The effect of bacterial infections on ketone concentrations in rat liver and blood and on free fatty acid concentrations in rat blood.

The concentrations of cytoplasmic lactate and pyruvate and the NAD+/NADH ratio and the concentrations of mitochondrial acetoacetate, beta-hydroxybutyrate, and the NAD+/NADH ratio were determined in normal, fed, and fasted rats, and in rats infected with Streptococcus pneumoniae, Francisella tularensis, and Salmonella typhimurium. The various infections were found to have little or no effect on the cytoplasmic parameters. In normal rats, fasting caused a marked increase in blood and hepatic ketone concentration and in serum free fatty acid content. Fasted infected rats, however, did not show the increase in ketone bodies or serum free fatty acids normally associated with fasting alone. The mitochondrial NAD+/NADH ratio increased as the infections progressed, reversing the normal trend. The introduction of an infection during the fasting state when ketone bodies and serum free fatty acids were elevated caused a marked depression in their concentration. These data have led to a postulation of decreased lipolysis in the infected host to account for the lowered hepatic and blood ketone bodies and the decreased level of serum free fatty acids.

Fine needle aspiration cytology in the UK breast screening programme: a national audit of results.

The National Breast Screening Service in the UK depends upon triple assessment, with or without core biopsy, to determine the need for diagnostic biopsy or treatment for screen-detected lesions. To determine the efficacy of cytology in this process a nationwide survey of sensitivity and specificity of the technique was instituted by the National Coordinating Committees for both Radiology and Pathology. Although some units were performing to the national recommended standards, a significant number of units were shown to have problems with a high false negative rate and high inadequate rates from lesions which were eventually diagnosed as cancer. This suggests problems in localizing lesions adequately at aspiration. Generally, indicators of pathology diagnostic performance (e.g. positive predictive values) were good. The figures suggest that some units are not benefiting from an optimal cytological service. Consequently training programmes targeted at aspiration technique may be beneficial.

Long-term amiodarone therapy: a cause of increased hepatic attenuation on CT.

Approximately 40% of the anti-arrhythmic drug, amiodarone, consists of iodine. During long-term therapy both the drug and its major metabolite, desethylamiodarone, are deposited in the liver. CT scans of patients receiving such therapy demonstrated increased hepatic attenuation.

Persistent hypophyseal (craniopharyngeal) canal.

Two cases with a broad persistent hypophyseal canal connecting pituitary fossa and nasopharynx are presented. Both had nasopharyngeal surgery in early childhood and presented later with hypopituitarism. Coronal CT demonstrated the defects with no visible pituitary tissue. The spectrum of basal skull defects is discussed. Children with midline nasal polyps should have CT or MRI of the skull base prior to surgery to prevent inadvertent hypophysectomy.

The appearances on computed tomography after abdominoperineal resection for carcinoma of the rectum: a comparison between the normal appearances and those of recurrence.

Computed tomography is well recognised as a means of showing recurrent tumour in patients who have undergone abdominoperineal resection for carcinoma of the rectum. The appearance of recurrent tumour has to be distinguished from that of normal postoperative fibrous tissue. To define the normal postoperative appearances CT was carried out on 15 patients at various intervals up to 18 months after the operation. All the patients were clinically free of recurrence at the time of the scan and for at least six months afterwards. The appearances were compared with those in 19 patients who had local recurrence at the time of scanning. The normal appearances are outlined, pitfalls in diagnosis are described and points of differentiation between the normal appearance and recurrent tumour are discussed.

The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic.

INTRODUCTION: In the National Institute for Health and Clinical Excellence (NICE) guidance on cancer services published in 2004, it was recommended that specialist clinics should be set up for the assessment of patients with neck lumps, structured in a similar way to one-stop breast lump clinics with a cytopathologist present and preferably ultrasound guidance. The aim of this study was to audit the performance of ultrasound-guided fine needle aspiration (FNA) with on-site cytology in a one-stop neck lump clinic at The Royal Liverpool University Hospital. PATIENTS AND METHODS: Data were collected between November 2008 and May 2009 (7 months). Details of the adequacy rate for the FNA were recorded and whether multiple passes were required. The likely adequacy rate if ultrasound guidance was not available was also calculated. RESULTS: A total of 274 patients were included in the audit. Of these, 227 (83%) patients required a single pass for adequate diagnostic material. Of the remaining, 45 (16%) required two passes and 2 (1%) required three passes. The overall sample inadequacy rate was 11 of 274 (4%). From these results, it could be predicted that, if immediate cytological evaluation was unavailable, the inadequacy rate would have been 41 of 274 (15%). CONCLUSIONS: This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.

References to contemporary papers on acoustics.

In most of the following references, the author's name is followed by the title of the paper or book in boldface, the journal, the volume number in boldface, the issue number in parentheses, the page reference, and lastly, in parentheses, the year. Where reference is made to abstract journals that number their abstracts, the abstract number is given instead of a page reference. Abstracts in Annales des Tèlècommunications are in French and those for Referativnyi Zhurnal, Fizika (three series, E, I, Zh) are in Russian [where, e.g., Ref. Zh. Fiz. 7 E425 (1979) means: July issue, E, abstract no. 425, year 1979.] When possible, the abbreviations for the names of the journals follow those in Bibliographic Guide for Editors & Authors (1974). A number preceded by the letters AD, DE, PB, or N refers to the accession/report number of the Government Reports Announcements & Index. The numbers to the left of the sections and sub-sections in this volume correspond to those that appear in the Classification of Subjects preceding the index in the June 1983 issue of JASA. Compiled from various sources. For many of the journals referred to here, those interested will find their addresses in either the semi-annual Author Index of Physics Abstracts or the annual Physics Briefs: List of Abstracted Periodical and Serial Publications.

