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Portal-hepatic venous shunt through a portal aneurysm complicated by hepatic encephalopathy and pulmonary hypertension.

We report a rare case of portal-hepatic venous shunt through an enormous portal aneurysm complicated by pulmonary hypertension. A 66-year-old woman was admitted to our hospital for hepatic encephalopathy. Chest roentgenography revealed pulmonary hypertension. Computed tomography and ultrasound examination demonstrated a shunt between the portal and hepatic veins through an enormous portal aneurysm. The diagnoses of portal-hepatic venous shunt and pulmonary hypertension were confirmed by hepatic venous catheterization and cardiac catheterization. Pulmonary hypertension might result from the effects of vasoconstrictive agents, which should be metabolized by the liver in normal subjects, passing through the intrahepatic shunt into the lung.

Aged↗

A case of sarcoidosis associated with bronchial asthma.

A 54-year-old woman was treated for bronchial asthma for 14 yr. In March of 1989, chest roentgenography and computed tomography (CT) revealed development of bilateral pulmonary hilar lymph node enlargement. Positive 67Ga uptake was observed in bilateral pulmonary hili. Although levels of serum angiotensin converting enzyme (ACE) and lysozyme were within normal range, biopsy specimen of scalene lymph nodes showed noncaseating epitheloid-cell granuloma, leading to the diagnosis of sarcoidosis. Steroid therapy ameliorated both sarcoidosis and bronchial asthma. Although the association of sarcoidosis and bronchial asthma is uncommon, there may be an etiological relationship between them.

Asthma↗

Pulmonary embolism after cerebral angiography--three case reports.

Three patients developed acute pulmonary embolism after cerebral angiography. The diagnoses were based on the clinical symptoms and echocardiography, chest roentgenography, blood gas analysis, and pulmonary perfusion scans after intravenous injection of 5 mCi of technetium-99m-labeled human albumin macroaggregates. Two of the three patients achieved clinical improvement, but one patient with severe embolization and circulatory deterioration died in spite of anticoagulation therapy. Recognition of the potential risk of pulmonary embolism after angiography and active prophylaxis are most important in preventing this complication.

Adult↗

Primary osteosarcoma of the sphenoid bone with extensive periosteal extension--case report.

A 28-year-old male presented with a primary osteosarcoma of the sphenoid bone with extensive periosteal extension manifesting as severe headache and right exophthalmos. Computed tomography (CT) and magnetic resonance imaging revealed an anterior middle cranial fossa tumor extending into both the orbit and the extracranial space. However, roentgenography and CT with bone windows showed no marked osteolytic changes of the sphenoid bone. Total removal of the tumor was performed via the orbitozygomatic approach. Surgery revealed that the tumor had extended periosteally without macroscopic bone destruction, but no obvious abnormalities of the skull. The histological diagnosis was osteosarcoma. The patient was treated with chemotherapy and radiation therapy, but died of tumor recurrence 10 months after the surgery.

Adult↗

The use of xeroradiography in the investigation of diseases occurring in the central nervous system.

A total of 88 cases of normal and pathological conditions of the skull, brain and spinal cord was studied by skull series, pneumoencephalography, and air myelography. The roentgenographic images of these structures were recorded by conventional roentgenograms, xeroradiograms, and tomogrrams and compared with each other. In general the high resolution and wide recording latitude of xeroradiography produced a more pleasing, sharper image than that obtained by conventional roentgenography. However, the individual tomographic image was superior to xeroradiography.

Acromegaly↗

Accuracy of 99mTC-diphosphonate bone scans and roentgenograms in the detection of prostate, breast and lung carcinoma metastases.

A technetium 99m diphosphonate scan is a sensitive detector of bony metastases of breast, prostate, and lung cancer. For these particular neoplasms, a negative bone scan in an asymptomatic patient is adequate evidence for absence of bony metastases and a correlative roentgenographic examination may not be necessary. Positive studies demonstrating multiple characteristic discrete areas of increased activity should be considered strong evidence for metastases. Single equivocal lesions require roentgenographic and occasionally biopsy correlation. If roentgenography fails to reveal the source of increased uptake, (e.g., degenerative disease) the scan lesion should remain suspicious for metastases.

Biopsy↗

Angiography and ultrasonography. A comparative study of abdominal aortic aneurysms.

