PNEUMOPERITONEUM IN PERFORATED PEPTIC ULCER—Factors in Roentgenographic Demonstration

Evidence compiled in review of data on 324 cases of perforated gastric or duodenal ulcer indicated that pneumoperitoneum is more likely to be demonstrated in roentgen films made within six hours after perforation than in films made after a longer interval. In several cases films made early did not show intraperitoneal gas and later films did. There appeared to be no constant relationship between the size of the perforation and the incidence of demonstrable pneumoperitoneum. Pneumoperitoneum was less often demonstrated in cases of posterior perforation than it was when the lesion was at an anterior site.In many cases roentgen examination was performed with the patient in both the erect and the left lateral decubitus positions. These two roentgenographic views were equally reliable and there was agreement between them in 94 per cent of the cases. Clinical factors, however, may influence decision as to which position should be used in each case. Occasionally when intraperitoneal gas is not demonstrated in one view, it may be observed in films made with the patient in the other position.     

Transurethral prostatectomies; a review of 560 cases

Spontaneous pneumoperitoneum most often occurs following ruptured peptic ulcer. In 80 to 85 per cent of cases of perforated ulcers, free intraperitoneal air is demonstrable. There have been reported three cases in which air was present without demonstrable cause, without peritoneal irritation or peritonitis. This presentation adds a fourth. Examination of a patient with acute disease of the abdomen should include not only a roentgenogram with the patient supine but films made in the left lateral decubitus position and/or upright position to demonstrate free air. The radiologist should be ready and willing to consult with the surgeon at the time of examination. Attention is called to a sign described recently by Rigler in supine films, namely, the visibility of both the inside and the outside of the intestinal lumen. Another sign in the supine film, namely the contrast of air against the peritoneal reflections, is described.     

Radiographic Diagnosis of Intestinal Perforation in Early Infancy

Records of 25 patients with intestinal perforation in early infancy who were treated at the Los Angeles County General Hospital in a period of 15 years were reviewed. Sixteen had roentgen evidence of pneumoperitoneum, and nine did not. The mortality rate was 94 per cent in the group with pneumoperitoneum, 78 per cent in the other, and 88 per cent overall. Multiple sites in the gastrointestinal tract were involved, and the causes of the lesions were diverse and frequently obscure. Prematurity, obstetrical and iatrogenic complications, and congenital anomalies were factors often associated with intestinal perforation. Roentgen features appeared to offer the best hope for diagnosis and appropriate treatment.     

Rheumatoid arthritis; diagnosis in peripheral joint affliction

The diagnosis of rheumatoid arthritis in a typical case depends upon a history of pain and swelling of various joints throughout the body. In the first stages the disease usually involves only the small joints of the hands and feet, but sooner or later it spreads to the larger joints. This may be accompanied by fibrosis of one or more joints, causing disability ranging from disuse of one joint up to total incapacity. Diagnosis in early or atypical cases is often impossible until the patient has been under observation a long time. It is important that diagnosis be made as early as possible, in order that appropriate therapy may be started and ankylosis and disability of the joints prevented. Since laboratory procedures and roentgen films do not show early changes, emphasis is placed on the history and physical examination for diagnosis.     

RHEUMATOID ARTHRITIS—Diagnosis in Peripheral Joint Affliction

The diagnosis of rheumatoid arthritis in a typical case depends upon a history of pain and swelling of various joints throughout the body. In the first stages the disease usually involves only the small joints of the hands and feet, but sooner or later it spreads to the larger joints. This may be accompanied by fibrosis of one or more joints, causing disability ranging from disuse of one joint up to total incapacity. Diagnosis in early or atypical cases is often impossible until the patient has been under observation a long time. It is important that diagnosis be made as early as possible, in order that appropriate therapy may be started and ankylosis and disability of the joints prevented.Since laboratory procedures and roentgen films do not show early changes, emphasis is placed on the history and physical examination for diagnosis.     

