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Since the lesions of multiple myeloma are widespread, satisfactory control of the disease process would appear possible only with an effective systemic therapeutic agent. Unfortunately, the results of treatment by chemotherapeutic agents such as urethane, steroid hormones, and diamidines remain, by and large, unsatisfactory (1–4). External irradiation has been successful in relieving isolated painful areas, or lesions of unusual size or destructiveness. Radioactive isotopes given internally can irradiate all the lesions but are limited by the tolerable total-body dose. Radioactive phosphorus (P32) has received a trial (5–7) because, in general, leukemic and neoplastic tissues concentrate this isotope preferentially. Radiophosphorus collects preferentially also in the bone marrow, and the dose must be held below that which will produce a severe reduction in granulocytes, platelets, and red blood cells. It seemed logical to try radioactive iodine (I131), which would be evenly distributed in vascularized tis...

The Roentgen signs of disease in the pancreas, both benign and malignant, have been adequately covered by numerous writers. The complete review offered by Case in 1940 (3) leaves little to be desired, as he reviewed thoroughly all of the literature. More recently Borak (2) has also discussed the roentgen findings. The most striking fact apparent from these papers is the difficulty of making an early diagnosis of disease or tumor in the region of th e body and tail of the pancreas. The diagnosis of enlargement of the head of the pancreas was well covered by Case (3) and subsequently by Rendich et al. (9). The routine methods of both clinical and roentgen examination may reveal the presence of a mass in the upper abdomen, but too frequently accurate localization of this mass is impossible, and the need for further information is felt. Gastric pneumography may be useful in just such cases. Since 1933, when Engel and Lysholm (4, 5) introduced gastric pneumography as an aid in the diagnosis of pancreatic disea...

The clinical diagnosis of appendicitis is still a major medical problem, not only because of its frequency but because of the morbidity which is associated with the condition, not to mention a mortality of over 17,000 deaths per year in the United States. The literature has been saturated with data on the cause, diagnosis, and treatment of the disease; in 1931 McClure (1) reported that over 9,000 articles had been written on appendicitis, and to that number over 3,000 have since been added, making a total of 12,000 articles. Even though great strides have been made in the technic of appendectomy, and despite the use of the more recent antibiotics (sulfa drugs and penicillin), the morbidity is still considerable and complications remain a serious hazard. In one large clinic (2) the complication rate is unchanged over a period of 19 years. The common origin of the complications in some mechanical factor must therefore be considered. Roux (3) in 1913 was the first to write on the use of roentgen rays in the ...

How do you know where you're going if you don't know where you have been? A review of hepatolienography was presented before the Radiological Society of North America at its annual meeting in December 1950 and published in 1951 (24). This was an attempt to bring the literature on the subject into focus and to report our own investigations. The purpose of the present communication is to review the published (English) work done by others since our earlier paper and again to exhibit our own studies. Thorotrast Most of the literature concerning hepatolienography in the last decade has been concerned with Thorotrast and its effects. Fibrosis: Reports on the effects of extra vascular injection of Thorotrast with fibrosing sequelae have further emphasized our statement concerning “the serious problem in the late fibrosis and scar formation which may occur either in the liver or spleen or at sites of accidental extravascular injection” (24). A recent paper by Brady et al. (4) exemplifies these findings. This revi...

Calcifications in the placenta occur normally and should not arouse suspicion of disease in the mind of the radiologist or obstetrician. Pathologists have known for a long time that microscopic and even macroscopic areas of calcification in the mature placenta are quite normal (1). The process is a simple degenerative one and not usually associated with any fetal or maternal disease. The calcifications occur on the maternal side of the placenta in fine linear areas of degeneration of the syncytial-like structure known as the trophoblast. The amount of calcium depends on the duration of the pregnancy (2) and also on the calcium metabolism of the mother (3). One reason why these opacities have not been reported by radiologists is the nature of the calcification rather than its absence. Because the calcifications are minute and are spread over a wide area, with a thick soft-tissue mass beneath; because the fetus frequently is moving or the uterus contracting; because of the motion transmitted by the uterine ...

