An unusual case of desmoid tumour presenting as haemorrhagic shock.

We report the case of a 22-year-old patient who presented to the emergency department with epigastric pain and vomiting. Haematological studies showed a rapid decrease in haemoglobin levels from 13.6 g/dl to 4.9 g/dl. Abdominal ultrasonography revealed the presence of fluid around the spleen and the patient was immediately referred for surgery. An intra-abdominal desmoid tumour presenting as a hemorrhagic shock has not previously been described. Given the relatively benign course of the disease and the young age at presentation, this clinical entity should not be overlooked as it has the potential to invade vessels and therefore be fatal.

[Use of C-arm CT for improving the hit rate for selective blood sampling from adrenal veins]. / Einsatz der C-Arm-CT zur Verbesserung der Trefferquote bei selektiver Nebennierenvenen-Blutentnahme.

Primary hyperaldosteronism is the most common curable cause of hypertension with a prevalence of up to 12% among patients with hypertension. Selective blood sampling from adrenal veins is considered the diagnostic gold standard. However, it is underutilized due to the high technical failure rate. The use of C-arm CT during the sampling procedure can reduce or even eliminate this failure rate. If adrenal vein sampling is augmented by native C-arm CT to check for the correct catheter position, the technical success rate increases substantially. General use of this technique will result in correct diagnosis and treatment for patients with primary hyperaldosteronism.

New nonsurgical therapies in the treatment of hepatocellular carcinoma.

The last decade has seen a rapid increase in the incidence of hepatocellular carcinoma in the United States, mostly because of the increased incidence of hepatitis C. Surgical therapy remains limited to the few patients who are surgical candidates at presentation. In addition, surgery has been plagued by high recurrence rates, which can reach 80% at 3 years. Systemic chemotherapy has been found to be ineffective, with response rates approaching 10% to 20%. Nonsurgical percutaneous therapies, including percutaneous locoregional ablative procedures (ethanol or acetic acid injection, radiofrequency ablation, microwave coagulation therapy, chemotherapy infusion, laser photocoagulation, and high-intensity ultrasound) and intra-arterial procedures (radioembolization with yttrium-90 microspheres or transcatheter intra-arterial chemoembolization) are gaining popularity because they are less invasive than surgery and can be nearly as effective in prolonging survival. Multiple studies have shown good response rates with high technical success rates, as well as significant survival advantages for nonresectable disease. Furthermore, they can be performed repeatedly without compromising liver function and at a considerably lower morbidity and cost than surgery.

MR imaging of the human brain at 1.5 T: regional variations in transverse relaxation rates in the cerebral cortex.

BACKGROUND AND PURPOSE: Heterogeneity in cortical signal intensity on T2-weighted MR images has been recently documented. Using a whole-brain, multiecho MR imaging technique, we sought to determine the T2 relaxation times of nine predefined regions in the cerebral cortex and one region in the deep gray matter. METHODS: Ten adult volunteers (nine men and one woman; age range, 18-40 y; average age, 30.8 y) underwent whole-brain imaging with an oblique coronal multiecho 3D Carr-Purcell-Meiboom-Gill MR sequence at 1000/25, 50, 75, 100, 125, and 150 (TR/TE). T2 measurements were obtained, with variably sized regions of interest, from the primary auditory cortex, primary visual cortex, caudate nucleus, superior frontal gyrus, inferior temporal gyrus, middle temporal gyrus, superior temporal gyrus, insula cortex, cingulate gyrus, and hippocampus. Repeated-measures analysis of variance was used to assess the existence of differences in T2 measurements among the anatomic locations. RESULTS: On the basis of T2 measurements, the gray matter structures examined could be divided into four statistically different groups. In ascending order of T2 measurements, the first group consisted of the primary auditory cortex and primary visual cortex; the second group, the caudate nucleus, superior frontal gyrus, inferior temporal gyrus, middle temporal gyrus, and superior temporal gyrus; the third group, the insula cortex; and the fourth group, the cingulate gyrus and hippocampus. CONCLUSION: Significant variation in T2 values among the cortical gray matter of the human brain exists.

Differences of renal parenchymal attenuation for acutely obstructed and unobstructed kidneys on unenhanced helical CT: a useful secondary sign?

OBJECTIVE: The purpose of this study was to ascertain whether the difference in attenuation frequently noted on unenhanced helical CT scans between a patient's acutely obstructed kidney and the unobstructed kidney is a reliable secondary sign of acute renal obstruction. CONCLUSION: In 95% of patients with acute renal obstruction, the affected kidney was less dense than the unobstructed kidney. When visually detected by radiologists using CT, this difference in density was at least two standard deviations above normal, making it a reliable secondary sign for acute obstruction.

X-linked adrenoleukodystrophy: the role of contrast-enhanced MR imaging in predicting disease progression.

