Endoscopic retrograde cholangiography (ERC) allows visualization of the entire biliary tree. The cholangiographic appearance of the intrahepatic bile ducts has received relatively little attention. This postmortem study was performed to define cholangiographic alterations produced by disease and to aid in the recognition of pathologic intrahepatic cholangiographic patterns produced by ERC. Intrahepatic cholangiographic patterns in the normal biliary tree, hepatic cirrhosis, hepatic infiltrative processes, and hepatic mass lesions are presented.

Adenocarcinoma↗

PubMedDate not supplied

Esophageal stenosis in benign mucous membrane pemphigoid.

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Aged↗

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Hypercalcaemia causing declining cognitive function in a head injured patient.

Although hypercalcaemia in young children or adolescents immobilized by fractures or spinal cord injury is well recognized, hypercalcaemia in adult immobilized patients is rare without a pre-existing bone disease. To our knowledge, hypercalcaemia in a head-injured, immobilized patient has not been previously reported. We report here a case where a previously normocalcaemic, immobilized, head-injured adult patient developed cognitive decline secondary to hypercalcaemia five months after injury, when transient interruption of enteral feedings led to mild dehydration. Indices of bone turnover were elevated and parathyroid hormone was appropriately suppressed. Possible predisposing factors in our patient included a severe degree of immobilization and a very high level of athletic activity prior to injury. Careful fluid management and specific monitoring of calcium levels, even several months post-injury, should be performed to avoid the added complications of hypercalcaemia in head-injured patients.

Adult↗

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Fluoxetine in treating emotional lability.

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Affective Symptoms↗

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Tomographic technique for visualization of the cruciate ligaments in double contrast arthrography.

Double contrast arthrography of the knee is the method of choice for visualization of the menisci, while the single positive contrast technique is the preferred method for evaluation of the cruciate ligaments. A technique is described which combines the advantages of these two methods. Following radiography of the menisci, an essentially single positive contrast study of the cruciate ligaments is obtained by positioning the patient in the lateral recumbent position with the knee flexed to about 90degree. The positive contrast medium in this position fills the joint cavity beyond its mid-point and surrounds the cruciate ligaments. Tomographic studies of the midline of the knee joint, made in this position with a polytome unit, demonstrate the cruciate ligaments to best advantage.

Humans↗