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A case of congenital aortic stenosis with an associated discrete saccular aortic aneurysm is presented. The few previously reported cases of this combination of lesions are reviewed and the nature and mechanisms of the aneurysmal changes are discussed. The apparent etiologic importance of the systolic jet striking a localized area of vessel wall is emphasized.

Stratification in the gallbladder with a radiolucent zone of nonopacified bile may be a physiologic phenomenon during intravenous cholangiography, and should not be confused with floating cholesterol gravel or sludge. A post-fatty-meal and/or delayed films may aid in the differentiation of these two conditions. If a fatty stimulus is given at least 1 hr. prior to the X-ray study, the stratification phenomenon may be avoided.

An in vivo roentgen study of the major lymphatic drainage of the uterus is presented. The factors involved in lymphatic intravasation are briefly reviewed.

Lymphangiography, as a diagnostic method, has been used for many years on a limited scale for the evaluation of lymphatic channels in lymphedema and related diseases (6–13). Its adaptation to the visualization of lymph node architecture (lymphadenography) has been relatively recent (1, 3–5), with the chief emphasis on its use in neoplastic disease (2, 14–16). While the value of the procedure in lymphoma and far-advanced metastatic neoplasms has been well documented by several authors (15–16), the demonstration of early or subclinical metastases would have greater potential. The reliability of the procedure in this respect has not been established, and there are those who have questioned its worth (15). In order to evaluate lymphadenography in early neoplastic involvement of lymph nodes, the authors felt that further information regarding the appearance of nodal architecture in normal individuals was necessary. To date, there is no published report of lymphadenography in normal persons.2 Our purpose is to ...

Case history An eight-year-old girl was referred for intravenous pyelography because of repeated bouts of urinary tract infection. These episodes were associated with frequency, fever and chills. There was no incontinence or flank pain. The patient was of average height and weight for her age. Physical findings were within normal limits. Pertinent laboratory results were limited to the urinary findings where 30-40 W.B.C. per centrifuged high power field were noted and cultures yielded abundant growth of E. coli. An intravenous pyelogram revealed complete triplication on the left (Fig. 1). There were no radiographic findings of chronic pyelonephritis or other abnormality. A cystoscopic examination was subsequently performed and revealed three separate left ureteral orifices within the bladder. The patient was treated with appropriate antibiotics for one

Radiation treatment of cancer usually has been reserved for surgical failures rather than use of radiation initially, and many surgeons attribute any postoperative complication occurring in or near an irradiated area to radiation effects. However, with the newer radiation techniques, the damage to vasculoconnective tissue can be greatly reduced, leading to less delay in wound healing and less postoperative morbidity. Thus, many therapists and a few surgeons now report that the postoperative morbidity after competent irradiation differs little from that of the surgical procedure alone. To determine the risks involved in major surgery following intensive high-energy radiation, 50 patients with head and neck carcinoma treated with Co/sup 60/ gamma radiation, and subsequently undergoing radical surgery in the irradiated area, were studied. All patients received a 5000- to 7000-r tumor dose in 6 to 7 weeks. In all 50 cases, at least the major portion of the operative field was in irradiated tissue, and in approximates half of the cases, the irradiated volume took in the entire operative field (radical neck dissection). Only 5 cases of postoperative sequelae of a severe nature were encountered, and are discussed in detail. While the highest incidence of complications occurred after Y-6 months, it wasmore » felt that the sample was too small for a definitive statement concerning the best time for surgery. Difficulties encountered during the surgical procedure itself may be classified into 2 groups: problems of dissection, which occurred in 10 patients (20%), ranging from minimal stickiness of tissues to difficulty in starting a fascial plane; and excessive bleeding or oozing in 4 cases (8%). It is concluded that the complication rate in the group reported here is not significantly higher than that associated with the radical surgical procedures alone. The technical difficulties encountered during surgery were usually minor and did not limit the surgery in any manner. Thus there is little additional risk in performing radical surgical procedures in an area competently irradiated, providing that the radiation dose has been fractionated properly and that high- energy radiations have been utilized. (BBB)« less