Pseudoaneurysm of the supracoeliac aorta following blunt trauma in a 83-year-old woman.

We report on the case of an 83-year-old hemiplegic female patient presenting with post-traumatic pseudoaneurysm of the supracoeliac aorta, treated with 38 mm x 100 mm Talent Endoluminal Stent-Graft (Medtronic Inc., Santa Rosa, CA) using local anaesthesia. The patient was discharged on day 3 and the 8 month follow-up was without complications.

Effect of fresh frozen plasma and gammaglobulin on humoral immunity in neonatal sepsis.

Fresh frozen plasma and intravenous immunoglobulin are used as prophylaxis against, and for the treatment of, neonatal infection. It is assumed that any beneficial effect is mediated through the humoral immune factors contained in each preparation. The effect of fresh frozen plasma and intravenous immunoglobulin on humoral immune markers (immunoglobulins and IgG subclasses, complement components and activation products, and C reactive protein) was investigated over a 24 hour period after their randomised administration to 67 infants with suspected infection. Thirty infants without suspicion of infection were studied as controls. Compared with control infants, infants with suspected infection had increased concentrations of C reactive protein, reduced concentrations of fibronectin, and increased concentrations of the complement activation marker C3d, but similar concentrations of IgG, IgG subclasses, IgA, and IgM. After intravenous immunoglobulin treatment (500 mg/kg) concentrations of total IgG and all IgG subclasses increased, as did IgA and complement component C4. Concentrations of C reactive protein decreased after intravenous immunoglobulin treatment and were significantly lower than baseline after 24 hours. In contrast, no change in IgG or IgG subclass concentrations occurred after fresh frozen plasma administration. At 24 hours after fresh frozen plasma administration, concentrations of IgA, IgM, and C4 were significantly higher than baseline and serum IgA was significantly higher than in infants tested 24 hours after intravenous immunoglobulin treatment. These results confirm the rational basis for intravenous immunoglobulin treatment but question the value of fresh frozen plasma, particularly in the light of its attendant problems as an untreated blood product.

Hepatic alveolar echinococcosis: MRI findings.

The purpose of this study was to describe the magnetic resonance imaging (MRI) appearance of hepatic alveolar echinococcosis (HAE) on T(1)-weighted, T(2)-weighted and postgadolinium images. A total of 13 lesions were demonstrated in 13 patients. All patients underwent MR examination at 1 T imager. MR examinations included precontrast T(1)-weighted breathing averaged spin echo (SE), breath-hold spoiled gradient echo, T(2)-weighted TSE sequences with and without fat suppression, and T(1)-weighted breath-hold spoiled gradient echo (SGE) sequence following i.v. after gadolinium administration. All lesions were confirmed with histopathology. HAE hepatic lesions revealed geographic patterns of variable signal intensities on noncontrast T(1)- and T(2)-weighted images. Slightly hyperintense, iso- and hypointense signal on T(1)-weighted images corresponded to calcified regions, which appeared hypo-isointense signal on T(2)-weighted images. Necrotic areas were hypointense signal on T(1)-weighted and hyperintense signal on T(2)-weighted images. On postgadolinium images, lesions did not reveal enhancement. Dilatation of intrahepatic bile ducts distal to HAE abscesses were observed in five patients and portal vein invasion or compression was observed in four patients, lobar atrophy of the liver was coexistent finding in cases with portal vein compression. The MRI appearance of HAE abscesses included large irregularly marginated masses with heterogenous signal on T(1)- and T(2)-weighted images and lack of enhancement with gadolinium.

Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization.

This article presents a review of the literature regarding the use of transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). There have been two different approaches to the treatment: (a) percutaneous tumor ablation methods which can be divided into injectable and thermal methods; percutaneous ethanol injection (PEI) is the most widely used method, and (b) TACE. PEI is the treatment of choice for single HCCs smaller or equal to 3 cm in size. For patients with large HCCs combined TACE and PEI is probably the most effective nonsurgical treatment. In the presence of multiple HCC nodules, TACE remains the treatment of choice.

Interventional radiology in inflammatory pancreatic disease.

This article presents a review of the interventional radiological procedures in inflammatory pancreatic diseases including imaging guided biopsy, percutaneous aspiration and drainage, and transcatheter embolization of ruptured pseudoaneurysms.

Balloon dilatation of iatrogenic urethral strictures.

