The inflammatory abdominal aortic aneurysm. Prevalence, clinical features and diagnostic evaluation.

Eight patients with an inflammatory abdominal aortic aneurysm are described. They constituted 3.1% of all aortic aneurysms operated in the period 1981-1990. All presented with abdominal complaints and/or backache, and an elevated erythrocyte sedimentation rate (ESR); 3 had significant weight loss. The discovery of the aneurysm was considered a non-related finding except for 2 patients for whom the correct diagnosis was suggested by CT scan. Except for the aortic dilatation, the clinical and histopathological features of the inflammatory aneurysm resembled those of idiopathic retroperitoneal fibrosis with obstruction of the ureters and involvement of the duodenum by extensive perianeurysmal inflammation with infiltrates of mononuclear leukocytes and varying degrees of fibrosis. Although the triad of abdominal complaints and/or backache, an elevated ESR and weight loss has been proposed to suggest the diagnosis, the positive predictive value of these parameters was at best 22%. Additional studies, including CT scan, have to be performed to exclude, among other factors, vasculitis. Treatment should aim at repair of the aneurysm. Resolution of the inflammatory process after operation is frequently observed. Immunosuppressive therapy should only be used with caution, considering the possible increased risk of rupture.

The impact of intraoperative ultrasonography of the liver on the surgical strategy of patients with gastrointestinal malignancies and hepatic metastases.

Intraoperative ultrasonography (IOUS) of the liver is a very useful tool during surgery for gastrointestinal tumors or hepatic tumors. In a prospective study of 82 elective operations for 57 gastrointestinal tumors and 25 hepatic tumors or metastases, we compared IOUS with preoperative ultrasonography, CT-scanning and MRI. IOUS supplied additional information in 38% of the operations. In 22% of the cases, this had a major impact on the intraoperative strategy with an alteration of the procedure. IOUS has a higher detection rate of intrahepatic lesions, discriminates better between solid or cystic nature of the tumor and offers the possibility of performing a safe and radical hepatic resection by its ability to localize lesions in relation to vascular structures. IOUS is a safe and simple technique which will be more cost-effective than extensive preoperative evaluation of the liver. It provides a more complete clinical staging of patients for whom adjuvant therapy is considered after resection of a colorectal carcinoma.

Bilateral excision of perinephric fat and fascia (Gerota's fasciectomy) in the treatment of intractable chyluria.

A case is described of a 59-year-old black man with massive chyluria, probably due to previous infection with Wuchereria bancrofti. Notably, no edema was present despite a urinary protein loss of 40 gm. per day resulting in a serum albumin level of 13 gm./l. Conservative treatment after lymphography, including prolonged bedrest and a medium chain triglyceride diet, was unsuccessful. Bilateral excision of the perinephric fascia and fat (Gerota's fasciectomy) in 2 separate operative sessions finally resulted in complete resolution of the chyluria.

Intra-operative ultrasonography of the liver: a prerequisite for surgery of colorectal cancer?

The results and consequences of intra-operative ultrasonography of the liver were studied in 50 patients who had laparotomy for colorectal cancer. Compared with preoperative imaging techniques like US, CT and MRI, intra-operative US had a higher sensitivity for intrahepatic lesions. Especially in case that adjuvant therapy could have been considered, intra-operative US gave relevant information in 10 patients (20%) by altering the stage of the primary tumour. Four of the 50 patients showed more liver metastases at intra-operative US than detected by preoperative imaging techniques. Resectional therapy of liver metastases could be prevented in these four patients. We advise intra-operative US as routine for all patients undergoing laparotomy for colorectal cancer especially if adjuvant chemotherapy is considered. When surgery is scheduled extensive preoperative liver examination can be avoided if intra-operative US is available.

Occult metastatic neck disease: detection with US and US-guided fine-needle aspiration cytology.

The authors performed a prospective study of the value of ultrasonography (US) and US-guided fine-needle aspiration cytology (FNAC) for assessment of N0 lesions in the neck. Preoperative US was performed in 107 patients with squamous cell carcinoma of the head and neck, who underwent 132 elective neck dissections. During the US examination of the last 54 patients, who underwent 70 elective neck dissections, US-guided FNAC was performed. US alone was found to be an unreliable method for detecting occult lymph node metastasis; the accuracy never exceeded 70% (93 of 132), with a sensitivity of 60% (32 of 53) and a specificity of 77% (61 of 79). In contrast, US-guided FNAC had an accuracy of 89% (62 of 70), a sensitivity of 76% (25 of 33), and a specificity of 100% (37 of 37). Because of the high sensitivity and specificity of US-guided FNAC for the assessment of the N0 neck, this modality may play an important role in directing treatment of these patients in the future.

Scoliosis as cause of pulmonary atelectasis.

We present a patients with persistent position-dependent productive cough and intermittent fever. He was first examined at 38 yrs of age. Chest X-ray showed a severe thoracic lordoscoliosis and an atelectasis of the right lower lobe. Bronchography revealed a total stenosis of the right lower lobe bronchus. Five years later had increased symptoms. Spirometry showed total lung capacity (TLC) 3.8 l (predicted value 6.7 l), forced vital capacity (FVC) 2.6 l (4.8 l) and forced expiratory volume in one second (FEV1) 1.7 l (3.9 l). Bronchoscopy demonstrated a smooth stenosis of the right lower lobe bronchus but the stenosis could be passed through with a brush. Computed tomographic scanning demonstrated compression of the right lower lobe bronchus and the atelectasis. After surgical removal of the right lower lobe, all symptoms disappeared. Histological examination of the right lower lobe revealed fibrosis and chronic inflammation.

Detection and characterization of metastatic cervical adenopathy by MR imaging: comparison of different MR techniques.