Ultrasound is presently the diagnostic procedure of choice in pulsatile abdominal masses. The ease and accuracy of this method have many advantages over aortography, and ultrasonography can accurately define the size of an abdominal aortic aneruysm. In addition, a normal aorta with an overlying mass, or a tortuous aorta which feels unusually prominent, can be detected, and aortography may not be necessary. Although ultrasound can detect involvement of iliac arteries, it does not allow assessment of the position of the aneurysm relative to the renal arteries, or detect involvement of other branch vessels of the aorta. Ultrasound is more accurate that clinical examination, plain roentgenography, aortography, or isotope aortography in the diagnosis of abdominal aortic aneurysms.

Aorta, Abdominal↗

Investigation on subclinical aspects related to intestinal parasitic infections among Thai laborers in Taipei.

BACKGROUND: The migration of foreign workers from developing regions to developed countries may potentially lead to transmission of intestinal parasitic infections. In order to determine the relationship between intestinal parasitic infections and the health status of foreign workers, 302 Thai laborers brought to Taiwan were examined in this study. Nine species of parasites were found in 64.9% of laborers; Opisthorchis viverrini, hookworm, Strongyloides stercoralis, Giardia lamblia, Trichuris trichiura, Fasciolopsis buski, Taenia sp, Echinostoma sp, Entamoeba coli. METHODS: From June 1992 to December 1993, a total of 302 Thai laborers, participating in the mandatory entry health examination at Chang-Gung Memorial Hospital, Lin-Kou Medical Center were interviewed and examined. These subjects underwent a physical examination, chest roentgenography, and serological tests for human immunodeficiency virus antibody, syphilis (VDRL), and hepatitis B surface antigen. RESULTS: Among the 302 Thai laborers examined, 196 (64.9%) were found to be infected with 1 to 5 species of parasites. All 193 infected Thai laborers were treated in Taiwan. Two or 3 courses of pyrantel pamoate, mebendazole, praziquantel, and metronidazole were administered to 119, 45, 24, and 5 infected patients respectively. After 1 week of treatment, all results of stool examinations were negative. CONCLUSION: Acquisition of infection has been determined to be related to the consumption of koipla, a dish prepared from uncooked freshwater fish. Not unexpectedly, in the present study, it was found that this species was the most important intestinal parasite among Thai laborers and was significantly associated with the consumption of koipla.

Adult↗

Superficial spreading-type mucosa-associated lymphoid tissue (MALT) lymphoma in the stomach--a case report.

We presented a case of a 71-year-old woman who presented irregular mucosal folds with tiny depressions and multiple erosions with ulceration in the stomach, on endoscopy and roentgenography. Histological findings from biopsy specimens showed dense and mildly atypical lymphoid-like cells invading the submucosa. Immunohistochemical examinations revealed monoclonal reactivity of Heavy-chain. She was then diagnosed to have low grade malignant lymphoma in the stomach and underwent total gastrectomy. The resected cancer demonstrated the pathological features including small lymphocytic plasmacytoid cells and lymphoepithelial lesions characteristic of a mucosa-associated lymphoid tissue (MALT) lymphoma. The lymphoma cells expressed B cell markers with a phenotype of IgG and lambda type. It is difficult to make a firm diagnosis of a MALT lymphoma from only small biopsy specimens. Accordingly it is necessary to complete the observed clinical process, endoscopic and roentgenographic findings with immunohistochemical characteristics to determine diagnosis. The MALT lymphoma should be treated as a low-grade malignancy and diagnosis sufficiently early can lead to a favorable prognosis.

Aged↗

Idiopathic osteonecrosis of the femoral head in the elderly.

Idiopathic osteonecrosis of the femoral head (ION) is a disease prevalent in adulthood, and its development in elderly persons is known to show a low incidence. To clarify its characteristics in elderly patients, radiological and histological examinations were performed on 18 patients aged 60 years or older histologically diagnosed as having ION. On roentgenography, three characteristic points were observed, 1) progress of collapse in the femoral head within a short period (12 cases, 66.7%), 2) narrowing in the joint space within a short period (6 cases, 33.3%), and 3) rapid destruction and resorption of the femoral head (4 cases, 22.2%). The lesion expanded to the acetabular region, and a course similar to that of so-called rapidly destructive coxarthrosis (RDC) was developing in 3 cases (16.7%). However, in these 3 cases, changes in the acetabular region were mild, compared with ordinary RDC, and they were considered different from common RDC. These radiological characteristics were found more clearly in women than in men. In the histopathological examination, severe degeneration in the cartilage of the femoral head was found, while wide infiltration of repairing tissue into the necrotic area was seen from the early stage. When necrotic trabecula were collapsed markedly and degraded severely, then destruction and resorption of bone expanded to non-necrotic regions in some cases. Osteogenic sclerotic line (the demarcation line), which has been often seen in ordinary ION, was not developed in most cases. These characteristics were more prominent in women.

