Sensitization of stabilized fibrin to urea dispersion by undiluted plasma and serum. Clots obtained from normal native platelet-poor plasma are dispersed by the addition of 5 M urea. Clots from plasma diluted greater than 1/4 and clots from undiluted plasma, thoroughly washed, are not dispersed by urea, but are rendered susceptible to its dispersing action by prior incubation in normal undiluted plasma or serum. The same phenomenon was observed by incubating the otherwise unsoluble clots in normal plasma or serum fractions precipitated at 33% saturation with (NH4)2SO4. The serum fraction does not interfere with the incorporation of putrescine into casein, although it conditions the urea-dispersing action on stable clots.


Binding of deoxyribonucleic acid to the surface of human platelets. It was demonstrated that washed human platelets can bind minute amounts of 14C-DNA on their surface during short-term incubation. The binding was specific and firm in the described experimental conditions. Washed platelets bound also 14C-DNA anti-DNA antibody complexes, although to a lesser amount than 14C-DNA alone. The possible significance of these findings is briefly discussed.


Metoprolol and the peripheral platelet count. An acute oral administration of 50 mg metoprolol (a selective beta-1-receptor antagonist) to 18 healthy volunteers induced a significant increase in the peripheral platelet concentration lasting more than 4 h. It is suggested that this increment in the platelet count originates from the exchangeable splenic platelet pool. The mechanism by which metoprolol exerts its effect remains to be established.


Classic hemophilia A in a female.

Classic hemophilia A in a female. A 53-year-old woman with a history of recurrent bleeding complications since childhood and a positive family bleeding history, previously diagnosed as von Willebrand's disease, was investigated. She was found to have a markedly reduced level of antihemophilic factor (AHF) activity, a low AHF activity/AHF antigen ratio, normal Ristocetin-induced platelet aggregation and a normal level of von Willebrand factor activity. These findings were consistent with the diagnosis of classic hemophilia A which was confirmed by the results of similar studies in nine of the patient's relatives. The report illustrates the usefulness of newer laboratory methods in the differentiation between classic hemophilia A and von Willebrand's disease which may have important clinical implications.


Incorporation of H3-leucine in the mouse kidney in thrombocytopenia. Attempt to demonstrate thrombopoietin production. Light and dark field autoradiography of semithin sections prepared 6 h after a treatment with APS showed that the incorporation of H3-leucine into the cells of the convoluted tubules of the kidney was increased in mice. There was no difference in the H3-leucine incorporation in the liver, either in thrombocytopenic or in untreated animals. The increased incorporation of leucine in the kidney in APS-induced thrombocytopenia showed coincidence with increased thrombopoietin production.


Oral contraceptives, anti-thrombin III and fibrinolytic activity in Africans. A comparison of the effects of progestogen-only and combined progestogen-oestrogen types of oral contraceptives on anti-thrombin III activity and fibrinolysis in African subjects in South Africa is reported. The changes in anti-thrombin III activity are similar to those reported in other races, but the augmentation of fibrinolytic activity is more marked than has been reported elsewhere. The possible significance of these findings is discussed.


Permeability of membrane to potassium in hypochromic red cells with different specific density. In hypochromic anaemias (heterozygous beta-thalassaemia and iron deficiency anaemia) ligher red cells lose more K+ than heavier ones, following incubation at 37 degrees C for 24 h. Both in the light and heavy fractions two subpopulations of cells with different permeability to K+ can be separated by a new centrifugation after incubation. On the basis of the results, a relationship between K+ permeability and probability of survival in hypochromic cells is suggested.


Red cell metabolism and severe neonatal jaundice in West Malaysia. A study was carried out of 332 babies suffering from severe neonatal jaundice who were admitted to the General Hospital, Kuala Lumpar, Malaysia. Of the 332 neonates, 51 were premature and 281 were full-term babies, 178 (110 Chinese, 58 Malay, 9 Indian and 1 European-Pakistani) had bilirubin levels of 20 mg% or higher, requiring exchange blood transfusion. Of the Chinese neonates, 23 (20.9%) had G6PD deficiency, 9 (8.2%) had Hb Bart's and 2 (1.8%) had an abnormal haemoglobin, one Hb Q and one fetal variant. Among the Malay infants, 10 (17.2%) had G6PD deficiency, 7 (12.1%) had Hb Bart's and 10 (17.2%) had abnormal haemoglobins (four had Hb E trait, one had Hb K and Bart's in addition to Hb E, three had Hb CoSp with Hb Bart's, one had Hb Q and one Hb Tak). One of the nine Indian neonates had G6PD deficiency and one had Hb S trait. The one European-Pakistani baby was a carrier of Hb D Punjab. In addition to G6PD deficiency, abnormal haemoglobins seem to have contributed to the high incidence of severe neonatal jaundice in Malaysia. The mean activities of GP, GR and GR after stimulation with FAD were higher, while the mean activity of PK and mean level of reduced glutathione were lower than in normal cord bloods. The percent increase of GR after FAD stimulation was significantly lower; fewer in this group had increases above 20% than in normal cord blood. The possible significance of the findings is discussed.


Proportions of mouse erythrocyte rosette-forming lymphocytes, immunoglobulin-bearing cells and E rosettes in patients with lymphoproliferative diseases. The proportions of mouse erythrocyte rosette-forming (MERF) lymphocytes, immunoglobulin (Ig)-bearing cells and E rosettes were examined in the peripheral blood of patients with lymphoproliferative diseases. The proportion of MERF lymphocytes was considerably increased in chronic lymphocytic leukaemia. The correlation between the proportions of MERF and Ig-bearing cells, characteristic of healthy individuals, is not observed in the lymphoproliferative diseases. It is suggested that in a part of the patients with these diseases, the study of the proportion of MERF cells provides more accurate information on the proportion of lymphocytes of bursal origin than does counting of the Ig-bearing cells.


Atypical B cell dyscrasia with Bence-Jones proteinuria and intracellular retention of gamma-chains. A case of atypical B cell dyscrasia is described. The patient presented with a history of weakness, bone pain, and bleeding. A K-type paraprotein was found in serum and urine. The histology of bone marrow was that of a malignant lymphoma, but no enlargement of peripheral lymphoid organs was detectable. Peripheral blood lymphocytes were increased in number and included two populations of immature cells, one lymphoid and the other lymphoplasmocytoid. Immunofluorescent staining showed both populations to contain K and gamma chains in their cytoplasm. The clinicopathological heterogeneity suggests a malignant clone of B cells undergoing incomplete maturation, with arrest at different stages of the cell cycle.


Scanning and transmission electron microscopy study on the plasma cells of a patient with multiple myeloma. The ultrastructural features of the plasma cells of a 32-year-old patient suffering from multiple myeloma are described. The high percentage (90%) of plasma cells in the bone marrow aspirate permitted the examination of an almost homogenous population. The appearance of the plasma cells seen with the transmission electron microscope did not differ from that described in other reports. The surface architecture of the plasma cells, such as revealed by the scanning electron microscope, differed from that of the normal and pathological white blood cells. Of particular interest were the membrane-bound portions of the cytoplasm seen as 'buddings', or round bodies in the vicinity of the plasma cells which contained most probably pathological proteins.


Susceptibility to autoxidation of lipids of paroxysmal nocturnal hemoglobinuria (PNH)-like red cells. The susceptibility to autoxidation of red cell lipids was studied before and after transformation of normal red cells to PNH-like erythrocytes. The transformation was effected by treatment of the red cells with the sulfydryl compounds D-penicillamine (DP) and N-acetyl-L-cysteine (NAC). The autoxidation was induced by incubating the cells with H2O2 and was estimated by measuring the generated malonyl dialdehyde. The susceptibility to autoxidation was significantly higher in DP-treated cells, while the opposite was true for NAC-treated cells. However, both DP- and NAC-treated cells showed a similar sensitivity to lysis by acid serum and about the same degree of acetylcholinesterase (AChE) activity decrease, thus indicating that the susceptibility to autoxidation of lipids is not involved in the determination of complement sensitivity or in the AChE activity decrease of the sulfydryl-treated cells. Finally, since, as evidenced from most of the reported cases in the literature, increased susceptibility to autoxidation is a feature of PNH cells, it seems reasonable to suggest that DP-treated cells should be used in preference to NAC-treated cells as a laboratory substitute for PNH cells.


Simultaneous demonstration of cholinesterases and glyoxylic acid-induced fluorescence of catecholamines in stretch preparations. A combined simultaneous method to demonstrate adrenergic nerves using glyoxylic acid-induced fluorescence and nerves showing cholinesterase activity using the thiocholine technique is described in whole-mount preparations. The subcutaneous fascia and the right atrium of the heart of the rat and guinea-pig were used as tissue specimens, and the innervation patterns of adrenergic and cholinergic nerves were demonstrated in UV and transmitted light. Technical points and the limitations of the method are discussed.


Morphohistochemical character of various cellular elements of normal and goitrous thyroid gland. There are many ASKANAZY cells in the goitrous the aged patients with the parenchymal dystrophy. The high level of phospholipids in the C-cells can be the basis of a new histochemical test for identification of these cells. The desquamation of the follicular epithelium on the one hand can be the result of the increase of the goitrous thyroids functional activity, on the other hand it can be the expression of the dystrophic processes of the follicular epithelium.


Cytophotometric determination of basic proteins with heparin-alcian blue method. For the quantitative cytochemical determination of basic proteins, Heparin-Alcian Blue (HAB-was found to be a more suitable staining procedure than the generally used alcalic Fast green reaction. HAB is able to stain all the histone fractions, but there is no staining following deamination (gelelectrophoretic examinations) and no aspecific staining (Millipore filter model). In EHRLICH ascites tumour cells, changes in the FEULGEN-DNA content is followed by the proportional changes of HAB-basic protein content. After HAB reaction, the FEULGEN reaction can be performed on the same slide.


