[The influence of rifampicin upon the metabolism of isoniazid (author's transl)]. The authors sought to determine whether the combination of rifampicin and isoniazid altered the rate of acetylation of the latter drug by possible hepatic involvement. INH inactivation and transaminase levels were studied in 36 patients with tuberculosis, before and after 30 days of treatment with a combination of INH in a dose of 5 to 7 mg/kg/day and rifampicin in a dose of 600 mg/day. The results failed to confirm such a hypothesis since, whatever the phenotype of inactivation, no significant difference was seen between residual INH levels at 3 and 6 hours, before and after treatment, nor any significant increase in transaminases.


[The duodenum : a psychosomatic organ? (author's transl)]. A pressure-captor tube was inserted into the duodenum close to the ampulla of Vater in 15 surgical patients. The authors present a selection of 12 pressure curves under different circumstances : sleep, awake, meal, psychological agression, physical agression, pharmacological agression. The curves indicate that the duodenum reflects a psychosomatic structure in terms of its motricity, which could explain various aspects of gastric or biliary pathology.


[Leydig cell tumours of the testis. Two cases presenting opposing sexual features : gynaecomastia, precocious virilisation, and revealed by study in vitro of aromatisation activity]. Two Leydig cell tumours presented with changes in sexual characteristics. The first patient was a child with precocious puberty whilst the second was that of an adult with recurrent gynaecomastia. Histochemical examination in vitro of tumour tissue from the second patient made it possible to explain the synthesis of oestrogens by a primary tissue destined to an essentially androgenic activity.


[Pleuro-pulmonary infections : importance of anaerobic bacteria and therapeutic consequences (author's transl)]. A prospective study of bacteriology and therapeutic outcome in 14 cases of pleuro-pulmonary infections is reported. Bacteriologic results are based on transtracheal aspirates and empyema fluid. Appropriate anaerobic bacteriologic methods were employed. Anaerobic bacteria were recovered from 11 patients, and were the only pathogens isolated in 6 patients. Patients were treated by penicillin G. This was judged satisfactory in all cases, although 1 patient died from pneumococcal septicemia few hours after his admission to the hospital. The results indicate that with reliable specimen (pleural fluidand transtracheal aspirates) and optimal anaerobic culture methods, bacteriologic diagnosis can be established. Since anaerobes play a key role in most cases of pleuro-pulmonary infections, penicillin G is the prefered initial drug.


[Cerebral ischemia, treatment by vascular micro surgical technique: intra-extra cranial anastomosis (author's transl)]. The introduction of vascular micro-surgical techniques has allowed to treat cerebral ischemia, through extra-intra-cranial anastomosis, when the causative arterial lesions have a surgically unfavorable location. Thirty patients underwent brain revascularization through extra-intra-cranial micro-anastomosis between the superficial temporal artery (branch of the external carotid artery) and a cortical branch of the middle cerebral artery. Twenty five patients had definite sensitive and motor deficits. Five patients, on the other hand, underwent preventive surgery because of transient cerebral ischemia. In our series, the global rate of the microanastomosis patency is 78%. When the anastomosis is patent, 85% of the cases with motor deficits are cured or improved. The results are even more favorable in case of transient cerebral ischemia, for the anastomosis in such cases was always patent. None of these later patients had ischemia attacks with a one-year follow-up.


[Perhexilline maleate: relationship between side-effects, plasma concentrations and rate of metabolism (author's transl)]. In three individuals (2 male and 1 female) with severe side-effects apparently related to the regular ingestion for a period of at least 5 months of perhexiline maleate, the authors studied the rate of fall in plasma levels of the drug, of its monohydroxylated metabolite, blood transaminase and glucose levels following the interruption of therapy. The relationship between these data would indicate two hypotheses which could be tested during future studies: the manner in which the body metabolises the drug would appear to vary in relation to plasma concentration and/or hepatic involvement.


[The radiological exploration of renal tumour syndromes [author's transl)]. Four radiological examinations are available to the clinician for the diagnosis of renal tumour syndromes: intravenous pyelography with vascular nephrotomography is used to make an initial classification. Hypervascularised masses, usually malignant, remain the indication of choice for renal arteriography. Apparently avascular or doubtful masses should first be studied by ultrasound echotomography which offers the possibility of a second classification into fluid-filled tumours, the cystic nature of which may be confirmed by translumbar puncture followed by kystography, and solid or doubtful tumours, suggestive above all of a necrosed carcinoma. In this latter case, the indications for renal arteriography with the use of angiotensin, translumbar puncture or immediate exploratory lumbotomy must be decided in the light of individual cases and local preferences.


[External drainage of the common bile duct. A new transcystic drain (author's transl)]. The authors present a new transcystic drain which offers the possibility of per-operative cholangiograms of excellent quality and provides an highly satisfactory means of external drainage of the common bile duct.


[The MB Iso-enzyme of creatine phosphokinase in myocardial infarction (author's transl)]. CPK and its MB iso-enzymatic fraction were measured in 240 patients, 180 of whom suffered from myocardial infarction. MB iso-enzyme was expressed as a percentage of total CPK and a minimum figure of 4 per cent of MB isoenzyme was taken as indicative of a diagnosis of myocardial infarction. In the 180 patients with an infarction, the average MB level as a percentage of total CPK was 12.1 +/- 5.4 per cent. Five patients with a proven infarct had an MB iso-enzyme level of less than 4 per cent. Amongst the 60 patients without a myocardial infarction who were included in view of a pathological level of CPK, the average maximum level of MB was 1 +/- 2.5 per cent. Five of these 60 patients (false positives: 8.3%) had an MB iso-enzyme level of greater than 4 per cent. It is concluded that the estimation of MB iso-enzyme of CPK using a chromatographic technic is a highly valuable laboratory method for confirming or eliminating a diagnosis of myocardial infarction in the numerous clinical circumstances when such a diagnosis is difficult or even impossible on the basis of standard data.


[Scintigraphic appearance and particular arteriographic aspects intrahepatic cholestasis]. Based on one case history, it is reviewed here that prolonged cases of obstructive jaundice can take on deceiving appearences, and all the more so when they fall within the framework of a "biological gap". Extensive distension of the extra and intrahepatic bile ducts are at the basis of images with multiple, radiating hilar gaps on scintigraphy, and of "chicken nests" and "Swiss cheese" at hepatographic times in selective hepatic arteriography. These rather uncommon images should lead to a diagnosis of a surgical cholestatic liver.


DNA-binding nonhistone proteins: DNA site reassociation. The DNA-binding nonhistone proteins (NHP) have been demonstrated to fractionate the rat genome into protein-bound and unbound DNA sequences. Twenty percent of highly sheared rat DNA [approximately 350 base pair (bp)] can be retained on membrane filters as protein complexes. When extracted from the filter and retitrated with the NHP, a 4- to 5-fold enrichment of binding sites is present in the bound DNA with few, if any, sites detected in the unbound DNA. Rat DNA restricted by EcoRI endonuclease can be fractionated by its DNA-binding NHP retention characteristics. Reassociation kinetics of the bound restricted sequences indicate that 45.6% is a subset of total single-copy sequence of the rat genome an 26.9% is repetitive sequences. Cross hybridization studies indicate the repetitive sequences of the bound DNA are not enriched as much as the slow component of the rat genome. Thus a 4-fold enrichment of a subset of the rat genome has been observed via NHP-DNA interactions.


Synthesis of histone messenger RNAs by RNA polymerase II in nuclei from S phase HeLa S3 cells. Nuclei were isolated from synchronized HeLa S3 cells and transcribed utilizing their endogenous RNA polymerases. Our data suggest that S phase nuclei are capable of synthesizing histone mRNA sequences while nuclei from G1 phase cells are not. Transcription of histone mRNA sequences by S phase nuclei can be abolished completely by low levels of alpha-amanitin (1.0 microgram/ml, a concentration which completely inhibits RNA polymerase II). From these results it appears that transcription of the histone mRNA sequences occurs during the S phase but not during the G1 phase of the cell cycle and that RNA polymerase II is responsible for histone gene readout.


Light scattering measurements supporting helical structures for chromatin in solution. Laser light scattering measurements have been made on a series of polynucleosomes containing from 50 to 150 nucleosomes. Radii of gyration have been determined as a function of polynucleosome length for different ionic strength solutions. The results suggest that at low ionic strength the chromatin adopts a loosely helical structure rather than a random coil. The helix becomes more regular on increasing the ionic strength, the dimension resembling those proposed by Finch and Klug for their solenoid model.


Calorimetric studies on viroids.

Calorimetric studies on viroids. Thermodynamic studies on highly purified viroid preparations were carried out with the help of a very sensitive adiabatic microcalorimeter. Parallel to the change of UV-absorption at 260 nm as a function of temperature, the additional heat capacity of the dilute viroid solution rises sharply within the melting interval, reaches a maximum at T = Tm and declines to a baseline again when the temperature is increased further. From the peak area the molar transition enthalpy can be calculated. The transition enthalpies of citrus exocortis viroid and cucumber pale fruit viroid are 4200 kJ/mol and 3930 kJ/mol, respectively. The calorimetric results are compared to the results obtained from melting studies using UV-absorption.


Common structural features of different viroids: serial arrangement of double helical sections and internal loops. The thermodynamic parameters of five different highly purified viroid "species" were determined by applying UV-absorption melting analysis and temperature jump methods. Their thermal denaturation proved to be a highly cooperative process with midpoint-temperatures (Tm) between 48.5 and 51 degrees C in 0.01 M sodium cacodylate, 1 mM EDTA, pH 6.8. The values of the apparent reaction enthalpies of the different viroid species range between 3,140 and 3,770 kJ/mol. Although the cooperativity is as high as found in homogeneous RNA double helices the Tm-value of viroid melting is more than 30 degrees C lower than in the homogeneous RNA. In order to explain this deviation, melting curves were simulated for different models of the secondary structure of viroids using literature values of the thermodynamic parameters of nucleic acids. Our calculations show that the following refinement of our earlier model is in complete accordance with the experimental data: In their native conformation viroids exist as an extended rodlike structure characterized by a series of double helical sections and internal loops. In the different viroid species 250-300 nucleotides out of total 350 nucleotides are needed to interprete the thermodynamic behaviour.


