Sonographic features of mucinous biliary papillomatosis: case report and review of imaging findings.

Because of its indolent course, high recurrence rate, and risk of malignant transformation, mucinous biliary papillomatosis is an important consideration in the differential diagnosis of bile duct obstruction. We report a case of mucinous biliary papillomatosis and review the sonographic and other imaging findings previously reported in the literature. On sonography, these tumors appear as nonshadowing intrabiliary masses that are clearly defined and associated with proximal biliary dilatation. They may be multiple and associated with mucoid sludge. The imaging findings reflect the macroscopic appearance of a doughy papilliferous tumor of a bile duct. Associated findings include cholelithiasis, choledocholithiasis, and gallbladder dysplasia.

Bleomycin lung: the effect of different chemotherapeutic regimens.

A review of hard-copy computed tomography (CT) images of patients who had undergone chemotherapy for testicular teratoma revealed that the incidence of lung toxicity appeared to be lower in those who had received bleomycin by slow infusion [EBCi (3) regimen, etoposide/bleomycin/cisplatin] rather than by intravenous bolus [PVB regimen, cisplatin/vinblastine/bleomycin; BEP (5) regimen, bleomycin/etoposide/cisplatin]. This difference reached statistical significance only for PVB vs EBCi (3) (t = 2.63, P less than 0.01). Nevertheless, in view of continuing reports of mortality resulting from bleomycin-induced pulmonary fibrosis in patients receiving the drug by i.v. bolus, further exploration of these results is clearly justified.

Non-operative management of gallstones--a preliminary review.

We describe our initial experience with extracorporeal shock-wave lithotripsy, direct solvent dissolution with methyl tert-butyl ether and mechanical extraction, in 17 symptomatic patients without significant gall-bladder wall disease using existing criteria for selection. Extracorporeal shock-wave lithotripsy and mechanical extraction are promising techniques. Methyl tert-butyl ether therapy has been fraught with difficulty.

Fibrin sealant as a plug for the post liver biopsy needle track.

Some patients are at particular risk of haemorrhage after liver biopsy. We describe the use of a two-component fibrin sealant (Tisseel, Immuno) for embolising the track left after biopsy with the 18 gauge 'Biopty' needle. In our series of five cases there have been no bleeding complications. We consider Tisseel much easier to apply than previously described embolisation materials.

The accuracy of volumetric measurement of high-grade gliomas.

To assess the accuracy of volumetric measurement of high-grade intracranial gliomas by computed tomography (CT), the scans of 26 patients were studied retrospectively. Twenty patients had only pre-treatment scans while six had scans both before and after chemotherapeutic treatment. Tumour volumes were measured separately by two observers, each on two occasions. A significant intraobserver variation in volumetric measurement was encountered, as well as a systematic variation between the observers; one radiologist consistently reading higher than the other. The after treatment readings were more variable than the pre-treatment readings, and most changes in tumour volume following treatment were obscured by the intra-observer variation. This study provides further evidence of the limitations of volumetric measurement as a means of assessing the response of high-grade gliomas to treatment.

The investigation of painless haematuria--a comparison of intravenous urography and DMSA scintigraphy.

In order to test in a prospective study the suggestion that there should be a shift from the intravenous urogram to DMSA scintigraphy for the diagnosis of suspected renal masses, both investigations were performed in 63 patients with painless haematuria. While the sensitivity of both investigations was similar in renal lesions, specificity was slightly less for scintigraphy. These findings, together with the intrinsic limitations of the DMSA scintigram in detecting lesions elsewhere in the urinary tract, lead us to conclude that the intravenous urogram should remain the initial investigation for painless haematuria unless there are specific contraindications.

Circumferential para-aortic masses: computed tomographic observations.

Of 59 patients in whom computed tomography (CT) demonstrated large para-aortic masses engulfing the aorta, lymphoma was responsible in 32 (54%). In 22 (69%) of these 32 patients the mass appeared confluent while in 10 some nodularity could be discerned. Thirty-five of the 59 patients were known to have an underlying malignancy at the time of the CT; in every case the underlying malignancy proved to be responsible for the mass. Amongst 24 patients in whom the CT abnormality was found in the course of initial diagnosis, lymphoma proved to be responsible in 11 (46%), periaortitis in 4 (17%) and various malignancies in 9 (38%). In none of the patients with periaortitis was the aorta displaced from the vertebral body. The combination of such aortic displacement and mesenteric lymphadenopathy is highly characteristic of non-Hodgkin's lymphoma. Knowledge of these results should assist the choice of the appropriate type of biopsy in this situation.