In deep-sea diving the respiratory gases are forced into solution in the body fluids and tissues as a result of increased pressure. When return to the surface is fairly rapid, these gases are present in a supersaturated state, and bubbles frequently form. Extremely small at first, these go through a period of expansion, followed by gradual absorption. Nitrogen gas, being physiologically inert, is most important in causing these bubbles; its inertness results in their slow absorption. Ascent to altitudes of 25,000 feet or higher in aircraft results in a similar supersaturation of dissolved gases, with a tendency to bubble formation. The intense pain of “caisson disease,” commonly spoken of as diver's “bends,” has its counterpart in aviator's “bends,” resulting from exposure to extremely high altitude. The symptoms can readily be elicited by simulated flight in an altitude chamber. Ordinarily the pain disappears at about 25,000 feet during the return to ground-level pressure. It is thought that the “bends” ...

The Pharmacopeia of the United States (U.S.P.) has been published since 1820 and is the standard reference work for information on the purity and physical state of a pharmaceutical. It is kept up to date through periodic five-year revisions and supplements. The drugs and physical standards listed in it are selected by a panel of experts in the varied pharmacologic fields. The specialty of Radiology is represented by a radiologist heading an advisory panel of radiologists who consider the individual drugs used by the specialty. The two other standard pharmaceutical reference books are The National Formulary, published by the National Pharmaceutical Association since 1888, and New and Nonofficial Drugs, published by the Council on Drugs of the American Medical Association. The purposes of these publications differ in that The National Formulary lists all the modern drugs not found in the U.S.P., as well as many that are, and New and Nonofficial Drugs includes drugs whether new or old. (Some of the drugs hav...

You have just completed the injection for an intravenous urogram and your patient is dying! You have a few minutes to reverse this process! You must be ready with the proper drugs and supportive measures and with a plan of action which is vigorous, yet controlled. These preparations must be made even though most patients suffering a reaction will recover without therapy, while some will die in spite of any treatment. You must plan for those who will recover with help but who will die without it. The sequence of events in such a catastrophic response to the contrast medium is unknown. We are powerless to prevent the primary allergic reaction of the host to the foreign substance. We are equally unable to eliminate the products of this reaction, be they histamine or unidentified compounds. It is necessary, therefore, that oxygenated blood be kept circulating until homeostatic mechanisms are effective. A dangerous reaction involves the cardiovascular, central nervous, or respiratory system, or a combination o...

Sporadic attempts to use radiation in conjunction with chemicals have been made (1, 5, 13), but it is difficult to assay either the clinical results or those obtained experimentally in lower forms of life, as for example Paramecium (6). Because of the poorly understood use of empiricism in treatment, it is necessary to dilate upon the empiric use of chemicals and radiation to insure a rational approach to the evaluation of combined chemotherapy. To understand this, one has only to review the difficulties which we, in our own specialty, have had in weighing the use of radiation, not only as to total dosage but also as to timing (fractionation) and assessment of the end-result. The empiric use of radiation in tumor therapy has been carried on for years, and to-day we have workable schemes of fractionation and a whole discipline by which we can produce results. The results, as time has passed, have improved only where the critical adjustment of dosage and dose rate has been carried out. What is to be expecte...

The liver and spleen are among the few structures in the body for which safe and reliable primary contrast roentgen diagnostic procedures have not been established. Hepatolienography with colloidal thorium dioxide2 has been widely performed for many years (65), but this material has fallen into disfavor with many workers, though not all, as a result of a number of cases in which injurious effects presumably related to its use have been reported. Since thorotrast has been in clinical use for over twenty years, there is available a rather large body of pathological and clinical material in which its long-term effects may be studied. It has seemed desirable to attempt an evaluation of these effects, to formulate criteria for an ideal medium for opacification of the liver and spleen, and to report preliminary studies with other media. I. Evaluation of the Effects of Thorotrast Thorotrast is a 25 per cent suspension of thorium dioxide (15 to 20 per cent by weight) with an average particle size of 3 to 10 milli...

