Saddle cancers of the colon and their progression to annular carcinomas.

Twenty-five cases of flat, ulcerating colonic carcinomas with heaped-up margins and central ulcerations were studied at various stages of growth. If not found at an early stage, a flat carcinoma will progress to an annular carcinoma. A retrospective evaluation of 8 "negative" colon examinations revealed the tumor as a contour defect, often on only one view, 9 months to 7 years before actual radiographic diagnosis of annular carcinoma. The primary symptom in 21 of the 25 patients was bleeding and there was a high incidence of local and distant spread.

Fine needle transhepatic cholangiography: a new approach to obstructive jaundice.

Transhepatic cholangiography performed with a newly introduced fine caliber (0.7 mm OD) "Chiba" needle produces a significantly higher success rate of biliary duct opacification with fewer complications than conventional needle or flexible cannula techniques. Distinct advantages over endoscopic retrograde cholangiography are also apparent, including more frequent bile duct opacification, ease of performance, and lower overall cost. In a group of 50 consecutive patients examined with the fine needle puncture technique, duct opacification was achieved in 92%, including 33 of 33 (100%) of patients with surgically obstructed ducts and 14 of 17 (82%) with normal caliber or narrowed ducts. Fine needle hepatic puncture is recommended as the preferred approach for direct biliary duct opacification in jaundiced patients.

Double tracking in the sigmoid colon.

Double tracking of barium in the sigmoid colon has been associated with granulomatous colitis by some; others consider it a sign of peridiverticulitis. Patients who showed no evidence of inflammatory disease elsewhere in the large intestine were analysed. The pathological diagnosis was diverticulitis in 29 of 35 cases, and granulomatous diverticulitis in only 1. In 5 the underlying process was perforated carcinoma of the sigmoid colon. In those with paracolonic sinus tracts due to peridiverticulitis, pathological study demonstrated tracts extrinsic to the muscularis and usually traceable to a perforated diverticulum. Long-term follow-up disclosed no evidence of subsequent inflammatory bowel disease.

Hypotomic cholangiography with glucagon.

Hypotonic cholangiography was performed with intravenous glucagon in 12 patients who demonstrated complete nonspecific obstruction of the distal common bile duct during postoperative T-tube or transhepatic cholanglography. In 8 cases (67%), a diagnostic result was obtained. Abolition of smooth-muscle spasm at the choledochal sphincter by glucagon-induced hypotonia appears to be a useful adjunct to roentgenography of the bile ducts.

Interpretation of roentgenograms via interactive television.

The diagnostic quality of roentgenographic images transmitted by interactive television was evaluated. A series of 100 kidney, ureter and bladder, chest, and bone radiographs were read individually by five radiologists, both on direct viewing and on viewing a monitor image of the television signal. The latter was transmitted by microwave a distance of 28 miles, including four transmission legs. Analysis in terms of receiver operating characteristic curves and critical tables indicated that the television interpretations were of acceptable accuracy, in view of the participants' inexperience with teleradiology.