Progression of imaging in pancreatitis panniculitis polyarthritis (PPP) syndrome.

Lobular panniculitis, together with a polyarthritis may complicate pancreatic disease. Abdominal symptoms are frequently absent and mis-diagnosis of the joint-skin complex can lead to inappropriate treatment in a condition with an already high mortality. We report a case of the pancreatitis panniculitis polyarthritis (PPP) syndrome, complicated by metastatic fat necrosis, with bone marrow involvement and characteristic magnetic resonance imaging (MRI) and describe the clinical characteristics, therapy and outcome of patients affected by the syndrome.

Routine thin slice MRI effectively demonstrates the lumbar pars interarticularis.

AIM: To confirm that routine thin slice sagittal magnetic resonance imaging (MRI) of the lumbar spine effectively demonstrates the lumbar pars interarticularis. METHOD: A retrospective review of 100 MRI examinations was carried out and the appearance of the pars interarticularis at L4 and L5 bilaterally was assessed and classified as Type 1 - normal, Type 2 - sclerotic pars, Type 3 - not assessable and Type 4 - pars defect. A total of 400 pars were assessed. Those with known or obvious lytic spondylolysis were excluded from the study. All MRI examinations had both sagittal T1- and T2- weighted sequences and both were assessed. Sagittal T1 sequences were carried out with a 3 mm slice thickness and T2 image sequences with a 4 mm slice thickness. RESULTS: The total number of pars assessed as normal (Type 1) was 299 (75%) of the T1-weighted images; 80 (20%) were classified Type 2. On T2-weighted imaging 290 (72.5%) were Type 1 and 66 (16.5%) were Type 2. Both of these types of appearances correlate well with the finding of a normal pars interarticularis. Thus, 379 (95%) of the pars appeared normal on T1-weighting and 356 (89%) on T2-weighting. CONCLUSION: Contrary to previous findings with 5 mm thick slices, routine thin slice sagittal T1 and T2 images effectively demonstrate the pars interarticularis, with acceptable data acquisition times and image quality. We believe this is mainly due to the thinner slices obtained in our series.

Lymphoma of the prostate treated with radiotherapy.

Primary prostatic lymphoma is a rare disease. We report a 73-year-old man who initially presented with features of bladder outflow obstruction. Histology revealed non-Hodgkin's lymphoma. He was treated with radical radiotherapy with complete regression of disease. Although the follow-up period is, as yet, relatively short, the apparently good result in this patient supports the view of other recent reports that the outcome in this situation depends on the features of the individual disease rather than it being universally poor as had been previously suggested.

Small bowel enema in non-responsive coeliac disease.

A small bowel enema was performed in patients with non-responsive coeliac disease, in coeliac patients on a normal diet (untreated) and those who had shown a good response to a gluten free diet, and in control subjects to determine whether there were any specific radiological features of the non-responsive state. A significant reduction in the average number of jejunal folds and an increase in the number of ileal folds (reversal of the jejunoileal fold pattern) was found in eight of nine non-responsive coeliac patients, one of seven untreated coeliac patients, and in none of the good responders or control subjects. This pattern identifies coeliac patients with a poor response to a gluten free diet who are likely to suffer major complications.

Postpartum pleural effusion.

A prospective ultrasound study investigated the reportedly high frequency of asymptomatic pleural effusions in the early postpartum period. The pleural space of 50 women within 1-45 h of delivery was scanned with a real-time sector scanner. Only one woman had a pleural effusion. This patient had severe pre-eclampsia with clinically apparent pulmonary oedema. Our findings do not substantiate the previously reported high frequency of pleural fluid in healthy women immediately after delivery.

Gall-bladder and colonic opacification following parenteral ioxaglate.

Of 50 successive in-patients with normal blood urea levels who received ioxaglate (Hexabrix 320; May & Baker Ltd), 60% showed gall-bladder opacification 12-25 h later. None of these patients had been asked to fast after receiving the ioxaglate. This has not been reported previously with any of the presently available urographic media, either conventional or the new low-osmolality agents. This should be regarded as a normal occurrence and does not imply impairment of renal function.