Study Result

Impression

IMPRESSION:
1. Stable postoperative changes of the stomach and bowel without evidence of obstruction.
2. Hepatic lesions appear slightly increased in size and are again concerning for metastatic disease.
3. Interval decreased ascites and resolved pneumoperitoneum. Resolved bilateral pleural effusions.
4. Mild wall thickening of the bladder with punctate foci of intraluminal gas may reflect recent instrumentation versus cystitis.
5. Mild ascending aortic aneurysm measuring 4.1 cm.

Images and interpretation personally reviewed by: Sudeep Soni, MD

Narrative

EXAM: CT CHEST/ABDOMEN/PELVIS W/ IV CONTRAST

INDICATION: Primary colon cancer, also with history of renal cell and prostate cancer.

TECHNIQUE: CT of the chest, abdomen, and pelvis with intravenous contrast was performed. Multiplanar reconstructions were performed.

COMPARISON: CT abdomen and pelvis 9/10/2022, CT chest abdomen pelvis 8/31/2022

FINDINGS:

CHEST:
Lung/Airways: Central airways are patent. No consolidation. No suspicious lung nodule.

Pleura: No pleural effusion or pneumothorax.

Thyroid: Stable subcentimeter right thyroid nodule.

Mediastinum: No mediastinal mass. Esophagus is normal.

Lymph nodes: No thoracic adenopathy.

Heart: Heart size is normal. Coronary artery calcifications. No pericardial effusion.

Vasculature: Mildly dilated ascending thoracic aorta measuring 4.1 cm, previously 3.9 cm. Normal caliber pulmonary trunk. Right IJ chest port with catheter tip at the superior cavoatrial junction.

Subcutaneous Tissues/Chest Wall: No concerning soft tissue mass.

ABDOMEN:
Liver: Redemonstrated multiple hepatic lesions. Reference posterior right hepatic lobe lesion measures 2.5 x 2.9 cm (2/92), previously 2.7 x 2.2 cm. Segment 8 lesion measures 1.8 x 1.7 cm (2/89), previously 1.7 x 1.4 cm.
Hepatic vein(s): Patent.
Portal vein(s): Patent.

Gallbladder/Bile Ducts: Cholelithiasis with nonspecific pericholecystic fluid and setting of ascites. No biliary ductal dilatation.

Spleen: Normal size.

Pancreas: No pancreatic mass or pancreatitis. Pancreatic duct normal in caliber.

Adrenal Glands: No adrenal nodule.

Kidneys: Stable small renal hypodensities. No hydronephrosis or nephrolithiasis.

Bowel: Stable postoperative changes of the stomach and bowel without evidence of obstruction. Redemonstrated fluid-filled bowel loops with air-fluid levels.

Peritoneum/Retroperitoneum: Interval decreased ascites. Previously seen pneumoperitoneum has resolved.

Lymph Nodes: No abdominal adenopathy.

Vasculature: Normal caliber abdominal aorta and iliac arteries. Mild scattered atherosclerotic disease.

PELVIS:
Reproductive Organs: Status post prostatectomy.

Bladder: Mild circumferential wall thickening with foci of intraluminal gas.

Lymph Nodes: No pelvic lymphadenopathy.

Vasculature: Unremarkable.

Subcutaneous Tissues/Abdominal Wall: No hernia.

SKELETAL STRUCTURES: No acute fracture or suspicious osseous lesion. Partially imaged left hip arthroplasty. Bilateral glenohumeral osteoarthritis, right greater than left.

Component Results

There is no component information for this result.

General Information

Ordered by Shruti Murali

Collected on 01/27/2023 9:08 AM

Resulted on 01/27/2023 9:42 AM

Result Status: Final result

This result was released automatically. You may be seeing it before your provider has seen it.

Prohibition in the United States began on January 16, 1920 and ended on December 5, 1933

The precursor to the "war on drugs":

Puritanism: the haunting fear that someone, somewhere, may be happy. 

~ H. L. Mencken (1880-1956) (A Book of Burlesques, "Sententiae") 

Abstainer, n. A weak person who yields to the temptation of denying himself a pleasure. A total abstainer is one who abstains from everything but abstention, and especially inactivity in the affairs of others. 

