Acta Radiologica

The possibility of using psychologic tests to demonstrate psychic changes following myelography with metrizamide was investigated in 15 patients. The tests were made before and after the examination. The results revealed psychic changes of cognitive nature to occur both at 6 and at 24 hours after myelography. Of the tests used determination of the reaction time gave most significant results. Subjectively the patients considered themselves better 24 hours after the examination than after 6 hours. This was not confirmed from the test results—an observation indicating the sensitivity of the test instruments used. Thus, these appear to be well suited to study cognitive changes caused by the contrast media used in this particular type of examination. Since the tests are repeatedly performed, the effect of habituation and of learning cannot be avoided. However, when applied in groups of patients, in whom the effects of different contrast media are compared, the disadvantages of these specific effects can be neglected.

The value of glucagon to facilitate hydrostatic reduction of childhood ileo-colic intussusception was tested in a series of 188 consecutive cases. Sixty-nine patients selected at random received 0.05 mg glucagon/kg body weight intramuscularly before attempts at reduction were started. The rate of successfully accomplished reductions was 84 per cent in the test group and 76 per cent in the control group (not significant). The time for accomplished reduction was approximately equal in the two groups. After 3 unsuccessful attempts at hydrostatic reduction patients in the control group received glucagon. The subsequent attempt at reduction proved successful in slightly more than every second case. No complications occurred. In general, glucagon was not found to improve the rate of employed reductions nor on the time necessary for reduction to take place. The investigation indicated, however, that there may be a limited benefit of adjuvant medication of glucagon. After two unsuccessful barium enemas glucagon administration is therefore recommended before a third attempt at reduction is performed.

The experiences gained with conventional radiographic examinations as a means of excluding childhood ileo-caecal intussusception are presented. According to these, a supplementary barium enema is indicated a) in patients under 6 months of age, b) in patients presenting with scant intestinal gas, c) in patients where the caecum cannot be outlined, d) in patients with a possible mass lesion of the colon, e) in patients with obstruction presumably due to intussusception, and f) in patients with discrepancy between the clinical and radiologic findings (1, 4). In all other patients the barium examination is not used. The key to a successful application of this protocol is a thorough familiarity with the limitations and potentials of the conventional abdominal examination.

Two cases are reported of osteomyelitis in the proximal end of the femur and humerus, respectively, with subsequent reduction of the blood supply to the corresponding head. A hypothesis is presented to explain the genesis of the ischemia, and the implications on treatment of osteomyelitis of the hip and shoulder regions.

Results with a previously described device for fine needle biopsies of non-palpable breast lesions are reported. During the past 5 years 182 biopsies were performed and 133 of these yielded diagnostic cell material. In the series, 41 carcinomas were found and fine needle biopsy in all demonstrated malignant or probably malignant cells. In the biopsies evaluated as benign or probably benign, malignancy has not been found during the observation period of 4 to 59 months (mean 21.5 months). The device described is cheap and biopsy is easily performed and, if necessary, repeated in a short time. The diagnostic accuracy is high and carcinomas as small as 3 mm in diameter have been diagnosed.

The heart volume was followed over a 7-year period in 819 healthy men aged 40 to 59 years. The subjects were selected on the basis of unremarkable clinical findings and technically satisfactory films on two occasions 7 years apart. On both occasions the mean heart volume in the upright position was 390 ml/m² (96.6% below 500), uninfluenced by age, and moderately larger in subjects with high physical fitness. Inclusion of subjects who were healthy during the baseline examination, but who developed heart disease or other diseases during the follow-up period, would have increased the mean heart volume by 15 ml/m². Latent coronary heart disease did not influence the heart volume, but intercurrent myocardial infection increased the follow-up volumes significantly.

In connection with a percutaneous retrograde heart catheterization via the femoral artery, the guidewire was captured in the deep circumflex iliac artery. On withdrawal of the guidewire stripping of the artery occurred. Occasionally this artery is catheterized unintentionally. Fluoroscopy used as a routine during the introduction of guidewire into the femoral artery could prevent catheterization of the deep circumflex iliac artery.

Experiments with a body phantom during dynamic CT scanning with the Somatom 2 CT scanner indicate that the periodic streak artifacts seen on the anterior part of the liver in patients are caused by peristalsis of the stomach and resulting motion of the air fluid level. Therefore, the attenuation values of the anterior portion of the liver artifactually oscillate around the baseline value during the dynamic series of scans. This artifact is produced by a change in the position of the stomach air fluid level and is dependent on the direction of tube rotation. The mean of the artifactually oscillating attenuation readings is close to the mean density but usually useless in dynamic CT because the attenuation values change so rapidly in the dynamic phase that averaging measurements also will cause errors.