Balloon dilatation of the urethra was performed in five patients with iatrogenic urethral strictures. The urethral strictures were successfully negotiated and dilated in all patients. Redilatation became necessary in a period ranging from 3 to 10 months. The authors believe that balloon dilatation of the urethra can be safely and successfully performed; the procedure produces minimal trauma and immediate relief of symptoms.

Preoperative CT staging of colon carcinoma (excluding the recto-sigmoid region).

Twenty-eight patients with colon carcinoma (excluding the recto-sigmoid region) underwent preoperative staging with computed tomography (CT). The CT had a sensitivity and a specificity of 60 and 67% for detection of extramural invasion, 75% sensitivity and specificity for lymph node metastases and a sensitivity of 87% and specificity of 95% for liver metastases. Compared with the modified Dukes classification, CT correctly staged 50% of the patients with Dukes A lesions; 40% with Dukes B; 75% with Dukes C and 85% with Dukes D lesions. The data presented in this study showed that CT has limitations in the sensitivity and accuracy of staging local colonic carcinoma. However, we recommend its use for patients who are clinically suspected of having extensive disease.

Neonatal outcome following early onset preterm premature rupture of the membranes--a case controlled study.

A case-controlled study was performed to determine whether preterm premature rupture of the membranes (PPROM), particularly if occurring in the second trimester, increased the duration of ventilatory support or hospital admission. Infants born after membrane rupture of at least 24 hours duration and prior to 37 weeks of gestation were identified. It was possible to match for gestational age and birthweight 40 PPROM infants, 15 of whom had onset of rupture of the membranes (ROM) prior to 27 weeks of gestation, with a control (an infant whose mother had not suffered PPROM). A greater proportion of the mothers of the PPROM infants had received antenatal steroids (p<0.01), had an antepartum hemorrhage (p=0.06) or delivered vaginally (p<0.02). More PPROM infants had pulmonary hypoplasia (p<0.03) or infection (p<0.01). Overall, however, and if only those matched pairs where membrane rupture had occurred prior to 27 weeks of gestation were considered, there were no statistically significant differences in the duration of ventilatory support or hospital admission. Step-wise regression analysis confirmed that in the study population overall and in the matched pairs where membrane rupture had occurred at less than 27 weeks of gestation, neither the duration of ventilation nor hospital admission significantly related to PPROM. These findings have implications when counselling parents.

Systemic lupus erythematosus presenting with generalized lymphadenopathy: a case report.

Systemic lupus erythematosus (SLE) is an immune complex disease with many different clinical presentations. Here we report a 13-year-old female patient presenting with generalized lymphadenopathy, who meanwhile developed butterflly rash and pericarditis. The diagnosis of SLE was based on the clinical features, positive antinuclear antibody, and positive antibodies to dsDNA. The patient had an active disease and developed renal involvement, despite steroid therapy. The patient's clinical presentation, course and response to therapy are detailed, and the literature on lupus lymphadenitis is reviewed.

Endovascular therapy in the management of moderate and massive haemoptysis.

The aim of this study was to retrospectively evaluate 140 patients with severe (97 massive, 43 moderate) haemoptysis treated by bronchial artery embolisation. Between January 1997 and April 2005, 140 patients (120 males and 20 females, aged 23-71 years) with severe haemoptysis considered surgically inoperable because of limited pulmonary reserve were treated by embolisation. The cause of haemoptysis was tuberculosis in 136 patients and malignancy in four. Embolisation succeeded in controlling haemoptysis immediately after the intervention in 138 patients (98.5%) and at 1 month in 126 patients (90%). Severe haemoptysis recurred in 11 patients with prior massive haemoptysis and 3 patients with prior moderate haemoptysis in a mean time of 3.7 months (1-7 months) after the last intervention. The bleeding source was detected during angiography and embolised in 12 of these patients. Two patients with malignant tumour died because of abundant bleeding, following an asymptomatic period of 30 days. There were no procedure-related major complications. Bronchial artery embolisation is a safe and effective palliative treatment alternative in moderate and massive haemoptysis.

Bladder tumors: virtual MR cystoscopy.

Virtual cystoscopy is a promising new technique based on computer-simulated rendering of the inner surface of the urinary bladder using volumetric magnetic resonance (MR) imaging data, thus enabling maneuvers that normally are not possible with conventional cystoscopy. Due to several distinct advantages over conventional cystoscopy such as minimal invasiveness, evaluation of the urethral orifice from a cranial point of view and an opportunity to observe diverticula formations and the inner urethral space, gadolinium-enhanced MR cystoscopy has a great potential for competing with conventional cystoscopy under some clinical circumstances. The recent improvement in MR scanners has significantly facilitated virtual cystoscopic evaluation of the urinary bladder lumen by MR imaging. Volumetric data associated with powerful postprocessing procedures allow imaging of the inner urinary bladder surface with excellent detail. In this article, imaging techniques and clinical applications of gadolinium-enhanced virtual MR cystoscopy are presented.