The concept of mRNA abundance classes: a critical reevaluation. Derivative plots have been constructed for hybridization reactions between polysomal poly(A)-containing RNA and oligo(dT)-primed cDNA. In one method the derivative was calculated directly from the data, and in the other, from a non-linear least squares fit using 9-10 ideal components. In some cases these methods yield very similar results and strongly suggest that the hybridization data support discrete components. Reactions with two and four major components indicate that the often-reported three abundance class model is only one of several possibilities for eukaryotic cells. In other situations neither method strongly suggests the presence of discrete components (in one case even after enrichment of the cDNA population by kinetic fractionation), implying that the components are closely spaced or that the entire mRNA population of those cells may not exist as discrete abundance classes. The universal occurrence of discrete abundance classes should be critically reexamined.


Theoretical calculations of base-base interactions in nucleic acids: I. Stacking interactions in free bases. Stacking interactions in free bases were computed on the basis of molecular association. The results of the calculations were compared with the stacking patterns observed in a few single crystals of nucleic acid components as examples. The following are the conclusions: (i) there can be two types of stacking pattern classified as normal and inverted types for any two interacting bases and both can be energetically favourable (ii) in both the types the stacking interaction is a combined effect of the overlap of the interacting bases and relative positions and orientations of the atomic centres of the two bases (iii) crystal symmetry and H-bonding interaction may influence stacking patterns.


Theoretical calculations of base-base interactions in nucleic acids: II. Stacking interactions in polynucleotides. Base-base interactions were computed for single- and double stranded poly,ucleotides, for all possible base sequences. In each case, both right and left stacking arrangements are energetically possible. The preference of one over the other depends upon the base-sequence and the orientation of the bases with respect to helix-axis. Inverted stacking arrangement is also energetically possible for both single- and double-stranded polynucleotides. Finally, interacting energies of a regular duplex and the alternative structures were compared. It was found that the type II model is energetically more favourable than the rest.


[Scintigraphic and experimental studies with 67Ga in 142 patients with bronchial cancer (author's transl)]. In 142 patients with untreated bronchial carcinoma positive 67Ga scintigrams were obtained in 132 cases (93%). 6 of 10 scintigraphically not detected tumors had diameters less than 2 cm, 4 carcinomas presumably consisted of necrotic tumor masses. There was no dependence of 67Ga accumulation on the histomorphological type of tumor. Differentiated and undifferentiated carcinomas showed a comparably high 67Ga uptake. These scintigraphic findings were confirmed by measuring the quantitative 67Ga concentration in 132 tissue samples of various tumors. In addition these studies revealed an absent or decreased 67Ga accumulation in more or less necrotic tumor masses. The positive tumor scintigraphy with 67Ga-citrate as a non-invasive method is suitable for detecting untreated bronchial carcinomas, especially those localized in the hilar or mediastinal region, which cannot be visualized roentgenologically as well as for indicating the effectiveness of radio- or chemotherapy. 67Ga scanning is also useful in establishing the reappearance of viable tumor tissue in follow-up studies of tumor diseases. The use of 67Ga as a tumor-seeking scanning agent is limited because of its lack of tumor specifity and of its inability to detect tumors smaller than 2 cm in diameter.


[Chemical form of the radioactive excretion products after intravenous application of 125I-orthoiodohippurate to rats (author's transl)]. 100 muCi 125I-Orthoiodohippurate were injected i. v. to 2 Wistar rats. Urine and faeces were analysed by means of thin-layer chromatography and high-pressure liquid chromatography. The combined metabolic balance resulted in the following findings: Rat 1: 15% 125I-Orthoiodobenzoic acid, 66% 125I-Orthoiodohippuric acid and 12,5% 125I-iodide. Rat 2: 18,5% 125I-Orthoiodobenzoic acid, 67,5% 125I-Orthoiodohippuric acid and 10,2% 125I-iodide.


[Electronic data processing of liver scintigrams in chronic hepatitis (author's transl)]. Following administration of 150 muCi of colloidal 198Au numerical scintigrams of the liver and the spleen were obtained in about 200 patients with various forms of chronic hepatitis or with liver cirrhosis as well as in 24 control persons. The data so obtained were electronically processed and the relative activities of the liver, the spleen and both liver lobes compared. Differences of diagnostic value were observed between the various stages of chronic hepatitis.


[A comparative radioisotope study of calcium metabolism in bone and teeth of rats (author's transl)]. Investigations with bone-seeking radionuclides (47Ca, 99mTc-PP, 113Sn) in rats of different age demonstrated a true accumulation in teeth as compared to bone. Blood flow was evaluated by 99mTcO4 and 51Cr-Albumin. Differences of accumulation depended on the isotopes used and on the age of the animals.


Production of lyophilized albumin macroaggregates and labelling with 99mTc. Optimal conditions of HSA aggregation in acetate buffer (pH = 4.6) were investigated. With the aim of obtaining a higher percentage of fixation in the lungs, the aggregates were rinsed three times with acetate buffer. A MAA suspension was lyophilized with SnCl22H2O (10 microgram/ml) solution. The lyophilized MAA was then labelled by adding pertechnetate of the desired activity in a volume of up to 5 ml. The radiochemical purity of 99mTc-MAA, greater than 95%, was determined by the methods of thin layer chromatography and low-voltage electrophoresis. All MAAs were uniform in shape whereas the size varied between 20 and 100 micrometer. Biodistribution studies have shown the maximum radioactivity to be deposited in the animals' lungs immediately after application of 99mTc-MAA.


Upper gastrointestinal endoscopy- a survey of patients' impressions. One hundred and forty patients were followed-up within one year of upper gastrointestinal endoscopy. The incidence of disease, complications and influence of findings on treatment are outlined.


Upper gastro-intestinal endoscopy and radiology in the elderly. The results of oesophago-gastro-duodenoscopy (OGD) and radiology in one hundred consecutive elderly patients were reviewed to assess the efficacy, safety and acceptability of endoscopy in this age group. False positive radiological features occurred in two of nine patients with normal endoscopic examinations. The remaining ninety-one patients had 138 lesions, sixty-four of which were diagnosed by both techniques. Endoscopy missed fourteen lesions partly because of unsuccessful intubation (one patient) or incomplete examinations due to obstructive lesions (eight patients). Radiology misdiagnosed or did not demonstrate sixty-one lesions. OGD proved to be safe and relatively well tolerated; it was invaluable at confirming or refuting the diagnosis of malignancy, at detecting multiple pathology and identifying bleeding lesions, but it gave inferior results with hiatus herniae. Thus it can usefully be undertaken in the elderly as a complementary examination to radiology.


Advanced carcinoma of the prostate- does the pre-treatment Leydig cell function determine the response to orchidectomy? In a study of twenty patients there was no support for the hypothesis that the response to orchidectomy of patients with advanced prostatic cancer depends on pre-operative Leydig cell function. The only significant prognostic factor was the histological grade of the primary tumour.


Splenic cysts: a report of six cases and a brief review. Six cases of splenic cysts, removed surgically in the Royal Free Hospital during the last 10 years, are presented. These include a hydatid cyst, two primary, epithelium lined, and three secondary, non-epithelium lined cysts. The histology, aetiology, symptomatology, diagnosis, treatment and complications of splenic cysts are discussed.


Auto-immune neutropenia in an infant.

Auto-immune neutropenia in an infant. A case of neutropenia in an infant is described, associated with repeated minor infections which responded to treatment with antibiotics. A granulocyte agglutinin was detected in the serum. Following treatment with prednisolone the neutropenia remitted, the antibody disappeared and the infections ceased. Treatment was discontinued after three months and the child remained well five months later. Reports of similar cases are reviewed and the significance of the antibody discussed.


Pituitary coma with continuing menstruation. A case of pituitary coma with continuing menstruation is presented. This association is extremely rare, but a history of recent menstrual periods does not exclude advanced hypopituitarism from the differential diagnosis of severe hyponatraemia.


Normal alkaline phosphatase in primary biliary cirrhosis. A patient with primary biliary cirrhosis is described. Throughout her illness the serum alkaline phosphatase remained normal and this unique feature emphasizes the importance of histology in diagnosing the disease.


Gastro-colic fistula secondary to benign gastric ulceration. An 80-year-old woman developed osteoarthritis of the knees as a complication of her obesity. Indomethacin treatment precipitated gastric ulceration, which led to the formation of a gastro-colic fistula.


Analgesic nephropathy and transitional cell carcinoma. A case of transitional cell carcinoma of the kidney associated with long-term phenacetin intake is described and the practical implications discussed.


Partial lipodystrophy with nephrotic syndrome. A patient with nephrotic syndrome in association with partial lipodystrophy is reported. The features of partial lipodystrophy are well recognized and the renal lesion is a mesangiocapillary glomerulo-nephritis of a dense deposit type with an associated depression of C3. This type of kidney involvement is becoming increasingly recognized as common in the syndrome of partial lipodystrophy.


[Effect of selenium on the enzymatic transformation of retinal and vitamin A assimilation]. The effect of sodium selenite on the enzymatic oxidation of retinal in vitro and vitamin A accumulation in the rat liver was examined. Selenium as sodium selenite at concentrations of 0.5--2.5 microgram/ml inhibited significantly (40--45%) the enzymatic irreversible oxidation of retinal. Dietary supplements of sodium selenite at a dose of 50--250 microgram/kg body weight caused an almost two-fold increase of the vitamin A content in the rat liver as compared with the controls that were given no selenium.


[Determination of ribonuclease reductase activity by thin layer chromatography on ECTEOLA-cellulose]. A rapid and sensitive method of measuring activity of ribonucleotide reductase has been developed. The method involves separation of ribonucleotides and desoxyribonucleotides in the ECTEOLA-cellulose thin layer, elution of desoxyribonucleotides and spectrophotometric assay of eluate extinction. The method utilizes an enzyme extracted from Propionibacterium shermanii.