THE TREATMENT OF METASTATIC BREAST CANCER IN BONE

The author report clinical experience with 212 cases of mammary cancer metastatic to bone, in 186 of which radiotherapy was given, and in 26 steroid hormone therapy.At least 70 per cent of patients with bone metastasis from breast cancer were relieved of pain by adequate roentgen therapy, the relief lasting for most of the survival time in many instances.About 25 per cent of patients had recalcification or reossification of bony lesions with roentgen therapy; while dramatic, this is not always an indication that relief of pain will continue or that survival time will be lengthened.If and when adequate radiotherapy has not been effective or cannot be administered (for example, in a patient with extremely widespread metastasis, or one residing at a considerable distance from radiotherapeutic service) steroid hormone therapy in adequate dosage is frequently beneficial. From 40 per cent to 75 per cent of patients with bone metastases from breast cancer are relieved of pain by steroid hormone therapy. In about 15 per cent of cases recalcification of the lesion occurs.Effective roentgen therapy may usually be given in a relatively brief period of time (one to two weeks). Effective steroid hormone therapy usually requires from 12 to 24 weeks.Complications of steroid hormone therapy are numerous. Some patients are made considerably worse by such therapy. These complications may only be controlled by reduction or discontinuation of the hormones. For this reason, it is recommended that irradiation always be used as the initial method of palliation.     

RADIOLOGIC DIAGNOSIS IN ABDOMINAL TRAUMA

In a survey of its use in 198 cases of penetrating and nonpenetrating abdominal trauma causing various kinds of lesions, roentgenographic examination was found to be a considerable diagnostic aid. Consultation with a radiologist before, during and after the examination would seem indicated.The general plan of examination included anteroposterior projections with the patient erect, recumbent and in the left lateral decubitus positions, plus a posteroanterior film of the chest with the patient erect. Techniques varied with the condition of the patient and the nature of the lesion clinically suspected. Special procedures were done as dictated by the clinical and radiologic findings. Studies designed to demonstrate displacement of gastrointestinal and urinary organs should be made in anteroposterior and lateral projections.Factors that were important in determining the site of internal lesions from radiographic evidence were the site of associated fractures, reactive ileus, the position of foreign bodies, and by far the most important the roentgen abnormalities caused by escaped gas, blood, other fluids or contrast media, which caused abnormal densities, displacements of organs and blurring or obliteration of outlines normally visible.     

常规腹部立位平片漏诊膈下游离气体原因分析及技术改进

目的：探讨常规腹部立位平片漏诊膈下游离气体的原因及技术改进。方法：15例疑有气腹但腹部立位平片阴性者加拍胸部正位片,观察有无膈下游离气体。结果：15例中12例胸片可显示膈下少量游离气体。结论：X线投照中心线位置不同会影响膈下游离气体的显示,胸片较腹部立位平片更容易显示少量气腹。     

常规腹部立位平片漏诊膈下游离气体原因分析及技术改进

目的：探讨常规腹部立位平片漏诊膈下游离气体的原因及技术改进。方法：15例疑有气腹但腹部立位平片阴性者加拍胸部正位片,观察有无膈下游离气体。结果：15例中12例胸片可显示膈下少量游离气体。结论：X线投照中心线位置不同会影响膈下游离气体的显示,胸片较腹部立位平片更容易显示少量气腹。     

ROENTGEN THERAPY OF RHEUMATOID SPONDYLITIS

Based on the pathological processes involved in rheumatoid spondylitis, comparison is made between the physical qualities of certain techniques of roentgen therapy. Graphic representation of the isodose curves and the homogeneous distribution of radiation pertaining to the method herein advocated is shown.Results obtained in the treatment of 125 cases illustrative of the evolution of technique experienced at the University of California Hospital are tabulated. The indications, contraindications, and complications of the method are discussed.Practically every patient with rheumatoid spondylitis, regardless of the stage of the disease, was benefited, with the best results having been obtained when the radiation was given in three courses, separated by rest periods, and homogeneously distributed along the spine.     