Localization of alkaline and acid phosphatase activity in the intestine of healthy breams (Abramis brama l.) and those infected with plerocercoid of tapeworm Ligula intestinalis (Linné 1758). The examination included 40 breams 4 to 7 years old (18 infected and 22 uninfected). Alkaline and acid phosphatase activity, as shown by the azo-coupling method, has been localized in the oesophagus and the intestine, being the strongest in the epithelium. It was distinctly less intensive in the Lamina propria mucosae and in the intermuscular connective tissue of the oesophagus, in the submucosa, in the cells of AUERBACH plexus and in the blood vessel walls. Besides only the acid phosphatase activity was noted in single (sometimes rather numerous) spherical cells - visible within the epithelium and Lamina propria mucosae. The cells are known as the components of so called "yellow bodies" (melanine macrophage centers) entering particular numerously in the spleen and in the pronephric kidney of infected breams. The activity of both enzymes in the epithelium was considerably weaker in the last third of the intestine, and none in cloaca and in Tunica muscularis all over the length of the intestine (and oesophagus) except for some cells of the connective tissue separating the layers of muscle fibres. No perceptible differences in the activity and localization of both enzymes in the intestine were observed between infected and uninfected fishes examined in different seasons of the year.


[Evolution of the adipose tissue during the postembryonic development in Coleoptera Catopidae. I. Studies in Choleva fagniezi and Speophyes lucidulus (author's transl)]. Cytological studies of the fat body have been performed during the postembryonic development of 2 Coleoptera Catopidae: Choleva fagniezi and Speophyes lucidulus. As in other insects, the cells store large amounts of glycogen, lipids and proteins during the larval life; these reserves would be lysed and used during the metamorphosis. According to the species, protein globules are constituted at different larval life periods. In Choleva fagniezi they appear during the 3rd and last larval instar. In Speophyes lucidulus, protein globules appear during the 10 first days of the 1st larval instar. In the prenymphs of the 2 species, the protein globules become rich in RNA.


Electron  histochemical and developmental study of glycogen metabolism in the retina of the chick fetus. The activities of glycogen synthetase and phosphorylase were electron histochemically examined in the retina of the fetal chick. These enzyme activities appeared in the cytoplasmic matrices of the developing paraboloid in the photoreceptor inner segment almost simultaneously at the 17th day of incubation. After the appearance of these 2 enzyme activities, glycogen particles were found in the developing paraboloid. It is concluded that glycogen is synthesized through the enzymatic pathway in the fetal retina and that glycogen is not found before the enzymes related to glycogen metabolism appear in the cell except the appearance of native glycogen in the egg. Branching glycosyltransferase seemed to appear after phosphorylase was activated and these enzymes became higher in their activity with the differentiation in the paraboloid in the fetal and early postnatal periods.


Cytochemical localization of peroxidase activity in normal, proliferating and neoplastic thyroid tissues of rats. An ultrastructural study. In the control animals of thyroid peroxidase is localized within the membrane of rough endoplasmic reticulum, perinuclear cisternae, microvilli, lamellar structures of the GOLGI apparatus and dispersed through the cytoplasm small vesicles. 3 weeks treatment of the animals with MTU leads to disappearance of the peroxidase activity from the follicular cells. However, a prolongation of MTU administration until the 6th month and latter causes a reappearance of the peroxidase activity within the same structures of the proliferating cells as in the control animals. In the epithelial cells of follicular and papillary carcinomas the reaction product is observed predominantly within the membrane of the rough endoplasmic reticulum, perinuclear space and outher membrane of the microvilli. The changes in the inhibitory effect of MTU on the peroxidase activity during thyroid carcinogenesis are discussed.


Histochemical (polysaccharides, proteins, nucleic acids and enzymes) and autoradiographic (incorporation of 35S labelled sodium sulfate) study of the epithelial intestinal cells of Xenodon merremii Wagler, 1824 (Ophidia). A histochemical and autoradiographic study of the lining intestinal epithelium of the snake Xenodon merremii is reported. The absorptive cells present neutral polysaccharides, arginine, tyrosine, tryptophan, cysteine, alkaline phosphatase, acid phosphatase, ATPase, AMPase, esterase and RNA. There are histochemical differences between the goblet cells of the small and of the large intestine. Whereas in the former predominates the neutral polysaccharides and are found arginine, tyrosine, tryptophan and cysteine, in the latter predominates the sulfated polysaccharides (confirmed by the uptake of radioactive sulfur) and no amino acids were found.


[Computer analyse of ultrahistochemical observed metal containing secretory granules in Langerhans islets cells of normoglycemic and diabetic rat]. Metal-containing secretory granules of alpha 2-cells of the LANGERHANS' islets of normal and alloxan-diabetic rats were stained for electron microscopy by a special method. Thereafter the electron micrographs were analysed by the Quantimet 720 image analysing computer with respect to size of the granules and their quantitative distribution in classes. The following statistical tests verified significant differences between the distributions of the secretory granules under normal and diabetic conditions. The secretory granules from alloxan-diabetic animals were diminished distinctly. The examination by image analysing computer confirmed objectively observations, we have made and published formerly.


X-ray microanalytical study of Mn and Fe compartmentation in maize chloroplasts. X-ray microanalysis of mesophyll and bundle sheath maize chloroplasts showed that bound manganese is located within thylakoids, whereas bound iron is equally present in thylakoids and stroma. A simple correlation between manganese content and oxygen evolution capacity (Photosystem II activity) is unlikely since Mn is also present in bundle sheath thylakoids of low Photosystem II activity. A major part of manganese has probably a distinct function and only a minor part plays a role in the process of oxygen evolution.


[Concanavalin A-binding to cyclic reassembled microtubules from pig brain-tubulin (author's transl)]. Concanavalin A reacts to cyclic reassembled microtubules. The results were analysed morphometrically and topochemically. Concanavalin A can be observed mainly on the outer part of the microtubules and also partly in the lumen. After Concanavalin A reaction the diameters of microtubules are significantly higher than in the controls. It is shown that the saccharide component does not disappear during cyclic reassembly of microtubules. This compoenent is seen as a glycoprotein and as a part of at least one of their protein fractions or as a constitutive factor of microtubules.


Electron microscopic study on the lipid content of intramitochondrial granules in proximal convoluted tubule of guinea pig kidney and their ability to accumulate calcium ions. The intramitochondrial dense granules of the kidney proximal tubule fixed with OsO4 are osmiophilic since they are bleached by H2O2 treatment and they disappear after glutaraldehyde fixation alone. Following ethanol extraction and subsequent osmification these granules become invisible but pure aceton treatment does not greatly alter their osmiophilia. The findings suggests that the osmiophilic intramitochondrial granules are rich in phospholipids. When the kidney cortex is incubated in the presence of calcium of acetate, calcium accumulates on the intramitochondrial granules increasing their size and number. The intramitochondrial granules are found more frequently in tissues where the transport of water or ions is big. They contribute to the sodium transport (RIEDEL, BUCHER and ERKOCAK 1968). They are composed mainly of neutral lipids (SANZONE, SWARTZENDRUBER and SNYDER 1970) and phospholipids (WENDEL and BARNARD 1974). They are formed by the precipitation of calcium and other ions (GREENAWALT, ROSSI and LEHNINGER 1964; Peachey 1964). in this present work the structure of dense intramitochondrial granules has been studied regarding electron opaque materials. This way on one hand the lipids and the nucleic acids have been investigated, on the other hand the intramitochondrial granules have been loaded with calcium, a cation showing density in precipitated form and found in great amount into the cell.


The effect of disodium cromoglycate in perennial allergic rhinitis. A controlled clinical study. The clinical effect of disodium cromoglycate was compared with placebo in patients with perennial allergic rhinitis. The results of a double-blind cross-over trial in 17 patients suggest that insufflation with 10 mg disodium cromoglycate four times a day has no better effect than placebo. No significant differences between the side effect of disodium cromoglycate and placebo were noted.


Nucleolar activity in the primate dorsal root ganglion cells associated with dietary protein malnutrition. The nucleolar changes in the dorsal root ganglion cells of the squirrel monkey, Saimiri sciureus, have been investigated by the use of histological and histochemical methods in the healthy neonates (born to mothers maintained on 25% protein diet during gestation) and young adults, and compared with those observed in the protein-malnourished neonates (born to mothers maintained on a 8% protein diet during gestation). Also studied were young adults maintained on a high protein diet (25% protein) as well as on a low protein diet (2% protein content) for a period of 15 weeks. Whereas in the healthy animals (neonates and young adults) only a few cells show nucleolar budding and finally their extrusion into the cytoplasm, the protein-malnourished animals show a significantly enhanced nucleolar activity in the form of increased size (3-4 times the original) and active budding either from one focal point or at several places on the body of the nucleolus. In the neurons which show chromatolytic changes, these extrusions migrate to the nuclear membrane, wherefrom they pass on to the cytoplasm through an evagination of the nuclear envelope. Such a migration appears to occur by a focal dissolution of the nuclear membrane. It appears that, under conditions of severe malnutrition and advanced chromatolytic changes in the neuronal cytoplasm, the nucleolar material provides a compensatory mechanism for the increased cytoplasmic catabolism and loss of ribonucleoprotein material in order to facilitate additional protein synthesis for cell survival.


Cerebral and retinal fat emboli in normal animals fixed by perfusion. The brains and retinas of laboratory animals fixed by perfusion occasionally contain isolated round fat emboli, which increase in number if the two organs are covered with oil during the autopsy. These emboli, in contrast to emboli induced by intravenous injection of oil, are present in smaller numbers, occur without adjacent aggregation of erythrocytes and do not cause widening of the occluded vascular channel. The fat emboli in the normal brain are attributed to connective tissue fat aggregating on the exposed cerebral surface and flowing through openings cut in the leptomeninges and the vascular walls during removal of the brain. Their formation could not be entirely prevented by covering the brain with running water or by submerging the forepart of the animal's body in water during the autopsy. Nevertheless, such a procedure is recommended to avoid introduction of extraneous fat when in a given experiment the question of fat embolism arises. Fat emboli demonstrable in the flattened retina of the cat and the mulatta monkey are ascribed to aspiration of retrobulbar connective tissue fat; they can be prevented by placing a ligature around the optic nerve prior to removal of the eye.


Features of the prosimian wrist joint in relation to hominoid specializations. The wrist joint of lemuroid and lorisoid prosimians is examined in relation to variations among higher primates, particularly the specializations characteristic of hominoids. The lorisines Nycticebus and Perodicticus share a metrically defined primitive morphopattern with other prosimians and cercopithecine monkeys, showing little convergence on apes in carpal bone and distal radius and ulna shape.


