The clinical value of autofluorescence bronchoscopy for the diagnosis of lung cancer.

The aim of this study was to evaluate the role of autofluorescence bronchoscopy (AFB) in the routine work-up of lung cancer. Consecutive patients with atypical or suspicious cells in sputum or bronchial aspirate, no localising abnormality on chest radiography and nondiagnostic white-light bronchoscopic (WLB) results were recruited. WLB and AFB were performed sequentially during the same session. All abnormal areas detected by WLB, AFB or both were sampled and the biopsy specimens sent for histological examination. Sixty-two patients were recruited within the 32-month study period. Seventeen had no endobronchial lesion detected. Among the 45 patients with endobronchial lesions, 37 had lesions with a histopathological grade of mild dysplasia or less; of the eight patients who had a lesion with a histological grade of moderate dysplasia or worse, five were found to have lung cancer, two invasive lung cancer and three an intra-epithelial neoplasm (severe dysplasia). Lesions showing moderate dysplasia or worse were more commonly found in patients with suspicious cells than in those with atypical cells on sputum examination. AFB was more sensitive than WLB (91 versus 58%) at detecting these lesions, but less specific (26 versus 50%). A combination of white-light and autofluorescence bronchoscopy can increase the diagnostic yield of this invasive procedure in patients exhibiting abnormal sputum cytology.

The relationship between mediastinal lymph node attenuation with parenchymal lung parameters in silicosis.

OBJECTIVE: Attenuation changes on computed tomography (CT) in mediastinal lymph nodes (LN) may be related to lung alterations and functional impairment in silicosis. DESIGN: CT and clinical data of 41 (64.2 +/- 8.3 years) males with silicosis were retrieved. Attenuation type (calcified, hyperdense, normodense) and calcification pattern (central, eccentric, dense, eggshell, speckled) of mediastinal LN were evaluated; LN attenuation of uncalcified LNs quantified on CT in six LN stations. Nodular profusion (CT-NP) and progressive massive fibrosis (CT-PMF) were graded. Relationships between LN, CT, lung function and clinical parameters were determined. RESULTS: LN sites were paratracheal (n = 39), subcarinal (n = 39), tracheobronchial (n = 37), aortopulmonary (n = 37), hilar (n = 27), and peri-oesophageal (n = 21). LNs were calcified, hyperdense and normodense in 107, 85 and 54 LN stations, respectively. Uniformly calcified LN was most common, followed by speckled calcification. Central, eccentric and eggshell calcification was rare. CT-NP scores > or = 16 were associated with higher LN attenuation and number of calcified LN stations than CT-NP scores < 16. PMF had no influence over LN morphology or calcification pattern. LN attenuation correlated with CT-PMF (r = 0.36, P = 0.01), CT-NP (r = 0.54, P < 0.001) and DLCO/VA (r = -0.33, P = 0.02). CONCLUSION: Uniformly calcified and hyperdense LNs are common in silicosis, and eggshell LN calcification is rare. There are associations between LN attenuation and lung function impairment, and CT grades of nodular profusion and PMF.

Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation.

Reactivation of varicella-zoster virus (VZV) is one of the commonest complications after stem cell transplantation, and often presents with atypical manifestations. We describe two unusual cases of occult disseminated zoster in allogeneic stem cell transplant recipients, presenting as severe abdominal pain and syndrome of inappropriate antidiuretic hormone secretion/hyponatraemia, and accompanied by leukaemia relapse. There was complete clinical recovery with high-dose aciclovir and intravenous immunoglobulin. Prompt treatment of leukaemia relapse also resulted in complete remission. A possible immunological link between concurrent breakdown of immune control of VZV and leukaemia is discussed.

Ultrasonography of intra-abdominal cystic lesions in the newborn.

Intra-abdominal cystic lesions are increasingly recognized in the newborn because of the advent of routine antenatal ultrasonography. As these lesions are often asymptomatic or non-specific in clinical presentation in the newborn, imaging by ultrasonography has an important role in diagnosis. We present a pictorial review of the commonly encountered intra-abdominal cystic lesions in the newborn, with emphasis on ultrasonographic features that can aid differentiation between the various lesions.

Mature teratomas of the adrenal gland: imaging features.

BACKGROUND: We describe the imaging features of three, histologically confirmed, mature teratomas of the adrenal gland not described previously in the radiologic literature and discuss the differential diagnosis of lipomatous tumors of the adrenal gland. METHODS: Computed tomographic (n = 3), magnetic resonance imaging (n = 1), and sonographic (n = 1) features were reviewed retrospectively and the findings correlated with gross pathology and histology. RESULTS: There were two females (age 8 and 18 years) and one male (age 17 years). Tumor size ranged from 5 to 11 cm (mean = 7.3 cm). All tumors were well circumscribed and contained fat components. Calcification was demonstrated in two tumors and was the predominant component in one. Only one was cystic. CONCLUSION: The radiologic features of these tumors were typical of mature teratomas occurring elsewhere in the body. This should be considered in the differential diagnosis of lipomatous tumors of the adrenal gland, especially in children and adolescents.

Portal venous velocity in the follow-up of patients with biliary atresia after Kasai portoenterostomy.

BACKGROUND/PURPOSE: Liver transplantation is the only therapeutic option for biliary atresia (BA) patients with failed Kasai portoenterostomy (PE). The indication for and timing of liver transplantation in these patients are important management issues. The aims of this study are to evaluate the relationship between portal venous velocity (PVV) and clinical and biochemical indicators of liver function in BA, and to examine the role of PVV in the postoperative surveillance of these patients. METHODS: Twenty-nine children (mean age, 8 years 4 months) who had PE for BA underwent Doppler ultrasonography to evaluate PVV. Using regression analysis, these findings were correlated with biochemical indicators of liver function. The Mann-Whitney test was used to detect any significant differences in PVV between the Child-Pugh A group and combined Child-Pugh B and C group patients. RESULTS: The mean +/- SD PVV for the Child-Pugh A group and the combined Child-Pugh B and C group was 17.1 cm/s +/- 8.9 cm/s and 10.2 cm/s +/- 3.3 cm/s, respectively, and this difference was statistically significant (P =.037). CONCLUSIONS: Doppler ultrasonography measurement of PVV provides adjunctive information to the clinical and biochemical assessment of the liver function status in BA. Its use in the postoperative surveillance of these patients is helpful in identifying the need for and in timing of liver transplantation.