Aged↗

On direct currents and bone formation in demineralized bone transplants.

The effect of direct current on the remineralization of a bone defect was studied in the rabbit. Bone defects in the radius of both forelegs were grafted with demineralized autologous bone. On both sides platinum electrodes were placed around the graft, and one side was connected to a power source delivering 20 microA constant current during the experimental period of 28 days. The remineralization was evaluated 14 and 28 days after operation by scintigraphy and roentgenography, planimetry included. At 28 days after operation this evaluation was supplemented by autoradiography. Roentgenographically, there was no difference between the two sides. At 14 days after operation scintigraphy demonstrated a minor delay in bone formation at the electrostimulated side. Between 14 and 28 days a significant increase in activity was noticed. On both sides, autoradiograms showed areas without uptake around the wires. It was concluded that direct currents of the studied magnitude have a negative influence on the primary bone induction process but also that it seems to influence the mineralization positively later in the bone-forming process.

Animals↗

Elimination of contrast medium from the maxillary sinus.

Drainage of contrast medium from the maxillary sinus during blowing and sniffing was studied by cine-roentgenography in 11 healthy subjects. The functional size of the maxillary ostium was measured by a manometric method. Sniffing facilitated drainage more than blowing but the effect was minimal for both procedures except when sniffing was performed with the head tilted to the side opposite the filled sinus. The latter procedures may trap air in the sinus above the level of the ostium and thus facilitate drainage during sniffing. Another facilitating factor which is discussed is that blowing the nose may catch tenacious mucus which has partly passed through the ostium by the ciliary activity in the sinus. The influence of the fluid viscosity is discussed. The time required for complete emptying of the sinus from contrast medium, studied over a period of several days, was found to be inversely correlated to the functional diameter of the maxillary ostium.

Adult↗

Prognosis of otitis media with effusion in children, and size of the mastoid air cell system.

We studied 334 ears in 176 patients who were chosen from children diagnosed as having otitis media with effusion (OME) at our clinic. These 176 patients were re-examined about 5 years and 10 months after the first visit and categorized into three groups according to otological findings at the time of review: group A (normal), group B (sequelae), group C (OME). For this study, 168 ears of 86 persons were examined by roentgenography both at the time of the first visit and at review, and the size of mastoid pneumatization and differences in size between the three groups were compared. The results of the investigation can be summarized as follows. The size of mastoid pneumatization in group A was large at the time of the first visit and the increase in size was also greater than in the other two groups. These results led us to conclude that the degree of mastoid pneumatization is an important prognostic sign of the clinical course of OME and provides important information about treatment.

Adolescent↗

Evaluation of time interval difference digital subtraction fluoroscopy in patients with cystic fibrosis.

In this study the potential of thoracic subtraction fluoroscopy has been evaluated on the basis of our experience with this functional imaging modality in patients presenting with cystic fibrosis. The method, which consists of subtracting dynamic digital fluoroscopic images of the breathing chest in the time interval difference (TID) mode, applies to the study of the lucency variations during the respiratory cycle and provides dynamic functional information about ventilation and/or perfusion and diaphragmatic kinetics, without any injection and with minimal irradiation. To assess the validity of the TID procedure, our results were compared with standard roentgenography, clinical data, and scintigraphic findings, with emphasis on the latter. The limitations and advantages of TID compared with scintigraphy are discussed. Three groups of discrepancies emerge which do not discredit TID. TID offers rather the advantage of providing anatomic pictures and unique dynamic information, which is emphasized.

Cystic Fibrosis↗

Dyspepsia in general practice: history and symptoms in relation to Helicobacter pylori serum antibodies.

