Quinolones and tendon ruptures.

We report two cases of tendon rupture associated with ciprofloxacin. One patient had a complete rupture of an Achilles tendon 6 months after taking the medication. The other case involved a partial rupture of the subscapularis tendon. Both ruptures occurred with minimal mechanical stress on the tendons, suggesting that the fluoroquinolone increased the susceptibility to rupture. We also review the literature describing the association between fluoroquinolones and tendon rupture and discuss the mechanisms explaining the heightened risk of tendon rupture associated with these drugs.

Subcutaneous implantation of percutaneous ureteral stents.

The authors describe their experience with subcutaneous implantation of percutaneous ureteral stents. Three of the five procedures were complicated by infection, urine leak and/or chronic drainage at some time during their course. One patient developed pressure changes of the skin overlying the implanted tube. The problems encountered in this initial experience are avoidable. Subcutaneous implantation of percutaneous ureteral stents can be useful in the management of appropriate patients.

Conversion of percutaneous ureteral stent to indwelling pigtail stent over guidewire.

A ureteral stent placed percutaneously through a nephrostomy can be readily exchanged endoscopically for a ureteral indwelling pigtail stent over a percutaneous guide wire. Percutaneous antegrade stent placement can sometimes be accomplished when retrograde placement cannot. We report 10 successful conversions to indwelling stent in 11 cases. In 1 case the percutaneous guide wire could not be retrieved endoscopically because of a bleeding tumor in the bladder. No serious difficulties or complications were encountered. The percutaneous approach offers an alternative method of providing internal urinary diversion if retrograde ureteral indwelling stent placement has failed.

Ileal lymphatic metastases from cecal carcinoma.

Involvement of the terminal ileum in cases of cecal carcinoma usually results from direct extension through the cecal wall and ileocecal valve. Extensive lymphatic metastasis from cecal carcinoma can result in deranged lymphatic flow and apparently cause metastatic involvement of the ileum and its mesentery in the absence of direct extension. Three cases with the lymphatic obstruction pattern are described. Demonstration of these changes on antegrade small bowel examination indicates that extensive lymphatic metastasis has occured and that resection will not be curative.

Percutaneous ureteral stent placement for stricture management and internal urinary drainage.

Percutaneous ureteral stent placement was attempted in nine patients with 14 ureteral lesions. Eight strictures in six patients were successfully stented. Three were subsequently converted to indwelling ureteral stents. The technique is described. No significant complications occurred. The procedure should be attempted as part of percutaneous nephrostomy for benign ureteral strictures, ureteral fistulae, or when ever long term nonoperative diversion can be useful.

Computed tomographic staging of malignant gastric neoplasms.

Eight patients with proved gastric carcinoma and 3 with gastric lymphoma were studied preoperatively with computed tomography. CT accurately identified abnormal stomach wall thickening and intra-abdominal tumor extension. Mural thickening was seen on the CT scan when a moderately distended stomach had a wall more than 10 mm thick. CT was useful for assessing surgical resectability, evaluating tumor response to chemotherapy or radiotherapy, and detecting postoperative recurrence. Fourteen patients with an abnormal barium study suggesting gastric malignancy were also studied with CT, which correctly demonstrated a normal stomach or identified the reason for the abnormal barium study, such as an unusual placed spleen or a pancreatic carcinoma invading the stomach.

The radiological spectrum of gastric bypass complications.

Gastric bypass is now the operation of choice for surgical management of morbid obesity. Prompt and accurate radiological diagnosis in the early postoperative period is critical for proper management of suspected gastrojejunal anastomotic leakage, abscess formation, and acute distension of the excluded stomach and afferent loop. Inadequate weight loss may indicate an increase in the gastric pouch and anastomosis or dehiscence of the staple line. Gastric and jejunal ulceration and anastomotic narrowing also require radiological and endoscopic evaluation.

Childhood sarcoidosis with fatal cor pulmonale.

A 14 year-old white girl who developed fatal cor pulmonale from severe pulmonary sarcoidosis had a previous clinical diagnosis of cystic fibrosis. Chest radiographs demonstrated marked pulmonary fibrosis without the changes of severe bronchiectasis that would be anticipated with cystic fibrosis.

Radiologic changes in the thymoma-hypogammaglobulinemia syndrome.

Radiologic findings in the thymoma-hypogammaglobulinemia syndrome are encountered in three stages reflecting the natural history of the syndrome. Initially, a mediastinal mass is apparent on chest x-ray in an asymptomataic patient. At this stage a failing immune system has apparently induced compensatory thymic hyperplasia which progresses to frank neoplasia. In 55% of the cases this thymic tumor is paracardiac in location. With progressive failure of immunoglobulin production, acute and chronic pulmonary infiltrates occur secondary to infection. Markedly, decreased IgA in the bowel may eventually be manifested by radiologic changes of exudative enteropathy.