坏死性小肠结肠炎的X线表现（附141例报道）

目的：总结坏死性小肠结肠炎的X线表现。方法：回顾性分析141例经临床证实的坏死性小肠结肠炎病例,怀疑或已诊断为坏死性小肠结肠炎者在首次腹平片后,根据病情每6～24小时复查腹平片,动态观察病情发展及转归。结果：小肠胀气扩张72例,部分肠管狭窄变细、形态僵直38例,局部胃肠道见＂泡沫征＂者12例,肠壁囊样积气者25例,肠壁线样积气者6例,肠壁囊样积气及线样积气者13例,门静脉积气者8例,气腹者21例。结论：坏死性小肠结肠炎的早期X线表现为肠管僵直、狭窄;进展期典型X线表现为肠壁积气及门静脉积气。X线检查为本病的首选检查方法。     

领春木茎次生木质部中导管穿孔板的变异

领春木Euptelea pleiosperma Hook. f. &; Thoms.隶属领春木科Eupteleaceae。该科为东亚特有的单型科,其系统位置一直颇有争议。本文对中国产领春木茎次生木质部中导管穿孔板的变异进行了观察,以期为它的系统位置提供进一步的解剖学证据。结果表明,领春木茎次生木质部中包括无明显穿孔板的管胞状导管和典型的导管两种类型。在无明显穿孔板的导管中,穿孔中的纹孔膜全部或部分消失,但穿孔无规则排列或聚集,不形成具典型的形态特征的穿孔板;在典型的导管中,穿孔板形态变异较大,包括几个类型:网状穿孔板(含麻黄式穿孔板)、网状和梯状混合型穿孔板、梯状穿孔板、梯状穿孔板向单穿孔板的过渡。在上述导管穿孔板类型中,只有梯状穿孔板的穿孔中可以观察到纹孔膜的残余。在领春木次生木质部中也观察到了端壁多穿孔板及侧壁穿孔板。根据观察结果,我们认为领春木次生木质部导管穿孔板的许多特征说明该科可能处于毛茛目中比较原始的系统位置。     

Gastric polyposis

In a series of 48 cases of gastric polyps, 40 patients had benign lesions while the polyps in the remaining eight cases were malignant. Although the symptomatology in this series was not uniform, only one patient was entirely asymptomatic. Of the eight patients with malignant lesions, three had polyps which could well be described as small, suggesting that size may not be a reliable criterion of benignity even in a single lesion. Laboratory studies indicated that anemia, achlorhydria and occult blood in the stools are frequently associated with gastric polyps. There was no apparent correlation, however, between these phenomena and the benign or malignant nature of the lesions.X-ray examination, performed in every instance, was completely negative in six cases and inconclusive in an additional five. Gastroscopy did not reveal the presence of polyps in three of 15 cases. Malignant change was detected by cytologic examination in one case in which both roentgen and gastroscopic examination were negative. The author believes that in most cases of gastric polyps operative treatment affords the greatest degree of safety. An operative procedure of considerably less extent than total gastric resection often is feasible. However, if true polyps occur where removal can be effected only by total gastric resection, the incidence of malignant change in these lesions would seem to indicate the advisability of such a procedure unless positive contraindicating conditions are present.     

Subacute thyroiditis

Twenty-one cases of thyroiditis, generally considered a rare disease, were observed in the Los Angeles area in a period of less than two years. Eight of them were observed at one clinic in the course of six months.Although diagnosis of the disease usually is made hesitantly or apologetically, and misdiagnosis is not uncommon, the clinical pattern is fairly characteristic. Subacute thyroiditis may cause pronounced disability. Treatment with propylthiouracil or roentgen radiation appeared to be the most effective.     

Rupture of the gastrointestinal tract; dealing with lesions caused by non-penetrating trauma

The possibility of rupture of the gastrointestinal tract should be considered in every case of abdominal trauma, and the patient should be carefully observed for a period of 12 to 48 hours. There are many factors that may confuse diagnosis, but in the presence of persistent pain and tenderness, persistent or recurring shock, fever, leukocytosis, roentgen demonstration of free intra-abdominal air, or of other signs of peritonitis, operation should be carried out. The mortality rate is much higher when definitive treatment is delayed more than 12 hours.     

SUBACUTE THYROIDITIS

Twenty-one cases of thyroiditis, generally considered a rare disease, were observed in the Los Angeles area in a period of less than two years. Eight of them were observed at one clinic in the course of six months.Although diagnosis of the disease usually is made hesitantly or apologetically, and misdiagnosis is not uncommon, the clinical pattern is fairly characteristic.Subacute thyroiditis may cause pronounced disability. Treatment with propylthiouracil or roentgen radiation appeared to be the most effective.     

