Communicating oesophageal duplication.

Oesophageal duplications are rare congenital abnormalities. Most of them do not communicate with the oesophageal lumen. We present a very uncommon finding of communicating oesophageal duplication in which the connection between the oesophagus and its duplicate portion was demonstrated by CT.

Primary cricopharyngeal dysfunction: treatment with balloon catheter dilatation.

BACKGROUND: Primary cricopharyngeal dysfunction (PCD) is a rare, idiopathic, functional disorder of the upper esophageal sphincter, characterized by dysphagia, frequent aspiration, and functional narrowing at the level of the upper esophageal sphincter. METHODS: Five of 29 patients with oropharyngeal dysphagia were found to have PCD. Patients presented with severe dysphagia and predisposition to aspiration. Radiography demonstrated narrowing at the level of the upper esophageal sphincter and aspiration. An endoscope could be introduced into the esophagus in only 2 patients before dilation. OBSERVATIONS: In contrast to organic stenoses, these functional upper esophageal sphincter stenoses were dilated without difficulty with a balloon catheter. After low-pressure (1.5-2 atm) progressive balloon dilation (to 20 mm), superficial mucosal injury was observed only in one patient. After dilatation, symptoms resolved and barium swallow demonstrated normal passage through the upper esophageal sphincter. During a mean follow-up of 21 months (7-33), redilation was necessary in only 1 case. CONCLUSIONS: Balloon catheter dilatation of PCD is minimally invasive and provides both important diagnostic information and effective therapy. It should be the first choice of therapy for PCD.

[Common bile duct tumor in a young woman with ulcerative colitis]. / Ductus choledochus-tumor kialakulása fiatal colitis ulcerosás nóbetegben.

Bile duct carcinoma is a rare complication of ulcerative colitis. In most of the cases it tends to occur together with primary sclerosing cholangitis predominantly in older males. The authors report a case of a 25 year old woman presenting with jaundice, 6 years after the diagnosis of colitis was made. The cause of the extreme extra- and intrahepatic bile duct dilation was revealed by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography showing polypoid tumor in the common bile duct. The histological result taken during the surgical exploration proved the diagnosis of adenocarcinoma. Radical pylorus preserving pancreato-duodenectomy was performed. Subsequently adjuvant chemotherapy was instituted according to the PAV protocol. This rare case proves, that a malignant bile duct tumor may develop in a young patient with ulcerative colitis without the presence of primary sclerosing cholangitis. The authors emphasise the connection between ulcerative colitis and bile duct carcinoma and the importance of the close follow-up of every patient with ulcerative colitis.

[Primary cricopharyngeal achalasia and its dilatation with balloon catheter]. / Primer cricopharyngealis achalasia és ballonkatéteres tágító kezelése.

The primary cricopharyngealis achalasia (PCA) is a very uncommon functional disorder of the upper oesophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and impaired relaxation of the UES. It should be differentiated from diseases of neuromuscular and ENT origin, from organic causes and other types of cricopharyngeal dysfunction. On suspected oesophageal inlet stenosis, swallow x-ray studies using water-soluble contrast material is performed, followed by oesophagoscopy. If the endoscope cannot pass into the oesophagus, balloon dilatation is performed to reach a diameter of 12-15 mm. This facilitates the passing of the endoscope and helps ruling out organic causes. If the stenotic segment dilates easily, the mucosa is intact, and no mechanical obstruction is discovered, then UES manometry is performed to differentiate from other motility disorders. Extraluminal causes are excluded using endosonography and CT. If PCA is diagnosed, low-pressure (1-1.5 atm) balloon dilatation is continued under fluoroscopic control until a lumen diameter of 18-20 mm is obtained. Efficacy of dilatation is assured clinically as well as with endoscopical, barium swallow and manometric studies. Five out of 28 patients with pharyngo-oesophageal dysphagia were found to have PCA. Patients presented with severe dysphagia and a predisposition to aspiration. The radiographic examination demonstrated stenosis at the UES level, and aspiration. It was possible to introduce the endoscope into the oesophagus only two of the five patients before the dilatation. The manometry was not pathognomonic, its value did not achieve the expectations. In contrast with organic stenoses, UES dilated easily using balloon catheter. Thereafter, the endoscope passed smoothly through the UES in each of cases. Following progressive dilatation--with low pressure (1.5-2 atm) up to 20 mm in diameter-, superficial mucosal damage was observed in one patient only. Patients' complaints ceased after treatment, and the barium swallow showed normal passage. Redilatation was necessary only in one case after following 21 (7-33) months. The authors supposed that the gastrooesophageal reflux plays role in the pathogenesis of PCA. Balloon catheter dilatation is an important diagnostic and at the same time effective, first choice, minimal invasive therapeutic method in PCA.

Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance.

Most intra-abdominal and other types of fluid collections are now successfully drained percutaneously under image guidance. The utility of percutaneous drainage of tuberculous abscesses, especially those associated with osseous changes, is, however, less well established. Six patients with tuberculous iliopsoas abscesses were successfully managed by percutaneous drainage combined with antituberculous therapy. The abscesses were bilateral in one patient and unilateral in the other five. Drainage was by needle aspiration under ultrasound (US) guidance in one patient, and by catheter under CT guidance in the other patients. Three patients had associated osseous changes. There were no procedural complications. Tuberculous iliopsoas abscess can be successfully treated by percutaneous drainage and appropriate antituberculous therapy.

