Idiopathic colonic perforation in the neonate

We describe a premature infant in whom spontaneous perforation of the colon was initially detected on routine abdominal films. There was no clinical evidence of necrotizing enterocolitis, peritonitis, or bowel obstruction. Surgical and pathologic findings confirmed the diagnosis of idiopathic bowel perforation. Since spontaneous gastrointestinal perforation in the neonate is often difficult to diagnose clinically, radiographic evaluation may allow earlier diagnosis and prompt surgical treatment of this life-threatening condition.

A phase II multi-institutional trial of low-dose N-(phosphonacetyl)-L-aspartate and high-dose 5-fluorouracil as a short-term infusion in the treatment of adenocarcinoma of the pancreas. A Southwest Oncology Group study

Adenocarcinoma of the pancreas is a highly lethal malignancy and chemotherapy has had little impact on the natural history of this disease. PALA, used to potentiate 5-fluorouracil (5-FU), has been shown to have synergy in vivo and in vitro. Twenty-seven patients were treated with an intravenous push dose of PALA (250 mg/m2) followed 24 hours later with a 24-hour infusion of 5-FU (2600 mg/m2). This regimen was repeated weekly. There was one partial response of 21 eligible patients with an estimated response rate of 5%. Toxicity was severe with one toxic death and four patients experiencing Grade 4 toxicity. 5-Fluorouracil and PALA, given in the schedule described, do not appear to be effective against adenocarcinoma of the pancreas.

Perforation of the colon due to endometriosis

Endometriosis is a common disease which affects the bowel in 12 to 35% of cases. Despite extensive serosal and intramural involvement, the intestinal mucosa usually remains intact and bowel perforation rarely occurs. We describe a patient with perforation of the sigmoid colon due to endometriosis. To our knowledge, this is the first such case to be reported in the radiologic literature.

Esophageal adenocarcinoma in a patient with surgically treated achalasia

Although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia, esophageal adenocarcinoma has been considered rare in this condition. We report a patient with long-standing achalasia in whom adenocarcinoma of the esophagus occurred many years after Heller esophagomyotomy, presumably related to Barrett's esophagus complicating gastro-esophageal reflux disease.

Tuberculous abscess of the testicle in AIDS: sonographic demonstration

A patient with acquired immune deficiency syndrome (AIDS) who presented with right testicular swelling is described. Sonography demonstrated diffuse enlargement and inhomogeneity of the testicle with central hypoechoic areas. Testicular abscesses were seen at surgery and Mycobacterium tuberculosis was cultured from the surgical specimen. Tuberculosis should be considered in the differential diagnosis of testicular enlargement or abscess formation in AIDS.

Leiomyoma involving the gastrocolic ligament: CT demonstration

A case of a large leiomyoma involving both the transverse colon and the greater curvature of the stomach is presented. Computed tomography (CT) demonstrated contiguous extension of the mass along the gastrocolic ligament. Although similar findings have been described in colonic and gastric carcinoma and in omental metastases, this is the first report in which these findings were due to a leiomyoma.

CT diagnosis of acquired small bowel volvulus

Small-bowel volvulus is an uncommon but important cause of small-bowel obstruction and often results in ischemia or infarction. Clinical examination and plain film radiography may be nondiagnostic, leading to delay in surgical intervention with subsequent increase in morbidity and mortality. We present two patients in whom the diagnosis of strangulating small-bowel volvulus was made by computed tomography (CT), allowing rapid surgical correction of this potentially life-threatening condition.

A phase II study of menogaril (NSC-269148) in colorectal carcinoma. A Southwest Oncology Group study

In this phase II trial, menogaril was administered to patients with metastatic colon cancer at a dose of 200 mg/m2 IV over one hour with cycles repeated every 28 days provided the absolute granulocyte count was greater than or equal to 2000 cells/microliters. Dose adjustments up or down were made depending upon nadir counts. Twenty-four patients were entered on this study with 21 eligible and evaluable for response. There was 1 CR lasting four and one-half months and 1 PR lasting three months for an overall CR + PR rate of 10% with a 95% confidence interval of 1% to 30%. Six patients (29%) had stable disease and 13 (62%) progressed. Median survival is 13.1 months. Toxicity was primarily hematologic with two cases of life-threatening leukopenia (less than 1000 cells/microliters) and one case of life-threatening granulocytopenia (less than 250 cells/microliters) among the 21 eligible patients, and one case of life-threatening leukopenia and granulocytopenia in one ineligible patient. There were no deaths due to treatment.

Spontaneous necrosis and hemorrhage in an enlarged accessory spleen: CT demonstration

Enlargement of an accessory spleen following splenectomy may be due to compensatory hypertrophy or recurrence of hematologic or other disorders. Spontaneous necrosis and hemorrhage in an accessory spleen are rarely described. We report a case in which an enlarged accessory spleen complicated by spontaneous hemorrhage was identified on computed tomography (CT) and confirmed at surgery.

Phase II trial of intravenous melphalan for metastatic colorectal carcinoma. A Southwest Oncology Group study

Based on the high response rates seen among patients with colon cancer receiving high dose Melphalan with autologous marrow infusion, the Southwest Oncology Group conducted a Phase II trial of the compound at a conventional dose. The initial starting dose of 40 mg/m2 was reduced to 30 mg/m2 after severe myelotoxicity was encountered in the first five patients. Toxicity was primarily myeloid and was moderate to severe in most patients with one treatment related death. There were two complete and one partial response among 43 patients. Melphalan at 30 mg/m2 has little activity among patients with metastatic colorectal carcinoma.