[Logarithmic attachment to a monochromator for recording small changes in absorption]. The paper describes a device consisting of a spectrophotometer (SP-4, SP-4A, SP-16), logarithmic amplifier, recording instrument and a flow-type cuvette that allows quantitative registration of biological substances during their separation on chromatographic columns.


[Isolation of the antibiotic hordecin by sorption on anionite AN-15]. It has been shown that Na-salt of hordecine can be selectively adsorbed on anion exchange resin AN-15 and the antibiotic can be then eluated with 96% ethanol acidified with HCl to bring pH to 3.0--3.5. Spectral analysis and testing of the antibiotic activity have demonstrated that hordecine prepared by the above method and that obtained by paper chromatography are identical.


Photoreactive probes for high resolution mapping of membrane proteins. The preparation and characterization of a novel series of radioactively labeled membrane probes is described. These probes are carbohydrate derivatives of fatty acids which contain a photosensitive azide moiety at a specified distance along the alkyl chain. The function of the carbohydrate group is to restrict the azide function to the outer surface monolayer of sealed membrane systems. The azide probes have been used in several well-characterized membrane systems including erythrocyte ghosts, membrane-enveloped viruses, and artificial vesicles. Upon activation, the probes attach to integral proteins to form a stable, covalent complex which may be extracted and identified. The activation protocol is outlined and some of the preliminary results are discussed.


Receptor-mediated uptake of lysosomal enzymes. This paper reviews the evidence for two different forms of carbohydrate-mediated recognition of lysosomal enzymes by cell surface receptors. The recognition marker on lysosomal enzymes which are rapidly pinocytosed by fibroblasts contains phosphate, probably linked to D-mannose as a phosphomannosyl moiety. The fraction of lysosomal hydrolases bearing this recognition marker for fibroblasts varies, depending on the tissue source. Another form of recognition accounts for rapid plasma clearance of infused lysosomal enzymes in the rat. This rapid clearance is mediated by receptors on Kupffer cells and other reticuloendothelial cells that recognize mannosyl residues on the glycoprotein hydrolases.


Cell surface carbohydrate recognition and the viability of erythrocytes in circulation. The presence of sialic acid on the cell surface is crucial for the survival of mammalian erythrocytes in circulation. In contrast, sialidase-treated chicken erythrocytes retain their viability in circulation. Galactose oxidase treatment of chicken red blood cells has no effect on their viability. However, after sialidase treatment, galactose oxidase treatment results in the rapid elimination of the chicken erythrocytes from circulation. This is compatible with the interpretation that consecutive treatment with the 2 enzymes abolishes the ability of the chicken erythrocytes to regenerate the sialic acid on the cell surface. Mammalian asialo-erythrocytes are sequestered in the liver and spleen. We have shown that at the cellular level there is a preferential recognition of sialidase-treated as compared to normal erythrocytes by mononuclear spleen cells and Kupffer cells of the liver. This recognition manifests itself in both autologous and homologous systems by rosette-like adhesions. These adhesions may represent the normal physiological mechanism for the removal of senescent erythrocytes from circulation by liver and spleen since it has been previously reported that older erythrocytes contain decreased amounts of sialic acid. The mechanisms in mammals for the elimination from circulation of asialo-erythrocytes and asialo-glycoproteins, while analogous in many respects, are definitely not identical.


The initial glycosylation of the Sindbis virus membrane proteins. The mechanism by which the membrane proteins of Sindbis virus are initially glycosylated during growth of the virus in chick cells was studied. The experiments suggest strongly that the 2 viral glycoproteins are glycosylated before release from the polysome and that this glycosylation involves transfer of a large, 1,800 dalton oligosaccharide to the polypeptide chains. The donor of the oligosaccharide is most probably a lipid.


Properties of a double gradient model for retinotectal specificity. The properties of a double gradient model for retinotectal specificity are discussed. The model utilizes only two complementary molecules, each located on both retina and tectum, to determine position along the dorsoventral axis. Two possible modes of interaction between these molecules are assumed. One of these allows all possible bonds between a retinal cell and tectal loci to be formed. This results in a rigid retinotectal projection in which the adhesion of each retinal cell to its normal tectal locus is maximal. The other assumes stochastic interactions between the molecules, and results in retinotectal specificity only if additional constraints are imposed on the system. Either of these modes of interaction predicts adhesive preferences for retinal cells to tectal halves similar to those observed experimentally.


Lectin receptors and cell surface recognition. Ricin-resistant (RicR) baby hamster kidney (BHK) cell lines have been classified into a small group (3 lines) showing a minimal surface change from wild type and a larger group (20 lines) which exhibit more extreme alterations in surface properties. Glycopeptides released by pronase from some RicR lines in the second group show a lower content of sialic acid, galactose, and N-acetylglucosamine and greatly reduced binding activity for ricin. Treatment of receptor deficient glycopeptides or RicR cells with neuraminidase reveals new ricin receptors and renders the cells very sensitive to ricin. Several classes of ricin receptors are postulated for BHK cells, some of which are cryptic and under independent genetic control from receptors selected against with ricin. The cell lines showing greatly altered surface properties in general adhere poorly to a substratum and also aggregate poorly compared to wild type or RicR cells showing minimal surface change. The lactoperoxidase iodinateable 250K glycoprotein of normal BHK cells is lacking in all but one of these RicR cell lines. The role of 250K glycoprotein in normal cell adhesion is considered and a hypothesis proposed relating changes in surface organization of the 250K glycoprotein to alterations in receptors induced by ricin selection.


Plantar flexor strength testing using the cybex isokinetic dynamometer. Twenty male subjects and twenty female subjects in each of three age categories, 6 to 8 years, 14 to 16 years, and 23 to 28 years, were tested on the Cybex Isokinetic Dynamometer to obtain normative strength values for the ankle plantar flexor muscle group. Values were established for both isokinetic and isometric contractions at two speeds. The results indicate that age and weight are the significant variables in determining strength scores.


Evaluation of patient education programs. Patient education is a vital component of comprehensive quality care for patients with chronic disease. Rarely is patient instruction evaluated, however, in terms of its effectiveness and efficiency. This article presents a rationale for evaluation of patient education and lists several benefits of evaluation to the clinician. A model for evaluation and evaluation activities is described for both the process of developing a patient education program and evaluating its results. Application of this model and examples of the use of evaluation activities are demonstrated in a "real world" experience. The description of a formal patient education program for rheumatoid arthritis patients in a general hospital setting illustrates the usefulness of evaluation in developing and carrying out effective patient education.


Review of cervical orthoses.

Review of cervical orthoses. Six commonly prescribed cervical orthoses are presented for a qualitative review of their structural properties and their clinical applicability. A quantitative review of each brace has previously been reported. The characteristics of 1) structure, 2) ease of donning, 3) ease of adjusting, 4) comfort, and 5) general clinical applicability are summarized for each brace. Generally, as the orthosis becomes more restrictive, it also becomes more cumbersome and more difficult to don. Ease of adjustment and comfort are compromised. The one exception was the Somi orthosis which was comfortable, easy to don and adjust, and which still provided good stability in forward flexion. The information presented in this paper in conjunction with information on the quantitative qualities of each brace and the services available at most health care facilities may be used as a guide for selecting specific cervical orthoses.


The yale cervical orthosis: an evaluation of its effectiveness in restricting cervical motion in normal subjects and a comparison with other cervical orthoses. The Yale cervical orthosis is a lightweight polyethylene foam Philadelphia collar with molded fiberglass extensions over the thorax. This orthosis was studied on 17 normal subjects in the extremes of the ranges of flexion, extension, rotation, and lateral bending using roentgenograms and axial photographs to assess how effectively it limited motion of the neck. Overall, it satisfactorily controlled cervical motion and was similar to the most effective rigid cervical orthoses. Flexion and extension ranges were compared at different segmental levels of the spine. The Yale orthosis was most successful in restricting flexion in the area of the middle and lower cervical spine and was acceptable in controlling extension range. The orthosis was least effective in controlling motion in the upper spine, particularly at the atlantoaxial articulation. The Yale orthosis is recommended for postsurgical protection of the middle and lower cervical spine and in select situations of spinal instability, but it is not recommended for control of odontoid fractures or atlantoaxial subluxation.


Mathematical modeling of rewarming after cold therapy. Statistical methods are presented for fitting mathematical models to skin temperature data. Three types of regression curves, namely, linear regression (Y = A + BX), second-degree regression (Y = A + BX + CX2), and asymptotic regression (Y = alpha + betapx), are discussed as possible models for the rewarming process following cold therapy. The data for fitting the curves consists of back surface temperature (degrees C) corresponding to various times after cold pack treatment (19 degrees C, administered for 20 minutes) was terminated.


Radical forehead remodeling for craniostenosis. A normal forehead has two parts, shaped differently: (1) the lower part (corresponding to the supraorbital rim and glabellar area) set at a steep angle to the nose; (2) the upper part, sloping gently backward. To reproduce this normal anatomy in cases of cranostenosis affecting the frontal area, we found it essential to mobilize and reshape a supraorbital bar of bone and to transfer a suitable piece of the cranial vault in one piece to make a new upper forehead. By this method we have treated 18 patients with oxycephaly since 1973, with good results. We have also operated on babies with craniostenosis to try to solve simultaneously the functional and the cosmetic problems. In faciocraniostenosis, there are dominant malformations at the base of the skull, but an isolated frontal advancement of two cm has produced gratifying early results.


Blepharo-canthal deformities in patients following craniofacial surgery. Functional problems and deformities of the eyes have become a major concern in the surgical treatment of ortital hypertelorism and craniofacial dysostosis, as experience with skeletal relocation for these disorders has been gained. Comprehensive preoperative and postoperative study and measurements of the bony orbits, the globes, the lids, the canthi, and the nose are necessary for the evaluation of present techniques and the design of alternative procedures. Some of the deformities of the blepharo-canthal complex are part of the congenital malformation. Other distortions, seen only postoperatively, are secondary to specific surgical maneuvers. Awareness of these primary and secondary factors has led to better soft tissue reconstruction at the time of the bony orbital translocations or the craniofacial disjunction. We describe the techniques which we have found especially useful in avoiding and correcting these postoperative blepharocanthal deformities.


