Value of lymphangiography in the staging of Hodgkin lymphoma.

PURPOSE: To evaluate the usefulness of lymphangiography in the staging of Hodgkin disease. MATERIALS AND METHODS: The authors retrospectively evaluated the lymphangiograms of 39 previously untreated patients with Hodgkin disease (clinical stage, 1-2A). The patients had no evidence of bulky mediastinal nodal disease, and results of abdominal and pelvic computed tomographic examination were negative for parenchymal organ disease and retroperitoneal and mesenteric node involvement. The studies were officially interpreted as normal or abnormal. No attempt was made to differentiate benign reactive changes from tumor infiltration. All patients underwent confirmatory staging laparotomy. RESULTS: Of the 39 patients, 29 had normal lymphangiograms. All 29 had normal lymph nodes at laparotomy. Of the 10 patients with abnormal lymphangiograms, only two had malignant infiltration of lymph nodes at laparotomy. The other eight showed benign reactive hyperplasia. CONCLUSION: Lymphangiography has no place in the management of Hodgkin lymphoma.

Gastric stump lymphoma.

Lymphoma occurring in the post-operative stomach would appear to be very rare with only five previously recorded cases. In three of these, focal lymphoid hyperplasia or pseudolymphoma had been found at the time of the original ulcer surgery, or at subsequent biopsies of the gastric stump or anastomotic sites. These latter three cases developed lymphoma within 11 years of the ulcer surgery as against the 20 years or longer generally found in cases of gastric stump carcinoma. Two cases presenting with gastric stump lymphoma approximately 20 years after Billroth 2 partial gastrectomy are reported. In neither of these two cases, nor in the other two patients previously recorded with post-operative gastric lymphoma 20 or more years following gastric surgery, was luminal focal lymphoid hyperplasia reported at the time of the original gastric surgery. It is postulated that these two small groups may have developed lymphoma due to differing malignant stimuli.

The clinical utility of transrectal ultrasound and digital rectal examination in the diagnosis of prostate cancer.

The development of high definition transrectal ultrasound probes has led to an increased interest in the ability of transrectal ultrasound of the prostate (TRUS) to assist in the diagnosis and management of prostate cancer. The present study was designed to examine the correlation of TRUS with digital rectal examination (DRE). The study group comprised 471 patients in whom the results of (a) DRE, (b) TRUS, and (c) histology of tissue obtained by transrectal biopsy of the prostate (TB), were all available. In those patients where both TRUS and DRE were negative, but prostate specific antigen (PSA) was greater than 10 micrograms ml-1, six random biopsies were performed. In all other cases the biopsies were TRUS directed to the suspicious lesion. There were 142 cases in whom both DRE and TRUS were negative or only mildly suspicious of malignancy. TB in these cases was positive for cancer in 17 cases (12%). In a further 126 cases, TRUS was positive for cancer, while DRE demonstrated no suspicious nodule. TB was positive in only 17 of these cases (13.5%). Similarly, in the 31 cases in which DRE was positive but TRUS was negative, TB was positive in only three cases (10%). In the 172 cases in whom both DRE and TRUS were positive, 99 biopsies were positive (57.5%). It was concluded from this study that DRE remains the most valuable single examination in the diagnosis of prostate cancer. TRUS increases the sensitivity of DRE if both are positive. When there is a discrepancy between the two examinations, the biopsy yield is low. When both are positive, a high cancer yield is obtained, TRUS having added value in directing the biopsy needle to the suspicious site. TRUS is thus a valuable adjunct to DRE in the diagnosis of prostate cancer.

Case report: asymptomatic aneurysmal intrahepatic porto-hepatic venous shunt--diagnosis by ultrasound.

Intrahepatic porto-hepatic venous shunts are rare entities with less than 20 cases reported in the literature. Many are associated with liver cirrhosis, but some appear to be of developmental origin. The rarest type of such a shunt is one via a portal vein aneurysm. A case is reported where the diagnosis was made by colour duplex ultrasound. No further investigation or treatment was deemed necessary. The ability to make such a diagnosis without the many invasive procedures hitherto employed indicates the value of this modality in the investigation of vascular anomalies.

Environmental assessment of avermectins by the US Food and Drug Administration.

