Biomedical subjects
Publications and source records attributed to J Gaa.
Myelolipoma is an uncommon, benign, adrenal lesion composed of fatty tissue and bone marrow elements. The presence of fat within this tumor is the key factor in identification and noninvasive diagnosis with imaging methods. Since fat has a characteristic behavior reflected by the MR signal intensity, a specific diagnosis can be made by MRI.
The diagnosis of colorectal carcinoma is based on double-contrast barium enema and endoscopy. However, in contrast to computed tomography (CT), these modalities do not permit a precise preoperative prediction wether a tumour is limited to the bowel wall or has spread into surrounding tissue. To improve the detection of colorectal neoplasms by CT we prospectively studied the use of intrarectally administered water for CT scan in 16 patients with colorectal cancer proved by barium enema and endoscopy. The water repletion technique allowed an improved depiction of the large bowel wall, and the primary tumour was demonstrated by CT in all cases. Furthermore the use of water prevented artifacts which was helpful in the evaluation of the liver for suspected metastases.
We report our experience with radiologically guided percutaneous tube gastrostomy in 125 patients by using a gastropexy technique in which the anterior gastric wall is nonsurgically sutured to the anterior abdominal wall with percutaneously placed T-fasteners before catheter insertion. Short-term follow-up of up to 2 weeks was available in all patients. In 63 patients, long-term follow-up (greater than 4 weeks; average, 3.5 months; maximum, 1 year) was available. Catheter placement was successful in 124 (99%) of 125 patients, including three patients with anatomic changes after Bilroth II hemigastrectomy and two patients with failed endoscopic attempts. There were no deaths related to the procedure, and no patients required surgical intervention for complications attributable to the gastrostomy procedure. The 30-day mortality rate was 11% (n = 7). These deaths were due to cardiorespiratory arrest and were not attributable to the gastrostomy procedure. Major complications occurred in 1.6% (n = 1) and minor complications in 9.5% (n = 6). These results indicate that percutaneous gastrostomy with gastropexy is a safe and effective technique for placement of catheters in the stomach.
A case of hepatocellular carcinoma in idiopathic hemochromatosis is discussed to illustrate the possible advantages of MR imaging. Since hepatic iron overload provides a natural source of paramagnetic contrast enhancement MRI should performed in preference to other investigative procedures to detect small and curative resectable hepatocellular carcinomas in patients with hemochromatosis.
Modern imaging techniques are presented in a case of Budd-Chiari syndrome. The etiological, clinical and therapeutic aspects of this rare type of hepatic vein occlusion are discussed.
Explore the source record for details and available documents.
In connection with a case of pulmonary cryptococcosis, the clinical manifestations, radiological findings and therapeutic possibilities are discussed. Although pulmonary cryptococcosis is relatively uncommon, the diagnosis should be considered in any immunologically compromised patient with an abnormal chest roentgenogram.
Explore the source record for details and available documents.
Examination of the intestine by computed tomography can supply additional information on diseases of the intestinal wall. However, the successful interpretation of the bowel wall by CT requires a special technique by which normal structures are opacified, identified and not mistaken for abnormal masses. The rectal administration of water improves the visualisation of the bowel wall and the diagnostic accuracy. This safe, reliable and acceptable method for opacifying the colon and rectum is described. Its value is demonstrated by means of normal and pathological examples.
To assess the safety of nonselective intraarterial digital subtraction angiography (DSA) performed from a transbrachial approach with 4-French-catheters, the complications occurring in 158 examinations were studied. Two patients developed local thrombosis and in four patients there were temporary pulse deficits. Three brachial artery catheterisations were unsuccessful due to transient arterial spasm. Our data support the conclusion that nonselective transbrachial DSA is a safe and accurate method, easily employed in an outpatient population.
A case of Waldenström's macroglobulinemia (MGW) is presented with a rare primary pulmonary manifestation. The disease was discovered from abnormal reticulonodular opacities in chest X-ray films, which at first did not have the classic features of MGW. The radiological findings and therapeutic possibilities are discussed with reference to the literature.
Spontaneous transmural rupture of the esophagus (Boerhaave's syndrome) is a life-threatening emergency. Prompt diagnosis is essential to a better prognosis, successful operative outcome and patient survival. The chest roentgenogram and the contrast esophagograms to follow are the most helpful diagnostic tests. The clinical manifestations are variable and may be misleading and thus delay accurate recognition. In our case report the major clinical features and radiological signs of Boerhaave's syndrome are described. The pathogenesis, characteristic clinical symptoms and the signs and radiological evaluation are reviewed.
Different roentgenometric methods are discussed with reference to a case of atlanto-occipital dislocation (AOD). The most accurate information is provided by Lee's X-line method, which also allows differentiation of the three forms of this injury. As survival has been reported in cases of AOD, early conventional radiographic diagnosis is especially important.
Intussusception is an uncommon cause of intestinal obstruction in adults. Unlike children, the diagnosis of intussusception in adults is often difficult due to its usually chronic history. A case of adult ileocolic intussusception secondary to metastatic melanoma is presented to discuss the efficiency of ultrasonography, characteristic CT features and the etiology of this disease.
Explore the source record for details and available documents.
We report on the diagnosis and treatment of a pancreatic pseudocyst of the mediastinum. The patterns of signs and symptoms, diagnosis and treatment of this rare disease are discussed on the basis of literature.
Thirty-three patients with 35 proven hepatic cavernous hemangiomas (HCH) were studied with intravenous CT angiography (IVCTA). 15 scans were performed during the first 30 s after bolus (6 ml/s) injection of 50 ml iodinated contrast material. Thereafter 2 scans/min were obtained up to 30 min. Three criteria were utilized at IVCTA to make a specific diagnosis of HCH: (1) detection of an intense mural nodular enhancement in the arterial phase. The density in the nodular region(s) should have a density level similar to that of the aorta or hepatic arteries; (2) well-defined nodular area(s); and (3) centripetally oriented enlargement of the nodular region(s). These criteria were seen in 31 of 35 hemangiomas. In contrast the 'typical' Freeny-Marks criteria were present in only 23 of 35 hemangiomas. The results show that our criteria may provide greater specificity.
OBJECTIVE: To determine the accuracy of water enema CT (WECT) for staging colon carcinoma. MATERIALS AND METHODS: Thirty patients with colon cancer, diagnosed by barium enema and/or colonoscopy, underwent preoperative WECT. Dynamic contrast enhanced CT studies were performed after rectal administration of < or = 2 L lukewarm tap water. Images were prospectively analyzed for depth of tumor invasion, nodal involvement, and distant metastases by investigators blinded to the results of barium enema and colonoscopy. Surgical/pathologic proof was obtained in all cases. RESULTS: Using WECT, 23 of 30 patients were correctly staged. Correct staging occurred in 2 of 2 patients with Stage A, 3 of 3 patients with Stage B1, 6 of 9 patients with Stage B2, 1 of 2 patients with Stage C1, 5 of 8 patients with Stage C2, and 6 of 6 patients with Stage D tumors. Of the patients incorrectly staged, 4 were understaged and 3 were overstaged; all were due to errors in predicting lymph node involvement. Sensitivity and specificity for evaluating nodal involvement were 60 and 79%, respectively. CONCLUSIONS: Water enema CT allows for accurate depiction and staging of colon carcinoma. Aqueous distention of the colon avoids artifacts seen with positive contrast agents yet allows accurate evaluation of the bowel wall and pericolonic structures.