A technetium 99m diphosphonate scan is a sensitive detector of bony metastases of breast, prostate, and lung cancer. For these particular neoplasms, a negative bone scan in an asymptomatic patient is adequate evidence for absence of bony metastases and a correlative roentgenographic examination may not be necessary. Positive studies demonstrating multiple characteristic discrete areas of increased activity should be considered strong evidence for metastases. Single equivocal lesions require roentgenographic and occasionally biopsy correlation. If roentgenography fails to reveal the source of increased uptake, (e.g., degenerative disease) the scan lesion should remain suspicious for metastases.

Three types of involvement of the rectum and recto-sigmoid by carcinoma of the prostate are reviewed through an analysis of eight cases. A fourth type with subserosal metastatic implant of the proximal sigmoid may occasionally be encountered. The roentgenographic findings are not pathognomonic, but are characteristic of extrinsic involvement of the bowel wall. When clinical symptoms are predominantly related to the bowel, carcinoma of the prostate is usually advanced. All patients presented with bone metastases, uretero-hydronephorsis, lack of function of one kidney, or both bone metastases and urinary tract obstruction. Rectoscopy and biopsy are helpful. However, biopsy specimens often show non-diagnostic features in secondary malignancy. Correct diagnosis is important, since there is a difference in treatment of primary carcinoma and of secondary involvement of the rectum by prostatic carcinoma. A diagnostic challenge exists if the patient is evaluated by barium enema examination for primary bowel symptoms, in particular, large bowel obstruction. At this time intravenous pyelography and bone survey for metastases may not be available to suggest the correct diagnosis. More widespread use of barium enema examinations in the evaluation of advanced carcinoma of the prostate is suggested, since the type of rectal disease shown on barium enema study was not clinically suspected in five of eight patients. The prognosis is usually unfavorable because of advanced carcinoma. Survival often does not exceed several months to one year. However, one of our patients is still well after three years of hormonal therapy.

The clinical and roentgenographic features of six cases of Amanita mushroom poisoning were reviewed. The roentgenographic manifestations included adynamic ileus (three patients) and small, irregularly shaped kidneys secondary to the healing process of acute tubular necrosis (one patient). Intestinal pseudo-obstruction can result from many medical problems and mushroom poisoning should be considered in its differential diagnosis.

Accurate localization of lesions seen on computerized tomographic scans obtained with the EMI unit is often difficult due to a paucity of reliable landmarks and to varying head angulation. A simple and accurate system of transposing the location of any particular lesion to a roentgenogram obtained with the scanner tube is described.

Dysphagia is a relatively infrequent complication of vagotomy in the postoperative period. The most common form is a transient post-vagotomy dysphagia which requires not treatment other than the temporary exclusion of solid food. Accurate diagnosis is possible on the basis of clinical history and typical roentgenographic findings. The onset of dysphagia characteristically occurs with the first ingestion of solid foods on the seventh to fourteenth postoperative days. A barium swallow examination reveals persistent tapered narrowing of the therminal three to four centrimeters of the esophagus. Most cases are relieved in two to six weeks without clinical or roentgenographic residua. Five cases of transient postvagotomy dysphagia are presented.

Five patients with acute megacolon with varied types of progressive muscular dystrophy are presented. Dysfunction of smooth muscle among patients with muscular dystrophy is reviewed. The extra gastrointestinal roentgen features are summarized. Recognition of the diffuse smooth muscular involvement among patients with muscular dystrophy is stressed for proper diagnosis and patient management.

Three new cases of cleidocranial dysostosis with hearing loss are reported in this paper. The significant points concerning this association are: (1) the hearing deficit is predominantly a middle ear conduction problem secondary to structural abnormalities of the ossicles; (2) there is sometimes a small bone conduction deficit indicating either a cochlear or an eighth nerve problem; (3) the middle ear hearing loss was corrected surgically in one reported case; (4) there is dense sclerosis of the temporal bone which makes a middle ear operation technically difficult; and (5) hearing loss with cleidocranial dysostosis may be more common than the number of cases in the literature suggests.

Microradioscopic study of metacarpals in 24 osteomalacic and 34 osteoporotic patients revealed excessive intracortical resorption (striations) in approximately 60 percent of patients suffering from osteomalacia, but in none of the osteoporotics. Phalangeal periosteal resorption was found less frequently in osteomalacia than metacarpal striations, and was absent in osteoporotics. On the other hand, quantitative evaluation of cortical thickness, percent cortical area, bone mineral mass, and density did not show any clear differences between the two study groups. It is concluded that the differential diagnosis between osteomalacia and osteoporosis may be considerably improved by microradioscopy of hand bones.

Extrapelvic spread of disease, particularly from gastrointestinal tract perforations which may be clinically occult, may first present in the buttock, hip, thigh, and even lower leg, and the extraperitoneal space of the abdomen itself. Clinical manifestations at these remote sites may be very misleading. Anatomic and roentgenologic observations establish the preferential pathways of extrapelvic spread. These are related to the insertions and fascial investments of the iliopsoas, pyriformis, and obturator internus muscles and the ensheathed penetrations of the superior gluteal arteries. Superiorly, extension from the pelvic tissues seeks out the posterior pararenal compartment of the extraperitoneal region of the abdomen. Roentgenologic signs may first identify the presence, extent, and localization of the primary process.