William B. Seaman

The Effect of Radiation on the Esophagus

IT HAS BEEN repeatedly shown that with supervoltage equipment it is possible to damage deep-seated organs without injuring the skin. The total dosage that can be delivered to a neoplasm is thus no longer dependent upon skin tolerance but upon the tolerance of deep-lying tissues in the path of the beam. Since any tissue can be destroyed by radiation, the definition of radioresistance is a relative matter; in the past it has been defined chiefly in relation to skin tolerance. Since the advent of supervoltage therapy, there is an urgent need for quantitative knowledge regarding the dose of radiation that the different tissues can tolerate without irreversible changes that result in serious loss of function. In our experience in the treatment of intrathoracic cancer with the betatron, a major limiting factor has been the tolerance of the esophagus. During the past two years, among the patients whom we have treated for carcinoma of the lung, there were 20 who could not be adequately treated without inclusion o...

Right-Sided Colonic Diverticula as a Cause of Acute Rectal Hemorrhage

Abstract Of 27 patients with acute rectal hemorrhage studied by emergency selective arteriography, the bleeding point was demonstrated in 18. Fifteen of these were in the colon, and 13 were secondary to diverticulosis. Twelve of the offending diverticula were located to the right of the splenic flexure. Nine were in the ascending colon. Emergency arteriography was the only method that consistently demonstrated the bleeding point in these patients. The location of the majority of bleeding diverticula in the ascending colon weighs strongly against the use of emergency sigmoid colectomy in this group of patients.

The clinical significance of cervical esophageal and hypopharyngeal webs.

One thousand consecutive cinefluorographic examinations of the hypopharynx and cervical esophagus were reviewed to determine the incidence of webs in a population routinely referred for upper gastrointestinal examination. The age, sex, and incidence of iron deficiency anemia in patients with webs were compared with those of the controls, and dysphagia and associated diseases were noted. 5.5% of the patients had one or more webs; these patients had a similar sex distribution to the control group but were generally older. Both groups had the same incidence of iron deficiency anemia. None of the patients with webs met the criteria for Plummer-Vinson syndrome. The authors believe that most cervical esophageal and hypopharyngeal webs are of no clinical significance.

Transhepatic Cholangiography: The Radiological Method of Choice in Suspected Obstructive Jaundice

Twenty-five patients with severe jaundice were studied prospectively with computed tomography (CT), gray-scale ultrasonography (USG), and percutaneous transhepatic cholangiography (THC). Nineteen had obstruction of the biliary tree. The differentiation of obstructive from hepatic parenchymal causes of jaundice was 72% accurate with USG, 92% with CT, and 96% with THC. Biochemical studies when used alone were 72% accurate. Although the precise location of an obstructing lesion was determined in 12/19 cases by CT and 9/19 by USG, the cause was established in only 5 by CT and 7 by USG. THC was 100% successful in establishing both cause and site of obstructive jaundice without significant complications.

Contrast Examination of the Larynx and Pharynx

The radiologist is often frustrated in attempting to record on film his fluoroscopic observations of the pharynx. The rapidity of passage of contrast substances causes great difficulty in recording changes of even a gross degree, much less those too fine to be seen fluoroscopically. The technics utilizing the contrast of intraluminal air and the soft tissues of the region are often inadequate for the demonstration of minor alterations. The persistence of contrast substance within the pharynx and larynx of those patients anesthetized for bronchography suggested to us the use of anesthesia and a contrast material for the examination of these structures. We have accordingly utilized topical anesthesia and contrast media for study of the normal and abnormal anatomy and physiology of the larynx and pharynx. History Jackson was apparently the first to report the use of contrast substances within the bronchial tree, describing insufflation with bismuth in 1918 (17). He also employed Lipiodol as a contrast substa...

