Cholecystosonography: accuracy, pitfalls and unusual findings

Gray scale cholecystosonograms in 200 patients were reviewed. The findings in 133 of the patients were proved correct at surgery or autopsy. The overall accuracy for the detection of gallstones was 92 percent, with a false-negative rate of 4 percent. A false-positive diagnosis of cholelithiasis was made in three patients, two of whom proved to have extensive cholesterolosis. Causes of false-negative studies were the presence of a single small calculus, obseity and a large distended gallbladder. Ultrasound was specific but insensitive in the detection of a thickened gallbladder wall. The significance of a nonvisualized gallbladder by ultrasound and the role of ultrasound in the diagnosis of gallbladder disease are discussed.

Limitations of the post-lymphangiogram plain abdominal radiograph as an indicator of recurrent lymphoma: comparison to computed tomography

A comparison was made between post-lymphangiogram abdominal radiographs and computed tomographic (CT) scans in 18 lymphoma patients. When radiographs were obtained more than one year after the original lymphangiogram, only a small percentage of the patients had adequate contrast medium remaining in the lymph nodes for a definitive diagnosis. In three cases with apparently adequate residual contrast material, the radiograph did not provide accurate information on the presence or extent of recurrent lymphoma. The authors conclude that CT is the preferred method for the initial staging of patients with lymphoma, as well as for follow-up studies after one year.

The "overturned lateral" view in arthrography of the knee

A simple method of improving visualization of the posterior horn of the medial meniscus during fluoroscopic spot-filming in arthrography of the knee is described. Since it results in increased diagnostic accuracy at the most common site of occult pathology, the authors recommend that it be part of the routine examination.

Focal irregularity of the rectal mucosa

Mucosal irregularity seen on air-contrast barium enema may be the only radiographic manifestation of a variety of pathologic conditions of the rectum. Seven patients are described to illustrate the fact that when the rectal mucosal irregularity is focal and well demarcated, neoplastic conditions should head the list of diagnostic possibilities. Adenocarcinoma, verrucose carcinoma, adenomatous hyperplasia, villous adenoma, and metastatic carcinoma can all be manifested in this way. The appearance of these lesions on air-contrast barium enema is contrasted with the diffuse mucosal irregularity characteristic of inflammatory and other rectal conditions.

Computed tomography in the staging of testicular neoplasms

Twenty-six patients with primary testicular tumor were evaluated by computed tomography. It was highly accurate in differentiating lymph node metastases from testicular tumors. CT scanning may reveal tumor in lymph nodes not normally opacified during bipedal lymphangiography. It can also be used in treatment planning, follow-up, and in localizing sites of recurrence when serum tumor markers become positive. Some pitfalls of CT are also discussed.

Utility of body computed tomography in the clinical follow-up of abdominal masses

The value of follow-up body computed tomography was assessed in 101 patients with a known or suspected abdominal or pelvic mass. Computed tomography proved to be a useful noninvasive technique for evaluating progression, regression, or recurrence of such masses after therapeutic intervention. Computed tomography provided new or unique clinical information in 87% of these patients: it was not helpful in 2% due to technical difficulty and was misleading in 4%.

Accuracy of CT in detecting intraabdominal and pelvic lymph node metastases from pelvic cancers

In 40 patients with pelvic cancers evaluated by computed tomography (CT), CT was less accurate in demonstrating lymph node metastasis compared to its high accuracy in detecting nodal involvement in lymphoma patients. This largely reflects the inability of CT to detect alterations in internal architecture in a normal-sized lymph node. While less sensitive, CT is a more specific method than lymphangiography in detecting nodal involvement by pelvic cancers. The role of CT in the staging of pelvic cancers is discussed.

Accuracy of computed tomography in detecting intraabdominal and pelvic adenopathy in lymphoma

Computed tomography (CT) is a highly accurate method of detecting intraabdominal and pelvic nodal involvement in patients with lymphoma. The correlation between CT and lymphangiographic findings in this series of 80 surgically proven and nonproven cases was high (84%). CT is superior to lymphangiography in demonstrating abnormality in such areas as the high retrocrural or the mesenteric nodes where contrast material from bipedal lymphangiography does not reach. An abnormal CT scan eliminates the need for lymphangiography, and normal CT scan at 2 cm intervals can exclude retroperitoneal adenopathy with high confidence. If details of internal nodal architecture are required, a lymphangiogram can also be performed. Lymphangiography is also indicated in patients where CT is equivocal either because of lack of fat or gross motion artefacts.

Time-qualified reference intervals - chronodesms

Methods are presented for qualifying clinical reference intervals, for individuals as well as peer groups, according to circadian and other rhythms, using chronobiologically-defined single samples or time series.

Quantitative determination of fenclorac in serum

A spectrophotometric method for the analysis of fenclorac and its metabolite, 3-chloro-4-cyclohexylbenzeneglycolic acid, in human serum was developed. The parent compound represented at least 90% of the total species present in blood; the metabolite was present to the extent of about 10%, primarily in the elimination phase. The basic procedure consists of extraction of both compounds from serum, further extraction to remove interfering substances, alkaline conversion of fenclorac to the alpha-hydroxy acid metabolite, oxidation of this metabolite to the corresponding benzaldehyde derivative, and spectrophotometric measurement of the absorbance of the aldehyde at 252 nm. A comparison of serum concentrations obtained by this method with concentrations calculated from 14C-data following oral administration of 1-14C-fenclorac to eight normal adult volunteers indicated a 90% correlation between methodologies over a range of 1.4-25.5 microgram of fenclorac/ml of serum.

Extensive central nervous system calcification in a stillborn male infant due to cytomegalovirus infection

The radiologic and pathologic findings of a stillborn male fetus with cytomegalic inclusion disease are described. Massive calcification of the cerebrum, cerebellum, eye (sclera and choroid), and spinal cord was present. There were unique deformities and apparent aplasia of some of the ribs. Classic intranuclear cytomegalic inclusion bodies were present primarily in the kidney. Routine radiography of stillborn infants is recommended for further study of intrauterine growth abnormalities.

Chronobiology in the diagnosis and treatment of mesor-hypertension

An elevation of systolic and diastolic bloodpressure to values regarded as abnormal ones on the basis of conventional criteria was recognized by self-measurement. For both systolic and diastolic blood pressure, the overall means adjusted for rhythms, the so-called mesors, also were elevated in the light of their response to treatment: these mesors were found to be lowered with statistical significance when values during treatment were compared by an objective test with values measured before treatment. Individualized rhythmometry quantitatively characterizes a predictalbe portion of the variability in human blood pressure and tests for the statistical significance of changes in blood pressure as a function of the treatment and also as a function of the circadian timing of such treatment. The case report thus illustrates an individualized chronotherapy of systolic and diastolic mesor-hypertension, diagnosed retrospectively from the tested effect of hydrochlorothiazide. In the case reported, and perhaps routinely, computer-analyzed self-measurements can serve 1) to prescribe the right kind and amount with the right timing, for a given therapy, and 2) for diagnosis and prevention as well (Meyer et al.; Halberg et al.).