~ Ambrose Bierce (1842-1914?) (The Devil's Dictionary) 

Prohibition will work great injury to the cause of temperance. It is a species of intemperance within itself, for it goes beyond the bounds of reason in that it attempts to control a man's appetite by legislation, and makes a crime out of things that are not crimes. A Prohibition law strikes a blow at the very principles upon which our government was founded. 

~ Abraham Lincoln (1809-1865) (speech, 18 December 1840 to the U.S. House of Representatives) 

The prohibition law, written for weaklings and derelicts, has divided the nation, like Gaul, into three parts - wets, drys, and hypocrites. 

~ Florence Sabin (1871-1953) (speech, 9 December 1931) 

Once, during Prohibition, I was forced to live for days on nothing but food and water.

~ W. C. Fields (1880-1946) (attributed) 

Prohibition (wiki) began on January 16, 1920, which was the effective date of the 18th amendment to the U.S. Constitution: it was a national ban on the sale, manufacture, and transportation of alcoholic beverages in the United States. An outgrowth of the temperance movement, which had been gathering momentum during the entire 19th century, Prohibition got a final impetus from World War I, which prompted the Congress to pass the 18th amendment in December 1917.* Ratification (by 36 of the 48 states) came on 16 January 1919, and the Volstead Act implemented the measure a year later.** 

Prohibition - highly unpopular - was only weakly enforced by the federal government, and thousands of "speakeasies" - many controlled by organized crime - quickly appeared to satisfy the nation's thirst. The illegal importation and distribution of booze soon became a major source of income for "the Mob" and led to the infamous gang wars of the late 1920s and early 1930s. 

Several states had banned alcohol prior to the federal ban, and in Illinois there was an organized attempt by a group of women to use telepathy to influence the outcome of local votes: the Temperance Thinkers mobilized some 500,000 women to dress all in white and to direct thought waves at voters. “Women arrayed in white will assemble at the polls,” described one paper, “and by concentrated mental effort endeavor to influence the men."

On December 5th, 1933, prohibition in the United States of America came to an end with the ratification of the 21st Amendment***. After 13 years, the country's attempt to ban the booze had ended.

The video below shows a newsreel from the time, documenting the 'happy news for the grain raisers of the United States and for many others throughout the land'. I like this quote: "The problems with legislating morality soon became abundantly clear":

* N.B. To save grain for the war effort, a temporary prohibition measure was enacted just after the Armistice and went into force in July 1919. More over, the discrediting by the war of the large German-American community, strong objectors to Prohibition, diminished the opposition. Similarly, it has also been claimed that the absence of a large proportion of American men - serving in France - had a significant effect. 

** Named for Minnesota representative Andrew Volstead (1860-1947), the act defined the alcoholic products affected, stated enforcement procedures, and set out the penalties for violation. It was passed over President Wilson's veto.

In the 21st Amendment Congress gave individual states the right to regulate alcohol as they saw fit, a move that created a dazzling array of confusing alcohol control laws under seemingly arbitrary regulatory agencies.

Here's Milton Friedman (wiki), at age 93, regarding drug prohibition:

"I do not think the state has any more right to tell me what to put in my mouth than it has to tell me what can come out of my mouth. Those two are essentially the same thing, and they are both essential elements of freedom."

My maternal grandmother was the president of the Poughkeepsie, NY chapter of the Women's Christian Temperance Union (WCTU) - there were 4 members and they met monthly (or thereabouts). Her four sons tried many times over her life to sneak a few drops of something into her lemonade or iced tea, but as far as I know they never succeeded and she went to her grave never having had alcohol pass her lips.

Related:

Winston Churchill's Doctor's Note Allowing Him to Drink "Unlimited" Alcohol in Prohibition America.

1860s series of photos illustrating the '5 stages of inebriation'.

How a Wine and Cocaine Cocktail became Coca Cola.

December 17 is the anniversary of the Wright brothers' first flight

For some years I have been afflicted with the belief that flight is possible to man. My disease has increased in severity and I feel that it will soon cost me an increased amount of money if not my life. I have been trying to arrange my affairs in such a way that I can devote my entire time for a few months to experiment in this field.

