Flow-cytometry-enhanced fine-needle aspiration biopsy of the spleen.

OBJECTIVE: Flow cytometry is proving useful in the evaluation of lymphoproliferative disorders. In a case series, the authors investigated the safety of cross-sectional fine-needle aspiration biopsy of the spleen under sonographic guidance, and the usefulness of flow cytometry in analysis of biopsy samples. METHODS: Five patients underwent fine-needle biopsy with freehand sonographic guidance. Samples were analyzed on a flow cytometer. RESULTS: Through cytologic examination enhanced by flow cytometry, 2 cases of lymphoma, 1 case of metastatic transitional cell carcinoma, and 1 case of focal splenic hemangioma were diagnosed. Normal lymphocytes were demonstrated in 1 case, in which long-term follow-up of splenomegaly showed that this was related to cirrhosis and portal hypertension in a patient with a history of treated non-Hodgkin's lymphoma. CONCLUSION: Flow-cytometry-enhanced fine-needle aspiration of the spleen is a safe and useful tool for the interventional radiologist. In our institution, it evolved as the result of effective teamwork between diagnostic radiologists and pathologists. Flow cytometry promises to be increasingly useful in the diagnosis and management of lymphoproliferative diseases.

Radiotherapy for the treatment of metastatic granulosa cell tumor in the mediastinum: a case report.

OBJECTIVE: We report a case of metastatic ovarian granulosa cell tumor in the mediastinum with a 2-year disease-free interval after treatment with radiotherapy and review the literature regarding the use of radiotherapy in recurrent and metastatic granulosa cell tumor. METHODS: The patient's medical records, histological slides, and radiological films were reviewed. The pertinent references were obtained using a Medline search and cross-references. RESULTS: A patient with Stage 1A granulosa cell tumor developed a recurrence in the retroperitoneum 10 years after initial surgery. She was treated with chemotherapy followed by surgical resection. She subsequently developed metastatic tumor in the mediastinum which responded completely to radiotherapy. She has remained disease free for 2 years since the completion of radiotherapy. CONCLUSION: Radiotherapy is a treatment option that should be considered in localized recurrent or metastatic granulosa cell tumor that is not amenable to surgery as it can potentially control the disease for several years.

Nontraumatic subcutaneous emphysema in association with rectal carcinoma.

Nontraumatic subcutaneous emphysema is a rare complication of colorectal cancer. To the authors' knowledge, only eight cases have been reported to date. The initiating event was free colonic perforation in seven of the patients and contained colosubcutaneous fistula in the eighth. In nontraumatic subcutaneous emphysema typical fecal flora is cultured, whereas in nontraumatic gas gangrene, a different clinical entity that has a fulminant course, the bacteria are generally clostridial. The authors report a case of nontraumatic subcutaneous emphysema associated with rectal carcinoma and describe the associated computed tomography findings.

Surgically transposed ovary presenting as an intraperitoneal mass on computed tomography.

The authors present a case of surgical transposition of the left ovary, which presented on computed tomography (CT) as an intraperitoneal cystic mass. To their knowledge, there is only one other report in the radiologic literature of the CT appearance of a transposed ovary, but in that case the ovary appeared as a retroperitoneal mass.

The response of the portal vein to an oral glucose load.

Changes of total blood flow, velocities, and cross-sectional area in the portal vein before and after oral glucose administration were studied using image-directed Doppler ultrasonography. Portal vein cross-sectional area, flow velocity, and total blood flow increased significantly compared with baseline studies. Relative increase in these values compared with baseline studies (95% confidence intervals) are presented, and future applications of this method are discussed.

Unilateral proliferative sickle retinopathy: a model for photocoagulation in the proliferative retinopathies.

We present a case report of a patient with unilateral proliferative sickle retinopathy who progressed to intractable vitreous hemorrhage, traction retinal detachment, and severe loss of vision after unsuccessful vitrectomy surgery. The patient's other eye had chronic uveitis resulting in widespread destruction of the retinal tissue, and subsequently the eye did not have any evidence of neovascularization. This observation is consistent with those seen in proliferative diabetic retinopathy where retinal damage from high myopia, trauma, or other cause typically protects that eye from the advanced stages of diabetic retinopathy. As in this case, the eye with long-standing uveitis did not have proliferative sickle retinopathy.

Lower-extremity in situ saphenous vein grafts: angiographic interventions.

In 16 consecutive patients, thrombosis, anastomotic and intragraft stenoses, and residual venous communications (arteriovenous fistulas [AVFs]), after in situ saphenous vein bypass of femoropopliteal and infrapopliteal arteries, were treated with interventional angiographic techniques. Streptokinase infusion for graft thrombosis was performed in four patients, with long-term clinical improvement in two; in the other two, early rethrombosis was treated with surgical thrombectomy. Delayed rethrombosis occurred at 13 months in another patient. Anastomotic (six occasions) and intragraft (four occasions) stenoses in six patients were dilated with percutaneous transluminal angioplasty (PTA). Two grafts subsequently occluded, one 3 weeks and one 3 months after PTA. Residual AVFs were occluded in ten patients. Ten of 16 patients remained clinically improved without further therapy. One complication occurred: A graft stenosis developed at the site where a coil, protruding from the AVF into the graft lumen, was successfully removed and replaced.

Neonatal aortic thrombosis treated with intra-arterial urokinase therapy.

We report a newborn infant with neonatal aortic thrombosis (a complication of umbilical artery catheterization) successfully treated by intra-arterial urokinase therapy.

Quantification of progressive diabetic macular nonperfusion.

We used the IS-2000 Image Analyzer to estimate the extent of progressive diabetic macular nonperfusion in a patient by means of an automatic clustering algorithm applied to digitized fluorescein angiograms of the patient's macula taken over time. This method may provide an objective and reproducible quantification of progressive macular nonperfusion.

Subretinal neovascular membranes associated with choroidal nonperfusion and retinal ischemia.

This is the first well-documented case of co-existent underlying choroidal nonperfusion in an eye with a subretinal neovascular membrane that was subsequently treated with krypton red laser photocoagulation by the senior author (LEM). The possible role of chronic macular ischemia secondary to choroidal circulatory impairment is discussed in relationship to other well-established risk factors. Perhaps treatment to improve macular oxygenation would be a reasonable alternative to eradication of the neovascularization by direct laser photocoagulation.

Pneumomediastinum associated with cocaine abuse: a case report and review of the literature.

A case of pneumomediastinum following inhalation of cocaine alkaloid (free-base) is reported. This is the third reported case in the literature. The presumed mechanism is barotrauma secondary to vigorous inhalation for valsalva maneuvers.