Mucopolysaccharidosis type I, II, IIIA and V. Pathological and biochemical abnormalities in the neural and mesenchymal elements of the brain. Histochemical and electron microscopic studies of the brains inclusive of the leptomeninges containing large blood vessels from 7 patients with mucopolysaccharidosis (MPS) I, II, IIIA and V showed marked increase in mesenchymal elements and the generalized presence of characteristic lesions around cerebral veins and arteries. The periadventitial space was greatly distended and filled with viscous fluid and numerous mononuclear cells containing large cytoplasmic vacuoles; these cells stained positively for glycosaminoglycans (GAG). In contrast, the neurons showed only a slight increase of GAG over the normal controls but contained an excessive amount of glycolipid-like material. The amount of GAG in the leptomeninges, inclusive of the large blood vessels, was 10.8, 6.5, 4.5 and 2.2 times greater in patients with MPS I, II, V and IIIA respectively, than the mean of unaffected controls. Dermatan sulfate (DS) accounted for most of the GAG increase in MPS I, II and V [mixed excretors of DS and heparan sulfate (HS)], and HS for the GAG increase in MPS IIIA (HS excretor). With the exception of the patient with MPS IIIA, whose GAG content and composition were the same in both the neural and mesenchymal elements, in all the other MPS types the mesenchymal elements contained more GAG, with a preponderance of DS. We conclude that the mesenchymal elements contribute substantially to the increased content of GAG in the brain and its coverings, mostly in the form of dermatan sulfate.


The effects of ethylene-1-hydroxy-1, 1-diphosphonate on the developing mandibular condyle -- a light microscopic study. The effects of high doses of ethylene-1-hydroxy-1, 1-diphosphonate (EHDP), a potential mineralization inhibitor, were studied in the developing mandibular condyle of the rat. The animals were given one injection of EHDP/day for four consecutive days. One group of animals received 30 mg and another group 50 mg EHDP/day. Animals from each group were killed either the day after or three days after the last EHDP-injection. EHDP-administration resulted in a failure of mineralization of the cartilage and osteoid, a widening of the hypertrophic zone, an appearance of cells in lacunae at the cartilage-methphyseal junction and in an inhibited capillary invasion. There was little evidence of a resumed mineralization in rats left to survive for three days after the last EHDP-injection. The results indicate additional effects of EHDP besides an inhibition of calcium phosphate crystallization, and also that EHDP may be a useful tool in the study of mechanisms of cellular hypertrophy and capillary invasion in mineralizing cartilage.


Permeability properties of the tissues in the optic nerve head region in the rabbit and the monkey. An ultrastructural study. The distribution of the protein tracer, horseradish peroxidase, has been studied in the optic nerve head region in rabbits and monkeys by light and electron microscopy. Following intravenous injection of the tracer, the eyes were enucleated after varying time intervals. Leaking out of the choroidal capillaries in the peripapillary choroid, peroxidase rapidly spread to the adjacent sclera and to the intraneural connective tissue, that is lamina cribrosa and the connective tissue surrounding the intraneural vessels. The tracer then diffused from both the perineural and intraneural connective tissue into the adjacent optic nerve tissue. This diffusion could take place because the intercellular spaces in the astrocytic cell layer interposed between the connective and neural tissues were freely permeable to the tracer. The present investigation confirms the presence of a defect in the blood optic nerve barrier in the optic nerve head. The clinical importance of this defect in the permeability barrier is not known. It may represent a predilection point for pathological events, e.g. in retrobulbar neuritis.


Total parenteral nutrition in infants. Blood levels of glucose, lactate, pyruvate, free  fatty acids, glycerol, d-beta-hydroxybutyrate, triglycerides, free amino acids and insulin. Two regimens (A and B) for TPN were designed to meet the requirements of newborn infants for calories, amino acids, fatty acids, electrolytes, trace elements and vitamins. Both "A" and "B" included fat emulsion (Intralipid). "A" contained fructose and glucose, "B" glucose only. "A" provided amino acids (Vamin) in proportions similar to those of whole egg, "B" similar to those of human milk. All nutrients were given simultaneously into peripheral veins by constant infusion. Nineteen patients (11 newborns, 8 infants) were studied for 1-28 days. Twelve infants recovered, 7 died. In none could TPN be regarded as the cause of death. Treatment was complicated by sepsis in 5 infants. During the course of treatment, blood levels of substrates and insulin were measured before, during and 30 min after discontinuation of TPN. Highly raised concentrations of circulating substrates seen in 3 infants seemed to be related to a poor clinical condition rather than to the regimen used. Infants in good condition tolerated TPN well. Low levels of branch-chained amino acids and tendency to ketonemia, when infusion was stopped, suggested that minimal rather than optimal supply of energy and of amino acids in relation to energy was provided with both regimens. Low insulin levels associated with elevated blood levels of substrates suggested that insulin administration to selected cases might be indicated. Fructose (0.30 g/kg X hour-1) given with regimen A increased blood lactate concentrations. Homocystinaemia appeared in 2 cases; disappearance after excess vitamin B6 administration indicated increased B6 requirement.


Abnormalities of immunglobulins in infants with congenital heart disease. Twenty-eight infants had their serum immunoglobulins estimated (by radial immunodiffusion) in early infancy. The IgG level was abnormal in twelve infants. Elevated levels of IgA were found in ten and IgM in fourteen. These variations, mostly obvious in the first ten days of life, were detected in the absence of clinical or immunological evidence of congenital rubella infection.


Adaptation of a single injection clearance method to physiological and pathophysiological facts. A review of data obtained in infancy and childhood. A retrospective analysis of 395 51Chromiumethylenediaminotetraacetate single injection clearances performed in infants and children is presented. In 61% of infants and 30% of the children the clearance values were calculated on the basis of a plasma disappearance half time of the reference substance, which was longer than the standard study, i.e. on the basis of extrapolated data. Plasma creatinine and urea levels were found to be appropriate indicators for predicting the plasma disappearance half time of the marker substance. 14 additional patients were studied prospectively with a duration of the study predicted by means of the plasma creatinine and urea levels.  In these patients, separate determinations of the clearances using either the data obtained during the standard time of procedure only, or the data of the entire study, clearly demonstrated that the clearances obtained by means of the standard procedure overestimated glomerular filtration rate. The analysis of the data in infants show that the plasma urea level is a reasonably good indicator for predicting the time schedule of the study whereas plasma creatinine should not be used. Additionally the retrospective data indicate that a prolongation of the study should be recommended in all infants. This study demonstrates the necessity and offers means of adapting the time schedule of isotope single injection clearances to physiological and pathophysiological facts.


Pituitary-thyroid responsiveness to thyrotropin-releasing hormone in preterm and small-for-gestational age newborns. A dose of 40 microgram TRH was injected intravenously in 12 preterm (PT) and 15 small-for-gestational age (SGA) babies (with advanced gestational ages) between 5 and 167 hours after birth. Serum-thyrotropin (TSH) was measured prior to and 30 and 180 min after TRH; serum-thyroxine (T4) and serum-triiodothyronine (T3) were measured prior to and 180 min after TRH. The percentage increase in serum-TSH in PT and SGA babies was comparable to that of fullterm newborns. The serum-TSH 30 min after TRH in SGA newborns was significantly correlated to basal TSH values, such a correlation could not be shown in the preterms. One SGA and four PT babies had a repeat TRH-test performed later in infancy: In all but one PT with a gestational age of 27 weeks the TSH rise was lower than in the neonatal period. The thyroid hormone responses after TRH were similar in the two groups of babies. The percentage increase above basal levels were: Median serum-T3 increase about 46% and median serum-T4 increase about 14%. It is concluded that in low-birth-weight newborn babies the pituitary TSH response to exogenous TRH was like that detected in fullterm newborns and more pronounced that later in infancy. The effect of endogenous TSH as measured by thyroid hormone increases was of the same magnitude as observed in fullterms and in adults.


Tracheopathia chondro-osteoplastica. A clinical study of thirty cases. During the last 12 years, 30 cases of tracheopathia chondro-osteoplastica have been diagnosed at the Department of Otolaryngology of Kuopio University. Ten of these were accidentally revealed by bronchoscopy, 2 by autopsy, but 18 were revealed through a systematic examination. Ten of these 18 were preliminarily diagnosed by indirect laryngoscopy. The average age for women was 51 and for men 42, the youngest patient being 11 and the oldest 71 years of age. The characteristic symptoms were long-term recurrent cough, hoarseness and periodic expectoration. The sputum was frequently abundant and crusty, and sometimes contained streaks of blood. Shortness of breath was a common symptom, but there were often entirely asymptomatic periods. The disease begins with a persistent purulent tracheitis, which, probably owing to calciphylaxis, causes accumulation of calcium salts in the tracheal mucosa. Cartilage and bone later develop around these accumulations. In most of the cases of tracheopathia chondro-osteoplastica in the present series, the condition was associated with atrophic rhinitis or pharyngitis. As the nasal disease improves, some regression may occur, though hardly healing. Calcium and phosphorus metabolism was not disturbed, and no immunological aberrations were found in any of the patients in this series.


The gastrointestinal absorption of penicillin V in children with suspected coeliac disease. The gastrointestinal absorption of penicillin V (pc-V) was investigated in 6 children, 6-12 months old, with suspected coeliac disease. The diagnosis was set after small bowel biopsy and absorption tests of vitamin A and d-xylose. As control groups served 7 children with diarrhoea but with normal small bowel biopsy and/or absorption tests and a group of 9 children with upper respiratory tract infection of the same ages as the children in the test group. The absorption of calcium pc-V in oil suspension (Penicals) was impaired in the patients with suspected coeliac disease compared to that of the control groups. There was no significantly different absorption of pc-V between the control children with diarrhoea and those with upper respiratory tract infection. After 6-8 months of gluten free diet in the children with suspected coeliac disease their absorptive ability of oral calcium pc-V in suspension form was equal with that of a control group.


In vitro studies on normal, stimulated and immunologically activated mouse macrophages. III. Intracellular multiplication of Listeria monocytogenes. The intracellular generation time of Listeria monocytogenes is increased in monolayers of PE macrophages from mice immunized with BCG, listeria and T.A.B. vaccine as compared with monolayers of PE macrophages from normal mice stimulated intraperitoneally with proteosepeptone. Thus non-specifically stimulated and immunologically activated macrophages, although sharing several other characteristics, differ in their capacity to control intracellular bacterial infection.