The Center of Veterinary Medicine (CVM) of the Food and Drug Administration (FDA) is required under the National Environmental Policy Act (NEPA) to include in its decision making, an objective consideration of the potential environmental impacts associated with each contemplated action. As part of the application process for new animal drugs, detailed data must be submitted in order to develop a prediction of the environmental fate and effects of the drug and/or its active metabolites. Ivermectin (22,23-dihydroavermectin B1) is a highly active antiparasitic animal drug utilized in a variety of injectable, oral and topical formulations. Residues of this drug may reach the environment through manufacturing and animal wastes and may potentially have effects on terrestrial and aquatic organisms. A comprehensive data base has been submitted to the FDA in support of the environmental assessments for ivermectin drug products. Detailed information has been submitted on the physical and chemical properties, introduction, fate and effects of the ivermectins in the environment. These data indicate that ivermectin binds tightly to soil and is subject to photodegradation and biotransformation to less active compounds. In contrast, ivermectin is highly toxic to certain aquatic organisms but would not be expected to partition into the aquatic environment. Much lower toxicity has been demonstrated toward bacteria, fungi, earthworms, plants and birds. CVM evaluated ivermectin products based on the use pattern of the product, the metabolism pattern in target animals, calculations of potential ivermectin residue concentrations in the environment and data on persistence, soil sorption and acute toxicity in aquatic and terrestrial environments.

Ossicles anterior to the proximal tibia.

Ossicles anterior to the anterior tibia are most usually seen in relation to the tibial tuberosity. While these are usually taken to represent sequelae of previous Osgood-Schlatter disease, they may, on occasion, represent normal variants in ossification of the tuberosity. Ossicles superior to the tuberosity may have similar origins. Representative examples are presented, as is a very large ossicle separated from the anterior tibia by a prolongation of the knee joint space. Theories of causation of such ossicles are discussed.

The ultrasound appearances of intramural bowel gas: the bright ring appearance and the effervescent bowel. A report of three cases.

Bowel necrosis is a serious condition with a very high mortality rate. The earlier the diagnosis is made, the better chance for survival. Ultrasound is a primary imaging technique in the diagnosis of the acute abdomen. Three cases are presented in which bowel wall gas could be demonstrated on ultrasound. In all cases there was computed tomographic and either operative or post-mortem correlation. In each case there was a "bright ring" appearance of the affected bowel when the ultrasound examination was carried out in transverse section. In one case, small bubbles were seen arising from the deep surface of the bowel.

On the antiquity of the seronegative spondyloarthropathies: evidence from ancient Judea.

A fused pelvis and two specimens of fused vertebrae were found in an ossuary at Ein Gedi, Israel; they date from approximately 2000 years ago. Examination of these bony specimens visually and by computed tomography demonstrated features of the seronegative spondyloarthropathies.

Breast metastases to bones of the extremities: simultaneous involvement of all four limbs.

Metastases to bones of the hands and feet are unusual, and simultaneous metastases to the bones of more than one extremity in a given patient is an extremely rare occurrence with only five previous case reports. In each of these cases the bones of two extremities were affected. A case is presented where the bones of both hands and both feet exhibited bone metastases. A second case with foot bone metastases is recorded. In both cases the primary tumour was a breast carcinoma. Theories of causation of such metastases are discussed.

The infracalcaneal os peroneum.

There is some confusion in the literature regarding the nature of the os peroneum. It has been claimed to be either a supranumerary os or a sesamoid in the tendon of the peroneus longus muscle. Its position in the foot is also a subject of dispute. Most authors state that it is related to the cuboid bone, and it has in the past been termed the 'cuboidum secundarius.' Occasionally an ossicle is seen inferior to the distal calcaneus distal to the calcaneocuboid articulation. This may represent a developmental anomaly of position of the os peroneum or be the sequel of a rupture of the peroneus longus muscle.

The active abduction view: a new maneuvre in the diagnosis of rotator cuff tears.

The plain film views of the shoulder in the case of a fresh rotator cuff tear are usually normal. Reduction of the space between the under surface of the acromion process of the scapula and the humeral head occurs only in late, neglected cases. A new projection is described, the active abduction view of the shoulder, where in many patients with a complete rotator cuff tear the humeral head is closely apposed to the acromion, obliterating the subacromial space. In such a situation, the medial portion of the torn rotator cuff retracts during active abduction, allowing approximation of the two bones.

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.

Lymphatic opacification in the prosthetic hip.

A retrospective analysis of 52 patients with hip pain following total hip replacement was made. Each of them was evaluated by plain radiographs, technetium 99m pyrophosphate scans, arthrography with plain film subtraction technique, and culture of joint fluid. In 30 cases there was evidence of prosthetic loosening, and in 21 of these lymphatic opacification during arthrography was seen. In 15 cases with lymphatic opacification the diagnosis of prosthetic loosening was subsequently confirmed by prosthetic revision. In none of the 22 cases in which no evidence of prosthetic loosening was seen was there lymphatic opacification. It is concluded that lymphatic opacification during arthrography for pain following total hip prosthesis is a valuable ancillary sign of loosening.

