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This study was designed to determine if technetium-99m penicillamine (TPEN), could be used to predict recoverable function in dogs with acute obstruction. Renal accumulation of TPEN was measured in four control dogs, in four dogs with acute obstruction lasting 7-14 days, and in the same four dogs following a variable recovery period of 15-63 days. The relative renal uptake of TPEN in vivo showed good agreement with the relative uptake in vitro and both measurements correlated closely with the relative inulin clearances in the normal and in the post obstructed kidneys. The uptake of TPEN in the obstructed kidney following 7-14 days of obstruction averaged 6.8% of the total renal uptake. After relief of the obstruction and a variable recovery period the relative uptake of TPEN in the post obstructed kidney had increased to a mean of 29.5%. These results indicate that TPEN scans should not be used during acute obstruction to predict recoverable function. The observations noted in the study almost certainly apply to similar chelating agents such as dimercaptosuccinic acid (DMSA) and probably to other renal radiopharmaceuticals as well.

Ultrasound has gained widespread acceptance in the evaluation of pancreatic disease. Echographic criteria for the diagnosis of pancreatitis, pseudocyst, and pancreatic carcinoma are presented. Additionally, three important areas of difficulty in the echographic evaluation of pancreatic disease are described.

The diagnosis of portal vein hypoplasia can be made based upon the angiographic findings of a large portal-systemic shunt, nonopacification of intra- and extrahepatic portal veins, and a liver biopsy without cirrho sis.

One hundred cases of eosinophilic granuloma diagnosed by open lung biopsy were reviewed. There were 60 women and 40 men, ages 18 to over 60 years. Radiographs and clinical histories were contributed by physicians referring the cases for pathological consultation. Clinical follow-up information was obtained in 60 cases. The outcome was generally benign; the 16 asymptomatic patients remained well; 17 others had complete remission of symptoms, 22 had persistent symptoms, though half had partial improvement; 4 patients had progressive disease despite treatment, but only 1 patient died (of bilateral pneumothoraces complicating severe fibrosis). The more severe manifestations were found in young men, who had a higher incidence of pneumothorax, fibrosis and honeycombing, and diabetes insipidus. Many previously reported cases have had a less favorable outcome; milder cases of primary pulmonary histiocytosis have probably been overlooked in the past. In this series the prognostic value of histologic, clinical, or radiologic findings was limited. The diagnosis can often be strongly suggested radiologically, though infectious granulomata must be excluded; it is arguable whether exclusion of sarcoidosis is clinically important. The effectiveness of treatment with adrenal corticosteroids could not be assessed because of lack of controls; some individuals appeared to benefit, but relapse was very unusual in any case. The etiology of EG remains obscure, but in view of the paucity of patients with a history of allergy or asthma, and the lack of eosinophilia in any case, hypersensitivity seems unlikely. Smoking was far more common among these patients (97% altogether; 80% current) than in the general population (about 35%), an unexplained finding.

GALLBLADDER disease is an enormous medical problem in the United States. It has been estimated that 15 million Americans have gallstones and that approximately one third of a million require cholecystectomy each year at a cost approaching half a billion dollars.1 The principal method for the detection of this prevalent disorder is oral cholecystography, and the contrast material most frequently employed for this purpose is iopanoic acid.* More than 40 million doses of this compound have been administered since its introduction as an oral cholecystographic agent 20 years ago. A major shortcoming of iopanoic acid is its failure to produce . . .

In order to explain opacification of the gall-bladder following urography in patients with acute unilateral ureteric obstruction by a stone, the biliary excretion of sodium iothalamate, administered at two dose levels, was measured in control dogs and in dogs with acute unilateral ureteric obstruction. The latter had lower creatinine clearances, lower six-hour cumulative urinary excretion of iothalamate, and higher blood iothalamate levels. A difference in the six-hour cumulative biliary iothalamate excretion between obstructed and control animals was found only at the low iothalamate dose. In a second group of experiments different plasma iothalamate levels were achieved by constant infusion, and bile iothalamate excretion was examined. It was found that iothalamate, in its original form, is excreted and concentrated in bile, that it has an hepatobiliary transport maximum, and that it causes a choleresis. On the basis of these observations, it is suggested that gall-bladder opacification by ioth...

Two cases of intractable epistaxis are reported in which angiographic demonstration of the bleeding site was followed by successful therapeutic embolization with Gelfoam particles. The particles were inserted through the catheter as near the bleeding site as possible, and cessation of bleeding was immediate

Frontal chest radiographs in the prone position enhanced visualization of the posterior lung base in the presence of pleural effusions. Though the lateral decubitus view often displaced fluid adequately, in several cases only the prone film revealed basilar lung pathology; this was due to gravitational shift of the fluid away from this region as well as improved aeration of the lower lobe in the prone position, as shown by horizontal-beam lateral views. The prone chest film is recommended for evaluation of the lung base when obscured by fluid.

The Y and Z proteins, found only in the liver and the mucosa of the small intestine, bind bilirubin, bromosulfophthalein, and certain other organic anions and may be responsible for the preferential hepatic uptake and biliary excretion of these compounds. Experiments show that two cholecystographic contrast media, iopanoic acid and iodipamide, bind to the Y and Z proteins, while iothalamate, a representative urographic contrast agent, does not, indicating that these proteins may be important in determining the pathway of excretion of contrast material.

B-scan ultrasonography appears to be useful in cases of radiographic nonvisualization or where impairment of hepatobiliary function is severe enough to preclude attempts at oral cholecystography or intravenous cholangiography. Sonographic demonstration of a normal gallbladder is an excellent indicator of the absence of disease. When consistently abnormal echoes are found, the test is a reliable indicator of biliary calculi.

The authors report a case of subacute spinal subdural hematoma in a patient with ankylosing spondylitis. Only 18 such cases have been reported in the nonradiological literature. Early diagnosis is imperative in order to minimize neurological sequelae.