Richard A. Mintzer

Clinical and Immunologic Criteria for the Diagnosis of Allergic Bronchopulmonary Aspergillosis

Clinical and immunologic characteristics are reported in a series of 20 patients with allergic bronchopulmonary aspergillosis seen by physicians in one consulting service during a period of 9 years. Seventeen of these patients have been identified in the past 2 years, reflecting the increasing recognition of the entity. Fifteen of the 20 patients are believed to have proven diagnoses; the other five are strongly suspected. Asthma, pulmonary infiltrates, and eosinophilia are the usual presenting symptoms. Serum immunoglobulin E was markedly elevated in all patients, and serum immunoglobulin D was normal in four out of five patients sampled. Bronchograms were abnormal in all cases in which they could be done. Lymphocyte transformation may be present in some cases but is not a diagnostic feature. The average age at time of diagnosis was 25.5 years, and seven of the 15 proven patients were 20 or younger.

Gastrointestinal complications of spinal cord injury.

The incidence, nature, and radiographic features of gastrointestinal complications encountered in a group of 567 consecutive spinal-cord-injury patients are reported. Eighty-seven episodes of gastrointestinal complications developed in 63 (11%) patients. During the first month post injury, these complications consisted of ileus, gastric dilatation, the body cast syndrome, peptic ulcer disease, and pancreatitis. More chronically these patients presented with fecal impactions, peptic ulcer disease, the superior mesenteric artery syndrome, hepatitis, amyloidosis, and the precocious appearance of diverticulosis, hiatus hernia, and gastroesophageal reflux. Radiographic findings were diagnostic in the majority of cases and aided in the early diagnosis of these potentially life-threatening complications.

The Spectrum of Radiologic Findings in Allergic Bronchopulmonary Aspergillosis

Early diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is important. Initiation of corticosteroid therapy in ABPA is essential to prevent progressive destruction of lung parenchyma. The earliest radiographic manifestations of the disease may be present only on bronchograms. In addition to the classic radiographic findings (infiltrate, massive homogeneous consolidation, tram-line shadow, parallel line shadow, ring shadow, toothpaste shadow, glove-finger shadow), perihilar infiltrates simulating adenopathy (pseudohilar adenopathy) and air fluid levels were frequently demonstrated.

Computed vs. Conventional Tomography in Evaluation of Primary and Secondary Pulmonary Neoplasms

One hundred patients, ultimately proved to have chest malignancies, were evaluated prospectively with conventional chest tomography and computed tomography. In 58 patients with primary malignancies, conventional tomograms were more useful in evaluation of the hilus than CT scans. The mediastinum was better assessed by CT. Thus, evaluation of the presence of neoplasia is better accomplished by conventional examination, while extent of disease is best assessed by CT. Thoracotomy for curative resection was not attempted (in the latter cases of this series) based on CT findings of mediastinal involvement. In 42 patients with metastases to the chest, CT scans of the lung parenchyma were more sensitive than whole lung tomography but had little additional impact on patient treatment. Nevertheless, in 18 patients the results of CT or whole lung tomography directly affected patient therapy.

Allergic bronchopulmonary aspergillosis in pediatric practice

Twelve cases of allergic bronchopulmonary aspergillosis in the pediatric age group are reported. The average age of diagnosis was 14.5 years with a range from 6 to 18 years. All patients had a history of pulmonary infiltrations or atelectasis or both documented by chest radiographs. Eight patients had bronchograms or tomograms, and seven of them showed proximal bronchiectasis. Total serum IgE concentrations were elevated in all patients. Preciptitating antibodies against Aspergillus fumigatus were positive in all patients at the time of diagnosis, and became negative in some after therapy. The specific IgE or IgG antibody activity agaist Af was elevated in all 12 patients. After prednisone was started the total serum IgE sharply declined to a plateau and remained at this level until a flare of allergic aspergillosis occurred. A flare of allergic aspergillosis is characterized by an increasing total serum IgE concentration followed by pulmonary infiltration. Clinical and roentgenologic improvements were observed after steroid therapy. The importance and methods of early diagnosis in the pediatric population are discussed.

Urological Complications of Regional Enteritis

Urological complications of regional enteritis occur frequently and may be clinically unsuspected. Radiographic findings include nephrolithiasis, characteristic stricture of the ureter, panvesiculitis, and enterovesical fistula. Less specific findings include renal amyloidosis and retroperitoneal abscesses. Mucosal nodularity of the bladder dome, even without gastrointestinal symptoms, should raise the possibility of regional enteritis. On the other hand, occult ureteral stenosis in patients with known regional enteritis may be present. For this reason, it is recommended that routine and periodic excretory urograms be a central part of the evaluation of the patient with regional enteritis.

Chiba needle percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography with the Chiba University needle has been utilized in 30 patients. The ducts were successfully demonstrated in all 21 patients with obstructive jaundice. Sixty-seven percent of normal or stenosed ducts were visualized. No serious complications occurred and emergency post-procedural laparotomy was unnecessary. Our results reflect other reports. Percutaneous transhepatic cholangiography is an efficacious method of evaluating the hepatobiliary system.

Image Quality Evaluation Of A Digital Fluorographic Imaging Device

A low contrast phantom designed specifically for the evaluation of the image quality obtained from a digital fluorographic imaging device (DFID) is described. The design rationale and the image quality evaluation procedure utilizing the phantom are discussed along with the test results.

Air gap technique for digital subtraction angiography of the extracranial carotid arteries

The technique of applying an air gap between the patient and the x-ray detector reduces scattered radiation from the patients neck sufficiently to allow performance of DSA of the extracranial carotid arteries with the antiscatter grid removed. When compared with the conventional grid technique, air gap allows 25 to 88% reduction of mA without increasing the kVp or exposure time and without loss of spatial resolution or diagnostic image quality. These considerable patient radiation-exposure savings can be implemented on DSA systems that use ordinary under-table x-ray tube fluoroscopic equipment without the purchase of additional hardware.

Evaluation of the prone position in digital subtraction angiography of the kidneys

In visualizing the kidneys and renal arteries, the digital subtraction angiography (DSA) image is degraded by peristalsis and overlying bowel gas. In 25 patients we evaluated the efficacy of the prone position to counter these technical difficulties and found that the prone position offers visualization superior to the supine, especially in obese and uncooperative patients and those with abundant bowel gas. We advocate that prone imaging be included routinely in renal DSA.