Journal of the Faculty of Radiologists最新文献

Review of the literature shows that the termination of the common bile-duct in a duodenal diverticulum of the papillary region is very rare. Only a few reports on the pathology of this condition and on its radiological demonstration have been found. Four additional cases showing the radiological visualization are presented in this paper.

The pathogenesis of this type of duodenal diverticula, in which the ampulla of Vater (the major papilla) is situated within the diverticular wall, is discussed. The view is put forward that these are true diverticula representing congenital malformations.

A short evaluation of the clinical significance of this condition suggests that it represents a predisposing factor for biliary-pancreatic disease and possibly for stone formation in the common bile-duct. Incompetence of the sphincter of Oddi is believed to be a common feature or even part of this anomalous position of the ampulla of Vater.

The importance of the pre-operative radiological demonstration of this condition is stressed. The value of the radiological methods available for this purpose (gastroduodenal barium examination; intravenous cholangiography; intra-operative cholangiography) is discussed. A few indirect radiological signs which point to the presence of the condition are described, in addition to the direct radiological demonstration of the termination of the common bile-duct in the diverticulum.

Case 4 is thought to be the first case reported in which the ending of the common bile-duct within a diverticulum of the papillary region has been demonstrated by intravenous cholangiography (biligrafin).

A case of parathyroid adenoma with development of secondary renal failure and osteosclerosis has been described and discussed.

Incomplete obliteration of the thyroglossal duct during fœtal development may result in a thyroglossal cyst or sinus, and is the only example of such congenital lesions found in the midline.

The remaining cysts, sinuses, and fistul˦ are found in the lateral aspect of the neck, and the commonest of these is the branchial or lateral cervical cyst or sinus. Solitary lymphatic cysts confined to the neck are rare; they are more commonly found in infants, extending into the superior mediastinum.

Small cysts and sinuses around the ear resulting from anomalies of the first branchial arch and the developing pinna are very rare, and none is included in the present series.

Radiographic examination employing contrast media is of value in determining the extent of these congenital lesions prior to operation.

Benign duodenocolic fistula is a rare condition, but is being recorded with increasing frequency. A further case, due to a duodenal diverticulum, is described. Of the 22 recorded cases, 13 have been annotated since 1949. Demonstration of the fistulous tract by radiological means is a relatively simple procedure, barium enema being the examination of choice.

Two cases of pyelo-ureteritis cystica are reported. A review of the clinical, histopathological, and radiological features is given and the differential diagnosis discussed.

The study reported was designed to assess the value of post-operative radiotherapy following radical mastectomy for breast cancer on a true clinical trial basis. Separate findings are given for each of two distinct post-operative techniques, one mainly covering the flap and axilla, the other mainly the axilla, supraclavicular area, and parasternal region.

No statistically significant overall differences could be established in crude mortality at five years between groups of cases treated prophylactically on orthodox lines and cases ‘watched’ and treated only on need. An apparent minor advantage to the ‘watched’ policy seems to be demonstrated for the surgical Stage-I cases and for younger women.

Investigation of the incidence of local recurrences showed the prophylactic irradiation to have been effective in the treated areas, but that subsequent purposive treatment eventually evened out the situation to a large extent.

Analyses of distant (blood-borne) metastases showed in general remarkable similarity of incidence, but a possible increased incidence in liver metastases in the irradiated cases is commented on.