Phase II trial of high-dose intermittent interleukin-2 in metastatic renal cell carcinoma: a Southwest Oncology Group study

A phase II trial of intermittent high-dose recombinant interleukin-2 (rIL-2) was initiated to evaluate the response rate, remission duration, and toxic effects in patients with measurable metastatic renal cell carcinoma. The rIL-2 was administered as a bolus intravenous infusion at a dose level of 10.0 x 10(6) U/m2 three times weekly, preceded by indomethacin (50 mg orally). Dose reductions of rIL-2 for hypotension and other grade 3 or 4 toxic effects were permitted. Forty-four patients were entered and 41 were eligible. Previous treatment included nephrectomy (23 patients), radiation therapy (seven), and hormone therapy (three). Most toxic effects observed were moderate and included nausea, vomiting, anorexia (85%); hypotension (85%); fever, chills (78%); central nervous system changes (24%); myelosuppression (27%); and creatinine elevation (15%). Four instances of grade 4 toxicity were observed and included nausea, vomiting with dehydration; hypotension; and myocardial infarction. Thirty patients (73%) required dose adjustments because of toxicity. Five responses (12%) were seen, which included one complete and four partial. Sites of response included lung, liver, and soft tissue; the duration of response ranged from 2 to 20+ months. These results demonstrate that this schedule of rIL-2 can be administered in an outpatient setting, and can produce tumor regression in patients with metastatic renal cell carcinoma, including durable complete responses.

Cervicothoracic myelopathy in Conradi-Hunermann disease: MRI diagnosis

A 10-year-old boy with Conradi-Hunermann disease diagnosed at birth who developed progressive myelopathy is presented. Despite the many descriptions of Conradi-Hunermann disease in infants and young children, long-term follow-up of this disease is rarely reported. Magnetic resonance imaging (MRI) played a critical role in the diagnosis of this patient's rare neurological dysfunction by demonstrating bony deformity and associated cord compression at the cervicothoracic junction. This area is often difficult to evaluate by conventional radiographic techniques.

Mycobacterial esophagitis in AIDS

A patient with acquired immune deficiency syndrome (AIDS) who presented with dysphagia is described. Barium swallow demonstrated diffuse esophagitis with longitudinal ulceration and sinus tracts to the mediastinum. Mycobacteria were seen on esophageal biopsies and Mycobacterium tuberculosis was cultured from a pleural effusion. Mycobacterial esophagitis should be considered in the differential diagnosis of esophagitis in AIDS, particularly when sinus tracts are demonstrated.

CT diagnosis of perforated duodenal diverticulum

We present a case of perforated duodenal diverticulum diagnosed preoperatively on computed tomography. This rare but potentially fatal condition has been difficult to detect with more conventional radiographic techniques.

Spontaneous free perforation of the ileum in Crohn disease: CT demonstration

A case of spontaneous free perforation of the ileum in Crohn disease is presented. This rare complication was demonstrated by computed tomography (CT) before becoming evident on plain films.

Perioperative pulmonary function in acute respiratory failure: effect of ventilator type and gas mixture

Whether maintaining pulmonary nitrogenation and/or a stable ventilatory pattern during surgery would minimize changes in perioperative pulmonary function in two groups of patients with acute respiratory failure (ARF) whose lungs were being mechanically ventilated was examined. Group 1 (n = 39 cases) (inspired oxygen fraction [FIO2] less than or equal to 0.5, minute ventilation less than or equal to 15 l/min, peak inspiratory pressure less than or equal to 50 cmH2O, positive end-expiratory pressure [PEEP] less than or equal to 10 cmH2O) were assigned randomly to one of four intraoperative ventilator-gas mixture (FIO2 approximately 0.5) combinations: 1) Siemens 900C ventilator, N2/O2; 2) Siemens 900C ventilator, N2O/O2; 3) Ohio anesthesia ventilator, N2/O2; or 4) Ohio anesthesia ventilator, N2O/O2. Group 2 (n = 15 cases) (ventilatory requirements exceeding any of those in Group 1) had their lungs ventilated intraoperatively with the Siemens 900C ventilator and a gas mixture determined by their anesthesiologist (FIO2 approximately 0.6-1.0). In patients whose lungs were ventilated with the Ohio N2O/O2 combination, PaO2/FIO2 decreased significantly (P less than 0.05) from 358 +/- 93 mmHg (mean +/- SD) preoperatively to 282 +/- 77 mmHg intraoperatively. The level of PEEP increased significantly from 5 +/- 3 cmH2O preoperatively to 9 +/- 4 cmH2O intraoperatively (P less than 0.05). In patients whose lungs were ventilated with the Ohio N2/O2 combination, PaO2/FIO2 decreased significantly from 270 +/- 86 mmHg preoperatively to 174 +/- 74 mmHg intraoperatively. These variables did not change significantly in patients ventilated with the Siemens ventilator (groups 1 and 2). Pulmonary oxygen gas exchange returned to preoperative values by the first hour postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Omental cakes in American Burkitt lymphoma. Computed tomography demonstration

Diffuse tumor infiltration of the omentum or so-called omental "cakes" is well recognized on computed tomography (CT) and is usually associated with pelvic or gastrointestinal carcinoma. However, this has not been described in American Burkitt lymphoma despite frequent intraabdominal involvement in this disease. We report two cases of American Burkitt lymphoma in which omental cakes were demonstrated by CT.