the method necessary for constant detailed visualization of both coronary arteries without increasing the risk associated with thoracic aortography. The results of these experimental studies in animals and the associated electrocardiographic and physiologi...

A NEW SIGN FOR EVALUATING PULMONARY CAVITIES: THE "WALL SIGN".

The purpose of this paper is to present a new roentgenologic sign for evaluating cavitary diseases of the lung. In some cases this was observed during the course of bronchography with a barium sulfate suspension as the contrast material (2) when a cavitary lesion was filled and outlined by the medium. The filling of a pulmonary cavity depends somewhat on the size of the bronchial communication with it, although the viscosity of the contrast medium is undoubtedly the most important factor affecting its entrance into the cavity, inasmuch as any air-containing cavity must have a bronchial communication. Material and Methods Most of the 300 patients in this study had chronic lung diseases. Bronchography was performed for evaluation of bronchiectasis or atelectasis due to endobronchial obstruction, in differential diagnostic problems between inflammatory diseases versus malignancy, for demonstration of suspected bronchopleural fistulas, bronchogenic cysts, etc. Routine preparation of the patients included the ...

A Diagnostic Physiologic Sign of Mechanical Obstruction of the Small Intestine

During previous investigations (1, 2) comparing the radiographic value and physiologic effects of a barium-sulfate suspension and a water-soluble iodinated compound in dogs with complete non-strangulating mechanical obstructions of the small intestine, an interesting and striking contour of the loop immediately proximal to the point of obstruction was often noted (Fig. 1, A). Here a short segment of dilated small intestine resembled the round or oval-shaped head of a snake, whereas a short annular constriction proximal to this dilated portion was similar to the relatively narrow neck of the snake. This frequently noted configuration stimulated an attempt at a physiologic explanation. The narrow “neck” was sometimes not apparent on all films made during a given examination (Fig. 2). Furthermore, on different films of the same animal the constriction occasionally varied in distance from the point of obstruction. The “snakes head” appeared longer and more oval when the narrow “neck” was farther from the obs...

Coronary arteriography: development of a method in animals with particular attention to physiologic effects.

New surgical approaches (1, 2, 9) offer some hope to the many persons suffering from occlusive disease of the coronary arteries. The rational selection of patients for surgery and, indeed, the outcome of the operation itself will certainly benefit by a reliable, precise method of preoperative localization of diseased segments of these vessels and the clarification of the state of the collateral circulation, if such exists. Many investigators (3, 4, 5, 9, 12, 13, 15) have reported methods of radiographically visualizing the coronary circulation in living animals, and others (7, 8, 10, 15, 17, 18) have used varying technics in man. Recognizing the need for a practical clinical method of portraying the coronary artery circulation, our group decided to approach this goal by modifying our previously reported method of aortic valvulography (14), inasmuch as this technic was already an accepted and useful tool in our institution. It is the purpose of this paper to describe the method of coronary arteriography wo...

Intersociety Collaboration in the Cyclic Presentation of Categorical Instructional Courses

Past, present, and future concepts for categorical courses given by the RSNA, ARRS, and ACR are discussed. A schedule for future categorical courses is given.

The continuing evolution of the categorical course concept.

The Societys initial venture in the categorical course was an overwhelming success. Future offerings coordinated between the RSNA, ACR and ARRS could play an outstanding role in recertification.