Actue Cholecystitis Following Unrelated Surgery

In a series of 26 cases of acute cholecystitis occurring after an operation for an unrelated condition, 88% of the patients were over 50 years of age and males outnumbered females by 2 to 1. In some of the cases diagnosis was difficult and delay was responsible for the death of one patient. Acalculous cholecystitis occurred in 20% of the cases and in these gangrene or perforation supervened early in the course of the disease.Efforts should be directed to ensuring adequate hydration after operation; resumption of a diet low in fat may be important. Even in the absence of a history of biliary disease, there is a place for the radiological study of the biliary tract before major elective operations are performed. If gallstones are discovered on the occasion of the initial surgery, cholecystectomy should be performed whenever it is feasible. In any patient with postoperative cholecystitis early operation is generally indicated.     

RADIOGRAPHIC SIGNS OF ACUTE SUPPURATIVE CHOLECYSTITIS

In a recent series of 26 pathologically proven cases of acute cholecystitis, preoperative radiographic examination of the abdomen confirmed the presence of an inflammatory process in 17.The radiographic signs associated with acute suppurative cholecystitis are:1. Enlargement of the gallbladder, as indicated by separation or alteration in position of opaque calculi or indentation of adjacent bowel.2. Localized peritoneal irritation, manifested by (a) ileus of hepatic flexure of colon; (b) ileus of duodenal loop; (c) effacement of haustra of the hepatic flexure or valvulae conniventes of the duodenum; (d) obscuration of fat line marking inferior border of liver.3. Cholecystitis emphysematosa.4. Perforation of gallbladder, which if localized (retroperitoneal) is manifested by bubbles of gas in the gallbladder bed. If generalized (intraperitoneal) the signs are adynamic ileus of small and large bowel, increased intraperitoneal fluid, subdiaphragmatic abscess and plate atelectasis of right lung base.Visualization of the gallbladder and biliary tree after intravenous cholecystography rarely occurred in the presence of acute cholecystitis.Plain film examination of the abdomen aids in establishing the diagnosis of an acute cholecstitis and leads to the early recognition of complications such as perforation and peritonitis.     

MEDIASTINAL TUMORS OF THYMIC ORIGIN

Twenty-one cases of mediastinal tumors of thymic origin are presented. Five of these were benign and 16 malignant.Surgical excision is proposed as the treatment of choice for the encapsulated benign tumors or for malignant tumors of limited extent. When surgical excision is not feasible, adequate roentgen therapy amounting to 5,000 to 6,000 r calculated tumor dose may eradicate or control the tumor.No correlation between the histological pattern of the tumor and the survival rate or radiation response could be demonstrated in this small series.     

Variability of measurements of cranial growth in the rabbit

This study concerns techniques used in experimental cranial growth research: roentgen cephalometry, roentgen stereophotogrammetry, and gross measurements (osteometry). A comparison of the precision of these methods has not been found in the literature. Computation of technical errors is fundamental to the sound evaluation of registered findings, and such a presentation must be obligatory in all biometric reports. We compared the measurement error of roentgen cephalometric and osteometric data with that obtained by roentgen stereophotogrammetry (RSA). RSA demonstrates a superior replicability, and this technique gives possibilities for kinematic and volumetric determinations simultaneously with distance evaluation. Roentgen cephalometry has the advantage of enabling distance and angular measurements between any well-defined skeletal points or lines. This technique, preferably after implantation of bone markers, is a reliable alternative, but optimal results necessitates calculations of the magnification factor for each bone segment involved. Direct osteometry does not contribute additional information, but problems of image magnification are omitted. Preferably, one individual should perform all measurements regardless of the method used. Growth rates and values calculated by one technique cannot be directly transformed to some other approach. In all probability, assessments of distance changes would gain substantially by using one technical approach consistently throughout actual age intervals. The least variable measurements of sutural growth are made for sutures growing primarily in one plane and with substantial growth rates. One must realize that differences among studies may be due to the limitations of, in particular, the cephalometric and osteometric techniques.