Late results after reduction mammaplasty with curved incisions. The results in 50 patients who had had mammaplasties done 3 years ago are described--both as regards the patients' opinions and the surgeon's assessments. The alterations that occur in breasts after reduction mammaplasty were studied, and also changes that may occur when the patient's weight increases or decreases.


Late complications vs. method of treatment in a large series of mid-facial fractures. The late presence of contour defects, as well as one eye being lower than the other, were directly related to a lack of interosseous wire fixation in this series of mid-facial fractures. In orbital floor fractures, the use of alloplastic material was found to give more satisfactory long-term results than bone grafts. The direct approach through the lower lid produced no complications of its own in this series. Associated injuries and preexisting disease were found in 61 percent of these patients, supporting the thesis that an M.D. should direct their care. The late presence of diplopia and/or enophthalmos was directly related to an underestimation and undertreatment of orbital floor fractures, or to treatment with bone grafts. The use of a shoulder strap, in conjunction with the lap belt, seems to almost completely prevent the occurrence of mid-facial fractures in automobile accidents.


Free perichondrial grafting in the treatment of temporomandibular joint ankylosis. Preliminary report. We have operated on 6 cases of temporomandibular joint ankylosis, resecting a small amount of bone to create a false joint and then covering the two joint surfaces with sheets of perichondrium (autogenous, from the ribs). The perichondrium forms new cartilage on the joint surfaces, and the early results are encouraging. Only one of these cases was operated upon more than one year ago. He has an excellent result and this case is reported on in detail.


Complications following silicone injections for augmentation of the contours of the face. We report 5 patients who have had severe inflammatory reactions following the injection of liquid silicone for augmentation of the facial contour. We offer an approach to the treatment of this complication which, although not resulting in complete resolution, has at least markedly ameliorated these patients' signs and symptoms.


Toxic epidermal necrolysis. Case report. We present a case report of a patient with toxic epidermal necrolysis (TEN), associated with therapy with trimethoprin and sulfamethoxazole. Because of the similarity of TEN to an extensive partial-thickness burn, and the favorable response to the treatment used in burns, surgeons who treat burns should be familiar withe disease and take an active role in its management.


Surgical treatment of fungating lesion of foot due to Moraxella phenylpyruvica. Case report. We present a case report of a man who had an abscess-like lesion on his left foot. The lesion discharged pus, enlarged, and became thicker, so that we could not differentiate the real toes from the out-growths. Moraxella phenylpyruvica and Pseudomonas putrefaciens were identified; direct agglutination tests were postive M. phyenylpyruvica. He was given antibiotics and antituberculosis therapy and had topical treatments. The foul odor disappeared with treatment, and the lesions were removed surgically 3 months later. The M. phenylpyruvica finally disappeared after the surgery. The final condition of this patient was markedly improved, although he had some residual scar contracture.


Cat scratch disease with involvement of intra-parotid lymph nodes. Case report. A case of cat scratch disease, presenting as a parotid tumor, is described. In its oculo-glandular form, this disease may be associated with swelling of the intraparotid lymph nodes, and the possibility should be considered in the differential diagnosis of parotid tumors in children. A careful history, and skin testing with cat scratch antigen, may aid in the diagnosis of this condition.


Parotid retention cysts as a complication of rhytidectomy. Case report. We present an unusual complication of rhytidectomy in which several salivary cyst formed in the region of one parotid duct. Treatment with drainage and presure resolved the problem.


Tarsal fixation in lower blepharoplasty. Proceeding from the premise that a "youthful" eyelid has a pretarsal bulge while a "senile" eyelid has a pretarsal flatness, the tarsal fixation technique for lower blepharoplasty has been introduced--to reposition part of the orbicularis in front of the tarsus to produce a pretarsal bulge. The technique is presented as a suggested adjunct to the usual types of lower blepharoplasty.


Host-tumor relationships in basal cell and squamous cell cancer of the skin. We suggest that aggressive clinical tumor behavior correlates with the presence of squamous differentiation and with irregularities in the peripheral palisading of basal cell carcinomas. The concept of non-melanoma skin cancer being a basosquamous continuum may help in formulating a method for prognosis in patients who had removed tumors with a pathologist's report of a "positive margin."


Congenital arteriovenous malformations of the upper extremity. The embryology and the clinical management of congenital AV fistulas of the upper extremity are discussed. Early excisional surgery of asymptomatic lesions should be confined to ones of a very limited extent. Excisional surgery on extensive lesions should be limited to those which are symptomatic and have decreasing hand function. Possibly of limited effectiveness in some lesions may be the selective occlusion of vascular feeders by injecting cyanoacrylate glue through a catheter.


Closure of scalp defects by using multiple flaps in a pinwheel design. A multi-flap design for closure of defects in the inelastic scalp is presented. Two cases are reported, and the advantages of the technique are described. The engineering principle is elaborated and discussed.


The prevention of postanesthetic delirium. We recommend the use of one dose of physostigmine salicylate, a few minutes before the termination of a general anesthetic, to prevent confusion, struggling, disorientation, or delirium during the recovery from anesthesia. We believe that it is well to prevent such behavior, particularly in patients who have just undergone reconstructive surgery where the unmanageable behavior could jeopardize surgical results. Our results indicate that such behavior is largely preventable.


Hypospadias in Nigeria.

Hypospadias in Nigeria. We present a review of 42 cases of hypospadias seen at the University College Hospital in Ibadan, Nigeria from 1969 to 1977. The incidence was low. No family history of hypospadias was noted in any of these patients. Fifty-seven percent had associated anomalies--mostly of the genitourinary system. Most of the patients had been circumscribed on arrival for treatment.


Complications of total ischiectomy for the treatment of ischial pressure sores. Five patients are reported, 4 of whom had total ischiectomies and the other an extensive partial ischiectomy. In each, recurrent ulcers, extending into the perineum, developed subsequently. One patient had a urethrocutaneous fistula as a result of his perineal ulcer, and he had to undergo an ileal loop diversion. Following a unilateral ischiectomy, the pressure is shifted to the opposite ischium, and this favors the development of another ischial pressure sore on the opposite side. After bilateral ischiectomy there is much more pressure on the perineum, and these patients may go on to develop a perineal pressure sore--particularly if there is a dislocated hip. Recurrent pressure sores which extend into the perineum are difficult to treat, and usually they appear to be related to a previous extensive removal of the ischia.


Assessment of cognitive organization in emotionally disturbed adolescents: a way of reducing parental perplexity? Four adolescents of comparable age and IQ scores were described, two with primarily psychiatric diagnoses and two with additional CNS organic injuries. Despite the normal IQ scores, two had a combination of cognitive disabilities that make them highly suspect as being unable to manage their own affairs without the massive support usually reserved for the retarded population. Piaget's description of the cognitive abilities developed during the concrete operational stage of development were found to be invaluable in separating these more perplexing adolescents. Their inability to decenter, to reverse, to conserve, and to classify and abstract from this classification leads to a major series of cognitive defects and difficulties, difficulties that if not clarified for the parents, will leave them as perplexed as the professional working with these children.


Effects of biofeedback and voluntary control procedures on heart rate and perception of pain during the cold pressor test. The effects of biofeedback training and voluntary control procedures on heart rate and subjective reactions to 30-sec immersion of the hand in ice water were investigated in five experimental conditions, nine subjects in each condition. All subjects were given an initial cold pressor test and a final test interspersed by the particular condition. In two of the conditions, subjects were given biofeedback training for increasing or for decreasing heart rate. No training was given to the other three groups. In two of the latter conditions, subjects were simply asked to increase or decrease their heart rate during the second cold pressor test, without previous training. The fifth condition was a no-treatment habituation control. Significant variations between groups were obtained of the tachycardia and reports of pain associated with the second cold pressor test. In general, there was a correspondence between heart rate change and subjective report of pain. Voluntary control of heart rate or other autonomically-mediated responses, enhanced by biofeedback training, may have implications for research on and clinical management of physiological and subjective reactions to stressful stimuli.


Event-related slow potential (ERSP) correlates of thyroid gland function level. This study shows an association between thyroid gland function level and event-related slow brain potential (ERSP) parameters (peak amplitude and area under the curve), obtained during "classical" and "operant" reaction-time paradigms. A significant positive correlation between ERSP parameters and 24-hr I131 uptake and a negative nonsignificant one between them and ankle jerk reflex were found. Organismic factors related to thyroid function had greater influence upon ERSP amplitude and area than situational ones, for no significant effect of task was evidenced and no interaction between them was found under the conditions employed. Hyper- and hypothyroids showed also a tendency to present longer reaction times than euthyroids. These results are discussed within the framework of the arousal-distraction coupling hypothesis as proposed by Tecce and Cole (1976) and compared to those previously obtained in high-neuroticism anxiety-prone indivuduals. Although these and hyperthyroids do show indications of similar behavioral manifestations (excessive reactive arousal), both groups are considered to differ regarding empirical referennts of anticipatory arousal (ERSP parameters). A major difference seems to be the absence of a "ceiling effect" in hyperthyroids. This hypothetical phenomenon can be expected on the basis of the inverted U-shaped relation between ERSP amplitude and arousal level. A stronger "distraction" effect associated with increased arousal in anxiety neurotics is postulated and tentatively attributed to covert verbalizations of worry and feelings added to increased awareness of autonomic input. The contention is advanced that similar behavioral manifestations could be distinguishable at the physiological level employed and this might add further insights to diagnostic typologies (e.g., "psychosomatic" vs. "psychoneurotic" patients).


Life events: perceptions and frequencies. Life changes have been associated with illness onset. The Social Readjustment Rating Scale (SRRS) records numerical perceptions of the meaning of life events while the Schedule of Recent Experience (SRE) records the frequency of occurrence of life events. Data on these two instruments from 19 studies done in this laboratory have been surveyed and analyzed. They reveal significant variability among groups in their perceptions of life events as well as in their reports of the frequency of occurrence. Variables indicated to be of significance in either or both of these parameters were age, marital status, sex, socioeconomic status, ethnicity, level of education, culture, and experiencing of an event. These variables impose caution on investigations that relate life changes to illness.


