Heterogeneity of enterochromaffin cells within the gastrointestinal tract.

Enterochromaffin cells were the first endocrine cells of the gastrointestinal tract to be chemically distinguished, almost 150 years ago. It is now known that the chromaffin reaction of these cells was due to their content of the reactive aromatic amine, 5-hydroxytryptamine (5-HT, also known as serotonin). They have commonly been thought to be a special class of gut endocrine cells (enteroendocrine cells) that are distinct from the enteroendocrine cells that contain peptide hormones. The study by Martin et al. in the current issue of this journal reveals that the patterns of expression of nutrient receptors and transporters differ considerably between chromaffin cells of the mouse duodenum and colon. However, even within regions, chromaffin cells differ; in the duodenum there are chromaffin cells that contain both secretin and 5-HT, cholecystokinin and 5-HT, and all three of secretin, cholecystokinin, and 5-HT. Moreover, the ratios of these different cell types differ substantially between species. And, in terms of function, 5-HT has many roles, including in appetite, motility, fluid secretion, release of digestive enzymes and bone metabolism. The paper thus emphasizes the need to define the many different classes of enterochromaffin cells and relate this to their roles.

The hypoechoic band: a normal finding on testicular sonography.

High-resolution sonograms were obtained in 119 patients in whom intrascrotal disease was suspected on the basis of history and physical findings. In 20 of these patients, a total of 22 conspicuous hypoechoic intratesticular bands (18 unilateral and four bilateral) were seen in the middle third of the testicle on scans obtained axially or slightly oblique to conventional axial scans. The bands were up to 3 mm wide and 3 cm long. The bands were on the side with suspected disease in six patients. Of these, three patients had a small epididymal cyst, one had a mild hydrocele, and two had no other sonographic finding. The remaining 16 bands were on the side opposite that with clinically suspected disease and were seen in otherwise normal testes. Follow-up examination in 11 of the 20 patients with the band showed no change. In four of eight patients examined with pulsed Doppler sonography, a normal low-resistance waveform was seen that was characteristic of intratesticular arteries (with gradual descent after peak systole and relatively high diastolic flow). In three of these patients, color Doppler imaging corroborated the presence of arterial flow, which did not fill the entire width of the band, thus suggesting an additional venous component of lower velocity in the band. Identification of flow in only half the cases may have been caused by the limitations in sensitivity of the equipment. We conclude that the hypoechoic bands noted on gray-scale testicular sonography are caused by a normal variant of intratesticular vessels, artery and vein, and that they are of no clinical significance.

Sonography of autonomous follicular ovarian cysts in precocious pseudopuberty.

Isolated follicular cysts of the ovary without elevated gonadotropin levels can occur as the primary source of early pubertal changes in young girls. To date, cyst excision or oophorectomy have been the treatments of choice. We studied three girls aged 5 to 8 7/12 years who presented with sexual precocity and revealed autonomous functioning ovarian cysts (2.2 to 5.5 cm). Clinical signs subsided following resection of the cyst in one case and after regression of the cyst documented by ultrasonography in the other two cases. On the basis of these three cases, we believe ultrasonography can be valuable in the workup of sexual precocity caused by primary ovarian cysts. Given that the spontaneous resolution of such cysts is possible, close clinical follow-up of unequivocally benign-appearing large ovarian cysts in young girls with pubertal changes deserves consideration.

Intestinal duplication in a patient with neurofibromatosis: aid of ultrasound and CT scan in diagnosis.

A 5-year-old boy with neurofibromatosis is described, whose symptoms of abdominal pain and vomiting were due to an intestinal duplication. Intestinal duplication has not been previously reported as a cause of gastrointestinal symptoms in neurofibromatosis. The utilization of ultrasound and computerized tomography scan as useful modalities for the diagnosis of duplication of the bowel is described.

Sonographic findings in a case of cloverleaf skull deformity and prune belly.

A rare case of cloverleaf skull is reported that was not diagnosed in utero. The case is more unusual because it was not associated with hydrocephalus and was associated with prune belly.

In utero thickening of the chordae tendinae. A cause of intracardiac echogenic foci.

Asymptomatic hyperechoic foci were noted within the left cardiac ventricular chamber on the prenatal sonograms of 26 patients between 16 and 20 weeks of gestation. Their range of occurrence, the prenatal follow-up in 12 patients and postnatal echocardiograms in six patients, indicate a clinically insignificant congenital anomaly associated with the chordae tendinae.

Fetal gastric pseudomasses.

Discrete echogenic areas of 4-12 mm were observed in the fetal stomach on seven prenatal sonograms. The finding was incidental and solitary during the second trimester in six normal pregnancies. It was noted during the third trimester in a case of meconium peritonitis. These echogenic areas displayed a homogeneous texture. They disappeared on repeat prenatal examination in six patients who did not reveal any gastrointestinal symptoms on postnatal follow-up. Although their origin is not certain, these fetal gastric pseudomasses should be interpreted cautiously.

Increased echogenicity in the lower fetal abdomen: a common normal variant in the second trimester.

Ten cases displaying a focal area of increased echogenicity in the lower fetal abdomen on prenatal sonography are reported. This was an isolated finding in each case. Nine cases were noted early in the second trimester. The last case corresponded to a postmature gestation. In all cases, a normal lower abdomen was documented on follow-up prenatal sonography, at birth, or at autopsy. The authors believe that increased echogenicity in the lower fetal abdomen represents a normal variant that is more common than suggested by the literature. A possible explanation of this pattern is offered.

Hypercalcemia in association with mesoblastic nephroma: report of a case and review of the literature.

Hypercalcemia, often associated with certain types of adult tumors, has also been described in pediatric neoplasms. In childhood, the more common associations include lymphoma, leukemia, rhabdomyosarcoma and rarely neuroblastoma. However, recently, several infants with hypercalcemia were described having renal tumors without bone metastases. The following is a case report of a 2-month-old infant who presented with severe hypercalcemia and a large right-sided abdominal mass, which at surgery was diagnosed as a cellular mesoblastic nephroma.

Sonography after splenic embolization: the wedge-shaped acute infarct.

After undergoing therapeutic transcatheter embolization of the splenic artery for treatment of portal hypertension, 11 consecutive patients were evaluated with sulfur colloid scintigraphy and real-time sonography of the left upper quadrant to determine which method was better for follow-up evaluation of the spleen. Six splenic infarcts were documented by both imaging methods; sonography, however, demonstrated the characteristic wedge shape of the infarct in four of the six cases. There were no cases of splenic abscess formation. Sonography should be the primary method for evaluation of the spleen after transcatheter embolization and can help in planning treatment to avoid abscess formation.

Sonography of tumefactive biliary sludge.

Five patients with low-amplitude echoes taking the shape of a mass within the lumen of their gallbladders are reported. Disappearance of the mass on repeat examination in four cases and surgical proof in the fifth case established that the finding was a pseudotumor due to a collection of sludge. Knowledge of this tumefactive appearance of biliary sludge is important and should help avoid misinterpretation.