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

Five cases are reported and reference is made to 3 previous similar cases of calcified intraluminal meconium in newborn males with "imperforate anus." A rectourinary fistula was found in most of the patients; none of the cases had meconium peritonitis. The calcifications may develop in areas of prolonged stasis; the possible added role of the mixture of urine and meconium in utero is raised.

A new prosthetic device for the treatment of urinary incontinence, caused by a variety of etiologies, has been used 8 times at the University of Michigan Medical Center. Since the entire device is filled with contrast medium, the radiologist plays a major role in its evaluation. A brief description of the implantable urinary sphincter and its normal and abnormal roentgenographic appearances are presented and discussed. Roentgenologic findings which could lead to early clinical detection of mechanical failure are illustrated.

Plain film tomography is of value in detecting small amounts of calcium in "non-opaque" stones. The use of this technique to help differentiate renal pelvic tumor from stone in patients presenting with a filling defect in the renal pelvis is suggested. Four cases in which plain film tomography detected calcium in a renal pelvic stone that could not be seen on routine roentgenograms are presented.

An attempt was made to control renal hemorrhage by selective embolization of the renal artery in 7 patients. In 2 patients the bleeding site was single, but in 2 others, several sites of arterial extravasation were present. Two patients had arteriovenous fistulas, and 1 had an unsalvageable, macerated kidney. Six of the 7 patients (86 per cent) were treated successfully. Nephrectomy was avoided in 5. No patient developed hypertension during the follow-up of 4 months to 2 years. Our results in these patients indicate that selective arterial embolization should have an important place in the management of patients with renal trauma.

Our experience based on the analysis of 12 proved cases of gallstone ileus is presented emphasizing the fact that the plain abdominal roentgenogram may be inconclusive or deceiving. It allowed us to suggest the correct diagnosis in only 4 cases. A high index of suspicion, particularly in elderly female patients, followed by barium examination of the upper gastrointestinal tract leads to a correct and rapid diagnosis. The demonstration of a diverticulum-like structure or a fistulous tract adjacent to the first portion of the duodenum associated with jejunal dilatation and barium dilution is highly reliable.

Two cases of pancreatitis associated with the trauma of child abuse are reported. In the first case the skeletal survey was initially negative but the child later showed widespread roentgen evidence of intramedullary necrosis and periosteal new bone reaction. These lesions healed without treatment. In the second patient, the pancreatitis was accompanied by ascites and subsequently by bile peritonitis, duodenal obstruction, and a bile-filled abscess in the pancreas. This patient had skeletal fractures. The clinical problems of these 2 patients emphasize the need not only to relate pancreatitis to the battered child syndrome but also to distinguish between the bone changes due to direct trauma and those related to pancreatitis.

Vesicoureteral reflux was detected in 200 adults seen in a 4 year period. In group 1 (no history of urinary tract infection and negative urine cultures), all patients had abnormalities on excretory urograms that were suggestive of reflux. In patients with a history of recurrent urinary tract infection (groups 2 and 3), the excretory urograms showed an abnormality in 79 per cent of those with negative cultures and in 83 per cent of those with positive cultures. Thus, reflux should be suspected in patients with a history of recurrent urinary tract infection even if infection cannot be documented with urine culture. Urographic evidence of renal parenchymal scarring, ureteral dilatation, or mucosal striations should also suggest the possibility of vesicoureteral reflux even when the patient may have no urinary tract symptoms. Voiding cystourethrography should be performed in all adults with these findings to exclude the possibility of vesicoureteral reflux.

The arteriographic findings are described and the embryology is discussed in a rare case of situs inversus of the abdominal viscera combined with reversed rotation of the bowel. The arteriogram correctly localized the precise site of hemorrhage in this perplexing case, and a complex surgical problem was simplified.

Uterine choriocarcinoma develops fairly frequently after passage of a hydatidiform mole and very rarely after normal pregnancy or abortion. The disease is highly curable by chemotherapy, especially if detected early. Histologic examination of uterine curettings is unreliable and the principal indicator of active primary or metastatic disease is the HCG titer. The ability to visualize the tumor is helpful for a variety of reasons. In the past, this has been achieved primarily through arteriography. Our experience with 6 patients suggests that sonography is as sensitive a detector as arteriography and perhaps somewhat more specific. These facts, plus its convenience and repeatability, make ultrasound the method of choice for visualization of intrauterine malignant trophoblastic disease. Arteriography will continue to play an important role where the sonographic findings are equivocal and where local invasion or distant metastases are suspected.

Yeast bezoar seems to be a relatively common late complication after various gastric operations. The incidence of bezoar depends decisively on the nature of the operation. Vagotomy in particular is conducive to the formation of a bezoar. Vagotomy + Billroth I resection proveded the most propitious conditions for the growth of yeast, for every one-half of the patients in this group developed a bezoar. Yeast bezoars usually appear within a year of the operation. The majority disappear during the first follow-up year, many without any therapy. However, in some cases the bezoar was a rather inconvenient late complication of gastric surgery and one that gave symptoms. It is difficult to draw any definite conclusions concerning the effect of therapy on the disappearance of the bezoar. We used gastric lavage and antimycotics as well as substances that increase gastric acidity. There is still no known method of preventing the formation of yeast bezoars. In the present consensus, a change in the acid conditions and disturbed gastric motility postoperatively are conducive to the formation of a bezoar.