Neuronal Intestinal Dysplasia in an Infant: Case Report

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.

Neuronal Intestinal Dysplasia in an Infant: Case Report

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.

The Effects of Erythromycin in Small-Bowel Follow-through

PURPOSE: To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). MATERIALS AND METHODS: We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. RESULTS: Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspen-sion and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4 points), but mean SBTT was not sig-nificantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. CONCLUSION: EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying.

Zollinger-Ellison Syndrome: A Case Report

Zollinger-Ellison syndrome (ZES) involves hypergastinemia produced by a gastrin-secreting tumor. Not only can it cause an ulcer but may also behave as a malignant lesion, metastasizing to the liver or other organs. The development of potent antisecretory agents for controlling acid secretion as well as techniques for localizing these islet cell tumors, has led to greatly improved survival rates. We describe a case of Zollinger-Ellison syndrome, emphasising the radiologic findings, and including a review of the literature.

Small Bowel Enteroclysis Using a Hemodialysis Blood Pump

PURPOSE: To describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. MATERIALS AND METHODS: Over a 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in132 patients using a hemodialysis blood pump. Following intubation of the proximal jejunum, barium at a dilutionof 50% and 0.5% methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spotfilms of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopitime and complications were evaluated. RESULTS: Only two of 135 examinations (1.5%) failed due to lack ofcooperation by the patient. Rates of good distensability were 97.6% in the proximal portion, 91.2% in the minportion and 52% in the distal portion and rates of good transparency were 96%, 84% and 56% respectively.Transparency and distensability of the small intestine were better in proximal than distal small bowel. Theradiographs showed positive findings in 25% of cases. The mean fluoroscopic time was 21 min, 10 sec(8min,22sec-57min, 30sec). No major complication was found during or after exam ination. CONCLUSION: It spite of thelong fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation ofsmall bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographsof good quality.

Modified Small Bowel Follow-through Using Methylcellulose After Administration of Barium Suspension :Comparison with Conventional Series

PURPOSE: To compare modified small bowel follow-through (SBFT) using methylcellulose after the administrationof barium suspension with a conventional series. MATERIALS AND METHODS: In order to evaluate small bowelpathology, modified SBFT was performed in 155 patients during a 15 month period. All patients received 600mL ofmethylcellulose ; 98 had taken 250mL of 40% wt/vol barium suspension and 57 had taken 150mL of 70% barium. For thegroup of 98, the barium suspension was prepared by mixing barium powder with water (n=46) or with methylcellulosein(n=52). For comparison with a modified series, 49 patients who underwent conventional SBFT using 500mL of 40%wt/vol barium were lso included. Image quality was rated by three radiologists as "poor", "fair", "good", or"excellent". We analyzed the relationship between image quality, transit time and small bowel pathology;the sensitivity and specificity of each technique was also determined. RESULT: Among the four techniques, modifiedSBFT with 250mL of 40% wt/vol barium suspension, prepared by mixing barium powder with methylcellulose, showed thebest image quality ["excellent" result in 33 of the 52 patients (63%)] and shortest transit time to the cecum. Thehigh image quality of this technique was not affected by the presence of small bowel pathology;its use resulted inthe lowest incidence and slowest development of flocculation. The sensitivity (91-95%) of the three modified SBFTprocedures was superior to that of a conventional series(76%), but there was no difference in specificity. CONCLUSION: Modified SBFT using methylcellulose after administering barium suspension with barium powder as amixing agent is a simple technique. Its use easily improves the image quality and diagnostic accuracy of peroralSBFT.

Qualitative Analysis of Barium Particles Coated in Small Intestinal Mucosa of Rabbit by Using Scanning ElectronMicroscopy

PURPOSE: To qualitatively analyse barium coating status in the intestinal mucosa, we used scanning electronmicroscopy to observe barium particles coated in the small intestinal mucosa of rabbit, and we attempted to assessthe relationship between electron microscopic findings and radiographic densities. MATERIALS AND METHODS: Sixdifferent combinations of barium and methylcellulose suspensions were infused into the resected small intestinesof 15 rabbits. Barium powders were mixed with water to make 40% and 70% w/v barium solutions, and also mixed with0.5% methylcellulose solution to make 40% and 70% w/v barium-methylcellulose mixtures. 0.5% methylcellulosesolutions were used as a double contrast agent. After the infusion of barium suspensions, a mammography unit wasused to obtain radiographs of the small intestine, and their optical densities were measured by a densitometer.Thereafter, photographs of barium-coated small intestinal mucosa were obtained using a scanning electronmicroscope (x8,000), and the number of barium particles in the unit area were measured. To compare therelationship between the electron microscopic findings and optical densities, statistical analysis using Spearmancorrelation was performed. RESULTS: With a Spearman coefficient of-0.544, correlation between the number of smallbarium particles of less than 1 micrometer and optical densities was statistically significant(p<0.05). CONCLUSION: Thisstudy shows that by using scanning electron microscopy, barium particles coated on the small intestinal mucosa canbe qualitatively analysed. It also shows that the number of small barium particles measured by scanning electronmicroscopy is related to optical densities.

Kaposi's Sarcoma of the Small Intestine After Renal Transplantation: Radiological and Endoscopic Findings

A case of Kaposi's sarcoma involving the small bowel two years after receiving a renal transplant is described. Immunosuppression had been achieved using cyclosporine A and prednisolone. Lesions extended from the duodenum to the ileum ; radiologically, they were demonstrated on small bowel follow-through study and computed tomography as multiple small nodular intraluminal masses with or without central umbilication, and endoscopically, were seen as intramural mucosal elevations with a central crater-like ulceration.

Kaposi's Sarcoma of the Small Intestine After Renal Transplantation: Radiological and Endoscopic Findings

A case of Kaposi's sarcoma involving the small bowel two years after receiving a renal transplant is described. Immunosuppression had been achieved using cyclosporine A and prednisolone. Lesions extended from the duodenum to the ileum ; radiologically, they were demonstrated on small bowel follow-through study and computed tomography as multiple small nodular intraluminal masses with or without central umbilication, and endoscopically, were seen as intramural mucosal elevations with a central crater-like ulceration.

Use of methylcellulose in Small-Bowel Follow-Through Examination: Comparison with Enteroclysis and Conventional Series in Normal Subjects

PURPOSE: To evaluate the efficacy of a modified small bowel follow-through (SBFT) and to optimize this technique. MATERIALS AND METHODS: Ninety-nine subjects without small bowel pathology underwent modified SBFT using oral administration of methylcellulose after taking 100ml of 120% or 100, 150, or 200ml of 70% barium. Thirty-three and 39 normal subjects undergoing enteroclysis or conventional SBFT, respectively, were also evaluated for comparison of image qualities and transit time. RESULTS: Enteroclysis was the most successful ofthree types of small bowel examination for obtaining the best quality of bowel transradiency and distension. Modified SBFT was, however much superior to the conventional series for obtaining good bowel transradiency and rapid transity time (mean, 37-49 minutes). The use of 150ml of 70% barium was better than the other three modified techniques in achieving good bowel transradiency, rapid transit time, and less flocculation. CONCLUSION: Our modified SBFT is a simple and safe method for easily improving bowel transradiency and transit time.