Uriel Kleinhaus

Gallium 67 imaging in monitoring lymphoma response to treatment

The value of gallium 67 (Ga) imaging in monitoring lymphoma response to treatment was assessed in 25 patients with Ga‐avid tumors and compared to body computed tomography (CT), chest radiographs, and palpation of tumor infiltrated peripheral lymph nodes. Ga imaging was negative in 95% (20/21) of the patients who were clinically considered to be in remission and in whom treatment was stopped. The disease did not recur during a follow‐up of 12 to 26 months in 15 patients. Six patients developed recurrence of the disease 3 to 12 months after treatment was stopped. In all six patients Ga imaging became positive again at the time of the appearance of active disease. In the group of patients in remission, CT was negative in 57% (11/19), chest x‐rays in 55% (6/11) and peripheral lymph nodes were palpated in none of the patients (13/13). In four patients that did not achieve remission after treatment, Ga scans were positive. Ga imaging appears useful in monitoring lymphoma response to treatment. This is probably because Ga imaging monitors tumor cell viability, whereas body CT and chest radiographs show the tumor mass, which may consist of fibrotic or necrotic tissue.

Ultrasonography in Crohn's disease

Eighteen patients with acute and subacute Crohns disease were examined by ultrasound. In 7, ultrasound was the initial screening procedure leading to the diagnosis of Crohns disease. This diagnosis was subsequently proved by results of barium studies. The most frequent ultrasonographic finding was conglomeration: an irregular mass containing scattered echodense and sonolucent areas that represented matted inflamed bowel loops. Some of the conglomerations showed a fine diffuse echo pattern with ill-defined posterior borders due to poor transmission. These areas denoted mesenteric fat covering the matted loops (fatty conglomeration). Other ultrasonographic findings were the “target” or “bulls eye” sign, abscess formation, and fluid in the cul-de-sac.

Computed tomography in the preoperative evaluation of gastric carcinoma

Computed tomography (CT) of the abdomen was done in 49 patients with gastric carcinoma. These cases were retrospectively staged and evaluated as to operability. Various staging parameters were also evaluated separately. The results were correlated to findings on surgery, liver scan, and cytology. Overall accuracy of CT staging and operability assessment was 72 and 82%, respectively. Among the various CT parameters, perigastric fat invasion had a positive predictive value of 91%. The demonstration of local node involvement and invasion of adjacent organs was unreliable. Since surgery is currently the only treatment for gastric carcinoma, CT staging has limited clinical value. The principal role of CT is in the assessment of operability in patients with carcinoma of the stomach.

Gastroduodenal Intussusception Secondary to Prolapsing Gastric Tumors

Gastroduodenal intussusception is a rarely documented condition that occurs secondary to a mobile leading gastric tumor that prolapses into the duodenum. Its typical radiologic presentation includes lumen narrowing, distally converging gastric folds, infolding and outpouching of the gastric wall, gastric intussusceptum presenting as a filling defect, and a leading tumor in the duodenum. The coil spring pattern, characteristic of bowel intussusception, is not a prominent feature. Two cases are presented and discussed.

Long bone growth during prolonged intermittent corticosteroid treatment and subsequent rehabilitation.

SummaryImmature A/J mice were treated for up to 7 weeks with intermittent doses of triamcinolone hexacetonide and were thereafter allowed to recover for 7 weeks. Qualitative and quantitative morphological measurements were performed on the epiphyseal cartilage plate and diaphyseal bone of the humerus. By the third injection significant structural changes were noted in the cartilaginous tissue followed by a complete cessation of bone growth. The hormonal inhibitory effect on long bone growth lasted throughout the experimental period. However, at the end of the recovery period the length of the humerus was 96% of the normal. In contrast, the humeral width at midshaft and the width of its medullary cavity revealed slower recovery, achieving only 80% of the control values. Following rehabilitation, the growth of experimental epiphyseal plates exceeded that of nontreated animals as their width and the number of hypertrophic chondrocytes were 131% and 125% of their controls respectively. Thus, in A/J mice (a highly susceptible inbred strain of mice) intermittent (every four days) administration of a long-acting corticosteroid hormone arrested endochondral and periosteal bone formation; the former, however, underwent full recovery following the termination of the hormonal treatment.

Villous tumors of the stomach.

Four cases of gastric villous tumors are presented. The radiologic features of these rare tumors in the stomach are described. Their high propensity for malignancy as compared to villous adenoma of the colon is emphasized. In 2 of 4 of our patients the villous tumors were malignant. The radiologic picture of villous tumors of the stomach is characteristic enough to suggest the diagnosis.

Rectosigmoid Pseudostenosis Due to Urinary Retention

Pseudostenosis of the rectosigmoid colon due to compression by a dilated urinary bladder may pose a diagnostic problem. Although probably quite common, it has not received much attention in the radiological literature. Four cases are presented and the radiological features on barium enema are described.

Multifocal bleeding due to anticoagulant therapy.

A 62-year-old patient on anticoagulant therapy presented with hemothorax, pulmonary hemorrhages and a high retroperitoneal hematoma with obstruction-infarction of the right kidney. Following plasma infusion and pleural drainage, the clinical condition stabilized and kidney function improved.

Computed tomography-guided percutaneous drainage of right upper abdominal abscesses.

Definitive computed tomography-guided percutaneous drainage of right upper abdominal abscesses was performed in eight patients (11 procedures). A lateral perpendicular approach was used in all cases. An Argyl trocar catheter was used in nine procedures and a pigtail catheter in two. The drainage was successful in seven patients. In one patient no drainable abscess was found.Percutaneous abdominal abscess drainage should be considered a satisfactory alternative to surgical drainage in poor-risk patients as well as in patients who have had repeated operations in whom any further surgery may be unduly difficult.