Effects of pure chlorobiphenyls (2,4',5-trichlorobiphenyl or 2,2',4,4',5,5'-hexachlorobiphenyl) on the disappearance of 14C from the  blood plasma after intravenous injection of 4-14C-progesterone and on the hepatic drug metabolizing system in the female rat. Effects of two pure chlorobiphenyls (2,4',5-trichlorobiphenyl or 2,2',4,4',5,5'-hexachlorobiphenyl) on the hepatic drug metabolizing system and on the elimination rate of 14C from the blood after intravenous injection of 4(-14)C- progesterone have been studied in the female rat. The results obtained show that females pre-treated with small amounts of 2,2',4,4'5,5'-hexachlorobiphenyl (o.5 mg/day for 14 consecutive days) have significantly higher elimination rates of 14C (originating from intravenous injection of 4(-14C-progesterone) from the blood plasma, significantly higher content of hepatic cytochrome P-450 and significantly heavier livers than control females. On the other hand, trichlorobiphenyl (0.5 mg/day for 14 consecutive days) do not differ significantly from the results obtained from control females.


Psychoendocrinological and therapeutic effects of TRH in depression. The antidepressive efficacy of TRH was investigated in 15 endogenous depressive patients in a double-blind cross-over design. The Hamilton depression scale, the AMP (PAS) system, v. Zerssen scale and thermometer scales were used. No therapeutic effect could be demonstrated. The blunted TSH-response to TRH, which has been described by other investigators, was confirmed. There was suggestive evidence of a psychoendocrinological relationship in the sense that the more severe the "somatic depressive" syndrome as calculated from the AMP system, and the more marked the diurnal variation of the endogenous type is, the lower are the basal TSH-values and the smaller the response to TRH. Thus, TRH may become a useful tool to identify subgroups of depressive patient populations.


Combination chemotherapy of an APUDoma. With special reference to the therapeutic value of monitoring hormonal substances. Investigations are presented on the occurrence of tumour products during combination chemotherapy of a 49-year-old female with an APUDoma metastatic to the liver. Calcitonin was demonstrated in high concentration in the tumour tissue. Serum calcitonin, serum histaminase and 5-HIAA in a 24-hour urine sample increased immediately after the administration of cytotoxic agents, falling subsequently below the pretreatment level. These findings indicate a therapeutic effect with lysis of tumour cells. Continuous determination of the three tumour substances showed an increase in these products before clinical suspicion of progression. Electron microscopic examination during the initial course disclosed the tumour to be an APUDoma. Autopsy failed to disclose a primary site outside the liver. Further autopsy findings were an adenoma of the thyroid and a chromofobe adenoma of the pituitary, thus assigning the patient to type 1 multiple endocrine neoplasia.


Skeletal growth in uremia.

Skeletal growth in uremia. Stable long-term chronic renal failure in the growing Sprague Dawley rat causes marked bone disease with impaired mineralization (i.e. rickets) and evidence of increased parathyroid hormone activity. Although significant bone disease is present, the rate of longitudinal growth is not diminished in preterminal renal failure. However, it is significantly diminished in terminal renal failure, when uremic rats are compared with sham-operated control rats at identical levels of food intake. At identical levels of food intake, weight gain is also diminished in rats with terminal uremia as compared with sham-operated control rats, suggesting increased calorie cost for growth.


The role of membrane damage in radiation-induced cell death. Radiation-induced cell death is probably mediated primarily through deposition of energy, in single events, in a few vital macromolecules, or targets, the integrity of which is indispensable for proliferation. The genome is customarily regarded as the main target, but several lines of evidence support the inference that there are important consequences of events in nuclear membranes in eukaryotes, and plasma membrane in bacteria. The identification of a target depends to some extent on parallelism between modifications of biological damage to putative targets and to the cell as a whole. An important modifying procedure is removal of oxygen from the irradiated system. The presence of oxygen almost always sensitizes cells, but when model systems with biological function are irradiated extra-cellularly a high degree of sensitization by oxygen has been observed only with those in which membrane function is important. This makes sense because the lipid content of membranes renders them readily peroxidizable. When the quality of the radiation is changed, its effectiveness changes in opposite directions for subcellular model targets and for cells. This could be accounted for if interactions between lesions in membranes and in attached DNA play a substantial role in cellular radiation effects.


The inhibition of prostaglandin synthetase in vivo by nonsteroidal anti-inflammatory agents. The effects of two nonsteroidal anti-inflammatory compounds, fenclorac and indomethacin, on arachidonate and prostaglandins (PG) E1- and E2-induced vasodepressor responses were determined in the spontaneously hypertensive male rat. A 0.4 to 2 mg/kg intravenous dose of fenclorac blocked the arachidonate-induced vasodepressor response and had no effect on PGE1- and E2-induced hypotension. Similar responses were observed after indomethacin. These results were indicative of in vivo inhibition of PG synthetase by fenclorac and indomethacin. Administration of propranolol did not alter the arachidonate or PG responses; regitine reduced the arachidonate and PG response, suggesting that alpha-adrengergic receptors in vascular smooth muscle may play a role in the prostaglandin-induced hypotension.


Impact of computed tomography on utilization of cerebral angiograms. In order to assess the effects of computed tomography (CT) of the brain on utilization of cerebral angiography, a retrospective analysis of three cohorts of patients was undertaken. Each cohort consisted of 50 consecutive patients receiving angiography either before a CT scanner was available, after installation of CT, or 1 year after CT. Since availability of CT, a progressive decrease in the proportion of angiograms that are normal has occurred (from 36% to 16%). Patients being evaluated for mass lesions account for the decrease. We conclude that CT is making neurodiagnostic evaluation more efficient and less invasive for patients with suspected mass lesions.


Sarcoma of the kidney: angiographic features. Sarcomas of the kidney are highly malignant neoplasms. Abnormal vascularity can be detected in almost all types of sarcomas, but arteriovenous shunting, pooling of contrast material, and tumor staining are seldom present. Extension to renal vein and inferior vena cava may occur. While angiographic findings in our seven cases of renal sarcomas were nonspecific, this diagnosis should be considered in a relatively hypovascular neoplasm especially when the capsular arteries contribute considerably to the vascular supply. Nevertheless, statistically the most likely diagnosis of a hypovascular mass is renal cell carcinoma. Angiographic studies do not alter the management of the patient but merely suggest the diagnostic possibility of sarcoma. Angiographic diagnosis of different histologic types of sarcomas is not possible.


Refinements in Chiba needle trans hepatic cholangiography. The recent wide acceptance of Chiba needle transhepatic cholangiography prompted this elaboration of present techniques, intraprocedure observations, and special interpretive considerations based on a series of 100 consecutive examinations. The established safety margin of this technique now permits up to 15 needle passes to obtain a cholangiogram; thus success rates of duct opacification presently approach 100%. Special phenomena related to the small caliber of the needle include duct filling from "invisible" radicles, perivenous or periductal dissection of contrast, and pseudolesions in an incompletely decompressed stagnant bile column. The role of fine needle cholangiography in light of other present day technology for evaluating obstructive jaundice (ultrasonography, computed tomography, and endoscopic retrograde cholangiography) is discussed.


Ultrasonic evaluation of the obstructed duplex kidney. The problem of a duplex collecting system associated with an obstructed ectopic ureter or ureterocele is common in pediatric urology. Four such patients were studied by gray scale ultrasound which was useful in demonstrating the dilated upper pole collecting system as well as an ectopic ureter and a ureterocele. Although the diagnosis of a nonfunctioning upper pole unit in a duplex kidney is usually suggested by the urogram, ultrasound provides a noninvasive means of confirmation which is independant of function. Further, ultrasound-guided puncture with antegrade pyelography demonstrates the course of the ectopic ureter, thus providing a more complete preoperative evaluation.


Stereotaxic instrument for needle biopsy of the mamma. A stereotaxic instrument is described which facilitates percutaneous needle biopsy of the breast for microscopic diagnosis. The instrument consists of an x-ray tube mounted on a hinged arm, pivoting stand, patient table, compression device with film holder and scale system, coordinate-controlled puncture device with separate stand, biopsy instrument, and calculator. The sampling site can be located at a precision within +/- 1 mm. The instrument can also be used for positioning of metal and dye indicators for guiding surgery and for postoperative identification of excised tumors.


Severe radiation injuries of the lung.

Severe radiation injuries of the lung. The lung is a radiosensitive organ whose limited tolerance must be treated with great respect in the radiation management of malignant tumors in the thorax. Severe radiation pneumonopathy can cripple and kill as the outcome of faulty judgment, error, accident, or calculated risk in an effort to control a locally advanced cancer. The clinical and radiologic profile of this unique and challenging syndrome is described and the histopathology and pathogenesis are reviewed. The clinical and technical factors of high risk are discussed, and guidelines for therapeutic management and safer clinical practice are offered.


CT demonstration of the splenic vein-pancreatic relationship: the pseudodilated pancreatic duct. Cross-sectional anatomy of the splenic vein-pancreatic relationship is reviewed and correlated with findings on computed tomography. A layer of fat which is normally present between the splenic vein and the pancreas may simulate a dilated pancreatic duct. Distinct demonstration of the splenic vein as a structure separate from the pancreas was possible in 43 of 86 patients studied. An additional 25% of the patients had partial or indistinct demonstration of the splenic vein. Appreciation of this normal relationship on CT is imperative to avoid misinterpretation of the fat layer as a dilated pancreatic duct. In addition, the measured size of the pancreas may be falsely overestimated by addition of the splenic vein width if the intervening fat is not identified.


The federal government's impact on radiology. The areas of involvement by federal agencies which have primary health missions are outlined. The roles of many federal agencies which touch on health peripherally are also discussed.


Retrospective comparison of radionuclide scans and computed tomography of the liver and pancreas. Computed tomography (CT) and radionuclide examinations of the liver and pancreas in 50 patients were compared retrospectively to evaluate their value as diagnostic tests. CT was superior to 75Se-selenomethionine in evaluating pancreatic disease. Both 99mTc-sulfur colloid scans and CT scans were sensitive detectors of liver masses; however, there were more false positive 99mTc-sulfur colloid scans (16% compared to 4%). CT was superior in detecting biliary obstruction and ascites, in assessing diseases that involved the liver extrinsically, and in evaluating the status of adjacent organs. 99mTc-sulfur colloid scans were more sensitive in detection of diffuse non-neoplastic liver diseases (cirrhosis, hepatitis, and cholangitis). Simultaneous interpretation of CT and radionuclide scans was often more helpful than independent interpretation, and the two techniques are therefore complementary.


