Pulmonary consolidation associated with infusion of a glucose-insulin-potassium solution in acute myocardial infarction.

From 1972 to 1975, we have observed seven patients with localized pulmonary consolidation distal to the tip of a Swan-Ganz catheter. These seven instances occurred in a population of over 300 patients receiving a hypertonic solution of glucose, insulin, and potassium for acute myocardial infarction. In four patients the glucose-insulin-potassium solution was instilled directly into the right pulmonary artery from the tip of the Swan-Ganz catheter. In the subsequent three patients the solution was administered via the right atrial port and thus perfused the entire pulmonary vascular bed. The roentgenographic appearance of this localized pulmonary consolidation is indistinguishable from infarction caused by pulmonary thromboembolus or wedging of the catheter.

Enhanced detection of asymptomatic renal masses with routine tomography during excretory urography.

In a prospective study of a diagnositc scheme for evaluating renal masses, it was observed that a significant number of masses (29 per cent) would have been undetected without the aid of routine tomography. The renal masses detected with the aid of tomography are either small or peripheral lesions which cause no impingement upon the renal collecting system. Without specific symptoms referable to a renal mass and without hematuria, many renal masses will be overlooked on standard excretory urography. The general improvement in diagnostic quality, the ease with which this procedure may be added to excretory urography, and the minimal expense involved would be additional factors which should justify the use of routine tomography with excretory urography in any radiology department.

Radionuclide evaluation of renal function.

The renal scintillation camera study and the excretory urogram should be considered to be complementary studies. The renal scintillation camera study provides an accurate evaluation of changes in total, differential, and segmental renal function but affords only a gross assessment of anatomic changes. The excretory urogram provides superior information about renal anatomic changes but only inferior information about functional changes of the kidney. The advantages of a renal scintillation camera study with regard to the patient are that it is done in a state of normal hydration, it requires no bowel preparation, it is not associated with allergic reactions, it provides a low radiation exposure, and it is a noninvasive procedure for differential renal function which requires no ureteral catheters.

Jefferson fracture of the atlas. Report of six cases.

Six cases of Jefferson fracture of the atlas are summarized. None had recognizable neurological signs that resulted from the injury when seen in the hospital. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. None of the patients underwent fusion of the cervical spine.

Selective angiography in renal and peri-renal inflammatory lesions: correlation with histopathology.

We have correlated the angiographic and pathological findings in renal and peri-renal inflammatory disease in acute, sub-acute and chronic phases. In all stages of renal infection, the renal vasculature is attenuated. This corresponds in acute inflammation to vasospasm, acute vascular necrosis and post glomerular peritubular capillary congestion. In sub-acute inflammation, the reduction in vascularity is due to peri-vascular fibrosis and intimal and medial hyperplasia. In chronic infections, the renal vessels are completely destroyed and replaced by fibrotic tissue. In contrast to this, peri-renal inflammatory disease leads to vaso-dilatation and enlargement of the renal capsular arterial complex, and of retroperitoneal arteries. If both renal and peri-renal inflammation occurs simultaneously, a discordance between the renal cortical and capsular arterial filling results: this striking phenomenon is highly suggestive of inflammation, and extremely rare in tumours. Three types of inflammatory vascularity are described, two of which can be easily distinguished from tumour vascularity. An inflammatory blush, slow emptying of vessels and a mottled nephrogram with loss of cortical definition are highly suggestive signs of renal inflammation. It is concluded that angiography is a sensitive and accurate method for the early diagnoses of renal and peri-renal flammatory conditions.

Rapid resolution of perfusion/ventilatory abnormalities in pulmonary air embolism.

A case of pulmonary air embolism is presented demonstrating a nearly total lung perfusion defect and a matching ventilation deficit. Despite advanced age, mild chronic obstructive airway disease, and congestive heart failure, the perfusion/ventilatory (V/Q) abnormalities produced by the air emboli resolved to near completion within three days. Rapid resolution of V/Q abnormalities due to air embolism is distinct when compared to the abnormalities seen with thromboembolism and the mechanism the matching V/Q defects is discussed.

Economic analysis of a comprehensive quality assurance program.