BACKGROUND: This study was designed to explore the relationships between serologic Helicobacter pylori positivity and demographic, behavioural, and symptomatologic factors in patients consulting for dyspeptic symptoms in general practice. METHODS: H. pylori enzyme-linked immunosorbent assay results and checklist data were collected by general practitioners at three community health centers in southern Sweden from consecutive patients aged 18-65 years with upper abdominal pain or discomfort (dyspepsia). RESULTS: Of the 130 available patients with dyspepsia, 127 agreed to participate, 45 (mean age, 41.2 years) being classified as H. pylori-positive and 82 (mean age, 33.5 years) as H. pylori-negative. Manual workers were diagnosed as H. pylori-positive significantly more often than were non-manual workers (p < 0.05). Of those patients examined earlier by gastroscopy or roentgenography, H. pylori-positives reported stomach or duodenal ulcer significantly more often than did H. pylori-negatives (p < 0.01). H. pylori-positives reported stomach/duodenal ulcer in their parents/siblings to a significantly greater extent than did H. pylori-negatives (45.2% versus 10.1%, p < 0.001). H. pylori-negatives reported stress-generated symptoms significantly more often than did H. pylori-positives (82.9% versus 61.5%, p < 0.01). Hierarchical regression analyses showed that, when age and sex were controlled for, the ability of each of these measures to predict the serologic results remained significant. CONCLUSIONS: Higher levels of H. pylori antibodies in dyspeptic patients appear to be associated with a relatively low self-perception of stress, with manual work, with being older, and with the occurrence, both in the patients themselves and in their close relatives, of stomach/duodenal ulcer.

Abdominal Pain↗

Bone formation in demineralized bone transplants treated with biosynthetic human growth hormone.

The influence of local administration of biosynthetic human growth hormone on the bone formation in a rabbit bone defect grafted with demineralized autologous bone was studied and compared to contralateral saline administration. The growth hormone was produced by hybrid DNA-technique and administered locally to the bone defect with the demineralized bone implant by an osmotic pump delivering 5 microliters/h during 14 days. At 14 and 28 days after operation the bone forming process was evaluated by roentgenography, planimetry included, and scintigraphy after injection of 99Tcm-labelled DPD. At 28 days after operation also autoradiography was performed. The roentgenographic and scintigraphic examinations revealed no influence from growth hormone neither 14 nor 28 days postoperatively. Centrally in the remineralized grafts the roentgenograms 28 days after operation showed radiolucent areas which in corresponding autoradiograms showed no uptake of 99Tcm. These areas turned out to be remnants of matrix. It is suggested that growth hormone has no influence on the bone induction process during the first 14 days when administered to bone matrix, probably due to relative lack of osteogenic cells. This study contributes a base for further evaluation of factors pertinent to hormonal stimulation of bone matrix transplants.

Animals↗

Multifocal recurrent periostitis responsive to colchicine.

A brother and sister with multifocal recurrent periostitis are presented. Their disease started at an early age and manifested itself as an episodic migrating arthropathy. At roentgenography, reversible solid periosteal reactions were visible along large tubular bones. Scintigraphic and histological investigations revealed a sterile osteitis and thickened periosteum, but there was no indication of a viral infection. The girl experienced spontaneous amelioration after puberty; the boy improved markedly on colchicine.

Adrenal Cortex Hormones↗

Nonspecific immunostimulation with low doses of cyclophosphamide (LDCY), thymostimulin, and Echinacea purpurea extracts (echinacin) in patients with far advanced colorectal cancers: preliminary results.

Outpatients (n = 15) with metastasizing far advanced colorectal cancers received immunotherapy consisting of low-dose cyclophosphamide (LDCY) 300 mg/m2 every 28 days i.v., thymostimulin 30 mg/m2, days 3-10 after low-dose cyclophosphamide i.m. once daily, then twice a week, and echinacin 60 mg/m2 together with thymostimulin i.m. All patients had had previous surgery and/or chemotherapy and had progressive disease upon entering the study. Two months after onset of therapy a partial tumor regression was documented in one and a stable disease in 6 other patients by abdominal ultrasonography, decrease of the tumor markers carcinoembryonic antigen (CEA), CA 19-9, CA 15-3, and/or chest roentgenography, which may also be attributed to the natural course of disease. Mean survival time was 4 months, 2 patients survived for more than 8 months. Immunotherapy was well tolerated by all patients without side effects.

Adjuvants, Immunologic↗