Calcitonin treatment in hereditary bone dysplasia with hyperphosphatasemia: a radiographic and histologic study of bone. Two children with bone dysplasia with hyperphosphatasemia (juvenile Paget's disease) were treated with synthetic human calcitonin. The progress of bone disease was monitored radiographically and histologically. Pretreatment radiographs showed markedly abnormal bone, characterized by lack of discrete cortex and absence of normal modeling. During treatment a discrete cortex was formed composed of compact bone, and more normal modeling occurred. This coincided with a histologic change from woven bone before treatment to a more lamellar type during treatment.


Neonatal mucolipidosis II (I-cell disease): clinical and radiologic features in three cases. Three unrelated southern Italian children manifested I-cell within the first month of life, but it was not recognized initially. Radiologic findings of osteopenia, subperiosteal new bone formation and resorption, and irregular metaphyses suggested systemic bone disease. Premature suture synostosis was evident at age 2-4 weeks. Review of the literature and experience with these cases establish these findings as valuable and specific clue to the diagnosis of I-cell disease. By 6-10 months of age, the clinical and radiologic features were similar to those in Hurler syndrome. Cardiorespiratory death occurred in two cases.


Unilateral locked facet in cervical spine injuries. Among 525 patients who sustained trauma to the cervical spinal cord, 86 (16%) had unilateral locking of facets. If the diagnosis is not promptly made, neurological recovery of root deficit will be impaired and orthopedic deformity will result. Since there is often only minimal forward displacement at the site of dislocation, it is possible not only to miss the locking of facets but even to erroneously conclude that no fracture or dislocation is present. Rotation of the cervical spine above the level of dislocation results in a diagnostic appearance on the lateral view. Rotation of the spinous processes was seen in the anteroposterior view in only one-third of the cases. The necessity of obtaining x-rays which adequately demonstrate the lower cervical spine is emphasized and the technique briefly described.


Injuries of the medial epicondylar ossification center of the humerus. The complex nature of the ossification centers makes elbow injuries in a child or adolescent difficult to evaluate. The medial epicondylar ossification center is involved in a significant proportion. Injuries vary from simple avulsions to wide displacement with entrapment in the elbow. When entrapment occurs, it may be mistaken for the trochlear ossification center and the true nature of the injury overlooked. Radiographic findings are presented. The anteroposterior view was found to be diagnostic in minimal or marked avulsions of the medial epicondyle because of the characteristic inferior displacement. The anteroposterior view may not always be diagnostic in cases of entrapment of the medial epicondyle; the lateral view is usually diagnostic. In elbow dislocation, the presence and position of the medial epicondyle must be ascertained. Comparison and oblique views are often of value.


Computed tomography in cerebral hemiatrophy. The clinical and radiographic findings in four cases of cerebral hemiatrophy are presented. CT findings reflect the underlying gross pathologic changes and are in agreement with those seen on plain skull radiography and pneumoencephalography. The most impressive finding was unilateral loss of cerebral volume with ipsilateral displacement of the midline structures. The differential diagnosis primarily includes Sturge-Weber syndrome and linear sebaceous nevus syndrome. The recognition of compensatory calvarial changes should indicate that the cerebral abnormalities are the result of an atrophic or hypoplastic process that began in early life.


Laminar avulsion in a cervical vertebra. An unusual avulsion fracture involving the lamina of a cervical vertebra, most likely due to tear of a ligamentum flavum, is described. Its radiographic features may be quite subtle. Simulation of this fracture on dried skeleton allowed a better understanding of its appearance on the standard projections, its mechanism of occurrence, and its delayed recognition on the patient's anteroposterior view. Only awareness of the existence of this type of fracture and special efforts directed toward its detection will determine its true frequency.


Radiographic manifestations of bone metastases from renal carcinoma. From 1964 to 1974, 1,668 patients with renal carcinoma were seen at the Mayo Clinic. Bone metastases were present in 167 of these patients (only lung metastatic involvement ranked higher in frequency). More than one-third of the patients with bone metastasis from renal carcinoma had this as a presenting lesion of occult renal tumor. This group constituted 4% of all patients with renal carcinoma evaluated during the study period. While most bone lesions were in the  pelvis and lower lumbar spine, any bone may be involved. All patients with bone metastases from renal carcinoma have a poor prognosis. However, some bone lesions appeared as long as 10 or more years after the initial tumor. The most common radiographic features are a lytic destructive process with indistinct margins, erosion of the cortex, and frequent expansion into the soft tissues. Pathological features are common in the long bones, and calcifications are occasionally seen. The synovial joints are not affected. A well defined sclerotic margin is a common finding after radiation treatment, although it is not a reliable indicator of the stability of the lesion.


Computed tomography in the diagnosis of subcapsular and perirenal hematoma. Six patients are described in whom subcapsular and perirenal hematomas were demonstrated by computed tomography. This new diagnostic tool provided a rapid noninvasive means of visualizing the hematoma, its extent, location, and relationship to renal parenchyma. Serial examinations were used to follow progress of the hematomas toward resolution. Correlation is made with conventional rediography, angiography, and gray scale ultrasound.


Visualization of the medullary rays on excretory urography in experimental ureteric obstruction. Excretory urography occasionally delineates striations of alternating density in the renal parenchyma. Experimental observations on a dog model of ureteric obstruction show that the dense striations have the same dynamic alterations as the obstructive nephrogram. They become progressively more dense to a plateau and then fade with relief of obstruction. Previous obstruction is shown to facilitate visualization of the striations presumably by having dilated the tubules. Previous obstructive episode, previous symptoms, or chronic obstruction were present in each of the clinical cases collected which show a similar striation pattern. We conclude that the dense striations represent shadows produced by hyperconcentrated contrast material which has accumulated in dilated collecting ducts or groups of ducts within the medullary rays.


Parenchymal striations in renal vein thrombosis: arteriographic demonstration. Arteriographic visualization of parenchymal striation in renal vein thrombosis is reported for the first time. The striations correspond to the location and orientation of the peritubular capillary beds of the renal cortex, which are in linear continuity with the vasa recta of the medulla. Opacification of these vascular structures in a cadaver kidney produced the same striation pattern. One possible physiologic explanation is that renal vein thrombosis causes elevated renal interstitial pressure which slows tubular urine flow. This altered intrarenal state prevents opacification of renal tubular structures while adjacent peritubular vascular structures are opacified, thereby producing a pattern of alternating striation.


Transitional cell tumors of the kidney: how diagnostic is the angiogram? Angiograms of 51 tests cases including 34 transitional cell carcinomas, eight inflammatory lesions, four hypernephromas, and five miscellaneous disorders were shown to six radiologists for analysis of the angiographic features and specific diagnosis. Overall accuracy was 60% with a false positive rate of 44%. The most common false positive diagnosis occurred with inflammatory lesions (seven of eight). False negative cases were variously called normal, hypernephromas, inflammatory, or other. Vessel encasement (26%), neovascularity (56%), and tumor blush (15%) were recognized far less frequently in the transitional cell tumors of this series than in previous reports in the literature. Further, when hydronephorsis was present, the angiogram was not helpful in determining the etiology. It is concluded that the "classic" angiographic findings associated with this tumor are only moderately reliable since they can be mimicked by other conditions.


Effect of size and position on chest lesion detection. A test series of radiographs was developed by duplicating normal chest radiographs with superimposed masks containing either a 0.5, 1.0, or 1.5 cm pseudolesion. Nine observers participated in the study. Receiver operating characteristic curves were formed and the responses from radiologists and physicists compared. The accuracy rate for detecting 1.0 and 1.5 cm lesions was 44%; for 0.5 cm lesions, 8%. Lesions located in the upper left quadrant were detected with an accuracy of 56% compared to 29% for those in the lower left quadrant.


PEEP: radiographic features and associated complications. Positive and expiratory pressure (PEEP) has been used for several years in the treatment of acute respiratory failure. Dramatic improvement in the chest radiograph may occur with institution of PEEP; the degree of change parallels the levels of positive and expiratory pressure used. Conversely, weaning from mechanical ventilation may be associated with deterioration in the radiographic picture despite improvement in arterial blood gases and lung compliance. Serial chest films of representative patients with adult respiratory distress syndrome are reviewed and changes in the radiographic pattern are correlated with the amount of PEEP. The efficacy of PEEP in reducing intrapulmonary shunting and improving arterial oxygenation is related to increasing functional residual capacity, with improvement of diffuse atelectasis and associated shift of pulmonary water from the alveoli to the interstitial space and pulmonary capillaries. The changing radiologic manifestations reflect these physiologic phenomena. Pulmonary barotrauma is a frequent complication of PEEP therapy. Pneumothorax, pneumomediastinum, and interstitial emphysema may lead to rapid deterioration of a patient maintained on mechanical ventilation with an already compromised respiratory status.


Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions. The results of 88 transthoracic needle biopsies of lung lesions using the Rotex biopsy instrument are analyzed. Of 57 malignant lung lesions, 55 were diagnosed correctly. Two patients with false negative biopsies had technically inadequate examinations. All but one of the 28 benign lung lesions were correctly diagnosed as nonmalignant. One false positive diagnosis of malignancy was made. The occurrence of complications was similar to those reported for conventional fine needle aspiration. The high accuracy rate is attributed to the effectiveness of the Rotex instrument in sampling the lesions and to the use of biplane fluoroscopy.


Nonmalignant lymphoid disorders of the chest. Several nonmalignant lymphoid disorders involve the lung parenchyma or the mediastinal or hilar lymph nodes. The pulmonary parenchymal lesions include lymphocytic interstitial pneumonitis, pseudolymphoma, and lymphomatoid granulomatosis. These disorders are generally not accompanied by lymph node enlargement. Lymph nodes (e.g., in the mediastinum and hilum) are involved in lymphadenitis, giant lymph node hyperplasia, and a new and unclearly defined entity called angioimmunoblastic lymphadenopathy. An awareness of the distinction between these reactive disorders and lymphoma is important because the radiologic appearances may be similar. Histologic diagnosis is essential before treatment is initiated. With the exception of angioimmunoblastic lymphadenopathy and possibly of lymphadenitis, involvement of the pulmonary parenchyma associated with radiologic evidence of lymph node enlargement militates against the presence of any of these nonmalignant disorders.


