Functioning islet cell tumor of the pancreas. Localization with dynamic spiral CT

PURPOSE

The purpose of this study was to evaluate the usefulness of dynamic spiral CT, including multidimensional reformation, in the detection and localization of islet cell tumors of the pancreas.

MATERIAL AND METHODS

Seven patients with histopathologically proven functioning islet cell tumors of the pancreas were studied with 2-phase contrast-enhanced spiral CT. Scanning of the arterial phase and late phase was started 30 s and 180 s, respectively, after injection of 100 ml of contrast medium at a rate of 3 ml/s.

RESULTS

Axial images in the arterial phase depicted the lesions in 5 patients, but in the late phase in only one patient. Multiplanar reformatted images of the arterial phase depicted the lesions in all 7 patients. Maximal intensity projection images demonstrated all lesions with information of their relationship to the vascular structure.

CONCLUSION

Dynamic spiral CT with scanning during the arterial phase and retrospective multidimensional reformation is useful for preoperative detection and localization of small islet cell tumors of the pancreas.

Tuberculous abscess in retromammary region: CT findings

PURPOSE

Our goal was to evaluate CT findings of tuberculous abscess in the retromammary region of the breast.

METHOD

Four patients with tuberculosis extending from the retromammary region to the pleura were examined by CT and the findings were evaluated. All cases were also examined with mammography and two cases were evaluated with sonography. Diagnosis was confirmed by acid-fast bacillus stain, culture, and histologic examination.

RESULTS

Mammography showed relatively smoothly marginated, round mass density in two cases, nodular density in one, and focal bulging of the pectoral wall in one. A sonogram demonstrated in two cases a fistulous connection from the heterogeneous, fluid-containing lesion with floating internal debris in the retromammary region to the thoracic cavity. In all four cases, CT showed relatively smoothly marginated, inhomogeneous, hypodense lesions with surrounding rims of the cold abscess type. A direct fistulous connection from the retromammary lesion through the thoracic wall into the pleura was seen in two cases. Destroyed rib fragments within the abscess were noted in two cases.

CONCLUSION

A tuberculous abscess in the retromammary region usually showed on CT a focal, smoothly marginated, inhomogeneous, hypodense lesion with a surrounding enhancing rim. A direct fistulous connection with the pleura or a destroyed rib fragment in the abscess as revealed by CT can be helpful in the differential diagnosis of other infectious types of retromammary abscess.

Spinal anaesthesia with 0.25% hyperbaric bupivacaine for Caesarean section: effects of volume

To investigate the safety and efficacy of 0.25% hyperbaric bupivacaine for spinal anaesthesia in Caesarean section, we studied 60 parturients allocated randomly to one of three groups. According to the patient's height, groups 1, 2 and 3 received 3.2-3.6 ml (8-9 mg), 3.6-4.0 ml (9-10 mg) and 4.0-4.4 ml (10-11 mg) of 0.25% bupivacaine in 5% glucose, respectively. Subarachnoid injection was performed in the right lateral decubitus position, and parturients were then turned immediately supine with left uterine displacement. Mean spread of sensory analgesia was significantly higher in group 3 (T2-3) than in groups 1 and 2 (T4-5 in each group). Duration of sensory analgesia was significantly longer in groups 2 and 3 than in group 1. Complete motor block of the lower extremities occurred in all patients but in only one in group 1. Onset time and duration of motor block were not significantly different between the three groups. The incidence of hypotension was significantly higher in group 3 (75%) than in groups 1 and 2 (40% in each group). The efficacy of intraoperative analgesia was significantly greater in groups 2 and 3 than in group 1. The incidence of patients requiring analgesics during operation was significantly lower in groups 2 (25%) and 3 (10%) than in group 1 (70%). There was no difference in neonatal condition between the three groups. Spinal anaesthesia with 3.6-4.0 ml of 0.25% bupivacaine in 5% glucose was satisfactory for Caesarean section.

[Magnetic resonance imaging of renal lymphoma with computed tomography correlation]

The magnetic resonance (MR) imaging and computed tomography (CT) findings in four patients (five kidneys) with non-Hodgkin's lymphoma involving the kidneys and perirenal spaces are presented. The patterns of disease in each case were as follows: bilateral renal nodules, infiltration in the perirenal space, infiltration in the perirenal space with renal involvement, and direct invasion from contiguous retroperitoneum. On plain CT, the lesions showed slight hyperdensity (three kidneys) and isodensity (two kidneys) as compared with normal renal parenchyma. But all lesions appeared as hypodense masses with more definite margins after contrast enhancement. MR imaging findings showed iso- or slight hypointense masses on T1-weighted images and definite hypointense masses on T2-weighted images as compared with the signal intensity of the renal cortex. Dynamic imaging and conventional delayed T1-weighted imaging following Gd-DTPA injection showed no significant enhancement of the lesions. In comparison with contrast enhanced CT, despite its poorer resolution, T2-weighted MR imaging showed nearly the same accuracy in the evaluation of number and extent of the lesions without contrast medium administration. MR imaging was also useful to evaluate the patency of vessel lumen surrounded by tumor mass and to determine the location and extent of huge lesions by its multiplanar imaging capabilities.

