Ceruletide, a decapeptide, is a potent cholecystokinetic agent with a direct spasmogenic effect on the gallbladder muscle and bile ducts in humans and animals. It was recently approved by the Food and Drug Administration for use as an adjunct in x-ray examination of the gallbladder and small bowel. The drug causes a coordinated propulsive activity from the duodenum to the ileum and segmenting activity in the colon. Because of this stimulatory effect, ceruletide is useful not only diagnostically as an aid in x-ray examination of the small bowel, but also therapeutically for treatment of postoperative ileus, intestinal atonia, and chronic fecal statis. Because of its pancreatic stimulatory action, it is useful in evaluation of exocrine pancreatic function. In therapeutic doses the adverse effects noted are mild, transient extensions of the drug's pharmacologic actions and are manifest as nausea, vomiting, abdominal pain, and rarely hypotension and tachycardia. On the basis of current evidence, ceruletide is a safe and effective cholecystokinetic agent and small bowel and exocrine pancreatic stimulant.

Animals↗

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Magnetic resonance cholangiography.

Magnetic resonance cholangiography (MRC) can be performed with data from a routine imaging protocol, without the need for additional pulse sequences or special equipment. We studied three patients with obstructive jaundice who underwent magnetic resonance imaging (MRI) of the liver. T2-weighted fat suppressed fast spin-echo sequences were processed with a maximum intensity projection algorithm to create three-dimensional images of the dilated portions of the biliary tree. Results were correlated with endoscopic retrograde cholangiopancreatography and computed tomography. These images compared favorably with those acquired on scanners in which special breath-holding gradient echo protocols are used.

Aged↗

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Relationships between computed tomography tissue areas, thicknesses and total body composition.

Computed tomography (CT) scanning was evaluated for its potential application to body-composition research. Three cross-sections (upper leg, abdomen, chest including upper arms) were scanned in 41 healthy men (mean age 57.6 years). Subcutaneous fat thicknesses measured at specific sites on the CT scans were correlated with the total area of fat from the same scans. For the chest and leg cross-sections, correlations were highly significant. Subcutaneous fat thicknesses at the abdomen were relatively poorer correlates of total abdomen fat area, because they were unrelated to intra-abdominal fat. Correlation analyses were performed between fat areas of each cross-section and total fat weight (by 40K counting), and the abdomen yielded the highest correlations. Multiple regression was used to predict abdomen fat area from external anthropometry, and abdomen circumference plus one skinfold provided excellent prediction of total abdomen fat area (R2 = 0.79). Subcutaneous or intra-abdominal fat areas separately were not predicted as well by external measurements. When lean body weight was predicted by multiple regression, leg lean area was the best predictor of any anatomical cross-section.

Adipose Tissue↗

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The diagnosis of unsuspected esophageal perforation by computed tomography.

The successful management of esophageal perforation requires prompt diagnosis and surgical intervention. The hazards of delayed recognition of esophageal perforation have been recently emphasized. A case of unsuspected esophageal perforation detected by computerized tomography of the chest (CT) is described and illustrated. CT is an effective technique for displaying mediastinal and complex pleural-parenchymal abnormalities and often provides information which is of diagnostic value.

Carcinoma, Squamous Cell↗

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Gelfoam and autologous clot embolization: effect on coagulation.

An episode of disseminated intravascular coagulation following therapeutic gelfoam embolization to control bleeding from esophageal varices in a patient with liver disease is presented. We have since followed 13 patients prospectively (six control and seven gelfoam/autologous clot) to determine the effect of this procedure on clotting. We were unable to show significant differences between the two groups as measured by the prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and platelet count. However, fibrin (ogen) degradation products were significantly elevated (p less than .01) in the gelfoam/autologous clot group. We suspect this occurred secondary to clot lysis at the site of embolization. No subsequent bleeding diathesis attributable to this abnormality occurred in any of the patients.

Disseminated Intravascular Coagulation↗

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CT appearance of appendicitis and its local complications.

During evaluation for occult fever or nonspecific abdominal pain CT will occasionally identify inflammatory disease of the appendix as the underlying cause. In these cases CT may also provide useful information about the presence of associated mesenteric inflammation, abscess, or perforation. Five cases are presented in which CT provided clinically useful information supplementing that gained from barium studies and clinical presentation. When a periappendiceal lesion is found, the extent and nature of inflammatory changes are shown directly rather than inferentially.

Abscess↗

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Computed tomography of the gallbladder: unusual diseases.

Abdominal CT has in many cases become the initial radiographic examination to elucidate the cause of obscure abdominal pain, fever of unknown origin, and other difficult diagnostic abdominal problems. Not infrequently, unsuspected disease involving the gallbladder may be encountered. Computed tomography commonly identifies calcified gallstones, occasionally indicates acute cholecystitis, and clearly determines the extent of gallbladder carcinoma. Other less common entities such as gallbladder perforation, porcelain gallbladder, and milk of calcium bile may be diagnosed if suspicion is high and attention directed to anatomic details of the gallbladder and adjacent organs. A review of abdominal CT performed during a 4.5 year period revealed 20 instances of unusual gallbladder diseases in 16 patients. Most often these were encountered incidentally or during CT evaluation of nonspecific abdominal problems.

Bile↗

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Problems in CT diagnosis of ruptured abdominal aortic aneurysms.

In a review of 17 cases in which the CT diagnosis of abdominal aortic aneurysm rupture was prospectively made and for which surgical correlation was available the CT diagnosis was correct in 10 and incorrect in seven. Two of the false positives were retrospectively reinterpreted as negative for rupture. Characteristics of 10 surgically confirmed cases revealed a spectrum of appearances not always in agreement with prior published reports, probably due to the age and magnitude of the aortic leaks at the time of diagnosis. The most common characteristic of aneurysm leak (eight of 10 cases) was an abnormal soft tissue collection located adjacent to the posterior aspect of the aneurysm, a sign not previously emphasized in other reports. Renal displacement was also a valuable sign but was present in only three cases, all of which had large hemorrhages. Other characteristics of aortic rupture such as density of the collection and sharpness of its margins were not found to be generally useful.

Aorta, Abdominal↗