BACKGROUND AND PURPOSE: Early assignment of disease progression among patients with X-linked adrenoleukodystrophy (ALD) is critical for the appropriate selection of effective therapy. We evaluated the association between contrast enhancement on T1-weighted spin-echo MR images and disease progression. METHODS: Clinical charts of patients with X-linked ALD were reviewed for age, availability of MR images of the brain, severity of neurologic impairment, and duration and number of follow-up evaluations. Forty-three male patients with X-linked ALD had undergone multiple MR imaging examinations of the brain that consisted of at least sagittal and axial T1-weighted spin-echo, axial double-echo spin-echo, and contrast-enhanced axial T1-weighted spin-echo imaging. The MR images were reviewed for the presence of contrast enhancement. In addition, global disease burden, as shown by the double-echo spin-echo images, was assessed using a visual scoring method (Loes score). RESULTS: Enhancement was seen on the initial T1-weighted spin-echo MR images of 21 (49%) patients; 18 (86%) of the 21 patients had disease progression revealed by the follow-up evaluations based on MR imaging (Loes) and neurologic scores. No enhancement was seen on the initial T1-weighted spin-echo MR images of 22 (51%) patients; for 18 (82%) of the 22 patients, no evidence of disease progression was revealed by the follow-up evaluations. CONCLUSION: There is a very strong association between the presence of contrast enhancement on T1-weighted MR images and X-linked ALD progression based on clinical evaluation and MR imaging.

Tectal gliomas: natural history of an indolent lesion in pediatric patients.

The mesencephalic tectal glioma is a distinctive form of brain stem glioma with an unusually benign clinical course. Periaqueductal location, lack of contrast enhancement, and long periods of stability are classic features. The clinical management of these lesions, especially at the time of radiographic enlargement varies widely in the published literature. It is unclear whether these progressive lesions need to be treated. Accordingly, clinical and radiologic features of 7 patients were reviewed, with attention to the clinical course of the disease after radiologic enlargement. The age at diagnosis ranged from 3.3 to 16.6 years. Six of 7 had MRI tumor enlargement beginning 0.3-5.7 years after initial diagnosis. One of these 6 patients had radiographic progression coupled with a new clinical symptom which was treated with stereotactic radiation therapy. The remaining 5 patients with MRI progression and normal neurological exams were not treated and remain free of new neurologic deficits 1.8-6.9 years after the first radiographic tumor enlargement. The results suggest that pediatric tectal gliomas are a very low-grade lesion. Conservative management in the absence of new clinical symptoms could be argued, reserving radiotherapy or chemotherapy for clinical progression.

Automation of dihydroxyaluminum sodium carbonate analysis in antacid tablets by energy dispersive X-ray fluorescence.

A sensitive, specific, automated energy dispersive X-ray fluorescence (EDXRF) method for determination of anhydrous dihydroxyaluminum sodium carbonate in antacid tablets has been developed. The compound was quantitated by impact grinding, pelletizing at 10 tons pressure, and monitoring the aluminum by using a rhodium anode X-ray tube, high resolution thermoelectrically cooled Si(Li) detector with sample spinning, and computer data processing. The assay procedure was validated with spiked laboratory-prepared samples at 100 +/- 20% levels. The average recovery was 100.6% with a relative standard deviation of 1.6% (n = 14). Instrument precision was determined and found to have an average relative standard deviation of 1.0% (n = 16). In addition, analysis precision by the EDXRF method was compared to that for titration and autoanalyzer methodologies and found to be statistically comparable. The sample precision had an averaged relative standard deviation of 2.7% (n = 16) by X-ray methodology. The advantages of this EDXRF method include increased sample throughout with excellent precision and accuracy, no solvent usage, and automated data handling.

Deoxycytidylate deaminase in the diagnosis of acute myocardial infarction.

The diagnostic value of deoxycytidylate deaminase (dCMP) in the diagnosis of acute myocardial infarction (AMI) was examined in 31 healthy controls and 32 patients with proven AMI. Its specificity in normal controls was 93.5%. Its highest levels were measured on the 3rd to 5th post-infarct day, when its sensitivity reached 97.5%. Its diagnostic performance was similar to that of SGOT, total LDH1/LDH2 ratio greater than 1, total CPK and CPK-MB. Its peak levels showed a highly significant correlation (p less than 0.001) with those of the above enzymes. The measurement of dCMP may be a valuable complement in the diagnosis of AMI since this enzyme is not affected by lung infarction or hemolysis. Moreover, since it expresses tissue regeneration rather than destruction it may aid in the assessment of various interventions designed for the promotion of myocardial healing process.

Alcuronium and intraocular pressure.

The effects of alcuronium on intraocular pressure (IOP) was studied in 20 patients undergoing elective ophthalmic surgery. IOP was measured with the Schiötz indentation tonometer before induction, after induction, and after tracheal intubation. Combined administration of a standardized sleep dose of thiopental (5 mg/kg) and alcuronium (0.25-0.30 mg/kg) significantly (P less than 0.001) decreased IOP from control values of 15.3 +/- 2.33 mm Hg (mean +/- SD) to 8.91 +/- 2.15 mm Hg. Intubation of the trachea significantly (P less than 0.001) increased IOP to 12.58 +/- 3.05 mm Hg, a level still significantly (P less than 0.001) lower than control values.