Appearances of paranasal fungal sinusitis on computed tomography.

The primary invasive granulomatous form of fungal sinusitis, due to inhalation of aspergillus spores, is commonest in the Sudan and the Gulf states. This condition often presents clinically as a chronic, severe sinusitis which has not responded to antibiotics. On CT scanning, the major feature is a soft tissue mass, which is either homogeneous or has lower attenuation components. There may be erosion or expansion of the bony margins of the sinuses. Intraorbital and/or intracranial extension sometimes occur.

Extrarenal angiomyolipomas of the perinephric space in tuberose sclerosis.

A case of bilateral angiomyolipomas of the perinephric space in a young Arab woman with tuberose sclerosis is reported. Multiple small angiomyolipomata were present in both kidneys and there was pulmonary involvement. The literature on this very rare occurrence is briefly reviewed.

Local recurrence of rectal cancer following preoperative irradiation.

The authors investigated local recurrence of rectal cancer in patients' groups preoperatively irradiated (40-50 Gy) or treated by surgery alone. In advanced disease both treatment groups were administered postoperative chemotherapy, too. Local recurrence was observed in 30.2% in patients treated by surgery alone, while it dropped to 11.65% in the patients' group subjected to radiation therapy prior to surgery (p < 0.05). Impairment of degree of differentiation resulted in an enhanced number of recurrences in both groups, even if they appeared later in irradiated patients.

[Sneddon syndrome as a clinical manifestation of the antiphospholipid antibody syndrome]. / Sneddon-syndroma mint az antiphospholipoid antitest syndroma klinikai megnyilvánulása.

A 39 year old female patient has had reticular skin lesions showing the clinical picture of livedo racemosa for 7 years. Her medical history revealed cerebrovascular disease. In the background of livedo racemosa no systemic disorder could be detected, so the authors considered their case to be Sneddon's syndrome. In the serum of the patient antiphospholipoid antibodies (high anticardiolipin antibody titer, factor lupus anticoagulant) could be detected so the diagnosis mentioned in the title seemed to be correct.

[Neurologic complications during chemotherapy of children with acute lymphoid leukemia]. / Központi idegrendszeri szövödmények akut lymphoid leukaemiás gyermekek chemotherapiás kezelése során.

The case histories of two patients with acute lymphocytic leukemia, who developed central nervous system complication during combined chemotherapy are described. The neurological picture could be characterized by symptoms of headache, mental deterioration, hemiparesis and seizures. Following L-asparaginase administration one patient had intracranial thrombosis with focal seizures and hemiparesis associated with clotting abnormalities, including severe hypofibrinogenemia and decreased antithrombin III activity. In the other patient, it was after intrathecal administration of Methotrexate when mental deterioration associated with the symptoms of progressive leukoencephalopathy occurred. It arises the possibility that with increasing complexity of combined chemotherapy the occurrence rate of neurological complications will also increase.

[Diagnostic imaging of the subdiaphragmatic lymphatic system in malignant lymphoma: confusion of abundance?]. / A rekesz alatti nyirokrendszer képalkotó diagnosztikája malignus lymphomákban: a böség zavara?

Staging of malignant lymphomas, monitoring of response to therapy and regular follow-up of treated patients can properly be performed by new diagnostic imaging modalities. Diagnosis of subdiaphragmatic nodal involvement by ultrasonography and computed tomography is based on enlargement of lymph nodes. Lymphography is the only method which can depict pathologic internal architecture in normal sized lymph nodes. Of 82 patients there were 72 on admission without known subdiaphragmatic nodal disease. Of these 22 (30.5%) were found to have nodal involvement in this region. Suggested diagnostic algorhythm is shown on flow diagram.

[Incidence of internal carotid artery thrombosis and disseminated intravascular coagulopathy in the early stages of acute myeloid leukemia]. / Arteria carotis interna thrombosis és disseminált intravascularis coagulopathia (DIC) elöfordulása akut myeloid leukaemia kezdetén.

The case history of a 15 year old boy in whom thrombosis of the internal carotid artery was associated with severe disseminated intravascular thrombosis (DIC) is described. Both peripheral blood smear and bone marrow aspirate revealed acute myelogenous leukemia FAB M-2 type as the cause of the disease. Consumption coagulopathy is common sign of hemostasis disturbances in leukemia. It is frequently observed in acute promyelocytic leukemia, but rarely it may be seen in the other forms of hemoblastosis, too.

Ewing's sarcoma in the occipital bone. Case report.

The head is a very rare primary site for Ewing's sarcoma which occurs most often in the long bones of the extremities and in the pelvis. This report describes an unusual case of Ewing's sarcoma arising from the occipital bone in a seven year old girl. The tumour compressed the venous sinuses, thus lowering the intracranial pressure resulted in temporary recovery which made the diagnosis difficult.

Renal cell carcinoma: value of imaging examinations in diagnosis and staging.

Authors analyse the value of intravenous pyelography, ultrasonography, computed tomography, angiography and fine needle aspiration biopsy in the detection, differentiation and staging of renal space-occupying lesions, on the basis of examinations performed in 158 patients, in comparison with results of surgery and/or clinical follow up. Their conclusion is that ultrasonography plays a major role in the detection and differentiation of these lesions, intravenous pyelography is only a complementary method, while computed tomography can provide diagnosis in cases with uncertain ultrasonographic findings. Staging has to be based on computed tomography. The role of angiography and fine needle aspiration biopsy is limited they need to be performed in a few selected cases only.