The quality assurance program at The University of Alabama in Birmingham is briefly reviewed and its economic efficacy examined. The development of the program was the result of the cooperative effort of the quality control technologists, the radiological service engineering staff, and the radiation physicists. Analysis of our film and chemistry consumption before and after the program was established indicates that its implementation has saved the hospital approximately $27,000 per year after personnel cost for the last four years. A further $32,000 to $55,000 savings per year is realized by having in house rather than contracted service.

Discovery of molecular subtypes in leiomyosarcoma through integrative molecular profiling.

Leiomyosarcoma (LMS) is a soft tissue tumor with a significant degree of morphologic and molecular heterogeneity. We used integrative molecular profiling to discover and characterize molecular subtypes of LMS. Gene expression profiling was performed on 51 LMS samples. Unsupervised clustering showed three reproducible LMS clusters. Array comparative genomic hybridization (aCGH) was performed on 20 LMS samples and showed that the molecular subtypes defined by gene expression showed distinct genomic changes. Tumors from the 'muscle-enriched' cluster showed significantly increased copy number changes (P=0.04). A majority of the muscle-enriched cases showed loss at 16q24, which contains Fanconi anemia, complementation group A, known to have an important role in DNA repair, and loss at 1p36, which contains PRDM16, of which loss promotes muscle differentiation. Immunohistochemistry (IHC) was performed on LMS tissue microarrays (n=377) for five markers with high levels of messenger RNA in the muscle-enriched cluster (ACTG2, CASQ2, SLMAP, CFL2 and MYLK) and showed significantly correlated expression of the five proteins (all pairwise P<0.005). Expression of the five markers was associated with improved disease-specific survival in a multivariate Cox regression analysis (P<0.04). In this analysis that combined gene expression profiling, aCGH and IHC, we characterized distinct molecular LMS subtypes, provided insight into their pathogenesis, and identified prognostic biomarkers.

Carcinoma of the urachus.

Characteristic roentgenographic and anatomical features of a mucinous adenocarcinoma of the urachus were observed in two patients. Both presented with a midline anterior abdominal mass in the supravesicular area. The tumor contained fine stippled calcification in one case. The cystogram demonstrated an irregular filling defect in the bladder dome in the other case. Ultrasonographic examination in one case was helpful in delineating the nature, size, and location of the mass in detail.

Unusual involvement of the rectum by carcinoma of the prostate.

The authors present three cases in which carcinoma of the prostate simulates a primary carcinoma of the rectum. Direct invasion by prostatic carcinoma should be included in the differential diagnosis of mass lesions of the rectum in males.

Starch granulomatous peritonitis.

An unusual case of recurrent starch granulomatous peritonitis that presented as a long-standing paralytic ileus is described and the literature pertaining to this unusual entity is reviewed. The roentgenographic finding of severe prolonged paralytic ileus usually developing late in the post-operative period should suggest the possibility of this disease.

Medullary sponge kidney presenting as polycystic renal disease.

We observed a 30-year-old woman in whom a large mass in the right lower quadrant and bilaterally enlarged cystic kidneys with markedly distorted collecting systems by excretory urography suggested a diagnosis of polycystic renal disease (PRD); but the linear and cystic dilatation of collecting tubules, many of which contained numerous calculi, was typical of medullary sponge kidney (MSK). Arteriography and CT scanning clearly showed that both the calcifications and the cysts were confined to the medullary portions. The cortical layer was entirely free of cysts except where large medullary cysts protruded to the surface. In patients in whom MSK imitates PRD, these conditions can be distinguished by CT scanning and arteriography.

Pathogenesis of Kerley's B lines on the chest roentgenogram.

A 36-year-old white man with gastric cancer manifested his disease clinically by respiratory distress and roentgenographically by Kerley's B lines. The pathogenesis of these lines and the importance of their recognition are emphasized.

Computed tomographic findings in suburothelial hemorrhage.

Retroperitoneal hemorrhage with associated intramural hemorrhage into the renal pelvis and proximal ureter is a well documented complication of coagulation defects. The urographic characteristics of this condition have been well documented by several authors [1-4], but to our knowledge the computed tomographic (CT) findings in patients with this condition have not been reported previously. We describe the CT findings in 2 such cases; one related to thrombocytopenia in leukemia, and the other to anticoagulant therapy in a patient with Budd-Chiari syndrome.