~ Wilbur Wright (letter to Octave Chanute, 13 May 1900)

SUCCESS FOUR FLIGHTS THURSDAY MORNING ALL AGAINST TWENTY ONE MILE WIND STARTING FROM LEVEL WITH ENGINE POWER ALONE SPEED THROUGH AIR THIRTY ONE MILES LONGEST 57 SECOND* INFORM PRESS HOME CHRISTMAS

~ Orville Wright (telegram to Milton Wright, 17 December 1903)

There are no signposts in the sky to show a man has passed that way before. There are no channels marked. The flier breaks each second into uncharted seas.

~ Anne Morrow Lindbergh (1906-2001) (North to the Orient, Ch. 1)

Per aspera ad astra.

~ familiar Latin tag, often used as a motto

(Through adversity to the stars.)

Today is the anniversary of mankind's first powered flight, achieved at Kitty Hawk, North Carolina on 17 December 1903 by pioneer American aviators Wilbur and Orville Wright (wiki) (1867-1912 and 1871-1948, respectively). The Wrights - Dayton, Ohio bicycle mechanics - become interested in aviation as an avocation and embarked on a systematic experimental program that eventually led to their extraordinary success - of which movable wing parts and a lightweight engine were the key elements. 

Via a now-defunct page from BrainFeed:

Prior To the powered flight, the brothers completed over one thousand glides from atop Big Kill Devil Hill. These flying skills were a crucial component of their invention. Through those experiments, they had solved the problem of sustained lift and more importantly they could control an aircraft while in flight. The brothers felt they were ready to truly fly. But first, the Wrights had to power their aircraft.

Zoomable version of the cutaway here.

Gasoline engine technology had recently advanced to where its use in airplanes was feasible. Unable to find a suitable lightweight commercial engine, the brothers designed their own. Using their air tunnel data, they designed the first efficient airplane propeller, one of their most original and purely scientific achievements. (Much more on the engine design here)

The Wright brothers were finally ready on December 14th. In order to decide who would fly first, the brother tossed a coin. Wilbur won the coin toss, but lost his chance to be the first to fly when he oversteered with the elevator after leaving the launching rail. The flyer, climbed too steeply, stalled, and dove into the sand. The first flight would have to wait on repairs.

Three days later, on December 17, they were ready for the second attempt. Now it was Orville’s turn. The flyer moved down the rail as Wilbur steadied the wings. The flyer was unruly, pitching up and down as Orville overcompensated with the controls. He kept it aloft until it hit the sand about 120 feet from the rail. Into the 27-mph wind, the groundspeed had been 6.8 mph, for a total airspeed of 34 mph. The brothers took turns flying three more times that day, getting a feel for the controls and increasing their distance with each flight. Wilbur’s second flight – the fourth and last of the day – was an impressive 852 feet in 59 seconds.

The most striking aspect of this anniversary is how quickly the Wright Brothers' invention led to the air and space age.  Man reached the moon only 66 years later - less than a human lifetime - and this remarkable acceleration of mankind's ability to achieve its most daunting goals is both exhilarating and frightening. 

Because satellites now do it so much better, French aviator and writer Antoine de Saint-Exupéry** (1900-1944) seems almost naive for remarking in 1939 that

"The aeroplane has revealed to us the true face of the earth."

Footage of later Wright Brothers' flights and an explanation of the history and mechanics: 

* N.B. Apparently, the actual time duration of that first flight was 59 seconds.

** A renowned flier, who described his experiences in vivid prose, Saint-Exupéry lost his life flying for the Free French in World War II. His most famous book is the children's story, Le Petite Prince ("The Little Prince").

On July 28, 1914, Austria declared war on Serbia, the first declaration of World War 1

The lamps are going out all over Europe; we shall not see them lit again in our lifetime. 

~Sir Edward Grey (remark, 3 August 1914, on the eve of Britain's declaration of war) 

The War was decided in the first twenty days of fighting, and all that happened afterwards consisted of battles which, however formidable and devastating, were but desperate and vain appeals against the decision of Fate. 