A mathematical model to determine facility needs for a radiology department. In summary, a mathematical model has been developed, tested, and applied which measures effectively the number as well as the type of radiographic rooms needed to meet the current and projected radiographic demand for a typical health care facility. The model first required a projection of radiographic procedures, based on historical data. Secondly, the projected total by patient classification was subdivided into procedure categories. Finally, the projected categorised radiographic procedures are introduced into the formula (Equation 1) and is shown below: (formula: see text). The formula is applied to each procedure category. The grand total for each of the four separately calculated categories will measure the total number of rooms and type of facility needed in the future. (formula: see text).


Vascular pseudo-tumours of the mediastinum in asymptomatic patients. A tomographic study. II. Veins. Vascular anomalies of the mediastinum which can imitate a tumour in asymptomatic patients, are divided into arterial and venous anomalies. This article discusses the venous anomalies with reference to a number of examples. In all cases, tomography is of value for identification of the anomaly. Angiography is indicated only in selected cases.


Congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease). With reference to a patient with Caroli's disease (segmentally dilatated intrahepatic bile ducts), the clinical features of this rare but serious disease are described. The condition differs from other cystic dilatations of the bile ducts in that only the intrahepatic bile ducts are involved. Its pathogenesis is obscure. It is suspected that an embryonic developmental disorder in the wall of the bile ducts causes cysts via physiological periodical increases of pressure. The diagnosis is made accidentally by cholangiography via the T-drain during or after cholecystectomy. When Caroli's disease is suspected, echography can be a valuable diagnostic aid.


Absent pedicle in the cervical spine.

Absent pedicle in the cervical spine. 2 cases of absent cervical pedicle are presented. It is important to be acquainted with this condition to be able to differentiate it from dumbbell tumour. Some other lesions which simulate it are briefly mentioned.


Computer processing of x-ray films. Preliminary report on arteriograms. An X-ray processing system by computer is described. The scanning device and display are illustrated. The main processing methods are analyzed, in particular the linear and non linear ones. An example of image processing which is the base for future work is shown.


Tongue implants: discussion of some dose-time-volume parameters and afterloading techniques. Detailed computerized calculations of 28 radium tongue implants permit the conclusion that dose-time adjustment especially when geometry is poor, increases the chance of recurrence. The overdosage volume in the vicinity of the needles could be calculated and is small. Because of greater adaptability of afterloading iridium techniques and better results according to others, our patients are now treated with a combination of external beam treatment and iridium implant.


Glottic cancer: clinical factors affecting irradiation control. An analysis of the results of 252 patients with glottic larynx cancer treated in the RRTI between January 1965 and December 1971 is given. The patients were treated by orthovoltage radiotherapy and classified according to the UICC/AJC staging system of 1972. The 3-year recurrence-free rates for T1, T2 and T3 are 83, 62, and 60%, respectively. The present series suggest a reduction in disease-free survival for T2 patients from 70% with extraglottic extension or partial immobility to 52% with both extraglottic extension and partial immobility.


Preparation technique and new contrast medium for radiography of biologic specimens. An easily prepared contrast medium for radiography of vascular and ventricular systems is described. The accompanying fixation methods are discussed. Utilizing a few, readily available components and chemicals, technologists should be able to easily prepare a contrast medium that will produce, both before and after preservative tissue fixation, a quality specimen for radiography. The methods are easily applicable to most biological specimens.


Federal licensure as consumer protection. In the continuing debate over licensure for radiologic technologists, more concern needs to be directed toward the patient as the unwary consumer. Radiology patients can only presume that maximum effort is being taken to minimize x-ray exposure. Unfortunately, the patient has little control in guaranteeing that premise.


The chest radiograph in legionnaires' disease. The chest radiographs of 24 patients with documented Legionnaires' disease were evaluated. Twenty-two of the 24 patients had positive findings for the disease initially. There was unilateral involvement in 68% and the most common lung shadows were poorly marginated round opacities (46%), diffuse patchy (25%) and peripheral opacities (21%). At peak, 70% of patients had a lobar shadow. Pleural effusions were present in 39% of cases but could be explained by underlying congestive heart failure or renal failure in 7 of the 9. Although the findings are not specific, the radiologist should consider this diagnosis in a patient with compatible clinical history, a pneumonia of obscure etiology, and these radiographic manifestations.


Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram. Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.


Pattern discrimination in matching chest radiographs. Including a role for logistic distribution of observer responses. Tests were designed to determine how well individuals can differentiate similar chest radiographs. These tests were given to 17 persons (radiologists, x-ray technologists, medical students, and secretaries). Each test contained a number of paired, dissimilar, and/or unique radiographs which were to be distinguished from one another or matched. The results suggest, that a radiologist does not have an innate advantage over untrained observers in pattern recognition. It is not known whether pattern-recognition tests are valuable in evaluating potential radiologists. A receiver operating characteristic curve is also described.


Angiographic features of carcinoid heart disease. Cineangiocardiograms from 2 patients with carcinoid syndrome and cardiac involvement were reviewed. Gross and microscopic pathology specimens were available for 1 case. Both patients exhibited tricuspid valvar stenosis and insufficiency. The area of the pulmonic valve was similar in both with narrowing of the annulus and tapering toward the valve of the proximal pulmonary artery and the subvalvar right ventricular outflow tract, producing an hourglass appearance, which the authors feel is characteristic of this disease.


Radiological manifestations of small intestinal South American Blastomycosis. Three cases of South American blastomycosis are described with involvement of the small intestine and/or ileocecal region. The radiologic findings are nonspecific, e.g., fixed narrowing and mucosal irregularities. Differential diagnostic possibilities include regional enteritis, tuberculosis and lymphoma. With increasing travel in endemic areas, recognition of tropical diseases becomes more important.


Interpersonal communication skills and the radiologic technologist. Studies done in the behavioral sciences suggest that the quality of the communication skills of persons in "helping" professions is related directly to the credibility, respect, and cooperation they receive from their clients. In his article, Dr. Calabrese discusses some specific communication skills that could strengthen the relationship between the radiologic technologist and his/her patients.


Radiographic characteristics of colonic "mucosal bridges": sequelae of inflammatory bowel disease. Colonic mucosal bridges are a relatively unusual entity occurring in patients with inflammatory disease of the colon. The authors describe two cases in which the pattern of multiple long, linear band-like defects may be easily misinterpreted as thickened mucosal folds, mucous strands, or foreign matter. The possibility of mucosal bridges should be considered if this radiographic pattern is demonstrated, and the patient's history is compatible with their formation.


Continued professional education: an adaptable method for radiologic technology. During the last decade, outside pressures have intensified the need for continued professional education. An adapted system is presented to provide a meaningful continued learning experience for participating professionals in radiologic technology. The system can be utilized to design an individual self-directed learning experience, or it can be adapted as a larger group program.


Filiform polyposis.

Filiform polyposis. Filiform polyposis presents a characteristic radiographic appearance consisting of long, filamentous filling defects in an otherwise normal colon. It has previously been reported in patients with a prior history of ulcerative colitis and in one patient with granulomatous colitis. The authors document its development in patients with ulcerative and granulomatous colitis. The authors have also seen a solitary filiform polyp in a patient with previously undiagnosed inflammatory bowel disease, and filiform polyps in the stomach in a patient with documented Crohn disease involving the small bowel. It is believed that this represents a nonspecific sequela of diffuse mucosal inflammation; it should not be mistaken for a neoplastic form of polyposis.


Linear shadows in the air-contrast barium enema. In 3 patients with carcinoma of the colon, lesions were seen as linear shadows on air-contrast barium enema studies. When the elevation of a lesion is slight or the tumor--mucosal interface is gently sloping, the tumor's proximal and distal edges may be ill-defined or disappear altogether. Thus only a linear shadow representing the interface between the tumor surface and air in the lumen appears. Other causes of these lines are also discussed.


Rapid diagnosis of pancreatic carcinoma. An algorithmic approach for radiological evaluation of suspected pancreatic carcinoma was applied in more than 200 patients. Outpatient ultrasonography and barium studies of the upper gastrointestinal tract were followed by inpatient endoscopic retrograde cholangiopancreatography, angiography, and percutaneous biopsy. Evaluation took no more than two hospital days and exploratory laparotomy was not needed. Twenty-five patients had carcinoma. The diagnostic accuracy of the algorithm was 96%. Although this method did not increase the diagnosis of resectable tumors, it did result in rapid, accurate diagnosis of pancreatic carcinoma at relatively low cost and with minimum patient discomfort. Hopefully, these results will eventually lead to earlier diagnosis and improved survival.


Single dose oral cholecystography.

Single dose oral cholecystography. The routine use of single dose oral cholecystography is suggested for the examination of outpatients. A diagnosis is more quickly obtained for the great majority of patients and there is a lower incidence of side effects. An effective method of contrast administration and filming is discussed. The medical, personal, and economic impact of single dose oral cholecystography is contrasted with that for routine consecutive dose examinations in an outpatient population.


Rectosigmoid pseudostenosis due to urinary retention. Pseudostenosis of the rectosigmoid colon due to compression by a dilated urinary bladder may pose a diagnostic problem. Although probably quite common, it has not received much attention in the radiological literature. Four cases are presented and the radiological features on barium enema are described.


Bilateral spontaneous urinary extravasation in ureteral obstruction. Spontaneous urinary extravasation caused by ureteral obstruction is infrequently encountered. A case is described in which bilateral extravasation was observed, confined beneath the renal capsule on one side.


Further refinements in the plain radiologic diagnosis of splenic rupture: the air enema. Plain film radiography, by appraisal of the soft tissues of the descending colon and left paracolonic gutter, comprises a safe, accurate, and quick determination of the presence of free fluid, which, in the proper clinical setting, indicates splenic rupture. The air enema, introduced under fluoroscopic control, is a valuable aid in eliminating false negatives and false positives, and also in distinguishing intraperitoneal clots from subserosal hematoma. The preoperative diagnosis was correct in 27 of 28 cases. The one error occurred in a case in which the interpretation of paravesical fluid (dog ears) was faulty, and in which the air enema had not been used.


