Theodore A. Tristan

Roentgen Technics in the Diagnosis and Localization of Pheochromocytoma

The term pheochromocytoma is Used to designate the relatively rare functioning tumor arising from the chromaffin tissue of the adrenal medulla or from chromaffin tissue elsewhere in the body. Patients may present with either paroxysmal or sustained hypertension and a wide variety of bizarre symptoms. Slightly over 10 per cent of pheochromocytomas are multiple or extra-adrenal. The most frequent sites in such instances are the opposite adrenal, the sympathetic ganglia, and the organs of Zuckerkandl alongside of the terminal portion of the abdominal aorta. Paraganglioma and chromaffinoma are alternate terms used to describe the extra-adrenal tumors, but for the purpose of this discussion all functioning chromaffin tumors, either adrenal or extra-adrenal, producing hypertension and certain associated symptoms will be classified as pheochromocytomas. They are reported occasionally to arise from either normal or ectopic chromaffin tissue in the chest, neck, and bladder (29, 30, 42, 58). Incidence Estimates by ...

INFERIOR VENA CAVOGRAPHY IN THE DETECTION OF ABDOMINAL EXTENSION OF PELVIC CANCER.

Inferior vena cavography is an old but seldom employed radiographic procedure (1, 2). The purpose of this paper is to emphasize its use in the clinical evaluation of pelvic neoplasms and, more specifically, to show its value in the demonstration of extrapelvic neoplasms. The inferior vena cava is a thin-walled, low-pressure venous structure which can be easily displaced, distorted, and obstructed by external pressure secondary to enlarged masses. It occupies about 15 per cent of the retroperitoneal space (3). Lymphatic channels draining the pelvis and abdomen are in juxtaposition to the inferior vena cava through its course in the retroperitoneal space, and metastatic disease which may enlarge abdominal lymph nodes can be identified by opacification of that vessel. Equipment Inferior vena cavography is easy to perform with no discomfort to the patient. Any radiographic room may be used, but one in which routine urography is carried out is to be preferred, having facilities for horizontal-beam lateral expo...

Cinefluorographic Investigation of Genitourinary Tract Function

This paper reports a method of examination of patients presenting with symptoms or urographic changes suggesting bladder neck dysfunction, ureterovesical reflux, and/or chronic or repeated bouts of urinary tract infection. The need for improved methods for investigation of these patients is discussed, the technic is described, and initial results are reported. The difficulty of assigning a cause for the numerous instances of upper urinary tract dilatation that result in destruction of the parenchyma of the kidney has received increased attention in recent years, particularly where the abnormality has been observed in patients with recurrent infection or neurologic disorders. Knowledge of the mechanisms that cause ureteral reflux and bladder outlet obstruction has been increased by many clinical and basic studies (1–13). Observations of isolated physiologic specimens, while providing basic information, have not permitted the evolution of a satisfactory classification or theory to explain the wide spectrum ...

Anomalies of the Bladder Neck

The bladder neck may be defined as the portion of that viscus which marks the junction of the bladder cavity with the urethral lumen. In a static phase this consists of the distal portion of the trigone and adjacent distal detrusor, actuallyapparent accumulations of smooth muscle bundles, some of which extend into the proximal urethra. The inherent tone of the smooth muscle augmented by abundant intermingled elastic tissue provides for urinary continence. Contraction of the smooth muscle of the detrusor results in shortening and widening of the proximal urethra to permit normal voiding [1,2]. Anomalous development of this area involves abnormalities in smooth muscle, connective and elastic tissue. Some of these abnormalities produce gross and severe organic obstruction to the bladder outlet, so that there is advanced damage to the urinary tract apparent at birth (Fig. 1). Varying degrees of obstruction or dysfunction results from others. These may become apparent only later in life when infection or signs and symptoms of renal failure supervene (Fig. 2).