~Sir Winston Churchill (Preface to Spears, Liaison 1914) 

When every autumn people said it could not last through the winter, and when every spring there was still no end in sight, only the hope that out of it all some good would accrue to mankind kept men and nations fighting. When at last it was over, the war had many diverse results and one dominant one transcending all others: disillusion. 

~Barbara Tuchman (The Guns of August, "Afterward") 

Although many consider the opening act of World War I to be the assassination of Austrian Archduke Franz Ferdinand at Sarajevo - its anniversary was just a month ago (28 June) - the first actual declaration of war took place on 28 July, 1914, when Austria-Hungary initiated hostilities against Serbia, after the latter rejected a draconian Austrian ultimatum intended to give Austria a free hand in bringing Franz Ferdinand's killers to account. As a result, Russia - self-appointed protector of the "South Slavs" - mobilized against Austria, which panicked the Germans (fearful of a two-front war against both France and her Russian ally) and so it went... 

28 July Austria declares war on Serbia

1 August Germany declares war on Russia

3 August Germany declares war on France

4 August Germany invades Belgium (to attack France)

England declares war on Germany in support of Belgium

6 August Austria-Hungary declares war on Russia

Serbia declares war on Germany

11 August France declares war on Austria-Hungary

12 August England declares war on Austria-Hungary*

After Germany's long-intended encirclement of Paris (under the Schlieffen plan) was thwarted by the French and British in the Battle of the Marne, the struggle on the Western Front devolved into a four-year stalemate in which the principal protagonists faced off across a line of trenches that ran from the North Sea to the Swiss border. Despite the unprecedented bloodbath that ensued, virtually no additional ground was gained by either side before the end of the conflict in November 1918.

Despite the "war-guilt" clauses of the Treaty of Versailles, which held Germany largely responsible for the hostilities and imposed extraordinary penalties and reparations, the causes of the war have been debated endlessly for most of the last century. I concluded some years ago after a good deal of reading on the subject that although there was certainly enough blame to go around, it was primarily Austria-Hungary that caused the catastrophe because of her reckless determination to settle long-standing scores with Serbia. Nothing I've learned subsequently has much changed that position. Be that as it may... One could argue - and I do - that World War I was the greatest misfortune that ever befell Western civilization. It destroyed the West's belief in inevitable human progress. It brought down the Austro-Hungarian, German, Russian, and Ottoman empires, bankrupted France and England, and put the British Empire on the skids. It was the proximate cause of the triumph of Communism in Russia and the formation of the Soviet Union, drove the United States into two decades of international isolation, and instilled in Germany a thirst for revenge that led directly to the rise of the Nazis and World War II.

Moreover, in the Middle East, Britain's and France's cack-handed and self-serving division of the remains of the Ottoman Empire was largely responsible for all the turmoil we suffer there today. On hearing the terms of the Versailles Treaty, Germany's much-maligned Kaiser Wilhelm II noted from exile that,

"The war to end war has resulted in a peace to end peace."

*The United States only joined the Allies on 6 April 1917, provoked beyond endurance by Germany's unrestricted submarine warfare campaign and the German "Zimmermann telegram" (wiki) - intercepted by British intelligence - which promised Mexico the return of her "lost territories" in the southwest United States in return for an alliance with a victorious Germany.

(Text above is adapted from Ed's Quotation of the Day, only available via email. Leave your email address in the comments if you'd like to be added to his list.)

If you're interested in further information on the subject there are hundreds of books and films - the best books I know of (and unlike Ed, who's recommendations are above, I'm no expert) are Barbara Tuchman's The Guns of August (which won a Pulitzer back when they meant something) and John Keegan's The First World War. 

Here's the The BBC’s Horrible Histories explanation of how the Brits got involved:

Here's a 6 minute overview of World War I:

The Atlantic has a series of photoessays entitled World War I in Photos on various WWI topics.

Previous posts: 

June 28 marks the centennial of the start of World War One: a few quotes/videos/links

Wilfred Owen, the best of the WWI "War Poets", was born 121 years ago today

It's the anniversary of the 20th of July plot, the unsuccessful bomb attempt to kill Hitler in 1944

Unhappy German nation, how do you like the Messianic role allotted to you, not by God, nor by destiny, but by a handful of perverted and bloody-minded men? 

