Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen.

No abstract

Angiocardiography and cardiac catheterization have produced many new problems in radiology, and it is most important that both the cardiologist and radiologist should be aware of the dangers to which they may expose themselves and their patients. For example, in designing apparatus for angiocardiography it must be borne in mind that if this procedure is used for routine investigations care must be taken beyond that necessary in experimental work, since it is essential that all concerned should be adequately protected from both direct and scattered radiation. Unfortunately a knowledge of the output of the X-ray set, in terms of kilovoltage and.milliampere seconds, is insufficient to enable the quantity of radiation received by the patient and those in close proximity to the patient to be calculated. In this paper an attempt is made to show what factors must be considered in estimating the direct and scattered X-rays, and to give some indication as to how this estimation can be carried out. Little has been published in the past about the measurement of scattered radiation in diagnostic X-ray work, and the recommendations set out in the following paragraphs are based on experiments carried out in the X-ray Department at Guy's Hospital during investigations of routine cases.The measurements recorded in the following paragraphs were made with two main objects in view, (a) to ensure that the patient does not receive an excessive dose; and (b) to protect those near to the patient. Whereas the risk to the patient lies in administering a dose of X-rays sufficient to cause burning of the skin, the danger to those nearby arises from the fact that they are frequently exposed to radiation and must be protected from its long-term effects, viz. injury to the superficial tissues, and changes in the blood and bone marrow and reproductive organs. With the average quality ofthe X-ray beam used for these investigations, that is filtered by one millimetre of aluminium or its equivalent in other ways, the dose that will produce a first-degree erythema of the skin is about 150 rontgen units* delivered on one day. In connection with the filtration of the beam it is useful to note that an aluminium filter is necessary for safety and such a filter or its equivalent is frequently incorporated during manufacture. The purpose of this is to suppress the very soft radiation from the tube since such radiation is particularly harmful. The filter does not eliminate the risk of burning referred to previously, nor does it give any indication of the dosage. The maximum permissible whole body dose for persons who are regularly exposed to radiation, such as the radiologist, surgeon, and anmsthetist, has been fixed as 0 5 r. per week, or a dosage rate of 4 x 10-6 r. per second. For the hands, informed opinion tentatively regards 1'5 r. per week as the maximum permissible dose. At the outset we wish to emphasize the fact that although these investigations are diagnostic procedures nevertheless it is quite possible for the patient to receive a dose suff...

Radiological examination of the heart has been practised from the earliest introduction of X-rays and gradually the importance of radioscopy, including the right and left oblique views, has gained ground as a valuable method of distinguishing the different chambers of the heart. In this country the method has been developed and applied largely by the teaching of Parkinson (1933 and.As early as 1931 Forssmann thought of the additional help that could be obtained in outlining the cavities of the heart after injecting opaque media by catheter. Laubry et al. (1935) injected hearts post-mortem and published some beautiful illustrations of the normal anatomy that found a useful basis for comparison with subsequent angiocardiograms. They showed the U-shaped right side and the window between the descending limb, formed by the right auricle, and the ascending limb, formed by the outflow tract of the right ventricle, with the right ventricle itself forming the horizontal base, and the right branch of the pulmonary artery an upper cross-bar.In 1938 Castellanos, Pereiras, and Garcia showed some good angiocardiograms of children with congenital heart disease. They demonstrated the normal U-shaped curve of the right side, the window between the right, auricle and the outflow tract of the right ventricle, and the post-stenotic dilatation of the infundibulum. Chavez et al. (1947) have given a summary of the gradual progress towards satisfactory angiocardiograms, referring particularly to the work of Ara, Cossio, Moniz, Carvalho and Saldanha, and Castellanos and Pereiras.Angiocardiography was developed on a practical scale by Robb and Steinberg (1939) who published many illustrations of the additional information they obtained by this method. They found that the right auricle was shown at 1-5 sec. after the injection, the right ventricle and pulmonary artery at 2-3 sec., the pulmonary veins and left auricle at from 6 to 8 sec., and the left ventricle and aorta at from 8 to 10 sec. This work has been extended on a large scale in several centres in America.Steinberg, Grishman, and Sussman have published a series of papers on angiocardiography in congenital heart disease, dealing particularly with a case of Fallot's tetralogy (1941), with dextrocardia (1942), with intracardiac shunts (1943a) with patent ductus arteriosus (1943b), and with the radiology of congenital heart disease (1943c). The paper on shunts is particularly pertinent to our present subject; 18 of the 65 congenital cases they had examined were thought to have shunts; 10 of these being through auricular defects and 2 through ventricular defects, and 6 due to an overriding aorta or one with some degree of dextro-position, 4 of these being regarded as Fallot's tetralogy and 2 as Eisenmenger's complex. Only two had post-mortem confirmation of the diagnosis.They found the time of filling of the pulmonary vein and left auricle (3*5-4-5 sec.) and of the left ventricle and aorta (5 0-80 sec.) rather quicker than Robb and Steinberg, possibly because more children were exam...

No abstract