Ileosigmoid knot: case report and CT findings.

Ileosigmoid knot (ISK) is an unusual clinical entity of small bowel obstruction in which the ileum wraps around the base of the sigmoid colon and forms a pseudo-knot. We present the case of a 75-year-old male in whom ISK was the definitive computed tomographic finding. ISK should be considered in differential diagnosis of patients who present with ileus.

[A case of short-bowel syndrome treated with parenteral nutrition at home--its effectiveness on improving nutritional status and quality of life].

Although the effectiveness of home parenteral nutrition (HPN) for short-bowel syndrome has already been demonstrated, there are some patients who suffer from severe malnutrition because they cannot be treated with this therapy. We here report the case of a patient with short-bowel syndrome due to massive bowel resection after superior mesenteric artery thrombosis. As she had not received adequate nutritional support, she became severely undernourished and her activities of daily life were very limited during two years after the operation. She was introduced to our department and HPN was initiated. Her nutritional status and quality of life rapidly improved. Thus, we further confirmed the effectiveness of HPN for ambulatory patients with short-bowel syndrome. It is important to take measures not to make patients with short-bowel syndrome, suffering from severe malnutrition without adequate nutritional support, HPN.

Adult right-sided Bochdalek hernia facilitated by coexistent hepatic hypoplasia.

An adult case of right-sided Bochdalek hernia complicating intrathoracic intestinal strangulation is presented. Formation of this rare right-sided diaphragmatic hernia was facilitated by coexistent hypoplasia of the medial segment of left hepatic lobe. Computed tomography showed characteristic findings such as dilated small intestine with convergence of mesenteric folds in the thorax, which was highly diagnostic of intestinal strangulation due to diaphragmatic hernia.

A case of Japanese encephalitis: CT and MRI findings in acute and convalescent stages.

We studied the CT and MR images of a patient with Japanese encephalitis. The first symptom was general malaise with high fever. The diagnosis of meningoencephalitis was made by spinal tap and clinical presentation. CT on the third day of illness showed no significant findings. MRI on the fifth day of illness demonstrated that the left thalamus and bilateral putamen were hyperintense on T2-weighted images. On CT one month later, the density in the thalamus and bilateral putamen was normal. MRI two month later showed high signal intensity only in the left thalamus. The patient recovered, but was judged to have dementia according to the simple dementia scale of Hasegawa. Flaccid paralysis was observed during the acute period.

Olivary degeneration after intracranial haemorrhage or trauma: follow-up MRI.

We studied serial MRI appearances of transneuronal degeneration in the inferior olives, retrospectively analysing follow-up images of five patients, three with head injury and two with brain stem haemorrhage. We performed 13 MRI studies 4 days to 2 years 7 months after the accident. All but one of the patients exhibited bilateral olivary high signal on T2-weighted images. The interval between causal event and appearance of olivary changes was 2-4 months, images 4 days to 1.5 months after the accidents revealing no changes. Olivary enlargement was observed in four patients 2-4 months after ictus.

Cross sectional observation of the effects of carbon disulphide on arteriosclerosis in rayon manufacturing workers.

OBJECTIVE: A prospective cohort study was designed to clarify the relations between occupational exposure to carbon disulphide (CS2) and its effects on arteriosclerosis in workers in 11 Japanese rayon manufacturing factories. This report is a cross sectional baseline observation in the first study year. METHODS: Study subjects were 432 male rayon workers (mean (range) age 35.5 (19.1-47.8); duration of exposure 13.4 (0.3-29.0)) and 402 male referent workers (age 35.8 (18.9-49.8)). Exposure to CS2 was assessed by determining the concentration of 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine. Mean (SD) TTCA was 3.42 (2.73) mg/g creatinine (Cr) (n = 422). About a quarter of the urine samples were > 5 mg/g Cr, a biological exposure index recommended by the American Conference of Governmental Industrial Hygienists. Health effects on arteriosclerosis were evaluated by measuring blood pressure, serum lipids, pulse wave velocity of the aorta, stiffness and blood flow of the carotid artery, and blood coagulation and fibrinolysis indices, and by use of brain magnetic resonance imaging, electrocardiogram (at rest and after exercise), ophthalmograph, and Rose's questionnaire. Information on potential confounding factors was collected by self administered questionnaire. RESULTS: Prevalence of microaneurysm of the retinal artery was significantly higher in workers exposed to CS2 (8.1%) than in referent workers (3.4%), and increased with age. Other examinations did not show any differences between the two groups even after allowance for confounding factors. CONCLUSIONS: Significant effects of CS2 on arteriosclerosis were not found in current rayon manufacturing workers, with the exception of induction of microaneurysm of the retinal artery.

