Pulmonary embolism. Is the clinical history a useful adjunct to aid the interpretation of the equivocal lung scan?

Pulmonary embolism is commonly fatal, yet notoriously difficult to detect. Diagnosis often relies on the ventilation-perfusion radionuclide scan, which itself is frequently equivocal. It has been suggested that if the equivocal ventilation-perfusion scan is interpreted in the light of clinical information, diagnostic accuracy can be improved. However, which features in the history should be considered? In this study of 197 patients undergoing ventilation-perfusion scanning, the clinical data of the 98 patients with either high-probability or normal scans were compared to the scan findings. The presence of a deep vein thrombosis was significantly associated with a high probability scan, whereas the presence of constant chest pain was significantly associated with a negative scan. Classical symptoms for pulmonary embolism, namely pleuritic chest pain and hemoptysis, were poor predictors of high-probability scans. Consequently, the authors advise considerable caution when using the clinical data to aid the interpretation of the equivocal lung scan in the individual case.

Case report: the effect of contrast density on computed tomographic arterial portography.

Artifacts associated with computed tomographic arterial tomography (CTAP) are well documented. We report a patient undergoing CTAP in whom laminar flow artifact occurred using Iopamidol 370 mg ml-1 but not when using Iopamidol 300 mg ml-1 under identical conditions. The denser Iopamidol 370 mg ml-1 mixed inadequately with unopacified blood in the portal vein. This was not a problem with the less dense Iopamidol 300 mg ml-1 which is likely to be a more reliable contrast agent for CTAP.

Enteroclysis--the influence of tube design.

The performance of three 10F enteroclysis tubes with different tip designs (E. Merck Ltd) was assessed using double-contrast, gravity infusion enteroclysis, with methylcellulose solution as negative contrast. Intubation times, screening times, patient tolerability and examination quality were compared. The results show that a streamlined tip design facilitated passage through the nose. None of the tubes provided consistently reliable results due to inadequate flow rates. The Corsafe tube transmits a higher flow rate of methylcellulose and produced satisfactory examinations more frequently. Mechanically assisted infusion of methylcellulose is recommended when using 10F enteroclysis tubes.

Case report: life-threatening hypercalcaemia secondary to pancreatic tumour secreting parathyroid hormone-related protein--successful control by hepatic arterial embolization.

Parathyroid hormone-related protein elaborated by pancreatic neuro-endocrine tumours can cause life-threatening hypercalcaemia. This is the first reported case where hypercalcaemia caused by such a tumour has been successfully controlled by hepatic arterial embolization.