The double-contrast shoulder arthrogram. A review of 158 studies. Experience with double-contrast arthrography indicates it is superior to the single-contrast technique. First, the double-contrast study provides additional information on the width of rotator cuff tears and on degeneration in the tendons. This information is valuable in choosing surgical candidates and electing the best surgical incision. Second, the air-distended capsule permits visualization of the entire intra-articular portion of the biceps tendon. Third, improved visualization of the articular cartilages is important in evaluating patients with previous anterior shoulder dislocations or inflammatory arthritis.


Radiographic and radionuclide findings in Rhizopus osteomyelitis. A case of Rhizopus osteomyelitis is described. The radionuclide and radiographic findings differ from those of osteomyelitis secondary to common pathogens: low-level radionuclide activity is observed, while soft-tissue swelling, periosteal reaction, and loss of fascial margins are absent.


Transcatheter brush biopsy of intravenous tumor thrombi. Transcatheter brush biopsy of intraluminal filling defects demonstrated during venography was performed in 6 patients with abdominal neoplasms. Tissue specimens consistent with either known or subsequently proved tumor were obtained from 4 patients. Biopsy was negative in the other 2 patients, who lacked surgical confirmation of the intraluminal mass. This technique is useful in establishing histological proof of neoplasm and in determining the extent of known tumor.


Partial embolization of large peripheral hemangioma for pain control. Pain associated with a large hemangioma of the thigh was relieved by embolization of a portion of the lesion with Gelfoam. The branch to be occluded was selected when the distribution of the heat associated with the injection of contrast material corresponded to the distribution of the patient's pain.


Axillary hibernoma: review of the literature with report of a case examined angiographically. A case of hibernoma of the axilla and a review of the literature are presented. This benign tumor showed angiographic findings of hypervascularity without neovascularity or A-V shunting which differentiate it from lesions such as lipoma, fibroma, or neurofibroma.


Extra-axial posterior fossa lesions simulating intra-axial lesions on computed tomography. Differentiation of extra- from intra-axial posterior fossa lesions is sometimes not possible on computed tomography. Six cases are presented wherein the lesion appeared to be intra-axial on computed tomograms yet angiographically and surgically proved to be extra-axial. False localization on computed tomography occurs with slowly growing masses which burrow into brain parenchyma.


Enlarged cisternae magnae and posterior fossa cysts simulating Dandy-Walker syndrome on computed tomography. Computed tomography was performed on 5 children with posterior fossa cystic abnormalities. On an axial tomogram, an enlarged cisterna magna could not be distinguished from a Dandy-Walker variant, nor could an encysted fourth ventricle be distinguished from a subarachnoid cyst. Supplementary air encephalography or sagittal reconstruction of tomograms is necessary to define posterior fossa cysts accurately.


Radiologic findings of hamartomas of the tuber cinereum and hypothalamus. Five cases, four histologically proved, or hamartoma of the tuber cinereum and hypothalamus in children (age range: 2--12 years) are reported. Three cases had pubertas praecox, and in all of these the hamartoma was located in the basal cistern between the chiasm and pons, and had a collar button shape and size typical of hamartoma of the tuber cinereum. In the third case, which presented with headache, a huge calcified mass in the suprasellar region was initially thought to be craniopharyngioma. The fourth case had a hamartoma within the substance of the hypothalamus and presented with hyponatremia and temporal lobe seizures.


A multiregional kinetics model for cerebrospinal fluid. A mathematical model was developed to describe the multiregional flow of intrathecal indium-111 DTPA, and hence indirectly the flow of cerebrospinal fluid, in sequential spinal and cerebral CSF images. The model provides for an arbitrary input function, transport delay between appropriate compartments, transmeningeal and transependymal transport, and for bidirectional flow between most compartments. Two- and eight-compartment models were evaluated. The set of eight nonlinear differential equations was solved using numerical techniques. This model provides a quantitative basis for the interpretation of CSF kinetics.


Neuroradiological manifestations of intracranial sarcoidosis. Six cases of sarcoidosis involving the central nervous system are reported with the neuroradiological findings and appearance on computed tomography. Communicating hydrocephalus with sarcoid arachnoiditis is the most common finding, but arteritis and masses have also been reported. Two rare cases of intracerebral masses are included. The radiological findings and clinical histories are reviewed with emphasis on the use of CT and complete neuroradiological studies for patients with possible central nervous system sarcoidosis.


Scintigraphic evaluation of childhood malignancies by 67Ga-citrate. The utility and limitations of 67Ga scintigraphy in children with solid tumors were evaluated. Thirty-five patients with malignancies (13 lymphoreticular neoplasms, 11 soft-tissue sarcomas, 8 neuroblastomas, and 3 primary bone tumors) had a 67Ga-citrate scan as part of their clinical evaluation. The sensitivity and specificity of the test were analyzed for the different tumor types. The overall sensitivity of the 67Ga-citrate scan for the lymphoma group was 87%. Higher values were obtained for the mediastinal and abdominal regions. Ninety-three per cent of the involved sites were correctly identified by 67Ga scintigraphy in the soft-tissue sarcoma group. Small lung metastases, however, were missed on scan. Thus, 67Ga scans should be complemented with chest radiographs and whole chest tomograms for both initial evaluation and follow-up in those patients. 67Ga had low sensitivity for neuroblastoma.


Tumor visualization using 67Gallium scintigraphy in children. One hundred and twenty-two children suspected of having malignant disease were examined by 67Gallium scintigraphy. True-positive detection was obtained in 22 patients before treatment and true-negative in 22. False-negative scans were obtained in 5 children with primary adrenal neuroblastoma. Local recurence and/or metastases were detected in 29 of 58 children previously treated for malignant disease. For malignant disease, diagnostic sensitivity was 78% and diagnostic specificity 79%. It is concluded that 67Ga scintigraphy should be used for primary visualization and control of malignant tumors in children.


Hepatic scintigraphy in Caroli's disease. Caroli's disease (communicating cavernous ectasia of the intrahepatic bile ducts) is manifested on the 99Tc-sulfur colloid images as multiple focal defects in the liver. Since several other conditions have a similar presentation, intravenous or transhepatic cholangiography may be of assistance in reaching the correct diagnosis.


Differential shunting in the diagnosis of patent ductus arteriosus with Eisenmenger physiology by radionuclide angiography. Radionuclide angiography and static whole body imaging performed with technetium-99m-labeled particulates can clearly demonstrate differential shunting in patients with patent ductus arteriosus (PDA) with Eisenmenger physiology. The anatomic arterial relationships in this condition which direct deoxygenated blood into the lower body (differential cyanosis) produce specific radionuclide images characterized by differential shunting of the technetium-99m-labeled particulates into the abdomen and lower extremity.


Gastroesophageal reflux in infants and children: correlation of radiological severity and pulmonary pathology. A review of the barium study of 507 children for the presence and severity of gastroesophageal reflux revealed 79 cases with coexisting pulmonary disease. Clinical-radiological analysis of the cases with respiratory disease showed good correlation between the radiographic demonstration of major reflux or no reflux and the presence or absence of pulmonary disease.


The cerebro-hepato-renal (Zellweger's) syndrome: report of four cases. Four cases of cerebro-hepato-renal syndrome are described. Radiographic findings of scimitar-shaped calcifications of the patellae and stippled cartilage califications have previously been described. We noted calcifications in the area of the greater trochanters in 2 of our patients, and bell-shaped thoraces in all patients. One of our patients is the longest survivor of the children affected by this syndrome.


Congenital dilatation of the intrahepatic bile ducts (Caroli's disease). Caroli's disease (congenital dilatation of the intrahepatic bile ducts) was diagnosed in an 11-year-old girl with the aid of intravenous cholangiography. Recurrent abdominal pain, fever, and intermittent obstructive jaundice are the most common symptoms and usually develop during childhood or young adulthood. Operative cholangiography has been the most valuable method of diagnosing the condition and determining the location and extent of the disease process.


Myotonic dystrophy (Steinert's disease) in the neonate. Radiological abnormalities of the ribs are reported in 5 newborn infants with myotonic dystrophy. In all 5, the ribs appeared very thin, in contrast to the normal appearance of the rest of the skeleton. This slenderness, which is important for diagnosis and prognosis, seems to be caused by hypotonia of the intercostal muscles. However, it is not pathognomonic of myotonic dystropy, for it can be observed in other myopathies.


The relationship between aortic valve closure and aortic root motion. The minimum interval between aortic valve closure and the onset of posterior motion of the posterior aortic wall (C--PW) was obtained from M-mode echographic studies in normal subjects and patients with mitral regurgitation (MR), rheumatic mitral stenosis (MS), mixed rheumatic MS and MR, pure aortic stenosis (AS), and pure aortic insufficiency. Three-fourths of the patients with MR and 2/3 of those with AS had short C--PW intervals. Short C--PW intervals are probably the result of early mitral valve opening with rapid LA emptying, whereas slow emptying due to dilated, relatively inert left atria may account for normal C--PW intervals in patients with MR. C--PW intervals are affected by both ventricular ejection and LA dynamics and may prove useful in evaluating suspected mitral or aortic valve disease.


Echocardiographic diagnosis of partial pericardial constriction of the left ventricle. In a patient with hemodynamic findings typical of severe, generalized pericardial constriction, echocardiography demonstrated partial constriction of the left ventricle; the patient had partial pericardiectomy 17 years earlier. Diagnosis was confirmed by angiocardiography and at surgery. Echocardiography suggested penetration of the myocardium at places by pericardial calcification; this finding was confirmed at surgery.


Gray-scale ultrasound in tubal pregnancy. Sonographic signs were correlated with clinical data, surgical findings, and pathology in 15 patients withtubal pregnancy. Sonograms showed absence of intrauterine gestation in 12 patients. In 3, structures resembling gestational sacs were produced by decidual reaction and blood in the uterine cavity separating the endometrial echoes. The uterus was normal in size in 6 cases. Almost all sonograms showed a pelvic mass (usually adnexal) displacing the uterus. Seven patients had predominantly sonolucent masses, 3 had complex masses, and 4 had both types. Only one woman exhibited a definite gestational sac in an extrauterine location. Four patients had a negative pregnancy test at the time of sonography. Meticulous sonographic technique and a high index of suspicion will facilitate the diagnosis of tubal pregnancy in most cases.