Breast tumors associated with nipple discharge. Correlation of findings on galactography and sonography

To compare the specific information provided by ultrasound (US) and galactography and to appreciate the clinical applicability of US as a primary diagnostic method for breast tumors associated with nipple discharge, a comparative study of each method in 15 patients with ductal tumors of the breast was performed. To evaluate the smallest anatomical unit of the lactiferous system demonstrable by US, 30 patients with normal lactating breasts were examined prospectively. The smallest anatomical ductal unit that could be evaluated with US in the normal lactating breast was the terminal duct lobular unit (TDLU). US is superior to galactography in detecting masses smaller than 0.5 cm or lesions involving multiple ducts. Galactography is better for visualizing the duct system and detecting calcification. In conclusion, US serves as a primary noninvasive diagnostic tool in patients with clinically suspicious breast tumor associated with bloody nipple discharge, but galactography also should be done in specific circumstances.

Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography

PURPOSE

To assess the diagnostic usefulness of ultrasonography (US) in intussusception in children and determine whether color Doppler sonography (CDS) can indicate bowel viability and help in prediction of reducibility.

MATERIALS AND METHODS

US was used to examine 176 children in whom the presence of intussusception was clinically suspected. CDS was performed in 64 patients with 65 cases of intussusception proved with US.

RESULTS

The positive US findings were confirmed with air enema; the negative findings, with air enema in 46 patients and clinical follow-up in 66 patients (100% specificity and sensitivity). CDS indicated blood flow in 62 of 65 cases of intussusception; pneumatic reduction was achieved in 58 (94%) of these 62 cases. Four patients (6%) underwent manual reduction of viable bowel; three patients (5%) who had no color Doppler signal underwent segmental resection. The difference in reduction rates based on blood flow was statistically significant (P = .0008).

CONCLUSION

US is sensitive and specific in the diagnosis of intussusception, and CDS is a promising predictor of bowel viability.

Diagnosis of acute appendicitis in pregnant women: value of sonography

OBJECTIVE

The diagnosis of acute appendicitis in pregnant women often is difficult to make on the basis of clinical findings, and radiologic examination is limited because of the potentially hazardous effects of radiation. This study was done to assess the value of sonography in the diagnosis of acute appendicitis in pregnant women.

SUBJECTS AND METHODS

We obtained sonograms in 45 pregnant women with clinically suspected acute appendicitis. Our sonographic technique included graded-compression scanning. The left lateral decubitus position was used in the third trimester of gestation. The sonographic criterion for the diagnosis of acute appendicitis was visualization of an incompressible appendix with a maximal diameter greater than 7 mm. We correlated the sonographic findings with the surgical findings in 22 cases and with the results of clinical follow-up in 23 cases.

RESULTS

Sonography could not be used to make the diagnosis in three (7%) of 45 patients because the size of the gravid uterus prevented use of the graded-compression technique. These three patients were in the third trimester of pregnancy (greater than 35 weeks' gestation). Sonographic findings were used as a basis for diagnosis in 42 cases. Acute appendicitis was diagnosed on the basis of sonograms in 16 patients, and in all but one of these patients, acute appendicitis was confirmed by surgical and pathologic findings. In the 42 cases in which the imaging findings indicated the diagnosis, the overall sensitivity of sonography was 100%, the specificity was 96%, and the accuracy was 98%.

CONCLUSION

Our experience suggests that graded-compression sonography is a valuable procedure for detecting acute appendicitis in pregnant women despite technical difficulty in performing it during the third trimester of pregnancy.

Visual evoked potentials in sarcoidosis

The visual evoked potential to pattern reversal was recorded in 50 patients with sarcoidosis. Abnormalities of latency and amplitude were found in 15 patients (30%), including all 4 patients with clinically evident brain disease and 4 of 17 patients with overt ocular disease. Twenty-nine patients had no clinical evidence of ocular or neurologic disease, and 7 of them (24%) had abnormalities of the VEP, implying subclinical sarcoid lesions in structures at the base of the brain.

Visual evoked potentials in occipital lobe lesions

Recording of visual evoked potentials (VEPs) to pattern reversal is considered to be a reliable diagnostic procedure for examining patients with anterior visual pathway lesions (optic nerves and chiasm). Less consistent results have been reported in studies of more posterior lesions. The VEPs were recorded in 20 patients with occipital lobe lesions. A maximal VEP response (P94) was recorded at the scalp electrodes situated over the involved occipital lobes and contralateral to the hemianoptic visual field defect, indicating a positive correlation of unilateral occipital lobe lesions, homonymous visual field loss, and the VEP abnormality.

Generalized chorea associated with chronic subdural hematomas

Two patients with chronic bilateral subdural hematomas developed symmetrical generalized choreiform movements. In one patient the chorea disappeared after evacuation of the hematomas, and in the other the movement improved. The latter patient has a family history of Huntington's disease.