Selective route of doxorubicin administration improves outcome in experimental malignant epidural cord compression.

Epidural spinal cord compression was produced in adult Fischer rats by injection of 10(6) viable cells of malignant fibrous histiocytoma anterior to the T-13 vertebral body. Using a tracer dye, it was demonstrated that a portion of the inoculum was always present in the anterior epidural space at the time of inoculation. Paraplegia and incontinence occurred consistently on Days 14 to 27 (median, 23 +/- 3.0). By sequential computed tomographic scans, the growth of the paravertebral tumor was documented and its volume was calculated. A single dose of cisplatin (i.p., 6 mg/kg) or doxorubicin (DXR, i.v. jugular, 6 mg/kg) was administered on Day 1. On Day 18, tumor volume was significantly reduced by DXR (P less than 0.001) and cisplatin (P less than 0.01), but paraplegia continued to occur as in the untreated rats. Comparison of treatment outcome with DXR administered via the jugular vs. the tail vein revealed that both were equally effective in retarding the growth of the paravertebral tumor, and both caused a similar transient leukopenia. However, only the tail DXR brought about a significant delay in the onset of paraplegia (P less than 0.004) and significantly increased the survival (P less than 0.001). It is suggested that the lack of efficacy of systemic chemotherapy for tumors located in the epidural space is probably related to inadequate drug exposure. The improved outcome with tail DXR infusion may be explained by the regional spinal venous perfusion, which allows an increase in the local drug concentration during its first passage through the epidural venous plexus.

Traumatic closed iliac bone biopsy defect simulating involvement by Hodgkin's disease.

A case is presented in which post biopsy changes in the iliac bone following traumatic closed biopsy resembled Hodgkin's disease radiographically and with computed tomography.

The diagnostic value of computed tomography in temporomandibular joint synovial chondromatosis.

Synovial chondromatosis of the temporomandibular joint was diagnosed and location of dens particles was assessed by means of computed tomography. Based upon the data collected, the joint was operated conservatively and most of the calcifications were removed leaving the patient symptom free. The importance of an accurate preoperative diagnosis of synovial chondromatosis by use of CT scan is stressed in view of numerous unnecessary condylectomies and parotidectomies reported in the literature.

Abdominal wall lipoma--CT and MRI appearance.

Although soft tissue lipomata are common tumours, a large lipoma arising from the deep layers of the abdominal wall would appear to be excessively rare and the site of origin may be difficult to determine. The CT and MRI appearances of such a tumour are described.

Computed tomography of unilateral hematometrocolpos.

A 14-year-old girl presented with urinary retention and a pelvic mass. Computed tomography revealed a uterus didelphys with a unilateral right moderate hematometra and a large hematocolpos.

Clinical efficacy of screening the entire abdomen during real-time ultrasound examination.

Unsuspected abnormalities are occasionally detected during real-time ultrasound examinations. To determine the frequency of these findings during standard, routine real-time abdominal survey, the records of 500 consecutive examinations were reviewed. We found that a significant number of important occult abnormalities were detected. The influence of the abdominal survey on clinical management and improved radiologic consultation is discussed.

CT appearance of giant colonic diverticulum.

The plain film, barium enema, and CT findings in a case of giant colonic diverticulum with the atypical feature of marginal calcifications are presented. The value of CT in the diagnosis and evaluation of giant colonic diverticulum is discussed.

Late-appearing diaphragmatic hernia following resolution of right pleural effusion.

A case of late-appearing congenital diaphragmatic hernia in a premature infant with previously normal chest X-ray is reported. Pleural effusion accumulation and resolution preceded herniation of the liver to the right hemithorax and development of respiratory symptoms. Chest X-ray, ultrasound and computed tomography of the chest were useful in establishing the correct diagnosis. Pleural effusion without obvious cause should alert the paediatrician to the possibility of this rare condition.

The changing sonographic appearance of fetal kidneys during pregnancy.

One hundred consecutive women between 11 and 40 weeks of gestation were studied to evaluate the changing appearances of the fetal kidneys. In the first trimester, the kidney was never positively identified. Between 15 and 26 weeks it was seen but was difficult to distinguish from surrounding tissue. In the early third trimester, either an echogenic border or increased echogenicity of the renal sinus was observed; in the late third trimester this increased echogenicity was observed in both areas. It is thought that the echogenicity is the result of fat deposition in the pararenal space and in the renal sinus.

Sonographic evaluation of fetal adrenal glands.

Seventy-five consecutive pregnant patients at 15--40 weeks of gestation underwent sonography, with special attention to identification of the fetal adrenal gland. The gland was found in 12% of fetuses of less than 26 weeks gestation and 90% of fetuses of more than 26 weeks. The gland characteristically has two long limbs that are relatively anechoic (thought to be the fetal zone of the cortex) and a central echogenic line in each limb (presumed medulla). The changes seen in the adrenal gland as pregnancy progresses are reviewed and correlated with the adrenal glands in newborn infants.

Neglected radiologic signs of the glucagonoma syndrome.

A case of glucagonoma where repeated gastrointestinal examinations revealed excessive mucosal fold thickening of the duodenum and small bowel with a markedly delayed transit time is reported. These findings in the appropriate clinical setting led us to persevere with further investigations despite equivocal ultrasound and CT examinations. We wish to emphasize the importance of the classical gastrointestinal findings in the diagnosis of the glucagonoma syndrome.

The ultrasound spectrum of emphysematous cholecystitis.

This report presents a gamut of ultrasound signs that may be seen in emphysematous cholecystitis. These can be summarized as follows: Intraluminal gas: (a) A dense band of hyper-reflective echoes with distal reverberations when gallbladder is full of gas. (b) A band of reverberations in the gas-filled portion of the gallbladder with the usual signs of cholecystitis in the bile-filled portion when the gallbladder is partially full of gas. Intramural gas: (c) An area of high reflectivity in the gallbladder wall with reverberations that may change position with change in position of patient. (d) A bright hyper-reflective ring emanating from the whole circumference of the gallbladder.