Intrauterine diagnosis of omphalocele.

Intrauterine diagnosis of omphalocele. Omphalocele can be diagnosed in utero by ultrasonography. Cesarean section can then help reduce neonatal morbidity and mortality.


B-mode ultrasonography of prosthetic vascular grafts. The role of contact B-mode ultrasonography in demonstrating prosthetic vascular grafts was assessed in 24 patients (27 grafts). All grafts were well delineated. End-to-side bypass grafts could be separated from end-to-end replacement grafts by their characteristic appearance. Patent and occluded grafts could not be distinguished either in vivo or in vitro. However, B-mode ultrasonography was ideally suited to the detection of other complications of vascular prosthetic grafts: hematoma, infection, and false aneurysm formation.


Treatment policies affecting survival in patients with carcinoma of the cervix. Radiotherapy treatment techniques were evaluated according to survival rates among more than 800 patients with Stage I and II carcinoma of the cervix. An increased survival rate was noted when a Fletcher tandem and ovoids and the Fletcher technique of external irradiation and fractionated radium therapy were applied. This increase was due to a larger radiation dose to the anoxic tumor core and to external irradiation shrinking the tumor to within the high-dose range of radium therapy.


Analysis of pattern of recurrence in non-seminomatous testicular tumor. In non-seminomatous testicular tumor, 60% of failures are seen within the first three months after diagnosis. The most common site of metastasis is the lung. Occasionally, bone, liver and brain metastases are seen. In this series of 33 cases, the definitively treated Stage I patients are alive and well for an average of 6.3 years (12 patients); one was lost to follow-up. The 20 more advanced patients have not done well--16 are dead from disease with an average survival of 17 months, 3 are alive with disease for an average of two years, and one was lost to follow-up. In Stages II and III, the best results were obtained with an aggressive multimodality approach of surgery, postoperative irradiation and chemotherapy.


A highly accurate focal spot camera--laboratory and field model. A device has been developed to determine accurately and quickly the shape, size, and intensity distribution of an x-ray tube focal spot. The pinhole device weighs only 1 kg and is portable, enabling it to be used either as a field unit or in a laboratory. The special design obviates any risk of irradiation danger to the investigator, or thermal overloading of the x-ray tube under investigation. The degree of accuracy with which the central beam can be located is better than +/-250 micron, well beyond the requirements of the latest NEMA standards regarding dimensional measurements of diagnostic x-ray tube focal spots. A star test pattern picture may be taken instead of the pinhole picture if required. The device is described and areas of application are discussed.


Comparison of skin doses to large fields using tangential beams from cobalt-60 gamma rays and 4-MV x rays. Excess radiation to the skin during external beam megavoltage radiation therapy has reportedly caused excessive erythema in patients treated with the Clinac 4 linear accelerator on sloping surfaces, but not for similar treatments with cobalt 60. Doses at the epidermal level were measured under geometries simulating sloping surfaces for a Clinac 4 and an Eldorado 8 cobalt-60 teletherapy machine. For equal doses to the axilla, doses to the epidermal layer were similar. When the tumor dose was calculated for the mediastinum, the dose to the skin in the axillary region was 12% higher for the Clinac 4.


Ultrasonic enhancement of cancer radiotherapy. Ultrasound treatment (1.5 W/cm2, 1.9 MHz, C.W.) for 15 minutes either before or after x irradiation reduced the TCD50 of sarcoma-180 by approximately 40% while similar ultrasound treatment for up to 30 minutes did not reduce the TCD50 of the C3HBA mammary adenocarcinoma. Water bath heating (44.5 degrees C for 15 minutes) after x irradiation reduced the TCD50 of both tumors. Ultrasound alone for up to 30 minutes had no effect on growth or cure rate of either tumor.


Tumor reoxygenation and postirradiation vascular changes. Postirradiation reoxygenation kinetics of the Walker 256 carcinoma were examined and related to radiation-induced changes in tumor vascular functions. Changes in the hypoxic cell component of irradiated Walker tumors may occur by two mechanisms. Reoxygenation of previously hypoxic cells may be due to an increased rate of blood flow in some parts of the tumor. Hypoxic tumor cells may also be eliminated by cell death due to prolonged or severe hypoxia in other parts of the tumor as a result of substantial damage to the tumor vasculature as seen in radiation-induced changes in vascular volume and blood vessel permeability. Reoxygenation of experimental tumors following single, massive doses of radiation may be different from that occurring in human tumors during the course of multifraction radiotherapy.


Respiratory strobotomography.

Respiratory strobotomography. A method of synchronizing tomograms with a predetermined phase of the respiratory cycle is described. Multiple short exposures are taken while the tube is in motion.


Myocardial imaging using emission computed tomography. Single-photon emission computed tomography (ECT) was evaluated during myocardial studies in dogs. Acute anterior and posterior infarcts were imaged following injection of 99mTc-pyrophosphate or 201Tl. In most cases, tomographic delineation of infarct location and extent correlated with tissue section. The 99mTc images were far superior to the 201Tl images. ECT improves delineation of tracer within the myocardium.


Dilatation of the nasolacrimal duct under radiographic control. Obstruction of the nasolacrimal duct is a major cause of epiphora, or tearing. The authors describe a method of dilating obstructions to re-establish drainage of the lacrimal sac which utilizes fluoroscopic control to stay within the natural lumen of the nasolacrimal duct. The procedure is simple to perform under local anesthesia. An unsuccessful dilatation does not interfere with subsequent dacrocystorhinostomy.


Increased bone marrow blood flow in sickle cell anemia demonstrated by thallium-201 and Tc-99m human albumin microspheres. Lower extremity vascularity in nine patients with sickle cell anemia was studied by intra-arterial Tc-99m human albumin microspheres or intravenous thallium 201. In eight patients, the normal pattern of greater muscle than bone activity was reversed with marked tracer localization in skeletal parts usually not visualized. In four cases, there were distinct focal abnormalities in the femurs and tibias which correlated with defects on Tc-99m sulfur colloid marrow scans. Tc-99m pyrophosphate bone scans demonstrated normal uptake in the same areas. The scintigraphic findings indicate a markedly increased relative bone marrow blood flow.


Voice change after radiotherapy. Some preliminary results. A one-third octave spectral analysis was performed on two sentences spoken by 5 patients with laryngeal cancer, 5 with head/neck cancer not involving the vocal cords, and 12 normal subjects. Recordings were made prior to and at weekly intervals during radiotherapy as well as at periodic intervals post-treatment. Patients with laryngeal cancer exhibited lower spectral levels than normal throughout radiotherapy as well as several months post-treatment. By one year after treatment, the spectral levels of these patients were largely in the normal range. Patients with head/neck cancer not involving the vocal cords exhibited greater than normal sound pressure levels throughout most of the spectrum. These levels remained high even at one month post-treatment. Irradiation of normal vocal cord tissue also seems to result in higher spectral levels.


Computed tomographic evaluation of traumatic spinal injuries. A full radiological evaluation of patients who sustained traumatic injuries to the spine may be difficult to obtain due to the danger associated with manipulation. Computed tomography offers a new modality for simple and accurate evaluation; valuable information may be gained without the use of invasive methods.


A versatile cinefluorography film marker. A versatile ciné marker which allows correlation of ciné films with simultaneous recordings of pressure, ECG, or other physiological data is described. A presettable portion of the ciné film is marked while concurrently marking the hard-copy tracing of the monitored functions. The marker frequency and duration are easily adjusted.


A new technique for transhepatic liver tract dilatation. An aid in transhepatic portography. Transhepatic portography is frequently difficult or unsuccessful in cirrhotic patients because of catheter friction by the fibrotic liver and the presence of ascites. The authors describe a technique of liver tract dilatation which circumvents these difficulties.


Percutaneous punctures: a new radiological skill. Percutaneous aspiration or biopsy of abdominal masses is being performed with increasing frequency. Percutaneous puncture under fluoroscopic control is the simplest technique; it has the advantage that contrast media can be inserted into a cyst to outline its walls. Ultrasound can play an important role in guiding punctures if the mass or organ to be punctured cannot be seen on a radiograph or will be approached from an unusual angle. CT scanning is the preferred procedure for guiding the puncture of bone lesions and some small structures. The author concludes there may soon be a need for abdominal-puncture experts.


The adult hip: an anatomic study. Part I: the bony landmarks. A comprehensive anatomic, pathologic and radiographic study of the adult hip was undertaken to define bony landmarks which, when altered, are reliable indicators of disease. Methodology included radiography of cadaveric specimens and analysis of over 300 anteroposterior (AP) radiographs of "normal" adult hips. This information was applied to clinical situations with the following conclusions: (a) The diagnosis of protrusio acetabuli is warranted if the acetabular line projects medial to the ilioischial line by 3 mm or more in men and by 6 mm or more in women. (b) In acetabular trauma, an AP and two oblique radiographs (30 degrees anterior oblique and 30--45 degrees posterior oblique) are required for complete evaluation. (c) Characteristic alterations in the joint space allow accurate diagnosis of disease.


Evaluation of calcium concentration in bones from CT scans. Fresh cadaveric lumbar vertebrae from 28 subjects were obtained at autopsies and then analyzed by CT scans. An average CT number, calibrated against water and representing the relative x-ray attenuation coefficient of cancellous bone of each vertebra, was obtained. Calcium concentrations in milligrams per cubic centimeter for each vertebral specimen, calculated by physical methods, were plotted against the average CT numbers. The results suggest a linear relationship between the CT numbers and the calcium content of bone.


The normal jugular spur, jugular foramen, and jugular bulb as visualized on skull and temporal bone radiographs. Special jugular foramen views or tomography are generally used to radiographically delineate the jugular spur, jugular fossa, and jugular foramen. Details of this area are not ordinarily searched for by the radiologist on skull films nor otoroentgen views of the temporal bone for various reasons: attention to certain small "key-areas," rectilinear distortion, superimposition of neighboring structures, radiodensity of the petrous pyramid, etc. This paper outlines the radiographic anatomy of the jugular area and details its appearance on plain skull films (AP, PA, and submentovertical projections) and on special views of the temporal bone (Schuller's, Owen's, Mayer's, Stenvers', Low-Beer's).