~ Thomas Mann (Order of the Day, "This War")

A few days before the attempt: Stauffenberg standing 

to attention, left, as Hitler visits the Wolf's Lair. To 

the right is Field Marshall Wilhelm Keitel, later 

executed as a war criminal

In Germany, they came first for the Jews, and I didn't speak up because I wasn't a Jew. Then they came for the Communists, and I didn't speak up because I wasn't a Communist. Then they came for the trade unionists, and I didn't speak up because I wasn't a trade unionist. Then they came for the Catholics, and I didn't speak up because I wasn't a Catholic. Then they came for me - and there was no one left to speak up. 

~ Pastor Martin Niemöller (attributed, in the Congressional Record of 14 June 1968) 

The greatest obstacle to being heroic is the doubt whether one may not be going to prove one's self a fool; the truest heroism is to resist that doubt; and the profoundest wisdom, to know when it ought to be resisted, and when it be obeyed. 

~ Nathaniel Hawthorne (The Blithedale Romance, Ch. 2) 

Es lebe unser heiliges Deutschland!

(Long live our sacred Germany!)

~ Claus Schenk Graf von Stauffenberg (wiki) (last words before a firing squad, 21 July 1944) 

Stauffenberg's bomb failed to kill Hitler after a general moved 

the briefcase containing the device; as a result the Nazi leader 

was shielded by a heavy oak table

Today is the anniversary of the denouement of the nearly-forgotten "20th of July" plot (wiki) in 1944, when a courageous, but incredibly quixotic, group of old-fashioned German patriots under the leadership of Army officer Count Claus von Stauffenberg (wiki) (1907-1944)* sought to achieve a compromise end to World War II in Europe by assassinating Adolf Hitler in his headquarters at Rastenburg, East Prussia, preparatory to opening peace negotiations with the western allies (i.e., excluding Russia). The conspiracy involved a number of high-ranking officers, including Generals Ludwig Beck and Friedrich Obert, but collapsed when a bomb placed by Stauffenberg himself failed to kill Hitler, and plans to seize Berlin fell through.  

Within a day Stauffenberg and the other ringleaders had been executed, but thousands of known opponents of the regime were killed also, and Field Marshals Erwin Rommel, Erwin von Witzleben, and Günther von Kluge were implicated and forced to commit suicide**. Ironically, within a year, the Third Reich had collapsed and Hitler was dead. English writer G. K. Chesterton (1874-1936) once wrote,

"Courage is almost a contradiction in terms. It means a strong desire to live taking the form of a readiness to die."

* N.B. Stauffenberg, a devout Roman Catholic, was born to a Bavarian noble family, entered a traditional cavalry regiment in 1926, and became an officer in the German Army in 1930. Despite growing misgivings about Nazi policies, he fought loyally in Poland, France, Russia, and Tunisia until he was seriously wounded in the latter, losing an eye, his right hand, and two fingers on his left hand. Subsequently, he served in several staff positions. Throughout his career, Stauffenberg seems to have been drawn to various anti-Nazi movements, and his war experiences, especially in Russia, intensified his feelings of unease with the regime. The 2008 motion picture Valkyrie presents a somewhat fictionalized version of the 20 July plot. 

** Stauffenberg got off easy. Eight of those executed were hanged with piano wire from meat-hooks and their executions filmed and shown to senior members of the Nazi Party and the armed forces.

British Pathe has a newsreel which includes footage of the aftermath of the bomb:

And an additional newsreel, apparently from shortly after the end of the war:

Related posts:

June 30, 1934 was the Night of the Long Knives, Hitler's purge of those standing in his way.

The Herd Reich? Brit farmer turned Nazi super cows into sausage because they were too aggressive.

January 27, 1945 - the Soviet Army liberated Auschwitz

Nazis with cats.

Hitler’s Last Surviving Food Taster.

Further reading:

The definitive source: Rise And Fall Of The Third Reich.

Parts of the text above are adapted from Ed's Quotation of the Day, only available via email - leave your email address in the comments if you'd like to be added to his list. Ed is the author of Hunters and Killers: Volume 1: Anti-Submarine Warfare from 1776 to 1943 and Hunters and Killers: Volume 2: Anti-Submarine Warfare from 1943.