Role of 3D-TOF magnetic resonance angiography for intracranial meningioma.

Three-dimensional (3D) time of flight (TOF) magnetic resonance angiography (MRA) was performed in 13 patients with intracranial meningioma. 3D-TOF unenhanced MRA depicted arterial displacement by tumour, and poorly demonstrated the sinuses, veins and tumour mass. The direct visualization of the venous abnormalities on 3D-TOF MRA was improved by the administration of contrast material. 3D-TOF enhanced MRA simultaneously depicted tumour enhancement, arterial and/or venous displacement, and dural sinus involvement by the tumour, all of which were in good agreement with findings on conventional cerebral angiography. However, MRA tended to poorly demonstrate the feeding arteries as compared to conventional angiography. Our results indicate that multiview 3D-TOF enhanced MRA non-invasively provides important information about the topographic relationship between tumour mass and the surrounding vasculature.

Corticobasal degeneration: MR with histopathologic comparison.

The purpose of this study was to illustrate the MR findings of corticobasal degeneration and to compare those findings with pathologic specimens. MR findings of atrophy in the perirolandic gyri, atrophy of the basal ganglia, and T2 prolongation in the posterolateral putamen are useful evidence supporting the clinical diagnosis of corticobasal degeneration.

Magnetic resonance angiography of cerebral arteriovenous malformations.

Magnetic resonance (MR) angiography as a method for the long-term follow-up of cerebral arteriovenous malformations (AVMs) was assessed in 14 patients with cerebral AVMs. These patients were either untreated or treated with transarterial embolization and/or stereotactic radiosurgery (gamma knife). Two-dimensional- and three-dimensional (3D)-time-of-flight (TOF) techniques were useful for following AVMs with a small nidus and few feeders and drainers which were either untreated or had been treated only a few months previously. 3D-TOF MR angiography with a contrast agent was more useful for visualizing the vascular structure, including the residual nidus, during long-term follow-up of treated AVMs.

[CT findings of sinonasal and orbital Wegener's granulomatosis].

We reviewed the CT findings of four cases of Wegener's granulomatosis that presented as inflammatory masses in the sinonasal cavity or orbit. In the present study, an infiltrative nature and homogeneous texture with contrast enhancement were typical of the masses. In addition, the masses were frequently accompanied by infiltration of the pterygopalatine fossa or destruction of adjacent bone. However, no pathognomonic findings were observed.

[CT-guided percutaneous lung biopsy using a cutting needle and an automated biopsy gun. Comparison with lung biopsy using a manual aspiration needle].

Twenty-five percutaneous lung biopsies using a 20-gauge cutting needle and automated biopsy gun (ABG) were performed under CT guidance in 25 patients with thoracic lesions. This procedure was compared with that using a 21-gauge manual aspiration needle in 36 patients (40 examinations, 37 lesions) in terms of success rate, rate of correct diagnosis, mean examination time and rate of complications. Specimens obtained from lung biopsy were graded by a histopathologist according to quality and quantity from 0 to 4 (pathological score). There were no statistically significant differences between the two procedures in terms of success rate, rate of correct diagnosis and rate of complications; only the time required was significantly different. However, sufficient biopsy material and a mean pathological score of G-II 2.8 (that of G-I was 1.9, p less than 0.05) could be obtained by the biopsy procedure using the cutting needle. The above results indicated that aspiration needle biopsy was adequate for lung biopsy, but that a cutting needle and ABG should be used when a good biopsy specimen is needed for tissue diagnosis.

[CT of abdominal aortic aneurysms--aneurysmal size and thickness of intra-aneurysmal thrombus as risk factors of rupture].

In order to seek for the factors to suggest a risk of rupture of abdominal aortic aneurysms (AAA), we measured the largest diameter of AAA and the thickness of intra-luminal thrombus on CT in 72 patients. The mean aneurysmal size was 64 mm in diameter in 9 patients with ruptured aneurysm and 61 mm in diameter in 63 patients with non-ruptured aneurysm respectively (p less than 0.90). The rupture of AAA was seen in 3 of 30 patients with AAA of the small size (less than 50 mm in diameter), in 3 of 16 patients with AAA of the intermediate size (51-66 mm in diameter) and in 3 of 26 patients with AAA of the large size (more than 70 mm in diameter), respectively. The mean intra-luminal thrombus was 9 mm in 9 patients with ruptured aneurysm and 19 mm in thickness in 63 patients with non-ruptured aneurysm respectively (p = 0.05). We concluded from the above results that the aneurysmal size was not important, but the thickness of intra-luminal thrombus was useful for suggestion of a risk of rupture of AAA.