Radiographic appearance of the chest after pleural space reduction procedures: construction of a pleural tent and phrenoplasty. Construction of a pleural tent and phrenoplasty are surgical procedures performed to reduce intrapleural dead space after partial lung resection. Both alter the radiographic appearance of the chest and may cause erroneous diagnosis including pneumothorax, subphrenic disease, subpulmonic effusion, diagphragmatic hernia, or diaphragmatic eventration. Radiologists should be aware of the potentially misleading appearance that these surgical procedures may present.


Transpleural abdominal systemic artery-pulmonary artery anastomosis in patients with chronic pulmonary infection. Systemic-pulmonary artery anastomoses commonly occur in lung diseases characterized by inflammation and decreased pulmonary artery perfusion. Three cases are reported in which anastomotic branches arose within the abdomen and crossed the pleural space. Arteriography differentiated acquired abdominal systemic artery supply from that seen in sequestration. In each case an inferior phrenic artery was involved, and a tangle of anastomotic branches was present at the pleural surface. Intensive medical therapy prior to lobectomy may be indicated in such patients.


Transhepatic obliteration of gastroesophageal varices: results in acute and nonacute bleeders. Seventy-three patients with hepatic cirrhosis and bleeding gastroesophageal varices underwent transhepatic portal vein catheterization and variceal obliteration. Gastroesophageal varices were successfully obliterated in 32 patients actively bleeding and in 35 patients with stabilized bleeding gastroesophageal varices. The remaining six were technical failures. Follow-up examinations in 10 patients from 1 month to 3 years later showed persistent obliteration of embolized veins. Recurrence of variceal bleeding occurred in nine patients. This method should be considered as a palliative, effective adjuvant to the medical treatment of patients with bleeding gastroesophageal varices.


Arteriography in the evaluation of pancreatic pseudocysts. A policy of limiting preoperative diagnostic imaging of pancreatic pseudocysts to barium studies, sonography, or computed tomography will result in failure to detect frequently associated lesions which may only be appreciated by arteriography and which radically alter both the prognosis and surgical approach. These associated lesions include: (1) pseudoaneurysms, probably the most common cause of major gastrointestinal hemorrhage in pseudocyst patients; (2) pancreatic carcinoma, a possible etiologic factor leading to formation of the pseudocyst; (3) benign or malignant cystadenomas which mimic pseudocysts clinically but can be usually identified arteriographically by prominant neovascularity; and (4) splenic vein obstruction which can produce extrahepatic portal hypertension and necessitate splenectomy. In our experience, these complicating lesions are relatively common. Their preoperative detection is desirable and is best accomplished by arteriography. For this reason, arteriography should be routinely performed in patients suspected of pancreatic pseudocyst.


Emergency embolization in blunt hepatic trauma. The right hepatic artery in a patient with traumatic liver tear was embolized with Gelfoam to stop an otherwise uncontrollable hemorrhage. The procedure was probably life saving in this patient. Transient elevated transaminase and bilirubin levels returned to normal 3 weeks after embolization. A repeat hepatic arteriogram 4 months after embolization demonstrated good revascularization of the right hepatic lobe from the left hepatic, left gastric, and gastroduodenal arteries. This case demonstrates the therapeutic value and safety of selective hepatic arterial branch embolization in massive life-threatening hemorrhage.


Selective hepatic artery embolization to control massive hepatic hemorrhage after trauma. Two patients who sustained liver trauma with intrahepatic and intraperitoneal hemorrhage are reported. Selective and subselective arteriography identified the hemorrhagic artery in each case. Transcatheter therapeutic embolization successfully stopped the hemorrhage acutely in one patient and produced almost complete cessation of hemorrhage in the other patient. No further blood replacement was required after the emoblization procedures. Liver function tests were abnormal prior to embolization and gradually improved afterward. Neither patient required surgery, and both were discharged from the hospital. Each patient has remained free of symptoms for 5 and 4 months, respectively. Arteriography offers accurate diagnostic information and therapeutic potential in patients who experience hemorrhage following trauma. In addition, therapeutic embolization may offer decreased morbidity and reduced hospital stay. Successful results of therapeutic embolization depend on awareness of its usefulness and upon rapid mobilization of angiographic and support personnel.


Right and left ventricular volumes and wall measurements: determination by computed tomography in arrested canine hearts. Computed tomographic (CT) images of in vitro hearts filled with iodinated contrast medium have delineated right and left ventricular cavities, papillary muscles, major trabeculae, pulmonary artery, and the aorta. Because of relatively good structural definition, this study was undertaken to determine the potential use of CT in the measurement of cardiac dimensions and cavity volumes. Ten isolated arrested canine hearts were filled with an iodinated oil-paraffin mixture and scanned transversely from base to apex. Measurements of the thickness of the interventricular septum and of the left ventricular posterior wall (indexes of cardiac hypertrophy) had a high degree of correlation to similar measurements of corresponding heart specimens. Using serial tomographic images, the cavity volumes of individual tomographic scans were totaled. The volume of each scan of given thickness was obtained either by the use of planimetry or from a numerical computer printout. Both the planimetric and computer methods gave right and left ventricular volumes which correlated well (P less than .05) with the volumes of paraffin casts. Unlike other techniques widely used for ventricular volume measurement, the method described does not depend on an assumption that the chamber resembles a specific geometric model. This method of volume measurement is applicable to both the left ventricle, regardless of its shape, and to the concave irregularly shaped right ventricle.


Utilization, reliability, and cost effectiveness of cranial computed tomography in evaluating pseudotumor cerebri. Cranial computed tomography (CT) has reduced the frequency of cerebral angiography from 95% to 32% and pneumoencephalography from 71% to 11% in patients with pseudotumor cerebri. Total hospital stay has been significantly reduced from a mean of 19.6 to 13.3 days and the hospital days required for diagnosis from a mean of 5.8 to 3.4. The diagnostic reliability of CT in pseudotumor cerebri was estimated using Bayes's decision theorem. The combination of CT and radionuclide brain scans provide diagnostic accuracy similar to radiologic contrast studies. The diagnosis of pseudotumor cerebri can be adequately established without cerebral angiography and air studies. CT has significantly reduced the morbidity, time, and cost of diagnostic evaluation in these patients.


On the nature and significance of bony proliferation in "rheumatoid variant" disorders. Radiographic and pathologic abnormalities of the peripheral joints in a cadaver with ankylosing spondylitis are described. Bony proliferation about involved articulations is is characteristic of all "rheumatoid variant" disorders and results from subchondral bony hyperplasia and periosteal new bone formation. Such proliferation may be related to the presence of the histocompatibility antigen B27 in these diseases.


The metal-cement interface in total hip prostheses. Serial radiographs of 101 total hip arthroplasties were reviewed to evaluate the clinical significance of lucent zones at the femoral metal-cement interface. Such lucent zones were identified in 19 hip prostheses, but only in four was there clinical evidence of infection loosening of the prosthesis. The remaining 14 patients (15 prostheses) were followed for periods ranging from 18 months to 5 years; none had complications despite the development of these lucent zones. Microdensitometry confirmed the existence of a true lucent zone in most cases, but in several the apparent lucency was due to the Mach effect. While progressive widening of the lucent zone or a lucency measuring greater than 2 mm in width should prompt careful clinical evaluation for evidence of infection or loosening, our data indicate that such complications need not necessarily be present.


Arthrography in the diagnosis of unexplained chronic hip pain with regional osteopenia. Three cases of chronic hip pain with radiographic periarticular osteopenia and normal joint spaces are reported. The articular nature of symptomatology, periarticular demineralization, and radionuclide localization suggested intraarticular disease. Computed tomography did not disclose the cause of hip pain when utilized in two instances. Positive contrast hip arthrography was the only diagnostic modality which demonstrated the chondromatosis or adhesive capsulitis responsible for pain. Differential diagnosis and pathophysiologic mechanisms are briefly reviewed.


Backward "displacement" of the spinolaminal line at C2: a normal variation. The base of the spinous process of C2 may be "displaced" backward in relation to the other vertebrae in some adult patients examined for reasons other than trauma. In 10.2% of normal children, it was 2-3 mm behind a line joining the base of the spinous process of C3 and the inner side of the posterior arch of the atlas. By recognition of this normal variant, an erroneous diagnosis of subluxation is avoided.


Erosion of the inferior aspect of the clavicle in secondary hyperparathyroidism. Erosion of the inferior aspect of the outer third of the clavicle has been found on chest films in 19 out of 100 randomly selected azotemic patients. This important manifestation of secondary hyperparathyroidism compares favorably with other sites of clavicular erosion. Its frequency and degree increase with length of time on dialysis. A review of the local anatomy and of the mechanical stresses imposed on the coracoclavicular ligament explains why anteroposterior and portable chest films are particularly well suited for early detection of these changes.


Gray scale ultrasonography in medullary cystic disease of the kidney and congenital hepatic fibrosis with tubular ectasia: new observations. The gray scale ultrasound findings of three patients with medullary cystic disease of the kidney and two patients with congenital hepatic fibrosis with tubular ectasia are reported. Medullary cystic disease of the kidney typically presents early in adulthood with renal failure and salt-losing nephropathy. The spectrum of gray scale ultrasound findings in this entity includes irregular widened central echoes when small cysts are present and well defined cystic structures when larger medullary cysts are the predominant lesion. The ultrasound findings in congenital hepatic fibrosis with tubular ectasia seem to be a characteristic combination of nephromegaly, a distorted renal echo pattern, and high level echoes in the liver. Ultrasound is a useful noninvasive method which is complementary to other methods in the identification and differential diagnosis of bilateral renal cystic disease.


Posterior widening of the S1-S2 interspace in children: a normal variant of sacral development. A lucency in the posterior S1-S2 area of the sacrum was seen in two pediatric patients. Bone scans in both and a myelogram in one case were normal. Follow-up has failed to show any clinical evidence of pathology. The lucencies are felt to represent normal variations in the development of the sacrum. A series of radiographs at different ages is presented to illustrate how normal developmental progresses in this area.