The adult hip: an anatomic study. Part II: the soft-tissue landmarks. A comprehensive anatomic, pathologic, and radiographic study was undertaken to define reliable soft-tissue landmarks about the hip. Methodology included an analysis of 300 "normal" adult hip radiographs, tissue maceration, cadaveric intra-articular injection studies and review of selected clinical cases. Results, when applied to clinical situations, indicate: (a) The iliopsoas and "capsular" fat planes are poor indicators of small to moderate amounts of intra-articular fluid in the adult. (b) The "capsular" fat plane is not associated with the joint capsule, but in fact is a fat plane between two muscle bundles anterior to the articulation. (c) Distinct soft-tissue planes are available for dissemination of fluid from the hip joint. These include the iliopsoas bursa, which may distend in association with articular disease, and the fat plane of the obturator externus muscle.


Spinal cord compression by extramedullary hematopoiesis in agnogenic myeloid metaplasia. Extramedullary hematopoiesis presented as a diffuse mass causing almost complete obliteration of the spinal subarachnoid space in a patient with known agnogenic myeloid metaplasia. Pre- and post-radiation therapy films correlate well with significant clinical improvement in his neurological status.


Metrizamide epidurography in dogs.

Metrizamide epidurography in dogs. Metrizamide, a non-ionic water-soluble contrast agent, was injected into the epidural spaces of 6 dogs to see if the posterior border of the L7-S1 interspace could be outlined. Between two and six Metrizamide epidurograms were obtained on each dog. The L7-S1 interspaces were usually well outlined. No complications were experienced by the dogs. The dogs were sacrificed at intervals between 3 days and 42 days following their last epidurogram in order to examine the epidural tissues for inflammatory changes. No histologic differences were observed between the control and experimental dogs.


Peridurography with metrizamide: animal and human studies. Metrizamide (300 mg l/ml) was tested for spinal peridurography in conscious dogs and humans. Epidural metrizamide was non-irritating in volumes up to 12 ml. Larger volumes caused mild discomfort in two patients. Radiographic contrast was satisfactory, and there were no sequelae. Peridurography with metrizamide (300 mg l/ml) appears to be a safe, useful diagnostic procedure in ambulant patients.


Aglossia-adactylia.

Aglossia-adactylia. Aglossia-adactylia is part of a family of malformation syndromes in which asymmetric reduction defects of the limbs are associated with oromandibular anomalies. The clinical and radiologic features of six cases are presented. Certain clinical observations, the results of animal studies by other authors, and embryologic considerations suggest a vascular pathogenesis.


Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children. The anterior humeral line is a valuable aid in the search for supracondylar fractures in children. When it is abnormal other signs of fracture should be carefully sought. The AHL was normal in only 5.8% of the cases reviewed (4 of 68 cases). There was other evidence of fracture in each case. Comparison of the AHLs on both sides is helpful when the AHL is normal since it may disclose subtle displacement of the line on the affected side. In children younger than 2 1/2 years the AHL may pass through the anterior third of the capitellum due to the small size of the ossification center; in these patients comparison with the opposite side may also be helpful.


Arthrographic findings in septic arthritis of the hip in infants. Both standard radiography and arthrography are essential in the diagnosis of septic arthritis in infancy. Plain films demonstrate lateral subluxation, marked delay in appearance of the femoral ossification center, deformity of the femoral neck, and acetabular dysplasia. Arthrography shows cartilaginous deformity, subluxation, and contracture of capsular structures. These observations may distinguish the late sequelae of bacterial infection from other entities such as noninfectious avascular necrosis.


Adrenal scanning and uptake with 131I-6beta-iodomethyl-nor-cholesterol. Adrenal scans were obtained in 50 patients with suspected adrenal disease; 131I-19-iodocholesterol was used in 12 and 131I-6-beta-iodomethyl cholesterol (NP-59) in 38 cases (42 scans). The scan diagnosis was correct in 48 patients. Successful images were obtained with 0.5 mCi, or less, of NP-59 instead of the standard dose of 2 mCi, thus reducing radiation dose to the patient and cost of the agent. Satisfactory scans were obtained in 2--3 days in patients with hyperfunctioning adrenals, and in 3--7 days in other groups of patients, when NP-59 was used. With 131I-19-iodocholesterol, however, 5--10 days were required for optimal results in all patients including those with Cushing disease. Adrenal uptake studies were very useful in the evaluation of adrenal function, particularly in differentiating bilateral hyperplasia from normal adrenals.


Congenital syphilitic hepatitis: a radionuclide study. A two-month-old girl with congenital syphilitic hepatitis had bizarre liver scintigraphic features showing diminished hepatic uptake of radiocolloid with accentuated pulmonary and bone marrow accumulation. These features were reversible following penicillin therapy and to our knowledge are previously undescribed manifestations of this multisystemic disease.


Intense concentration of technetium-99m pyrophosphate in the kidneys of children treated with chemotherapeutic drugs for malignant disease. Seventeen of 265 bone scans in children receiving chemotherapy for various malignant diseases exhibited intense renal parenchymal uptake of radioactivity during bone imaging. In a retrospective analysis, it was learned that uptake occurred when imaging was performed within one week of cancer chemotherapy. It was encountered after injection of cyclophosphamide (P less than 0.05), vincristine (P less than 0.01), and doxorubicin (P less than 0.02). In this series, none of the 265 scans showed intense renal uptake unless the patient received chemotherapeutic drugs in the preceding week. This finding did not seem to result from altered renal function, and the exact cause has not been defined.


The effect of the urinary bladder in obstetrical sonography. Observations of random obstetrical cases out of a large-volume practice are presented to demonstrate the often overlooked effects of filling the urinary bladder for obstetrical sonography. The effects, predominantly evident in the second trimester, include: perssure effects on the lower uterine segment, displacement of the cervix and/or corpus of the uterus, rotation, flexion, version, and tilting of the uterus. These events may affect the perception of placenta location and fetal position. This is especially important in the diagnosis of placenta previa in the second trimester. Many instances of placental "migration" may be due to this phenomenon. Implications for amniocentesis are briefly discussed.


Accuracy of placental localization by ultrasound. In a retrospective study, ultrasound diagnoses were correct in 93% of 164 patients referred for examination because of suspected placenta praevia. There was one false-negative finding in 13 cases of proven placenta praevia, and ten false-positive errors in 151 true-negative cases. False-positive results represented the largest number of errors. Examination of the patient with an empty bladder, in addition to the routine technique, is suggested to reduce the number of false-positive results.


Determination of bladder volumes by gray scale ultrasonography. Gray scale ultrasonography was used to measure bladder volumes. A high degree of accuracy (r = 0.097) in correlating volumes with instilled volumes is attributed to the inherently greater accuracy of gray scale as compared to bistable B-mode scanning.


The peripatetic placenta.

The peripatetic placenta. The author reviewed 249 arterial placentograms obtained between 1964 and 1974. In some cases a placenta, which at first lies low and encroaches on the incipient lower uterine segment, will move upwards towards the fundus and come to rest wholly in the upper uterine segment as gestation progresses. The mechanism of this movement and the possible reasons why some placentae move and others do not are also discussed.


Ultrasonic findings in intramural exogastric lesions. Four cases of intramural exogastric lesions studied by ultrasound are presented. In all four patients, a large mass was identified in the left mid- and upper abdomen with a strip of solid tissue extending toward the left hemidiaphragm anteriorly, adjacent to the left lobe of the liver. This finding, best demonstrated on longitudinal scanning, suggested that the mass originated in the stomach rather than in the spleen or splenic flexure of the colon, which are posterior in location. Two of the lesions were leiomyoblastomas and two leiomyosarcomas.


The gray scale sonographic appearance of intra-abdominal mesenchymal sarcomas. Twenty-eight patients with intra-abdominal mesenchymal sarcomas were examined with gray scale ultrasonography. Masses were present in the mesentery, abdominal hollow viscera, liver, and retroperitoneal areas. Four different ultrasonic patterns were observed in the extra hepatic abdominal masses: (a) hyperechoic masses intermixed with anechoic zones; (b) hyperechoic masses with central fluid-filled zones; (c) homogeneous hyperechoic masses; and (d) homogeneous hypoechoic masses. Three of 6 patients with hepatic masses were totally anechoic alongside other more typical metastatic patterns. The presence of a large mass with sonographic signs of necrosis should strongly suggest the possibility of sarcoma. The differential diagnosis is discussed.


Incomplete pulmonary interlobar fissure sign. The author describes findings of pleural fluid in the major pulmonary interlobar fissure. Clear areas of perihilar lucency are bordered laterally by a sharp concave line, peripheral to which is opacification consistent with pleural fluid rising into the major fissure. Perihilar lucency, curvilinear demarcation, and lateral opacity indicate fluid extending into the major pulmonary fissure. The fissure is incomplete medial to the line.


A comparison of mammographic x-ray spectra. X-ray spectra produced by mammographic systems are compared to spectra from conventional diagnostic x-ray systems. Some systems use special anode materials and beam filters to produce x-ray spectra more suitable for mammography. The data show that the spectra produced by some systems are unique; in fact, one using molybdenum for both an anode and beam filtering element can produce an x-ray spectrum having more than 80% of the photons below 20 KeV. Using some typical breast phantom materials as attenuators, the primary x-ray spectra incident upon the imaging system were simulated and displayed. Implications of spectral shaping to image quality and patient dose are discussed.


Optimization of xeroradiographic exposures. Xeroradiographs were exposed over a range of mAs and kVp in the mammographic energy range. At each kVp, the technique yielding the widest halo also produced the greatest detectability of small aluminum specks in mammographic phantoms. As the kVp increased, the maximum halo width and number of visible specks decreased. At all kVps, the techniques yielding the widest halo furnished almost constant energy deposition in the selenium plate. This constant plate dose was correlated to patient exposure at the entrance of the breast, and the relationships between patient entrance exposure, kVp, and minumum detectable speck size were determined.