Gastrointestinal stromal tumour presenting acutely as gastroduodenal intussusception.

INTRODUCTION: Gastrointestinal stromal tumours (GISTs) are uncommon tumours of the gastrointestinal (GI) tract. We report a case of a gastric GIST that presented acutely as a gastroduodenal intussusception. CASE PRESENTATION: A 59-year-old woman presented with a week's history of vomiting anything she swallowed. Physical examination revealed a mildly tender abdomen without guarding or rebound tenderness. An epigastric mass was, however, palpated. Abdominal ultrasonography suggested an intussusception. At laparotomy, a tumour on the anterior wall of the stomach causing intussusception of the stomach into the duodenum was found. After reducing the intussusception, a wedge resection of the tumour was performed, which proved to be a GIST. DISCUSSION: GISTs represent a rare group of neoplasms of the GI tract. Gastric intussusception is a rarely documented condition. Symptoms range from intermittent epigastric pain to sudden onsets of severe pain with vomiting and shock. Pre-operative diagnosis can be difficult and diagnosis cannot be confirmed until surgery. The treatment of choice for localised gastric GIST is surgical resection. CONCLUSION: Although gastroduodenal intussusception, particularly secondary to a GIST, is uncommon, clinicians need to have a high index of suspicion in acutely vomiting patients, especially if they have experienced similar symptoms intermittently in the immediate past.

Evaluation of gastro-pulmonary aspiration by a radioactive technique: concise communication.

Seven selected patients were given 3-5 mCi of Tc-99m sulfur colloid orally at bedtime and the lungs were imaged in the morning. Two showed definite evidence of aspiration and one suggestive evidence. This is a simple, non-invasive method of demonstrating pulmonary aspiration of gastric contents.

Changes in the pulse wave form with flow through vessels with repetitive saccular dilatations and stenosis.

Several patients with fibroplasia of the renal arteries without significant stenosis were found to have surgically reversible renal hypertension. The hypothesis is advanced that receptors in the kidney may respond to altered wave form by causing an increase in blood pressure. Various models of normal and pathological renal arteries were made and tested in a pulse duplicator. A discrete harmonic analysis was made of input and output waves. The results indicate that nodular, non-stenotic models significantly alter the systolic rise in perfusion pressures to the kidney. Therefore, irregularity of vessel lumen without stenosis may be sufficient to alter organ function.

Effects of iopamidol and iohexol in rat lungs following experimental aspiration.

Experimental aspiration of water soluble contrast agents was performed on rats via transoral endotracheal injection. Iopamidol, iohexol and diatrizoate were the contrast agents tested. One group of rats received normal saline as a control. Adjusted lung weights were measured at 2 and 24 hours post aspiration. Radiographs were taken at 2 and 24 hours post aspiration and scored for abnormal pulmonary air space density. Diatrizoate alone demonstrated an increase in adjusted lung weights. Diatrizoate, iopamidol and iohexol showed abnormal pulmonary air space disease on radiographs at 2 hours but not at 24 hours. Histopathologic examination of rat lungs following aspiration of all three contrasts showed pulmonary vascular congestion and perivascular edema. Iopamidol showed evidence of acute cellular inflammation. Iohexol provoked a pulmonary alveolar macrophage response.

Reverse ventilation--perfusion mismatch.

Patients having lobar airway obstruction or consolidation usually have decreases of both ventilation and perfusion on lung scans. We report three patients in whom hypoxic vasoconstriction was apparently incomplete, resulting in a "reversed" ventilation-perfusion mismatch. Perfusion of the hypoxic lobe on the radionuclide scan was associated with metabolic alkalosis, pulmonary venous and pulmonary arterial hypertension in these patients.

Correlation of radiographic measurements and pulmonary function tests in chronic obstructive pulmonary disease.

Measurements on standard frontal and lateral radiographs that reliably predict the presence or absence of chronic obstructive lung disease would be useful to the clinical radiologist when no other clinical data are available. Therefore, statistical correlations of pulmonary function tests and measurements of chest films were made in 104 men chosen from 1000 cases referred for pulmonary function tests in whom no obvious abnormality was present on the chest film. Two measurements were significantly correlated (p less than 0.001) without requiring correction for body surface area: (1) The height of the arc of the right diaphragm in the lateral projection. When 2.6 cm or less it identifies 67.7% of all patients with abnormal pulmonary function tests and 78.3% of patients with moderately or severely abnormal pulmonary function tests. (2) The height of the right lung in the posteroanterior projection. When this is 29.9 cm or more it will identify 69.8% of all patients with abnormal pulmonary function tests and 79.7% of patients with moderately to severely abnormal pulmonary function tests. These simple measurements will assist the radiologist to judge from standard chest radiographs whether a patient may or may not have chronic obstructive lung disease.