Subcutaneous calcification following chest wall and breast irradiation: a late complication.

Subcutaneous calcification as a complication of chest wall irradiation has only been described once before in the literature. Six patients who developed heavy calcification of soft tissue following chest wall and breast irradiation are described here, and relevant literature is reviewed.

Sonographic diagnosis of portal vein invasion in patients with hepatocellular carcinoma: comparison with arterial portography.

The results of sonographic assessment of the main portal vein were compared with arterial portography in 65 patients with documented hepatocellular carcinoma. When compared with fully-diagnostic angiograms, obtained in 54 patients, sensitivity of ultrasound was 64% with a specificity of 98%. We conclude that ultrasound is a valuable first-line method of detecting portal vein invasion in the preoperative assessment of patients with hepatocellular carcinoma.

The value of computed tomography in the diagnosis and management of bronchiectasis.

In order to evaluate the usefulness of computed tomography (CT) in the diagnosis and management, as distinct from only the diagnosis, of bronchiectasis, we retrospectively reviewed the clinical, lung function, and radiological data of 38 patients suspected of having the disease. All had chest radiographs, CT scans, and bronchograms. The approach was to examine the radiological investigations with the clinical data in three stages: I, chest radiograph; II, CT; III, bronchography (BG), as if they were newly presenting cases. At the end of each stage, a decision was made either to proceed to the next stage or to stop because further investigation was considered unlikely to alter management. Apparent normality, equivocal abnormality, or unilateral abnormality were criteria for proceeding. Unfitness for surgery, unequivocal bilateral disease, or mild disease were criteria for stopping after a firm diagnosis had been made. We stopped at stage I in four patients (11%) because the chest radiograph showed bilateral bronchiectasis and two had poor lung function. We stopped at stage II in 15 patients (39%): 12 had bilateral disease on CT; three had unilateral disease on CT but their clinical features were so mild that BG was considered unjustified. Scrutiny of the CT and BG films of those patients who were judged not to require CT or BG in the retrospective review confirmed that these would not have altered their management. Of the remaining 19 patients who proceeded to stage III, BG was useful in 15 (39%) by confirming or refuting CT findings, but was not useful in four (11%) because of underfilling. We conclude that optimal use of chest radiographs and CT in patients suspected of having bronchiectasis can significantly reduce the necessity of performing BG.

Massive hydrothorax in continuous ambulatory peritoneal dialysis: diagnosis, management and review of the literature.

Recurrent massive hydrothorax is an uncommon but serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). Accurate confirmative diagnostic procedures of the pleuroperitoneal communication is lacking and the management remains difficult. We reported three patients who developed massive hydrothorax at different periods after commencement of CAPD treatment (1.5-9 months). These patients underwent different investigatory procedures for demonstrating the pleuroperitoneal communication. We conclude that both technetium 99m-tagged macroaggregated albumin intraperitoneal radionuclide scan and stereoisomeric analysis of lactate in the peritoneal and pleural fluid are safe and reliable procedures to demonstrate the pleuroperitoneal communication. The massive hydrothorax was successfully treated in two patients by pleurodesis induced by intrapleural administration of oxytetracycline combined with 10-days small volume intermittent peritoneal dialysis. The clinical findings of 18 other cases previously reported in the literature are also reviewed.

The painful swollen sterno-clavicular joint.

Thirteen patients with isolated pain and swelling of a sterno-clavicular clavicular joint have been reviewed. Three groups were identified. Group 1 comprised four patients, all of whom had a short history of less than six weeks and suffered a pyarthrosis or malignant disease; group 2, four patients who were shown to have features of condensing osteitis of the clavicle (Cone et al, 1983); and group 3, five patients, had degenerative arthritis of a sterno-clavicular joint. The only difference between groups 2 and 3 were that patients in group 3 had a rather longer history, both articular surfaces were involved and showed a possible increase in the incidence of degenerative joint disease elsewhere. It is suggested that condensing osteitis is but a part of a spectrum of degenerative disease of the sterno-clavicular joints, akin to discogenic vertebral body sclerosis (McCarthy & Dorfman, 1982).