Utilization of conventional radiography in a regional neonatal intensive care unit in Ireland.

OBJECTIVE: To audit the demand and radiation exposure of conventional radiography in a regional neonatal intensive care unit (NICU) in Ireland. METHODS: A retrospective study of radiographs performed on all admissions to the NICU in University Maternity Hospital Limerick (UMHL) over 2 years. RESULTS: A total of 1405 radiographs were performed on 506 infants. 153.5 radiographs per 1000 live births was the observed demand and 44% of radiographs were done out of hours. 47% of all radiographs were performed on infants <1500 g. Median number of radiographs per infant was one (IQR 1-2; range 1-39). Significant negative correlation was observed between number of radiographs and gestational age. Mean lung radiation doses estimated using published values for normal weight (>2500 g), very low birth weight (VLBW), and extremely low birth weight (ELBW) infants based on the median number of chest X-rays were 31.7 µGym, 84.66 and 232.75 µGy, respectively. CONCLUSIONS: Conventional radiography remains a key diagnostic tool in neonatology particularly in VLBW and ELBW infants and is invaluable in supporting timely clinical decision making. Clinicians should be aware of the cost and potential hazards of neonatal radiography and is recommend that the cumulative radiation exposure among the ELBW and VLBW infants is monitored. Increasing awareness and standardisation of point-of-care ultrasonography could decrease the reliance on conventional radiography in neonatal units.

A colonic duplication cyst causing bowel ischaemia in a 74-year-old lady.

Colonic duplication cysts are rare congenital malformations that predominantly present before the age of 2 years. We report the case of a 74-year-old lady who presented with sudden onset abdominal pain. A computed tomography scan noted a calcified structure adjacent to abnormal loops of bowel. Intraoperative findings revealed an ischaemic loop of small bowel wrapped around a mass in the mesentery adjacent to the sigmoid colon. Final histology revealed a colonic duplication cyst. Colonic duplication cysts are rare entities that most commonly cause obstruction or perforation. We present the very rare case of a colonic duplication cyst causing bowel ischaemia in an elderly female.

Combined adult granulosa cell tumor and mucinous cystadenoma of the ovary: granulosa cell tumor with heterologous mucinous elements.

We describe an unusual ovarian neoplasm in a 57-year-old woman composed of an admixture of mucinous cystadenoma and adult granulosa cell tumor (AGCT). In areas the two components were separate but elsewhere there was intermingling of the two elements. The combination of mucinous cystadenoma and AGCT has only rarely been reported. Theories of histogenesis include a collision tumor and heterologous mucinous differentiation within an AGCT. We favor the latter theory in this case, because in many areas there was an intimate admixture of the two components. Because heterologous mucinous elements are well described in other ovarian sex-cord-stromal neoplasms, especially but not exclusively Sertoli Leydig cell tumors, it is not unexpected that a similar phenomenon could occur in an AGCT. We review the previously reported cases of combined mucinous cystadenoma and granulosa cell tumor of the ovary.

Renal, colonic and retroperitoneal actinomycosis--a case report.

An unusual case of actinomycosis involving the kidney, retroperitoneum and colon is reported. A 41 year old patient with two weeks history of loin pain was found to have a palpable renal mass on clinical examination. Imaging revealed a solid mass arising from the left kidney, invading the retroperitoneum suggestive of an invasive hypernephroma. A nephrectomy, partial resection of psoas and colonic resection with end to end anastomosis was performed. Histopathology revealed renal actinomycosis with involvement of the adjacent colon and retroperitoneum. He recovered well after surgery and was treated with penicillin for one year. Five years have elapsed since presentation without any evidence of clinical recurrence. Abdominal actinomycosis though rare, should be borne in mind while investigating patients presenting with an abdominal mass.