Primary Thoracic Hemangiopericytoma

Primary thoracic vascular tumors are uncommon; primary thoracic hemangiopericytomas are rare. Many of the early cases were unrecognized or were grouped under the general heading of vascular neoplasms. Because of the malignant potential, however, it is essential that hemangiopericytoma be recognized as a separate entity. Only 8 cases of primary thoracic hemangiopericytoma have appeared in the literature. Eleven additional cases are now presented, bringing the total to 19 (Table I). These include 4 hospitalized patients and 7 additional ones referred to Presbyterian Hospital (New York) for consultation and review.2 Hemangiopericytoma has no predilection for age or sex; it was congenital in 3 of Stouts patients. In cases of thoracic hemangiopericytoma, the age range was from ten to seventy-five years, with an average of forty-six years. Distribution Since its original pathologic description (38), hemangiopericytoma has been reported in various sites including the skin (33), superficial soft tissues (11, 13,...

The Roentgenologic Appearance of Sclerosing Cholangitis

Abstract Primary sclerosing cholangitis is a rare disease of unknown etiology. While the condition can be recognized at surgery when the accessible portion of the extrahepatic biliary system is involved, patchy and/or intrahepatic involvement can only be recognized radiographically. Characteristic signs include strictures of variable length, decreased arborization, and a beaded appearance of the bile ducts. Five cases of primary sclerosing cholangitis are presented. The recently recognized association with ulcerative colitis is emphasized.

Lateral Pharyngeal Diverticula

True lateral pharyngeal diverticula occur only rarely, less than 20 such cases having been reported in the literature. In addition, and perhaps because of the infrequency of the condition, there is some confusion concerning the differentiation of acquired diverticula, congenital diverticula, simple localized bulging of the lateral pharyngeal walls, and pharyngo-celes. Therefore, we present three new cases, a practical classification (TABLE I), a brief account of the pertinent anatomy of the region, description of the radiographic appearance of the various types of lateral pharyngeal outpouchings, a review of the literature, and a discussion including clinical manifestations. We have found most useful the classification shown in TABLE I. Anatomy And Radiographic Technic A familiarity with the anatomy of the lateral oropharyngeal (mesopharyngeal) and hypopharyngeal walls is necessary for an appreciation of the various types of lateral pharyngeal protrusions. The lower portion of the oropharynx is separated ...

The significance of webs in the hypopharynx and upper esophagus.

The true incidence of webs in the hypopharynx and upper esophagus is not known, as many are probably not detected by the routine radiological examination of the upper gastrointestinal tract. This is particularly true if the patient has no symptoms referable to deglutition. Since the introduction of cineradiologic technics in the Columbia-Presbyterian Medical Center five years ago for the routine examination of the upper gastrointestinal tract, the detection of webs has increased sharply. During the ten-year period, 1950–1960, only 9 patients with webs were discovered, while during the past five years, 44 additional examples of this lesion were detected, 15 during the immediate past year. This fact prompted a review of 53 cases with radiographically demonstrable webs in the pharynx or upper esophagus that have been seen during the past fifteen years, in order to assess the clinical significance of the finding (Table I). Clinical Material The ratio of whites and Negroes was 30 to 23 and of males to females ...

Arteriography of the Breast

Angiography has found wide application in the diagnosis of abdominal, thoracic, and peripheral vascular disease. However, its role in the detection and local ization of breast lesions has not yet been adequately explored. This fact prompted us to investigate possible angiographic differences between carcinoma and benign disease of the breast and the normal vascular anatomy. Our material consisted of 12 women admitted to the surgical service with a clinical diagnosis of breast cancer plus one normal control. In 11 cases masses were palpable and were operated upon for a biopsy or a definitive procedure. One patient had contralateral supraclavicular nodal metastases and a previous mastectomy. Our criteria for malignancy were based on vascular patterns previously associated with malignant growths in other areas. These included subtle or overall disruption of the normal vascular architecture with the following findings existing either singly or in combination: Contour irregularity of vessels Tortuosity Loss of...