Papillary cystic neoplasm of the pancreas in a teenage boy.

We present a case of a 13-year-old boy with a left-sided abdominal mass which proved to be a papillary cystic neoplasm of the pancreas. This low-grade malignant lesion of young patients is very rare, and exceedingly rare in males. The prognosis following resection of this tumor is good. We present the ultrasound and computed tomographic picture of this lesion, as well as the gross and microscopic pathology.

Rhabdomyosarcoma in a child with massive pleural effusion: cytological diagnosis from pleural fluid.

We report on a case of embryonal rhabdomyosarcoma in an 11-yr-old boy investigated for mild chest pain after trauma. Chest radiography showed a massive right pleural effusion. Cytological analysis of the pleural fluid demonstrated the presence of malignant small undifferentiated cells. The rhabdomyoblastic nature of the cells was confirmed by positive immunostains of HHf35 actin, desmin, and skeletal muscle myosin; histological examination of a core biopsy confirmed the diagnosis of rhabdomyosarcoma. Computed tomography and gallium scan revealed the presence of an extensive anterior and lower chest wall mass involving the mediastinum, as well as retroperitoneal lymphadenopathy. Massive pleural effusion is a frequent presentation in malignant disease, but is rare in rhabdomyosarcoma. The immunochemical stain studies performed on cytological smears in this case proved to be very useful for making the definitive and accurate diagnosis. Diagn. Cytopathol. 1999;21:125-128.

Closure of the ductus venosus in premature infants: findings on real-time gray-scale, color-flow Doppler, and duplex Doppler sonography.

OBJECTIVE: Our objective was to use gray-scale, color-flow, and duplex Doppler sonography to study the anatomy, flow pattern, and time of closure of the ductus venosus in healthy premature infants. SUBJECTS AND METHODS: We prospectively examined the ductus venosus in 130 premature infants whom we divided into two groups: Group I comprised 27 neonates of gestational age 28-32 weeks, and group II comprised 103 neonates of gestational age 33-36 weeks. Neonates who had undergone umbilical vessel manipulation were excluded from the study. All examinations included gray-scale, color-flow, and duplex Doppler sonography. Patency, length, color flow, and Doppler characteristics of the ductus venosus were recorded. Neonates were examined 1-2 days after birth, 6-7 days after birth, and subsequently every 3-4 days until ductus closure was observed. The time of closure of the ductus for the two groups was compared using the chi-square test. RESULTS: The ductus venosus was patent during the initial examination in 128 of the 130 neonates. Doppler waveform was venous with little variation in velocity. Ductus length slightly exceeded 1 cm in both groups. We found a statistically significant difference in the percentage of infants having a patent ductus venosus after the initial examination: At 1 week after birth, ductus patency was shown in 85% of the infants in group I and in 56% of the infants in group II; at 2 weeks, the respective percentages were 42% and 14%; and at 3 weeks, 27% and 0%. CONCLUSION: The ductus venosus is patent 1-2 days after birth in virtually all premature infants. From 6 days after birth and onward, a significantly greater percentage of smaller premature infants (i.e., 28-32 weeks' gestational age) have a patent ductus venosus than do larger premature infants (i.e., 33-36 weeks' gestational age).

Contracted gallbladder in hepatitis. Value of postprandial examination.

A completely contracted gallbladder is occasionally seen in patients with acute hepatitis. We have observed that postprandial examination in these patients shows the gallbladder filling with bile to a degree that permits an adequate diagnostic examination. This simple procedure may prevent having to recall the patient for follow-up examination.

Enteropathy-associated T-cell lymphoma: a case report with radiographic and computed tomography appearance.

We report a case of enteropathy-associated T-cell lymphoma (EATL) of the jejunum in a 56-year-old man. The patient suffered for several years from nonspecific abdominal complaints, with no clinical evidence of malabsorption. The patient underwent extensive imaging procedures including barium meal and computed tomography. Computed tomography of the abdomen showed small mesenteric lymph nodes and an area of intestinal wall thickening. Barium meal demonstrated a short jejunal stricture. Histology revealed lymphoma of the jejunum, with microscopic changes distant from the lesion consistent with celiac disease. The spectrum of EATL ranges from patients with frank celiac disease, to patients with only immunohistochemical evidence of celiac disease, who develop small bowel lymphoma.

Posttraumatic intestinal stenosis: radiographic and sonographic appearance.

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We include CT images at the time of trauma, and barium meal and abdominal sonography obtained during the subsequent admission. Examination of the resected bowel loop showed transmural infarct and posttraumatic changes in the adjacent peritoneal fat. This is the first report which includes both imaging at the time of trauma and sonographic appearance of the narrowed bowel loop. Posttraumatic intestinal stenosis should be considered in the differential diagnosis of a narrowed bowel loop in a patient with a history of blunt abdominal trauma.