Successful medical treatment of abdominal aortic aneurysms in a patient with Behcet's disease: imaging findings.

Arterial manifestations of Behcet's disease consist of aneurysm formation, stenosis and occlusion. Aneurysms in Behcet's disease most commonly involve the pulmonary arteries and have been shown to resolve with medical treatment. However, this regression pattern with medical therapy has not been reported for aortic aneurysms to date. We present a 43-year-old man with bilateral abdominal aortic aneurysms resulting from Behcet's disease resolving with medical therapy.

Granulomatous mastitis: gray-scale and color Doppler sonographic findings.

PURPOSE: We examined the roles of gray-scale and color Doppler sonography in the diagnosis of granulomatous mastitis. METHODS: We retrospectively studied the clinical, mammographic, and sonographic findings in 10 women 24-57 years old (mean age, 35.9+/-13.9 years) who had a histopathologic diagnosis of granulomatous mastitis. All patients underwent gray-scale sonographic examination, and 8 patients were further examined with color Doppler imaging. Seven patients had previously undergone mammography. RESULTS: Mammographic findings were nonspecific in all 7 patients. Gray-scale sonographic findings were compatible with mastitis in 6 (60%) of 10 patients. Doppler examination showed increased arterial and venous vascularization within and around the lesion in 5 of 8 patients, but the spectral analysis findings were not specific for granulomatous mastitis. CONCLUSIONS: Neither mammography nor Doppler sonography plays a significant role in the differential diagnosis of granulomatous mastitis versus fibroadenoma or carcinoma. Gray-scale sonography shows findings specific for granulomatous mastitis in some cases, but all cases require histopathologic confirmation for final diagnosis.

Chest sonography. Differentiation of pulmonary consolidation from pleural disease.

Ultrasonography was used to evaluate 53 patients with equivocal juxta-diaphragmatic and/or lateral densities in chest radiographs. An air bronchogram, fluid bronchogram, and scattered echogenic foci due to residual air in the consolidated lung parenchyma were used as US criteria of pulmonary parenchymal consolidation. One or more of these signs were observed in 39 patients with a clinical or bacteriologic diagnosis of pneumonia. The US air bronchogram was seen in 32 of the 39 patients (82%), the fluid bronchogram in 37 patients (94%) and the scattered echogenic foci in 30 (77%). In 14 patients, pleural effusion was diagnosed sonographically and verified by aspiration of fluid. The final diagnoses in these cases were pulmonary tuberculosis in 11 patients, staphylococcal empyema in 2, and tuberculous empyema in one patient. It is concluded that US criteria provide a useful differentiation of pulmonary parenchymal consolidation from pleural effusion.

Palliative treatment of hepatocellular carcinoma by chemoembolization.

PURPOSE: The efficacy of transcatheter arterial chemoembolization (TACE) and the correlation between iodized oil uptake pattern and tumor response were investigated in cases with inoperable hepatocellular carcinoma (HCC). MATERIAL AND METHODS: TACE, using sequential intra-arterial doxorubicin, mitomycin, iodized oil and gelatin sponge particles, was used to treat patients with inoperable HCC localized to the liver. One hundred and two patients (aged 16-80) were treated in this manner from 1995 to 2001. The objective response was determined by sequential CT. Iodized oil uptake pattern as well as the relationship between uptake pattern and tumor response was evaluated in each case. RESULTS: The one-year survival rate was 46%. Tumor response was found to be better in cases with dense and peripheral iodized oil uptake in comparison to those displaying scarce and patchy iodized oil uptake. CONCLUSION: TACE is an efficient and safe palliative treatment for inoperable HCC with prolonged survival and good life quality. Iodized oil uptake pattern can be considered a good prognostic marker.

Palliative treatment of inoperable malignant esophageal strictures with conically shaped covered self-expanding stents.

