Gastritis, duodenitis, and bleeding duodenal ulcer following mefenamic acid therapy.

A 46-year-old woman developed hematemesis and melena two weeks after starting mefenamic acid therapy for osteoarthritis of the spine. Esophagogastroduodenoscopy, arteriography, and a laparotomy revealed antral gastritis, duodenitis, and an acute bleeding ulcer in the third portion of the duodenum. Although mefenamic acid has many of the pharmacologic and physicochemical properties of aspirin and produces gastrointestinal ulceration in animals when administered in large doses, the English literature reveals only one case of gastric ulceration and a single instance of upper-gastrointestinal tract hemorrhage associated with its use. This case warns that mefenamic acid may cause serious gastric and duodenal inflammation and ulceration more commonly than is presently suspected.

Risk assessment of pulmonary embolism by multivariate analysis.

A prospective study of 6,527 hospitalized patients was performed to evaluate the effectiveness of multivariate analysis of risk factors to correctly designate risk for pulmonary embolism. History of previous pulmonary embolism was the single most important factor. In patients without prior history, five factors emerged: inactivity, congestive heart failure, Doppler ultrasound evidence of deep-vein occlusion, female sex, and black race. Used together, these factors permitted a discrimination of risk such that 68.7% of pulmonary embolization was found to occur in 32.2% of the population designated as showing increased risk. Multivariate analysis of clinical factors improved assessment of risk, compared to the use of lower extremity findings alone, and proved to be useful in identifying individuals at increased risk for pulmonary embolism.

High resolution computed tomography, Part 1: Soft tissues of the neck.

Normal and pathologic anatomy of the soft tissues of the neck is clearly delineated with high resolution computed tomography (CT). The CT densities of soft tissues, fat, and enhanced blood vessels are strikingly different from each other and, therefore, mass lesions are clearly discernable. Often, a histologic diagnosis may be suggested with a high level of confidence based on the location and tissue characteristics.

High resolution computed tomography, Part 2: The salivary glands and oral cavity.

High resolution computed tomography (CT) has been of extraordinary value in all areas of the head and neck. Previous communications have indicated its effectiveness in the evaluation of the temporal bone and soft tissues of the neck. This current communication illustrates and discusses the anatomy and pathology of the salivary glands and oral cavity as seen on CT.

High resolution computed tomography: Part 3. The larynx and hypopharynx.

High resolution computed tomography (CT) is a highly desirable addition to clinical examination of the larynx and hypopharynx. The anatomy and pathology of the larynx and hypopharynx is discussed and illustrated by CT.

High resolution computed tomography: Part 4, Evaluation of odontogenic lesions.

High resolution computed tomography (CT) has been a mainstay in the preoperative evaluation of odontogenic lesions. Unsurpassed bony detail is complemented by exquisite delineation of the soft tissue mass itself. Our experience with these lesions is presented. Selected illustrations are supplemented by pathologic review.

High-resolution computed tomography: Part 5. Evaluation of the temporomandibular joint.

High-resolution computed tomography (CT) is evolving as the most valuable radiographic study when detailed information about the status of the temporomandibular joint is needed. High-resolution CT is faster, less invasive, and in most cases much more accurate than other imaging modalities used in the past. Erosive, hypertrophic, and ankylosing arthropathies are illustrated, as are condylar dislocations secondary to acute trauma, chronic trauma, and neoplasm. A detailed discussion of the common problem of the anterior displaced meniscus is undertaken.

Radiology of renal infection.

Radiology plays a key role in the diagnosis and treatment of renal inflammatory diseases. The efficacious use of the various imaging modalities in evaluating renal inflammatory disease requires knowledge of their attributes as well as their weaknesses. We review the available studies and use of contrast agents, and illustrate radiologic findings in specific inflammatory disease processes.

Computed tomography of the disarticulated incus.

Complete incus disarticulation may be a complication of trauma, chronic otitis, or prosthetic stapedectomy. Purposeful incus disarticulation (with incus interposition) is used as a method of ossicular reconstruction. CT has been a valuable diagnostic tool for preoperative location of the incus in the former disorders and for determination of the status of the ossiculoplasty in the latter.

External auditory canal dysplasia: CT evaluation.

Dysplasias of the external auditory canal can be evaluated with high resolution CT using proper technique. Images are studied to determine the type of atresia (membranous or bony) and the thickness of the associated atretic plate (if present). Other findings sought include the degree of pneumatization, the status of the fenestrae, the size of the tympanic cavity, and the location of both the mandibular condyle and the facial nerve canal.

The foramen ovale. MR and CT correlation.

Six patients with lesions involving the foramen ovale are presented and analyzed. Anatomy, pathology and imaging of diseases occurring in the vicinity of the foramen ovale are reviewed. Computerized tomography (CT) and magnetic resonance imaging (MRI) are complimentary in the evaluation of pathology in this region. CT is better able to evaluate bony detail while MR imaging is useful in detailing the anatomical extent and tissue characteristics.

Radionuclide esophageal and intestinal transit scintigraphy in patients undergoing radiation therapy.

Radiation esophagitis and enteritis are common and significant side effects of radiation therapy. Non-invasive assessment of functional and/or anatomic changes responsible for the symptoms produced by radiation esophagitis and enteritis has been unsatisfactory. This paper demonstrates the value of radionuclide esophageal and intestinal transit scintigraphy in patients undergoing mediastinal or abdominal radiation.

Initial experience with SPECT imaging of the brain using I-123 p-iodoamphetamine in focal epilepsy.

Nineteen patients with complex partial seizures refractory to medical treatment were examined with routine electroencephalography (EEG), video EEG monitoring, computed tomography or magnetic resonance imaging, neuropsychological tests and interictal single photon emission computed tomography (SPECT) with I-123 iodoamphetamine (INT). In 18 patients, SPECT identified areas of focal reduction in tracer uptake that correlated with the epileptogenic focus identified on the EEG. In addition, SPECT disclosed other areas of neurologic dysfunction as elicited on neuropsychological tests. Thus, IMP SPECT is a useful tool for localizing epileptogenic foci and their associated dynamic deficits.