A prospective study evaluating the usefulness of continuous supplemental oxygen in various endoscopic procedures.

The influence of oxygen supplementation on the prevalence of hypoxemia during endoscopic procedures was studied in 289 patients in a prospective clinical trial. The frequency of oxygen desaturation was found to decrease significantly in patients receiving oxygen via nasal prongs, compared to patients not receiving oxygen supplementation. The effect was demonstrated especially in patients who underwent an additional procedure during their endoscopic examinations. Similar effects were found in patients undergoing gastroscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography. In view of the risks related to hypoxemia and its high prevalence in endoscopic procedures (28-50%) we recommend that a routine oxygen supplementation policy be considered in every patient undergoing endoscopy, especially when additional procedures are to be performed.

Acute focal bacterial nephritis in childhood brucellosis.

Brucellosis is an infectious disease transmitted from various animal hosts to man. In children the most common route of infection is unpasteurized milk or milk products. Brucellosis affects the urinary tract uncommonly, most frequently causing orchioepididymitis. We report the case of a 4-year-old boy with brucellosis who developed acute focal bacterial nephritis (AFBN), documented by sonography, gallium scan, and computed tomography. After appropriate treatment his symptoms and his sonographic abnormality resolved completely. To the best of our knowledge, this is the first report of the association of AFBN and brucellosis.

Study of sympathetic innervation of cranial bones by axonal transport of horseradish peroxidase in the rat: preliminary findings.

This study performed by intraneuronal tracing directly demonstrates the presence of sympathetic postganglionic fibers in the cranial vault of the rat. Superior cervical sympathetic ganglia were injected with horseradish peroxidase (HRP), and after a 48-hour period, to permit anterograde axonal transport, the animals were sacrificed after in situ perfusion. An area of the calvaria that included portions of the frontal and parietal bones was fixed, decalcified and sectioned. HRP-containing axons were localized in the developing frontal and parietal bones of the calvaria. Adrenergic innervation was not demonstrated in sutural tissue (superior sagittal, coronal or metopic) by this technique. To our knowledge, this study is the first to trace sympathetic nerve fibers in the rat calvaria by intra-axonal transport of HRP.

Closure of the ductus venosus in neonates: findings on real-time gray-scale, color-flow Doppler, and duplex Doppler sonography.

OBJECTIVE: Our objective was to document the anatomy, flow pattern, and time of closure of the ductus venosus in healthy full-term neonates. SUBJECTS AND METHODS: We examined the ductus venosus in 73 neonates by using gray-scale sonography, color flow imaging, and duplex Doppler sonography. Each neonate was examined 1-2 days after birth, 6-7 days after birth, and then every 3-4 days until closure was confirmed or the neonate was 18 days old. The length, width, and color flow and duplex Doppler characteristics of the ductus were noted. Closure of the ductus at 6-7 days after birth was examined with respect to birth weight, hemoglobin level, and gestational age. RESULTS: The ductus venosus, extending from the left portal vein to the inferior vena cava, was identified with all three techniques. The ductus was patent in all 73 neonates 1-2 days after birth. It was still patent in 41 (68%) of 60 neonates reexamined 6-7 days after birth and in two of three neonates (11% [7/60]) reexamined 17-18 days after birth. Blood flow within the ductus was cephalic, in a constant venous waveform. Initial flow velocity ranged from 0.15 to 0.70 m/sec and decreased consistently in subsequent examinations. There was no significant difference in birth weight, hemoglobin level, or gestational age between the group whose ductus was closed and the group whose ductus was open at 6-7 days after birth. CONCLUSION: The ductus venosus in neonates is consistently detectable on sonography. It is patent in a greater percentage of neonates, and for a longer time, than was previously shown with conventional radiographic studies with angiography.

[Intrabiliary rupture of hepatic echinococcal cyst].

Echinococcal disease of the liver generally presents as single or multiple hepatic cysts. Rarely, these cysts may rupture into the biliary tree and cause cholangitis, biliary tract obstruction, or biliary colic. These complications are accompanied by high morbidity, and in the case of biliary tract obstruction, mortality rates as high as 50% have been reported. We present a woman with a hepatic echinococcal cyst, biliary colic, and transient jaundice, who proved to have echinococcal involvement of the biliary ducts and gall bladder. Prompt diagnosis of hydatid disease of the biliary tree allows the physician to institute rapid, appropriate medical and surgical treatment.

Fibroblast growth factor: effects on osteogenesis and chondrogenesis in the chick embryo.

