Biomedical subjects
Publications and source records attributed to D Bryk.
In a paraesophageal hernia, the esophagogastric junction remains below the hiatus while portions of the fundus or other parts of the stomach herniate in front and to the left of the esophagogastric junction through the hiatus into the thorax. We describe an unusual presentation of a paraesophageal hernia, in which herniation of the splenic flexure of the colon led to colonic obstruction.
Two cases of retroperitoneal lipomatosis with an unusual distribution are reported. In the first case the fat was confined to the perirectal soft tissues and the sigmoid mesentery, whereas in the second case it was peripancreatic and extended into the small bowel mesentery. The lipomatous nature of these retroperitoneal masses was suggested by the lucency of the fat on the plain abdominal roentgenograms. These cases were studied prior to the availability of computed tomography, so that the diagnoses were confirmed by surgical exploration, which may have been avoided by this currently available noninvasive technique.
Two cases are reported of acquired microcolon distal to long-standing transverse colostomies performed 25 and 13 years previously. The radiologic appearance of the bypassed unused colon was similar to that of the microcolon of infants, demonstrating shortening, tubulation, and lack of haustrations.
A retrospective study of 82 cases of peripheral vascular occlusive disease examined by retrograde femoral arteriography with a catheter needle technique showed a 6% incidence of retrograde arterial wall dissection involving the iliac arteries and the aorta. In one patient, the dissection re-entered the abdominal aorta near the renal arteries, producing an iatrogenic chronic dissection. The others did not demonstrate any permanent side effects. In 1974, in view of the appreciable risk in the use of a catheter needle, the technique was changed to percutaneous femoral catheterization of the abdominal aorta using a catheter with multiple side holes. No further cases of iatrogenic aortic dissection were observed. A veriety of mechanisms may have been responsible for the dissections.
Colonic intussusception is a condition primarily found in infants and young children. In adults, it is usually associated with a colonic neoplasm. The following report illustrates a case of colonic intussusception in an adult uremic patient in whom postmortem examination showed evidence only of intramural colonic hemorrhage.
Five cases of generalized Kaposi's sarcoma are reported with roentgen evidence of involvement of the intestinal tract. In three instances, there was extensive involvement of the small bowel with multiple intramural nodules. The fourth patient demonstrated multiple polypoid lesions of the colon, and in the fifth a constricting lesion of the ileum was present. Two patients with small bowel involvement had significant malabsorption. This latter complication of diffuse Kaposi's sarcoma of the small bowel has not been previously reported. The diagnosis of the nature of the roentgen intestinal abnormality can usually be made, because intestinal involvement generally occurs late in the disease, when both extensive cutaneous nodules and edema of the extremities are apparent.
A simple method of shielding the hand during cross-compression angiography is described. A standard lead glove with the fingertips cut out of the palmar aspect is used, allowing sensation and mobility while still protecting the hand.
Fifty consecutive cases of strangulating obstruction were compared with 100 consecutive cases of surgically proven simple obstruction due to adhesions or hernia. All cases were studied by the usual supine and either erect or decubitus abdominal films, and by two successive supine films made at 5 min intervals. Radiographic criteria previously described as signs of possible strangulation were evaluated in the two series. Reduced activity of the small bowel loops on the successive supine films was the only frequent sign (58% of the cases with strangulating obstruction) which showed a statistically significant difference in incidence between the two groups. Other signs seen with some frequency (22%-28% of the group with strangulation) were long air-fluid levels, loss of valvulae conniventes, retention of bubbly fecal matter in the right colon, and predominance of fluid-filled loops; however, they occurred with the same frequency in simple obstruction. The more specific signs of bowel congestion and necrosis (i.e., a narrow rigid loop or intramural gas) were seen in 10% and 2% of the cases, respectively. Only the incidence of a narrow rigid loop in strangulation reached statistical significance. This study confirms the difficulty of diagnosing strangulating obstruction using plain films of the abdomen. Successive abdominal films were shown to be valuable in providing information about small bowel activity, which can help in the differential diagnosis.
Obstruction and reflux occur fairly commonly in the duplex kidney. Although obstruction with attendant hydronephrosis is more frequently seen in the upper pole of a duplex system, a similar process involving the lower pole should be considered in the differential diagnosis of renal mass lesions. Four cases are described in which lower pole hydronephrosis simulated neoplasm.
Temporary postoperative tube gastrostomy may produce permanent deformity of the stomach as visualized on an upper gastrointestinal series. Six cases were studied illustrating two configurations of the gastric deformity. These appear to be related to the location of the gastrostomy opening in the stomach. The findings were either anterior displacement of the gastric antrumwith adherence to the anterior abdominal wall or acute angulation of the gastric body in a medial and anterior direction.
Postmortem examination of a child with osteodysplastia (Melnick-Needles syndrome) showed peculiar fibro-osseous tissue in the marrow cavity, with areas of bone constriction but no abnormality of endochondral ossification. Pectus excavatum and scalloping of the vertebral bodies were also present.
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The pseudodiaphragmatic contour of infrapulmonary effusion may differ from the contour of an elevated hemidiaphragm in the frontal view in that its medial portion is straight and shows a gradual inclination upward and laterally from the cardiac shadow, so that its apex is located more laterally. Previous studies have indicated that this configuration is seen only in about 50% of cases of infrapulmonary effusion. Using expiration radiographs, it is possible to routinely demonstrate this characteristic pseudodiaphragmatic contour. This study provides an additional sign of infrapulmonary effusion and aids in the explanation of the pseudodiaphragmatic contour.
Two cases of chronic aortic dissection are presented. In both, plain chest roentgenograms revealed calcification in the outermost aspect of the dilated aorta. It is clear that this represented calcification of the dissection rather than of the true intima. These cases indicate that apparent aortic intimal calcification with dilatation of the aorta is not completely diagnostic of an arteriosclerotic aneurysm and that a chronic calcified aortic dissection must also be considered in the differential diagnosis.
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Serial erect roentgenograms of the gallbladder during oral cholecystography were taken in 50 patients before and after a fatty meal. In the presence of good opacification, layering of opaque and nonopaque bile was noted in most cases 2 hours after the fatty meal. The degree of layering was related to the extent of gallbladder contraction produced by the fatty meal and the degree to which the gallbladder refilled by the inflow of nonopaque liver bile. The layering phenomenon thus appears to be a manifestation of a normally functioning gallbladder and occurs when the gallbladder refills with fresh nonopaque bile.
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Gastric atrophy in the elderly may cause problems in the interpretation of gastrointestinal studies. Seventeen such cases are reported: 8 patients showed limited distensibility and irregularity of the distal stomach simulating scirrhous carcinoma; 6 patients showed gastric retention of food; and 2 patients showed gastric retention of oral cholecystographic medium. Awareness of these phenomena may prevent serious errors in roentgen diagnosis.