The American journal of roentgenology, radium therapy, and nuclear medicine最新文献

Extrapelvic spread of disease, particularly from gastrointestinal tract perforations which may be clinically occult, may first present in the buttock, hip, thigh, and even lower leg, and the extraperitoneal space of the abdomen itself. Clinical manifestations at these remote sites may be very misleading. Anatomic and roentgenologic observations establish the preferential pathways of extrapelvic spread. These are related to the insertions and fascial investments of the iliopsoas, pyriformis, and obturator internus muscles and the ensheathed penetrations of the superior gluteal arteries. Superiorly, extension from the pelvic tissues seeks out the posterior pararenal compartment of the extraperitoneal region of the abdomen. Roentgenologic signs may first identify the presence, extent, and localization of the primary process.

Three types of involvement of the rectum and recto-sigmoid by carcinoma of the prostate are reviewed through an analysis of eight cases. A fourth type with subserosal metastatic implant of the proximal sigmoid may occasionally be encountered. The roentgenographic findings are not pathognomonic, but are characteristic of extrinsic involvement of the bowel wall. When clinical symptoms are predominantly related to the bowel, carcinoma of the prostate is usually advanced. All patients presented with bone metastases, uretero-hydronephorsis, lack of function of one kidney, or both bone metastases and urinary tract obstruction. Rectoscopy and biopsy are helpful. However, biopsy specimens often show non-diagnostic features in secondary malignancy. Correct diagnosis is important, since there is a difference in treatment of primary carcinoma and of secondary involvement of the rectum by prostatic carcinoma. A diagnostic challenge exists if the patient is evaluated by barium enema examination for primary bowel symptoms, in particular, large bowel obstruction. At this time intravenous pyelography and bone survey for metastases may not be available to suggest the correct diagnosis. More widespread use of barium enema examinations in the evaluation of advanced carcinoma of the prostate is suggested, since the type of rectal disease shown on barium enema study was not clinically suspected in five of eight patients. The prognosis is usually unfavorable because of advanced carcinoma. Survival often does not exceed several months to one year. However, one of our patients is still well after three years of hormonal therapy.

Tracheal agenesis is a rare anomaly that produces neonatal respiratory distress and has been uniformly lethal to date. In this malformation the entire trachea is usually absent, air reaching the bronchi through a communication with the esophagus, and the lungs are normally formed. The diagnosis should be suspected in any infant in whom improved ventilation is obtained despite difficult intubation and abnormal tracheal tube placement. Coexistent cardiac, gastrointestinal, and genitourinary anomalies are common. The growth of the tracheoesophageal septum and the elongation of the dividing foregut are crucial phases in the morphogenesis of this malformation.

The angiographic findings in 13 patients with renal hemangiomas (one pararenal) are presented. The material suggests, contrary to earlier reports, a predominance for the female sex and the right kidney. Nine of the patients had macroscopic hematuria, of which five had renal colic. Obstruction was found at urography in seven cases. Renal angiography is the definitive diagnostic procedure and should be performed in all cases of unexplained macroscopic hematuria. Diagnosis may eventually be improved by pharmacoangiography or by hemodynamic studies using a dye dilution technique, as small arteriovenous shunts may remain undetected at angiography. Cardiac decompensation was not noted in our material, even though arteriovenous shunting within the hemangioma was seen in eight cases, suggesting that the shunt flow in renal hemangiomas usually does not reach levels high enough to impair the general circulation. Hypertension was present in only one patient, attributed to chronic pyelonephritis. Hematuria disappeared in all nine patients operated upon.

Three cases illustrate the principal clinical and roentgenographic varieties of granular cell myoblastoma (GCM) of the lung. The vast majority are small benign intrabronchial tumors without roentgenographic findings. These remain asymptomatic and are detected accidentally at autopsy, surgery, or bronchoscopy (Case III). Larger obstructing lesions (Case I) cause focal atelectasis or pneumonitis, leading to cough, expectoration, and hemoptysis. Hilar enlargement from reactive lymph node hyperplasia is common. Clinically and roentgenographically these are indistinguishable from bronchial adenomas. Least often the tumor extends entirely extrabronchially (Case II) presenting as a parahilar parenchymal asymptomatic nodule, simulating a granuloma, hamartoma, arteriovenous malformation or a neoplastic nodule.

The natural history of the upper tracts (170 renal units) of 87 patients undergoing total cystectomy and ileal loop diversion has been followed roentgenologically for up to seven years. The complications inherent in the procedure are illustrated and the appearances of new upper tract tumors demonstrated. Of 126 renal units which was obstruction of the anastomosis, seen in 29 units. The need for regular contrast material examination of the surgically modified upper tracts is emphasized.

A technetium 99m diphosphonate scan is a sensitive detector of bony metastases of breast, prostate, and lung cancer. For these particular neoplasms, a negative bone scan in an asymptomatic patient is adequate evidence for absence of bony metastases and a correlative roentgenographic examination may not be necessary. Positive studies demonstrating multiple characteristic discrete areas of increased activity should be considered strong evidence for metastases. Single equivocal lesions require roentgenographic and occasionally biopsy correlation. If roentgenography fails to reveal the source of increased uptake, (e.g., degenerative disease) the scan lesion should remain suspicious for metastases.

Three new cases of cleidocranial dysostosis with hearing loss are reported in this paper. The significant points concerning this association are: (1) the hearing deficit is predominantly a middle ear conduction problem secondary to structural abnormalities of the ossicles; (2) there is sometimes a small bone conduction deficit indicating either a cochlear or an eighth nerve problem; (3) the middle ear hearing loss was corrected surgically in one reported case; (4) there is dense sclerosis of the temporal bone which makes a middle ear operation technically difficult; and (5) hearing loss with cleidocranial dysostosis may be more common than the number of cases in the literature suggests.

Porotic hyperostosis was observed in 34 percent of 539 crania excavated from sites in Arizona and New Mexico. Common causes of this cranial pathology in the Old World (thalassemia, sickel cell anemia, and malargia) do not explain its occurrence in the American Southwest, as malaria and hemoglobinopathies are not known to have existed in the New World prior to European contact. Iron deficiency anemia which may also be assoicated with porotic hyperostosis occurs on a mass level only with hookworm infestation or nutritionally-related iron deficiency. Since hookworm infestation is rare in the American southwest and has not been reported in prehistoric southwestern American Indians, the hypothesis of nutritional anemia was examined. In canyon bottom sites where the diet was heavily dependent on maize, which is low in iron and also contains an inhibitor of iron absorption, significantly more crania had porotic hyperostosis than in sage plain sites, where the diet included ample animal protein rich in easily absorbable iron (p less than .001). Furthermore, canyon bottom children, who were more susceptible to iron deficiency anemia, had a higher incidence of porotic hyperostosis lesions than adults (p less than .0001).