Dominantly inherited ureteropelvic junction obstruction.

We report on siblings from two families with unilateral ureteropelvic junction obstruction. HLA studies were undertaken and found to be a useful marker between affected members. We believe that incomplete penetrance with variable expression is the most probable mode of transmission of this disorder.

Comparison of colonoscopy and the contrast enema in five hundred patients with colorectal disease.

Endoscopic examination of the entire colon (colonoscopy) is an important new method of diagnosis and treatment of diseases of the colon and rectum, particularly cancer. The records of 500 patients who had one or more contrast enemas and subsequent colonoscopy were analyzed in an attempt to evaluate the competitive and complementary features of the two methods. The endoscopists had the advantage of having a radiologic report or radiographs available to them. In general, when the level of abnormality could be reached, colonoscopy had a higher degree of accuracy, particularly since observation could be combined with biopsy. This was particularly true in the case of polyps in which colonoscopy confirmed 166 radiologically described growths plus an additional 118 lesion, twenty-one of which were over 1 cm in diameter. By endoscopic excision of these polyps via the colonoscope, malignant changes can be identified, a conclusion rarely reached by radiographic means alone. With respect to cancer, exclusive of polyps, only twenty-four of thirty-two cases were diagnosed by x-ray study alone. Another nine, interpreted aa demonstrating malignancy from the radiographs, had cancer excluded when subjected to endoscopic confirmation. Colonoscopy has also proved valuable in identifying lesions of the cecum, notoriously a problem for the radiologist, and in identifying milder degrees of inflammatory change which are undetectable by radiographic means. Colonoscopy and the contrast enema are best reported as completmentary rather than competitive approaches, and by their combined use, diagnostic accuracy is greatly enhanced.

Hydatidiform mole with a live fetus.

The incidence of a live fetus associated with a hydatidiform mole is extremely rare.(1) While hydatidiform mole without a fetus in the United States has a reported incidence of 1 in 2000 pregnancies, the incidence of hydatidiform mole with a coexisting fetus varies from 1:10,000 to 1:100,000 pregnancies.(2)

Acute osteomyelitis of the pubic bone following pelvic surgery.

Primary osteomyelitis of the pubic bone has not been recorded previously. The authors present a case of this unusual entity.

Anencephaly: agent orange implications?

A case of anencephaly is presented and the question of its association with Dioxin ("agent orange") is raised.

Intra-arterial knotted catheter.

Although cerebral arteriography is commonly employed as a diagnostic radiologic procedure its use is not entirely innocuous. Beside the usual complications of an invasive technique the retention of a knotted distal flexible catheter tip may be encountered. This report presents a case in which this occurred with subsequent extraction by way of incision of the femoral artery.

Bacteroides fragilis pelvic abscess: resolution with metronidazole therapy alone.

An 81-year-old woman had Bacteroides fragilis sepsis with a sonographically demonstrated, multiply echogenic collection in the pelvis. She failed to respond to clindamycin therapy. The patient and her family refused surgical intervention. On intravenous metronidazole alone, the patient's fever decreased, she improved, and the pelvic collection disappeared in a period of between six and 30 weeks.

Unusual leiomyoblastoma of the stomach.

Only about 250 cases of benign gastric leiomyoblastoma of the stomach have been reported. Most occur in the smooth muscle of the antrum, and may be intramural, intraluminal, or exogastric in position. A pedunculated gastric leiomyoblastoma occurs less frequently, and those containing radiographically identifiable calcifications are extremely rare.

Combined use of percutaneous transhepatic cholangiography (P.T.C.) and endoscopic ampullary cholangiography in the diagnosis of "difficult" jaundice cases.

When bilirubin levels are elevated, visualization of the biliary ducts is only possible by endoscopic transampullary cholangiography or by P.T.C. Cannulation of the biliary tree is difficult under the best of circumstances and when obstruction exists at the caudal end of the ducts, success is frequently precluded. P.T.C. then becomes the modality of choice, since visualization can be achieved in 98% of cases when obstruction exists. These methods are complementary. Each should be used when the other fails. Their dual application and complementary role in "difficult" jaundice cases is elaborated upon in the 16 cases reported in this current series. Their combined use should help elicit the diagnosis in almost all cases of jaundice.