Lateral widening of epiphyseal plates in knees of children with bowed legs. Five children are described in whom genu varum was associated with widening of the lateral segment of epiphyseal growth plates at the knees. The proximal end of one tibia was involved in three cases and the distal end of one femur in two. This finding is thought to represent an epiphyseal diastasis caused by the low grade chronic stress of the bow leg deformity.


Hepatic cavernous hemangiomas and hemangioendotheliomas in infancy. Six infants with either cavernous hemangiomas or hemangioendotheliomas of the liver are described. Typical clinical features include cardiac failure, hepatomegaly, and cutaneous hamangiomas. Prompt recognition will direct management to prevent lethal complications of cardiac failure, hyperconsumptive coagulopathy, and hepatic rupture. Dynamic and static hepatic scintigraphy will demonstrate the vascularity and size of the liver mass and provide distinction from other tumors, although in certain circumstances angiography is required.


Clearance of radioactive tantalum from the human lung after accidental inhalation. Techniques of body radioactivity measurement were used to study the clearance of activated tantalum oxide accidentally inhaled by three reactor workers. The whole-body retention after 7 days was about 1% of the initial deposit. In one subject studied for a further 424 days the residual activity in the thorax was cleared with a biological half-life of about 1,400 days. The results support indications from other studies that tantalum powder administered in aerosol bronchography may be subject to prolonged alveolar retention.


Diagnosis and evaluation of retroperitoneal tumors by computed tomography. Nineteen patients with primary and recurrent retroperitoneal tumors were examined by computed tomography. Correlation between CT and subsequent operative findings was remarkably accurate. CT provided clinically useful information regarding the presence, size, extent, and composition of the tumors and also their effect on adjacent structures. CT is recommended for any patient suspected to have a primary or recurrent retroperitoneal tumor.


Detection of retroperitoneal hemorrhage by computed tomography. Retroperitoneal hemorrhage can be directly documented by computed tomography. In patients with confusing clinical findings, CT scans may provide a definite diagnoses and direct appropriate therapy. This contention is supported by seven illustrative cases.


Diagnosis of urine extravasation after renal transplantation. Urine extravasation in the early postoperative period after renal transplantation is a serious complication requiring expedient surgical intervention. Whereas clinical and laboratory findings are inconclusive, radiologic diagnostic studies have definite value. Routine ultrasound and radioisotope studies were performed on 111 renal transplant patients. In the eight who developed urine extravasation, ultrasound and/or radioisotope studies identified the extravasation in seven cases. Four of the eight were studied by intravenous pyelography and another two were studied by cystography. All results were positive. We recommend use of radioisotope and ultrasound studies for routine postoperative screening with invasive techniques reserved for inconclusive cases.


Fungal infection of the urinary tract: demonstration by antegrade pyelography and drainage by percutaneous nephrostomy. Most fungal infections of the urinary tract involve the drainage structures rather than the kidney parenchyma. They usually occur in patients with diabetes or other chronic debilitating diseases and in the presence of urinary stasis. Conglomeration of fibrillar hyphae results in fungal balls which produce nonopaque filling defects in the renal pelvis, ureter, or bladder. Such fungal ball colonies were demonstrated by percutaneous (antegrade) pyelography in the upper urinary tract in two cases. A percutaneous nephrostomy was performed in one patient to provide drainage of pus in the renal pelvis.


Radiologic spectrum of opportunistic infections of the upper gastrointestinal tract. Clinical findings and barium studies were reviewed in 34 patients with upper gastrointestinal opportunistic infections, including two with gastric involvement. The spectrum of radiologic features is presented with particular attention to early subtle findings such as disturbance of esophageal motility and tiny marginal filling defects. While most cases are due to Candida albicans, other organisms may also invade the upper gastrointestinal tract in the debilitated host.


Radiologic aspects of Beck gastric tube in esophageal reconstruction. Over a 28 month period, 19 patients underwent esophageal reconstruction using the Beck tube fashioned from the greater curvature of the stomach. Eighteen had unresectable carcinoma of the esophagus and one had a benign stricture secondary to reflux esophagitis. The degree of palliation was considered good in 13 cases. The surgical aspects of the Beck gastric tube are described and radiologic features in both uncomplicated and complicated cases are illustrated. Early experience with the procedure is encouraging.


Air in the esophagus: a frequent radiographic finding. While the radiologic literature discusses the presence of air in the esophagus on chest radiographs, this has almost always been reported as a finding associated with other radiologic abnormalities. In a retrospective study, esophageal air was noted on 36% of normal posteroanterior chest radiographs. The radiologic anatomy of the esophagus and the typical locations of air within it are discussed.


Hepatic venography and wedge hepatic vein pressure measurements in diffuse liver disease. Ninety patients with chronic diffuse liver disease were evaluated with free hepatic venography, wedge hepatic venography, hepatic vein pressure measurements, and liver biopsy. Free hepatic venograms were normal and minimally pruned in patients with hepatic sarcoidosis and fatty liver due to alcohol, and their biopsies showed little or no fibrosis. Pruning of hepatic vein branches on free hepatic venography correlated well with the corrected wedged hepatic vein pressure and with the degree of fibrosis in patients with alcoholic hepatitis, alcoholic cirrhosis, and postnecrotic cirrhosis. Free hepatic venography correlated better with hemodynamic measurements and fibrosis than did wedge hepatic venography. Free hepatic venography is a reliable predictor of the presence and degree of hepatic fibrosis and may be a useful alternative to liver biopsy in patients with clotting disorders.


Doppler ultrasonic screening prior to venography for deep venous thrombosis. A total of 244 patients were examined using both ultrasonic Doppler technique and conventional venography for deep venous thrombosis. The Doppler examination was 93.8% accurate overall in detecting the condition, with a specificity of 96% and sensitivity of 85.7%. Indications for venography after Doppler evaluation include: (1) a positive or equivocal Doppler examination; and (2) critically ill patients with negative Doppler results where absolute diagnostic accuracy is essential. Had these criteria been followed in this study, 174 normal examinations would have been avoided and only six large vein thrombi (ileofemoral or popliteal) in 244 examinations would have been misdiagnosed.


The target sign: a new radiologic sign of septic pulmonary emboli. A new radiographic sign consisting of a pulmonary density suspended in a thin-walled cystic area is described in five patients with hematogenously disseminated infection. A pathogenetic mechanism is suggested to account for this "target sign." The relationship of these findings to pulmonary pneumatoceles is also discussed.


A statistical description of the normal computerized brain scan. A total of 100 CT brain scans performed with an EMI head scanner were analyzed in order to define the statistical limits of normal. The statistical parameters are means and standard deviations. Frequency polygons of the attenuation coefficients for each of five brain slices have been constructed. The concept of the water to brain ratio is introduced.


Cerebral granulomatous angiitis: case report and literature review. Granulomatous angiitis is a pathologically distinct central nervous system segmental vasculitis of unknown etiology and pathogenesis which may be indirectly related to herpes zoster infections. The condition primarily affects adults and presents with nonspecific, unexplained progressive neurological dysfunction. The cerebrospinal fluid is often under increased pressure and contains excess protein and white cells, mostly lymphocytes. The necrotizing vasculitis primarily affects the small intracranial arteries and veins and alters vascular permeability, ind,cing cerebral edema. Angiography demonstrates segmental, diffuse, distal vascular irregularity and narrowing, while computed tomography shows poorly defined, diffuse, non-contrast-enhancing low density areas with or without mass effect. In the approprite clinical setting, the angiographic and CT findings should be highly suggestive. The possibility of efficious therapeutic intervention makes early diagnosis important. CT can also be used to monitor therapeutic response.


Angiography in vascular malformations of the face. While angiography has been established as a useful procedure in evaluating vascular malformations of the face, the role of selective catheterization has not been stressed. Five patients with either capillary-cavernous hemangiomas or arteriovenous racemose hemangiomas were selected to illustrate the angiographic features of vascular malformations of the face as well as problems in angiographic evaluation and therapeutic techniques. Angiographic studies were valuable in establishing the extent and type of hemangioma, its blood supply and drainage, and associated intraorbital or intracranial extensions. We believe that selective catheterization is essential in preoperative evaluation of facial hemoangiomas, particularly in detecting unsuspected intracranial involvement.


Metrizamide myelography.

Metrizamide myelography. Complete myelography using metrizamide and a lumbar puncture is described with special emphasis on the cervical region. Good visualization of the cervical region was obtained in 19 of 20 patients using 10-12 ml and iodine concentrations of 250 mg/ml without special techniques or precautions. Possible explanations of failure to visualize the complete subarachnoid space are discussed.


Avulsion of nerve rootlets with the Cuatico needle during Pantopaque removal after myelography. Three cases of histologically proven nerve root avulsion during Pantopaque removal with a Cuatico needle are described. While use of such multihole needles poses some risk to patients, we feel the advantages outweigh the disadvantages, particularly when a large volume of Pantopaque has to be removed. To minimize the possibility of nerve root avulsion, we recommend minimal manipulation of the needle and cannula during Pantopaque removal, use of gentle suction, termination of suction and injection of cerebrospinal fluid if pain occurs, and slow withdrawal of the cannula and stylet.


Extramedullary hematopoiesis in Paget's disease of bone. Two cases of Paget's disease of bone with radiographic manifestation of extramedullary hematopoiesis are described. While extramedullary hematopoiesis usually occurs as compensatory phenomenon in response to anemia, this was not the case in our patients. We believe pathologic fractures led to extrusion of hematopoietic marrow and resultant tumorous extramedullary hematopoiesis.


Scanning multiple slit assembly: a practical and efficient device to reduce scatter. A scanning multiple slit assembly consisting of an array of long narrow beam-defining slits coupled with scatter-eliminating slots beneath the patient is a feasible, practical, and efficient method of reducing scatter and increasing contrast and image quality in diagnostic radiology. Measurements of the ratio of scattered-to-primary radiation transmitted by a scanning multiple slit assembly and a conventional high ratio grid under similar conditions showed the relative intensity of scatter transmitted by the slit assembly to be only one-third that of the grid. A noticeable improvement in contrast was obtained using the slit assembly, without increase in patient exposure. The design, construction, and clinical implications of such a scatter-eliminating technique are discussed.