The mechanisms by which ionizing radiation ultimately produces a clinical result are very complicated, but a study of the process of polymerization offers a suitable approach. Polymerization can be initiated by very low doses of ionizing radiation. The random events occurring within chemicals, within cells, or within tissues after irradiation are the results of effects produced by the energy exchange at the randomly spaced sensitive areas, and the results can be both degradation and synthesis of polymeric matrices. This concept is proposed as an integrating complement to the chemical and target theories of radiation effects. It should also afford a logical basis for the methodical investigation of the place of chemicals in combination with irradiation in the treatment of tumors.

Hazard is defined as “the incurring of the possibility of loss or harm for the possibility of gain” (1). Today, yesterday, and the day before, the evaluation of medicine has entered our lives. The function of the garbage man is the direct outgrowth of public-health measures. The milkman brings us milk from tuberculin-tested cows, pasteurized to kill the pathogenic bacteria. Protection of the water supply of the public is checked by repeated bacterial cultures. These measures and many others which form a background for day-to-day living are based on maximum permissible levels of service and bacterial counts. Some bacteria in milk and water are accepted, and in these instances reference to a maximum permissible level has been used. These standards were derived after many years of trial and error by an evolutionary process, whereby the permissible levels were raised or better defined. Acceptance of a maximal permissible level of irradiation, on the other hand, has been fraught with an emotional response not ...

The radiologist's share in shaping the type of medicine practised in a community, clinic, or hospital is considerable. His report, in many cases, furnishes the final evidence for diagnosis; upon it treatment is based, and it may be the deciding factor in the settlement of a claim for compensation or insurance. It behooves him, therefore, to use a language which is correct and yet understandable without being stilted; to be concise but explicit. The accuracy of his words and descriptions and his regard for the finer shades of meaning will be taken as a measure of his professional ability. In no other specialty is the slightest misuse of a word or phrase so likely to reflect upon the writer. The radiologist, therefore, should clean his verbal house. Examples come readily to mind. Many radiologists, for instance, speak of “getting accommodated” or “dilated” in the fluoroscopic room, whereas what actually takes place is the adaptation of the retina to the dark. It is the pupil that is dilated and the lens tha...

Reaping the harvest of the medical literature of the world, or indeed the literature of one's own language or specialty, is far too extensive a task for even the genius, let alone thee and me. Some ten years of abstracting for RADIOLOGY has led the writer to reflect on the great service rendered by the abstract sections of the medical journals, even though these are not as widely read or generally appreciated as they should be. The necessity of dependence upon abstracts is made obvious by the present-day popularity of various abstracting services. Yet the journals which regularly publish comprehensive abstracts are numbered. The field of radiology knows little limitation, overlapping a wide range of specialties. Of all the practitioners of medicine, the radiologist must keep not abreast but ahead of the times. His central and referred position in medical practice makes it mandatory that he survey the new, select the useful, and replace the old and outworn. How can anyone encompass this tremendous task? Sh...

To the Editor:— I realize that I transposed "small" and "large" in Sentence 2 of the second paragraph to the initial question. It should read: "The organic salt used in intravenous urography is also filtered by the glomerulus in a large percentage but a small part is excreted into the collecting tubules." Dr. Pollack does not appreciate the fact that radiopaques can come through in very dilute form and especially in a very thick patient and not be seen at all. On a radiograph where as on chromocytoscopically a very low percentage of opaque material could be seen with the eye, the usual dye material used is in very low concentration, whereas the organic salts for radiopaque urography are needed in very high concentration. Chromocystoscopy gives no measure of how well a kidney is functioning but whether or not it is functioning.