In vivo effects of fibroblast growth factor (FGF) on osteogenesis were evaluated in the chick embryo. Autoradiographic studies of 3H-proline labeling over bone matrix indicated that 24 h after treatment on day 11, FGF stimulated osteogenic cell proliferation, while inhibiting the production of bone matrix collagen. However, 4 days after multiple doses of FGF, the large pool of newly formed osteogenic and chondrogenic cells expressed their function with the increased formation of matrix. The data provide in vivo evidence of the effects of exogenous FGF on osteogenesis and also point to a possible role for FGF both in embryonic osteogenesis and in fracture repair.

The early effects of surgical sympathectomy on bone resorption in the rat incisor socket.

Earlier studies have shown that one week after sympathectomy in the rat, both bone apposition and resorption are significantly altered. Resorption in the incisor socket was now examined 1, 3 and 5 days after surgical sympathectomy. Morphometric analyses indicated that the total resorbing surface, active resorbing surface and number of osteoclasts per socket were increased one day after sympathectomy; the area and length of the bone surface of the socket were not significantly altered. Sympathetic denervation thus affects bone resorption within the first few hours after surgery.

Effect of surgical sympathectomy on bone remodeling at rat incisor and molar root sockets.

Sympathectomy was carried out in 4-week-old Sprague-Dawley rats by unilateral surgical removal of the superior cervical ganglion. Sham-treated rats served as controls. All rats were injected with tetracycline hydrochloride at surgery as well as 36 hr prior to sacrifice. Rats were killed at 7, 14, or 21 days following sympathectomy. Mandibular periosteal and endosteal surfaces were analyzed by fluorochrome morphometry. Osteoclasts were identified by acid phosphatase staining, and incisor and molar root sockets were analyzed morphometrically. Following sympathectomy, periosteal and endosteal apposition as well as the rate of mineralization were significantly lower. At the same time, a significant increase in the number of osteoclasts per socket as well as in active and inactive bone resorption surfaces was also seen. All parameters, however, returned to normal values 2-3 weeks after sympathectomy. The data provide the first direct quantitative evidence that sympathetic neurons modulate bone resorption and bone remodeling in vivo.

Effect of beta-amino-propionitrile on the regenerating newt limb evaluated by uptake of 3H-proline and 3H-lysine.

Newt forelimbs were unilaterally amputated and Beta-amino propionitrile (BAPN) was added to the water in which the newts were maintained. Sixty-three days after amputation, animals were injected with either 3H-proline or 3H-lysine. Forelimbs distal to the elbow of both amputated and non-amputated sides were removed 72 hours later. Uptake of 3H-proline and 3H-lysine in whole limbs was assessed by liquid scintillation and in cartilage cells and matrix by autoradiography. Amputation was a potent stimulus to both collagen formation and maturation during regeneration. BAPN reduced the stimulatory effect of amputation on collagen formation but not on its maturation. Collagen synthesis and maturation are independent events and, in intact non-regenerating limbs, BAPN adversely affected collagen maturation while collagen synthesis was unaltered.

Autoradiography of [3H]-proline uptake by fibroblasts of the periodontal ligament and odontoblasts of the rat incisor after guanethidine-induced sympathectomy.

The uptake of [3H]-proline was monitored by quantitative autoradiography at 30, 45 and 90 days of age. Grain counts in sympathectomized rats did not vary significantly from control values at any time. Thus the sympathetic nervous system does not influence the metabolic activity of these cells, which agrees with morphologic evidence that the innervation of the rat incisor may not be autonomic.

Effect of guanethidine-induced sympathectomy on osteoblastic activity in the rat femur evaluated by 3H-proline autoradiography.

Osteoblastic activity in the rat femur was assessed following sympathectomy by injections of guanethidine sulfate from birth to 14 days of age. At ages 30, 45 and 90 days, osteogenesis was monitored by quantitative autoradiography using 3H-proline. Grain counts over periosteal osteoblasts of the femoral diaphysis showed a significant reduction in the uptake of 3H-proline in sympathectomized rats. The results indicate that the sympathetic innervation of bone influences osteoblastic activity and provide support for a role of the autonomic nervous system in the regulation of bone formation.

Histologic evaluation of the sympathectomy induced by guanethidine sulfate in neonatal rats.

Guanethidine sulfate was administered to rats from birth to 14 days of age. Cell counts were carried out in the superior cervical sympathetic ganglion at 30, 45, and 90 days of age. Massive permanent destruction of sympathetic ganglionic cells was demonstrated during the experimental period. Evidence for a natural loss of neurons during the morphogenesis of the superior cervical sympathetic ganglion is presented.