PURPOSE: To investigate the effectiveness of conically shaped covered self-expanding (Flamingo) stents in palliative treatment of malignant esophagogastric strictures in terms of patency, improved dysphagia score and survival. MATERIAL AND METHODS: Flamingo stents were placed under fluoroscopic guidance between August 1998 and December 1999 for palliation of malignant dysphagia in 33 cases. There were 21 males and 12 females aged 40--80 years (average 64.2 years). RESULTS: Stent placement was successful in all patients, with good symptomatic control and no procedure-related complications. Spontaneous esophago-respiratory fistula and perforation accompanying malignant esophageal stricture in a total of 4 cases (12.2%) were successfully closed. In 1 case, tumor ingrowth was detected from the distal uncovered segment of the stent. In 2 cases with esophago-respiratory fistula, gastrointestinal bleeding occurred. The cause of hemorrhage could not be found by angiography. The mean survival time in 17 patients, later deceased, was 129 days (range 9--360), and the mean observation time in 16 patients still alive is 180 days (range 18--365). CONCLUSION: Flamingo stents provide an effective and safe choice of palliative therapy in inoperable malignant esophagogastric strictures.

Hydatid disease with unusual localization.

Hydatid disease (HD) may develop in almost any part of the body. The liver is the most frequently involved organ (75%), followed by the lung (15%) and the remainder of the body (10%). Hydatid cysts with unusual localizations may cause serious problems in the differential diagnosis. In this article the various imaging findings of hydatid cysts with unusual localizations are reviewed, based on our experience. Findings in brain, heart, pericard, kidney, intraperitoneum, retroperitoneum, bone, soft tissue, and breast are discussed. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations, especially when they occur in areas where the disease is endemic. The combination of clinical history, imaging findings, and serologic test results usually help the diagnosis.

Thrombocytopenia: an important indicator for the application of partial exchange transfusion in polycythemic newborn infants?

BACKGROUND: The conventional therapeutic approach in polycythemic newborn infants is to apply partial exchange transfusion (PET) when hematocrit value exceeds 70% or when the infant develops symptoms with the exception of plethora. METHODS: In order to investigate the possibility of using platelet count as a simple criterion implying the PET requirement, we retrospectively reviewed polycythemic newborn infants with respect to the relationship between thrombocytopenia and severity of symptoms, and the association of platelet count and the PET performance. Thrombocytopenia has been defined as a platelet count < 150,000/microL. RESULTS: We studied 18 polycythemic infants with thrombocytopenia (group 1, 35%) and 34 without it (group 2, 65%). Perinatal asphyxia, gestational toxemia and intrauterine growth retardation, which are the three common causative factors leading to polycythemia, were not significantly different in the two groups. No correlation existed between platelet counts and hematocrit values within each group, but there was a very significant difference between the two groups in terms of severity of clinical findings (P < 0001); no difference in terms of moderate findings and moderately significant difference with respect to mild symptoms and asymptomatic situation (P < 0.05). Partial exchange transfusion was performed in all patients in group 1, while only 12 infants in group 2 (32%) received transfusion and the difference was statistically significant (P < 0.05). A significant rise in platelet counts has been achieved only in group 1, while hematocrit values decreased significantly in both groups following PET. CONCLUSIONS: This study emphasizes the relationship between thrombocytopenia and the severity of clinical findings and PET performance rate in polycythaemic newborn infants, implying that thrombocytopenia is a possible marker of hyperviscosity, the results of which warrant further investigation.

Imaging of extrapulmonary tuberculosis.

Diagnosis of extrapulmonary tuberculosis is often difficult. Although positive chest radiographic findings or a positive tuberculin skin test supports the diagnosis, negative results do not exclude extrapulmonary tuberculosis. However, recognition and understanding of the radiologic findings of extrapulmonary tuberculosis can help in diagnosis. The spine is the most common site of skeletal involvement. The femur, tibia, and small bones of the hands and feet are most commonly involved by tuberculous osteomyelitis. Tuberculosis of the joints is characteristically monoarticular; the knee and hip are most frequently affected. Central nervous system tuberculosis takes various forms, including meningitis, tuberculoma, abscess, cerebritis, and miliary tuberculosis. Ileocecal involvement is seen in 80%-90% of patients with abdominal tuberculosis. The most common manifestation of abdominal tuberculosis is lymphadenopathy. Genitourinary tuberculosis is the most common manifestation of extrapulmonary tuberculosis. Lymphatic tuberculosis is more common among children, with cervical or supraclavicular nodes most frequently involved. Tuberculosis of the breast is extremely rare and occurs most often in young, multiparous, lactating women. The radiologic features of extrapulmonary tuberculosis mimic those of many diseases. A high level of suspicion is required, especially in high-risk populations. A positive culture or histologic analysis of biopsy specimens is still required in many patients for definitive diagnosis.