The psoas sign in normal subjects without bowel preparation: the influence of scoliosis on visualisation.

The lumbar spine films of 1494 subjects who were examined for low back pain or prior to job placement were studied to assess psoas muscle visualisation. The study group were almost all aged 18-39 years. None of the subjects had prior bowel preparation for a contrast examination. In the subjects without scoliosis only 36% had well seen psoas shadows on both sides. Taking the psoas shadows separately, 72% of left psoas shadows were well seen, while only 40% were seen on the right side. In the scoliotic group, the psoas shadow was seen bilaterally in 30% of subjects while in another 50% the muscle was seen only on the convex side of the curve. In no case was it seen only on the concave side. The direction of the curve to left or right did not influence visualisation. Thus in 80% of subjects with scoliosis of 5 degrees or more, the psoas was seen on the convex side, while in only 30% was it seen on the concave side.

Survival after ultrasonographic demonstration of portal venous gas due to mesenteric artery occlusion.

Portal vein gas as a result of bowel necrosis following occlusion of the superior mesenteric artery has an extremely grave prognosis. Only two previous cases have been recorded as having survived. In both those cases the diagnosis of portal vein gas was made on an abdominal radiograph. The present report is of the first such case surviving after ultrasonic demonstration of portal gas. In this case, no evidence of portal gas was seen on the abdominal radiograph. The increased sensitivity of ultrasound over plain radiography mandates urgent liver and portal ultrasound in all cases of suspected mesenteric event.

DNA restriction patterns and DNA-DNA solution hybridization studies of Frankia isolates from Myrica pennsylvanica (bayberry).

Sixteen Frankia strains were isolated from Myrica pennsylvanica (bayberry) root nodules collected at diverse sites in New Jersey. Restriction pattern analysis of total genomic DNA was used to group the isolates into gel groups, and the genetic relatedness among the isolates was evaluated by DNA-DNA solution hybridization studies. Restriction pattern analysis provided a distinctive reproducible fingerprint for each isolate. Isolates fell into nine separate groups (strain types). More than one strain type was isolated from most sites. Isolates from two different gel groups were found in 3 of 10 nodules examined. Of the 16 isolates, 10 contained extrachromosomal DNA. Six different extrachromosomal DNA banding patterns were found. Genomically similar isolates carried related, but different, banding patterns. DNA hybridization studies indicated that isolates from a single plant species can be minimally related as determined by total genome homology. Homology ranged from 12 to 99%. Highly divergent strains were isolated from the same plant and found to cohabit the same nodule. Thus, this study demonstrated that Frankia strains which infect the same host plant are not only phenotypically different but also genetically diverse.

Physiological, chemical, morphological, and plant infectivity characteristics of Frankia isolates from Myrica pennsylvanica: correlation to DNA restriction patterns.

The filter exclusion method was used to isolate Frankia strains from Myrica pennsylvanica (bayberry) root nodules collected at diverse sites in New Jersey. A total of 16 isolates from five locations were cultured. The isolates were characterized by morphological, chemical, physiological, and plant infectivity criteria and compared with genomic DNA restriction pattern data, which were used to assign the isolates into gel groups (see accompanying paper). The isolates from M. pennsylvanica evaluated in this study were characteristic of Frankia physiological group B strains and were indistinguishable on the basis of whole-cell wall chemistry and diaminopimelic acid isomer analysis. Distinct differences in the spectrum of utilized organic acids and carbohydrates were observed among the isolates and were the only phenotypic criteria by which the isolates could be separated and assigned into separate groups. In general, isolates within a restriction pattern gel group had identical utilization patterns, whereas intragroup isolates had different utilization patterns. Correlation of these phenotypic characteristics with the results of molecular analysis revealed an exclusive carbohydrate and organic acid utilization pattern for each gel group as established by restriction pattern analysis.

Small bowel phytobezoars: detection with radiography.

The authors reviewed the radiographic findings in 19 patients with phytobezoars of the small bowel. The most common predisposing causes were previous gastric outlet surgery and persimmon ingestion. Twelve patients underwent contrast material-enhanced studies of the upper gastrointestinal tract, and one patient underwent a barium enema study. These examinations revealed four gastric, two duodenal, and eight small bowel phytobezoars in 10 patients. The obstruction caused by small bowel phytobezoars frequently occurred in the jejunum or proximal ileum, more proximally than has been reported in previous series. Barium studies are useful in differentiating obstruction due to postoperative adhesions from obstruction caused by bezoars. In addition, barium studies enable the detection of residual gastric bezoars. This information has important implications in patient treatment because bezoar obstruction is unlikely to respond to conservative treatment, and concurrent gastric bezoars must be removed to prevent recurrent bowel obstruction.