Special lecture: the breast cancer screening controversy: a perspective. Analysis of the data of the Health Insurance Plan of New York Breast Cancer Screening Study indicates that in patients whose cancers were found by screening, the case fatality rate at all ages is almost half the case fatality rate of controls. The data also strongly suggest that maximal benefit in young women resides in the detection of in situ cancers. Due to relatively low yield of these early lesions, projected 20 year survival in that study may be little different for all women screened compared to controls. We have shown that the yield of these early lesions can be increased by aggressive screening and liberal use of biopsy. Furthermore, where J.C. Bailar has indicated a net gain (or loss) of -4 to +8 lives per 20,000 women using the HIP data, using his method and our data we find a savings of 25-27 lives/20,000 women by 3 year screening to date. These are lives that have been saved by mammography alone.


Acute cholecystitis: 137 patients studied by infusion tomography of the gallbladder. Clinical experience with inflammatory cholecystopathy recognized in 137 patients studied by infusion tomography of the gallbladder is presented. Diagnostic accuracy was 96% in positive and 94% in negative histologically proven cases. Our results show that infusion tomography of the gallbladder is an accurate, rapid, and safe diagnostic aid in the evaluation of acute cholecystitis. In cases of chronic cholecystitis, infusion tomography may be confirmatory but should not be relied on as a final diagnostic test due to a high percentage of false negative cases.


Infusion tomography of the gallbladder: mechanism of gallbladder wall opacification in experimental acute cholecystitis. A canine model of acute cholecystitis was used to determine the mechanism of opacification of the gallbladder wall by infusion tomography. The experimental data indicate that opacification of the thickened wall of the gallbladder in acute cholecystitis is a function of hypervascularity and transport of the radiopaque material across the capillary wall by polymorphonuclear cells. Tissue-fluid equilibration of the contrast agent may also play a role.


Gray scale ultrasonography of calcified liver metastases. Three cases of calcified liver metastases demonstrating acoustical shadowing on gray scale ultrasonography are reported. Ultrasonography may show calcified liver masses that are not readily apparent on plain film radiographs. The discovery of calcified liver metastases by ultrasound can suggest a primary site of malignancy.


Intraluminal diverticulum of the esophagus. Two patients with intraluminal esophageal diverticulum are described and illustrated. Both had chronic esophagitis. One had a distal esophageal stricture, while the other showed persistent retrograde gastroesophageal reflux following hiatal hernia repair. Possible causes are considered, based on the presumption of intermittently or chronically increased intraluminal pressure associated with an area of congenital or acquired weakness of the esophageal wall.


Primary ulcerative carcinoma of the esophagus. Six patients with primary ulcerative carcinoma of the esophagus are described. The radiologic appearance is analogous to the Carman-Kirklin complex seen with gastric malignancies. The clinical course of this uncommon type of esophageal carcinoma is the same as the more common constricting and polypoid varieties.


Pneumatosis intestinalis as a complication of jejunoileal bypass. Four patients with pneumatosis intestinalis involving the unbypassed functioning bowel after jejunoileal bypass for obesity are reported. Previous publications of pneumatosis intestinalis after jejunoileal bypass discussed involvement only of the bypassed defunctionalized bowel. Symptomatology can range from mild to severe. The treatment of pneumatosis intestinalis is conservative. The specific etiology of the pneumatosis in this group of patients is not known.


Radiologic spectrum of melanoma metastatic to the gastrointestinal tract. Radiologic experience in 67 patients with melanoma metastatic to all portions of the gastrointestinal tract is reviewed. Besides the well known "bull's-eye" lesion of the upper gastrointestinal tract, a large variety of radiologic presentations of melanoma metastases is discussed and illustrated. Because of extended survival due to improved chemotherapy and immunotherapy, the importance of careful radiologic examination of the melanoma patient is stressed.


Cavitating metastases of the small intestine. Ten patients with small intestinal excavating metastatic lesions are described. Cavitation of a mass is a generally unrecognized appearance of metastatic disease to the small intestine and should be considered in the differential diagnosis of small bowel excavation.


The use of prone films for suspected bowel obstruction in infants and children. Prone frontal and cross-table lateral views of the abdomen are recommended as most helpful in radiographic evaluation of infants and children suspected of having obstructive of nonobstructive ileus. A series of films in multiple projections is recommended to evaluate the gas in the large bowel, particularly the rectum. When studies must be limited, prone and left lateral decubitus views are recommended. In obstructive ileus, the collapsed rectum contains little or no air. Utilization of the prone view will often obviate the use of fluoroscopic contrast studies. The level of obstruction, as well as the cause, can often be determined by this plain film approach. Six cases are presented to illustrate these points.


Imperforate vagina with vaginourethral communication. Six female children are described with an unusual congenital anomaly characterized by imperforate vagina with otherwise normal external genitalia as well as communication between the proximal patent vagina and a normal female urethra. This abnormality was associated with hydrometrocolpos at birth in two patients. The anomaly may embryologically be related to the primitive urogenital sinus.


Hypothyroidism in cystinosis.

Hypothyroidism in cystinosis. It has recently been shown that hypothyroidism complicates cystinosis. The radiographic bone changes of hypothyroidism (retarded skeletal age) cannot be detected while the patient has overt rickets, since the secondary ossification centers are not ossified. When the rickets is treated and the secondary ossification centers fail to appear (the skeletal age remains retarded), then the diagnosis of hypothyroidism should be suspected. After treatment with thyroid hormone is begun and a growth spurt occurs, rickets that has been controlled may reactivate. The previous doses of vitamin D will no longer be adequate because of the patient's growth spurt.


The trichorhinophalangeal syndrome: study of 16 patients in one family. The trichorhinophalangeal syndrome has recognizable clinical and radiographic features. In most patients, hand radiographs show typical cone-shaped epiphyses which affect predominantly the middle phalanges. Pattern profile analysis may help establish the diagnosis in the absence of typical clinical features of radiographic hand changes. The evolution of hip disease in young and older patients is illustrated and differs from what has been reported previously. Chest and spinal abnormalities, though not well known, are also features of this syndrome.


Pediatric lymphography: performance, interpretation, and accuracy in 193 consecutive children. Experience with 193 children 15 years of age or less who were referred for pedal lymphography over the past 11 1/2 years was reviewed. Successful bilateral lymphatic cannulation was obtained in 94% of cases; in only 2% was the study a bilateral failure. No significant complications or permanent sequelae were encountered. Lymphographic-histologic correlation in 94 children yielded an overall accuracy rate of 95% (specificity, 99%; sensitivity, 80%). Interpretative aspects were similar to that in adults; however, the frequent presence of reactive hyperplasia in childhood was noted. These results suggest that lymphography can be successfully and safely performed in children and that its diagnostic accuracy is at least as high as in adults.


Involvement of an aberrant right subclavian artery in dissection of the thoracic aorta: diagnostic and therapeutic implications. There have been few reports of an aberrant right subclavian artery in patients with aortic dissection. The diagnostic and therapeutic implications of the association of these two abnormalities are important and potentially ominous. Two patients with extensive type III dissections of the thoracic and abdominal aorta are described. In one patient, extension of the dissection into the aberrant right subclavian artery led to eventual exsanguination into the esophagus. In the second patient, cross-clamping of the abdominal aorta proximal to the left subclavian artery at surgery resulted in complete cutoff of blood supply to both vertebral arteries and the patient's subsequent demise.


Radiographic isolation of the inferior vena cava. On the lateral chest radiograph, the posterior wall of the inferior vena cava is an almost constant structure in the posterior cardiophrenic angle. Recently the anterior as well as the posterior walls of the vein have been noted in several patients. The "isolation" of the inferior vena cava, creating a linear density on the lateral chest radiograph, is a normal variant and should not be mistaken for chest pathology.


Extaarticular manifestations of septic arthritis of the glenohumeral joint. Five patients with septic arthritis involving the glenohumeral joint are described. Although initial plain films were normal in all six involved joints, abnormalities were frequent on subsequent examinations, including demineralization (five joints), joint space narrowing (three joints), superior subluxation of the humeral head (three joints), osseous erosion (two joints), and inferior subluxation of the humeral head (one joint). Arthrography was helpful in documenting intraarticular placement of the needle for aspiration, synovial abnormalities, and extraarticular extension of disease. Particularly noteworthy was the occurrence of rotator cuff tears in four of six shoulders, suggesting a possible relationship between joint infection and disruption of the rotator cuff.


Metastatic disease to the breast: clinical, pathologic, and radiographic features. Metastatic lesions to the breast are unusual. We add 21 cases to the previously reported 131 clinical cases. The most common sources are malignant melanomas and the lymphoma/leukemia group. Metastatic lesions to the breast tend to be painless discrete lumps that are generally small at the time of discovery. They usually occur in the upper outer quadrant and are commonly associated with axillary adenopathy. Occasionally, they are the initial manifestation of an occult extramammary primary cancer. Prognosis is poor but appears slightly improved since availability of more refined chemo- and immunotherapeutic regimens. The clinical, pathologic, and radiographic features of this problem are described.


Laryngeal tuberculosis.

Laryngeal tuberculosis. Laryngeal lesions observed in patients with pulmonary tuberculosis are most likely tuberculous. Although tuberculosis and carcinoma may be indistinguishable clinically and radiographically, specific radiographic studies better delineate the lesion and may suggest its true etiology. Five cases of laryngeal tuberculosis referred to M.D. Anderson Hospital and Tumor Institute as carcinoma of the larynx are described and illustrated. In the acute exudative type, inflammatory disease was suspected, but in the chronic localized lesion, carcinoma was the primary consideration. The histologic diagnosis was established by biopsy.


Computed tomography of intracerebral hematomas. I. Transmission CT observations on hematoma resolution. Changes in the size and density of intracerebral hematomas were investigated by analyzing the sequential CT studies of 40 patients. Intracerebral hematomas decrease in density by an average of 0.7 EMI units per day. The dense portion of the hematoma decreases in size by an average of 0.65 mm per day. Mass effect does not decrease in proportion to the decrease in size of the dense portion of the hematoma but is delayed. The only instances of increasing mass effect occurred in patients undergoing surgical evacuation of the hematoma and in those who sustained trauma. Posthematoma residua include decreased parenchymal density, focal atrophy, and ventricular enlargement.