The role of radiology in the management of systemic sclerosis.

Systemic sclerosis is a multisystem connective tissue disorder. Radiology plays an integral part in its management, guiding the clinician concerning the onset and severity of visceral involvement. After skin involvement, the gastrointestinal tract is the most commonly affected system; contrast radiography and magnetic resonance imaging (MRI) play a role in diagnosis. Non-specific interstitial pneumonia is the most frequent respiratory disease and high-resolution computed tomography (CT) is the cornerstone of management. In common with other rheumatic disorders, the role of cardiac MRI is expanding. Radiography remains the main technique in the investigation of skeletal involvement, although MRI is useful as a problem-solving tool. Neurological involvement is increasingly recognized and the major role of radiology is the exclusion of coexistent pathology. We present a thorough review of the role of radiology in the management of systemic sclerosis.

Case report: soft tissue and perivisceral calcification occurring in an infant: a case of brown fat necrosis.

Fat necrosis is a well described cause of widespread subcutaneous calcification occurring in a young infant. In this condition the radiographic demonstration of soft tissue calcification is often dramatic but is clinically irrelevant since the diagnosis is usually evident without recourse to radiology. Visceral fat necrosis and calcification, in the absence of hypercalcaemia, have been reported occasionally in association with subcutaneous fat necrosis. We report a case with calcification largely confined to deep perivisceral sites without clinical signs of subcutaneous fat necrosis.

The radiology and terminology of cryptogenic organizing pneumonia.

The clinical features, radiographic and computed tomographic findings of nine patients with histological proof of cryptogenic organizing pneumonia were analysed. Patients present with cough, dyspnoea and malaise and commonly have bilateral multifocal consolidation on chest radiography, which may show resolution or relapse with or without steroid treatment. A good response to steroids is the rule, usually with complete radiological resolution or minimal residual scarring. The relative merits of the terms cryptogenic organizing pneumonia and bronchiolitis obliterans organizing pneumonia, both currently used to describe this entity, are discussed.

CT monitoring of therapy for meconium ileus.

Meconium ileus equivalent is a common complication of cystic fibrosis in the postneonatal period. Because of the added risks of surgery in these patients, conservative management is preferred. We describe here a method of monitoring the conservative treatment of this condition using CT and suggest that its application will reduce the need for potentially dangerous surgical intervention.

Opioid-mediated inhibition of oxytocin during insulin-induced hypoglycemic stimulation of vasopressin in man.

We have investigated the importance of endogenous opioids in the differential control of neurohypophysial peptide secretion. The effect of the opioid antagonist naloxone on the vasopressin and oxytocin responses to insulin-induced hypoglycemia was studied in 14 male subjects. Either saline (N = 8) or naloxone (4 mg bolus + 6 mg/h, N = 6) was infused iv during the study. After 60 min infusion soluble insulin 0.15 U/kg was injected. Naloxone infusion for 60 min did not alter basal plasma AVP or OT levels. Insulin-induced hypoglycemia led to a significant rise in plasma AVP in both saline and naloxone-infused subjects (P less than 0.05), which was maximal 45 min after insulin. There was no significant difference in the plasma AVP response to hypoglycemia between the 2 groups. Saline-infused subjects did not show any change in plasma OT in response to hypoglycemia whilst during concurrent naloxone infusion there was a significant rise in OT from 1.9 +/- 0.4 pmol/l before insulin to 3.2 +/- 1.3 pmol/l at 45 min (P less than 0.05). We conclude that there is opioid-mediated inhibition of OT which prevents its release when AVP is secreted in response to insulin-induced hypoglycemia.