Forty-nine patients with clinical signs of acute cholecystitis underwent conventional and computed tomographic cholangiography. Among 39 patients with signs of contrast medium in the biliary system at both examinations there was a diagnostic discrepancy in only one patient. Conventional radiography demonstrated cholecystopathy in this patient while contrast medium in the gallbladder and an acute pancreatitis were found at computed tomography. Ten patients with an indeterminate conventional cholangiography had a conclusive computed tomographic examination. Twenty of 30 patients with an abnormal computed tomographic cholangiography underwent cholecystectomy and all had diseased gallbladders. All 17 patients with histopathologically confirmed acute cholecystitis had signs of subserosal edema and/or changes in the omental fatty tissue adjacent to the gallbladder at computed tomography. A layer of tissue of water-density adjacent to the gallbladder and/or changes in omental fatty tissue were also seen in one patient with congestive heart failure and in one with a penetrating duodenal ulcer. None of the 19 patients with a normal computed tomographic cholangiography had a proven acute cholecystitis.

With the aim of designing a duplex scanner especially suited for flow estimation in abdominal vessels, a mechanical coupling device was constructed, combining a real time sector scanner and a pulsed Doppler velocity meter. The possible error in estimation of vessel cross-sectional area by means of ultrasound measured diameters, was studied through diameter measurements of blood-filled plastic tubes. In conclusion, the ultrasound measured outer-inner diameter seemed to be the most accurate estimation of true inner diameter. The accuracy and reproducibility of flow estimation was tested under optimum in vitro conditions, with special reference to the ability of the mechanical coupling device in giving the correct angle between Doppler beam and blood-filled tube. Ninety blood flow estimates with varying angle of insonation were all within ±10 per cent of true flow.

A new non-invasive method for in vivo investigations of the inner diameter and pulsatile oscillations of large muscular arteries by means of an ultrasound time-motion technique is presented. Each histologic layer of the arterial wall is identified at in vitro examination of the external iliac artery. The method has been used for in vivo investigations of 16 long term diabetics and of 16 non-diabetics. A reduction of the lumen and decrement in pulse deflections were found in the diabetics when compared with those of the normal group.

A series of 202 patients (133 men, 69 women) with spondylolysis were examined with respect to radiographic variables describing lumbosacral lordosis, size of lumbar vertebrae, transverse processes and disc height. An age-standardized and sex-stratified comparison was made with a control group of 170 subjects (68 men, 102 women) without lumbar spine disorders. The difference in ***lumbosacral lordosis between the spondylolysis and control groups was considered to be secondary to olisthesis, and to lack an etiologic role for the genesis of lysis. The lengths of the transverse processes and their distances to the crista iliaca posterior demonstrated no differences between the groups and therefore did not seem relevant to the context of the pathogenesis of spondylolysis. The fifth lumbar vertebra in the spondylolytic patients was more wedged and less wide than in the controls. The question of the primary or secondary nature of this change has not yet been clearly elucidated, and should be given further attention. The spondylolytic patients demonstrated a decrease in the height of the L5-S1 disc much earlier than the controls, and the degree of narrowing of the disc space was much more marked.

The clinical methods for measuring tibial torsion are based on the assumption that the proximal tibial tilt invariably is 0°, an assumption which proved to be false in 38 legs examined using computed tomography. The conventional radiologic methods have not gained general acceptance. The various CT methods available for measurement of tibial torsion were investigated and have indicated too wide a variation to be clinically useful. At present, no reliable method for measuring tibial torsion seems to be available.

Four to five ml of absolute ethanol was injected into a segmental hepatic artery in eight pigs to study the occlusive effect on the hepatic arterial system. Liver cell damage was indicated by a transient moderate elevation of liver enzymes. Follow-up angiography at various time intervals showed persistent occlusion of intrahepatic arteries at different levels in all pigs and occlusion of the common hepatic artery in four. Reconstitution of the intrahepatic arterial circulation via abundant intrahepatic collaterals was, however, observed. Microscopic examinations demonstrated arterial thrombi and necroses in the vascular walls as well as a great variation in the extent of liver parenchymal damage.

The rate of conversion in vitro, of prekallikrein to kallikrein has been measured in 74 reactors to contrast medium and 70 controls. The conversion rate is significantly more rapid in reactors than controls. There was no difference in C1-esterase inhibitor and factor XII levels between reactors and controls. This retrospective investigation suggests that prekallikrein/kallikrein conversion rate may form the basis of a test for differentiating between reactors and non-reactors.

The ionic contrast medium diatrizoate used in high-dose unilateral nephroangiography in dogs produced an abnormal nephrogram, ‘patchy contrast medium retention’, and a marked decrease in renal blood flow in five of eight injected kidneys. Increased glomerular permeability (albuminuria), reduced glomerular filtration rate (creatinine clearance), and reduced osmotic diuresis were demonstrated in all selectively injected kidneys.