Solitary plasmacytoma. II: Solitary plasmacytoma of bone.

The clinical features and the results of treatment of twelve patients with solitary plasmacytoma of bone (SPB) are reported. The median age at presentation was 53 years and there was a predominance of males. Five patients have developed multiple myeloma (MM), for within three years and one after twelve years. Seven patients have not shown evidence of dissemination, and five are alive 1--15 years (median 9 years) after diagnosis. Two patients had metastases to local lymph nodes. There are no reliable criteria by which patients with truly SPB can be prospectively distinguished from those with occult MM, and it is recommended that all patients with apparent SPB should receive "curative" local therapy.

Acute focal bacterial nephritis.

In the kidney, acute focal parenchymal infection without liquefaction can produce a 'mass lesion' that may mimic an abscess or tumour, both clinically and radiologically. Ultrasound and computed tomography can differentiate between these lesions and allow appropriate antibiotic treatment to be used safely, avoiding unnecessary surgical intervention.

The pre-operative assessment of advanced gastric cancer by computed tomography.

Forty-five patients with proven gastric adenocarcinoma underwent pre-operative abdominal computed tomography (CT). The radiological findings of tumour spread were prospectively compared with the surgical findings obtained at laparotomy. CT evidence of involvement of three organs, together with the presence of a large gastric tumour mass, correlated with the inability to resect the tumour in this series.

Hemorrhagic angiomyolipoma of the kidney.

Hemorrhage within a renal angiomyolipoma alters its characteristic appearance. We present a case diagnosed preoperatively with computerized tomography and ultrasound.

Computed tomography in patients with an abdominal mass: effective and efficient? A controlled trial.

In 28 of 53 patients with a palpable abdominal mass computed tomography (CT) was used as the initial imaging technique, and conventional imaging was used in the remaining 25 patients. The diagnosis was established more quickly in the CT group, and the period of inpatient investigation was shorter. The cost of imaging investigations was higher for the CT group, but this difference was small when compared with the difference in cost of inpatient stay. CT seems accurate in the investigation of a palpable abdominal mass and particularly useful in excluding a pathological cause. The need for the latter is emphasised by the fact that no lesion could be found in 23 of the 53 patients.

Value of computed tomography of the abdomen and chest in investigation of Cushing's syndrome.

Computed tomography (CT) scans were performed on 37 patients with biochemically proved Cushing's syndrome to evaluate the role of CT in the investigation of this condition. CT rapidly and correctly identified all 15 adrenocortical tumours, distinguishing five carcinomas from the 10 adenomas. In ACTH-dependent Cushing's syndrome appreciable bilateral adrenal enlargement was common in patients with an ectopic source (6 of 10 cases), while those with a pituitary source usually had normal sized adrenals (9 of 10). Two patients with a history of over seven years had bilateral adrenal nodules. CT was more accurate in locating a primary ectopic source of ACTH (5 of 12 cases) than any other technique and was particularly valuable in detecting small (less than 1.5 cm) peripheral lung carcinoid tumours which may be undetectable by conventional x-ray techniques. Its speed, accuracy, and simplicity make CT the technique of choice both to show the adrenal anatomy and to locate a suspected ectopic ACTH-secreting tumour in patients with proved Cushing's syndrome.

The role of computed tomography in the detection of intrathoracic lymphoma.

Computed tomographic scanning of the chest in 100 patients with newly diagnosed malignant lymphoma detected mediastinal lymphadenopathy (39%) and parenchymal deposits (15%) with a significantly greater sensitivity and specificity than conventional radiological techniques. This principally affected the staging and treatment of patients with limited stage disease. The stage was changed in 10/61 patients (16%) with Stages I-III prior to CT scan and treatment was altered in 11/29 (38%) patients for whom radiation was the treatment of choice. Complete remissions as defined by CT scan have been more durable than those defined by CXR alone.

Can ultrasound and computed tomography replace high-dose urography in patients with impaired renal function?

Ninety-one patients with unexplained impaired renal function were investigated by high-dose urography, ultrasound and computed tomography (CT) without contrast. The aim was to evaluate the role of ultrasound and CT in renal failure, in particular their ability to define renal length and to show collecting system dilatation. In the majority of patients, renal length could be measured accurately by ultrasound. Measurements were less that those at urography because of the absence of magnification. Renal measurement by CT was not a sufficiently accurate indicator of renal length to be of clinical use. Both ultrasound and CT were sensitive detectors of collecting system dilatation: neither technique missed any case diagnosed by urography. However, in the presence of staghorn calculi or multiple cysts, neither ultrasound nor CT could exclude collecting system dilatation. CT was the only technique which demonstrated retroperitoneal nodes or fibrosis causing obstruction. It is proposed that the first investigation when renal function is impaired should be ultrasound, with plain films and renal tomograms to show calculi. CT should be reserved for those patients in whom ultrasound is not diagnostic or in whom ultrasound shows collecting system dilatation but does not demonstrate the cause. Using this scheme, ultrasound, plain radiography and CT would have demonstrated collecting system dilatation and, where appropriate, shown the cause of obstruction in 84 per cent of patients in this series. Only 16 per cent of patients would have required either high-dose urography or retrograde ureterograms.