Thirty-five patients scheduled to undergo a neck dissection for squamous cell carcinoma of the head and neck were evaluated preoperatively by magnetic resonance (MR) imaging. Axial and occasionally sagittal and coronal images were obtained. To define the most reliable technique to detect cervical lymph node metastasis, we compared several MR pulse sequences with and without Gd-DTPA administration to histopathologic findings in the neck dissection specimens. T1-weighted spin echo combined with T2-weighted gradient recalled echo (GE) sequences were found to be more useful than any other combination of pulse sequences in localizing lymph nodes. On T2-weighted GE images, lymph nodes were depicted with intermediate to high signal intensity in contrast to low signal muscular and fatty tissue. Gadolinium DTPA enhanced T1-weighted GE images reliably depict central lymph node necrosis, the most specific criterion for lymph node metastasis.

Percutaneous transcatheter embolization of symptomatic renal angiomyolipomas: a report of four cases.

Successful percutaneous transcatheter embolization of renal angiomyolipoma is reported in four female patients. The angiomyolipomas measured more than 4 cm in diameter. Three patients had severe haemorrhage and one patient had a growing angiomyolipoma in a solitary kidney. This patient had percutaneous transcatheter embolization to prevent further deterioration of kidney function. Three patients had multiple renal angiomyolipomas as part of tuberous sclerosis. Two of them had selective transcatheter embolization of more than one angiomyolipoma. After embolization, one patient had partial loss of kidney function and one patient developed an abscess that could successfully be drained percutaneously under ultrasound guidance. The following conclusions can be drawn. All patients with tuberous sclerosis should be screened for renal angiomyolipomas. All symptomatic renal angiomyolipomas and all angiomyolipomas that measure more than 4 cm in diameter require treatment. Embolization should be considered as a primary therapeutic modality for multiple angiomyolipomas.

Defecography in patients with anorectal disorders. Which findings are clinically relevant?

To evaluate the results and clinical impact of defecography in patients with anorectal disorders, 100 results of defecographic examinations from 92 patients were reviewed. The defecographic results were screened for the anorectal angle, defined both at rest and during straining, perineal descent, and abnormalities of the rectal configuration during straining. Anal manometry, saline infusion test, rectal capacity measurement, and anal electromyography (EMG) were also performed. There was a significant difference (P less than 0.001) both at rest (22 degrees) and during straining (12 degrees) between the two anorectal angle measurements. Incontinent patients had a larger anorectal angle, both at rest and during straining, than continent patients (P less than 0.04), but with a large overlap. The anorectal angle was not influenced by gender or age. An abnormal rectal configuration was found in 62 defecographic examinations. From the 8 patients with rectopexy performed for a large rectocele or intussusception, incontinent patients with an intussusception had the best results. In four patients, anal EMG showed an increased activity of the external sphincter during straining. Two of these four patients had abnormal defecograhic results. No correlations were found between anorectal angle and the other function tests. In conclusion, the anorectal angle lacks clinical relevance. In patients with defecation problems, defecography may be indicated whenever other investigations (physical examination, anal manometry, anal EMG) have excluded local pathology or a spastic pelvic floor syndrome. In these situations, defecography could detect an intussusception, which could easily be treated with rectopexy.

Moyamoya disease associated with renovascular hypertension.

This is a report of a case history of a child with cerebral Moyamoya disease and gradual development of systemic hypertension. Sodium depletion combined with enalapril induced renal failure. A bilateral renal artery stenosis was found. Percutaneous transluminal angioplasty was not successful and was followed by autotransplantation of both kidneys. Histopathological examination of the renal arteries revealed intimal hyperplasia.

Dacryocystography after paranasal sinus surgery.

The influence of nasolacrimal duct dissection and irradiation of the lacrimal system on lacrimal drainage were assessed. Findings at dacryocystography, in correlation with the results of dye tests and symptoms, are presented. Lacrimal drainage obstruction was demonstrated in one of 10 patients after paranasal sinus surgery not followed by irradiation and in four of 10 patients in which surgery was followed by irradiation.

The immediate effect of nitroglycerin on total body blood volume distribution in patients with congestive heart failure: a non-invasive study.

The effect of sublingually administered nitroglycerin (0.5 mg) on distribution of blood volume in 16 patients with congestive heart failure (NYHA class II and III), randomly assigned to placebo (N = 8) or nitroglycerin (N = 8) was studied 20 minutes after in vivo labelling of red blood cells with 99m-Tc pertechnetate. Count rates over thorax, abdomen and legs were collected with a large field gamma camera and expressed as percentage changes of baseline value. Changes in count rates, averaged for 5, 10 and 15 minutes after drug administration showed a significant decrease in the nitroglycerin group as compared to the placebo group over the thorax (mean 5%, P less than 0.01) and over the liver (mean 5%, P less than 0.05) and a significant increase over the abdomen (mean 4%, P less than 0.01) and the legs (mean 9%, P less than 0.01). After nitroglycerin, the changes in pulmonary activity were variable and did not differ from the placebo group. These results indicate that nitroglycerin causes a redistribution of blood volume in patients with congestive heart failure. An increase in the vascular capacitance in the abdomen and legs may be responsible for a decrease of blood volume of the thorax and the liver in these patients.

Diagnosis of deep venous thrombosis with 99mTc plasmin using the gamma camera.

The 99mTc-plasmin-uptake test is a screening test for deep vein thrombosis with a reported sensitivity of 91%-100% and a rather low specificity of 33%-51%. In trying to improve the qualities we used gamma camera imaging and compared the results with those of the standard probe techniques and X-ray venography. In 34 patients, 23 thromboses were detected by venography. The probe technique had a sensitivity of only 75% and the gamma camera technique 100%. The specificity of both techniques was about the same (36% and 50%). A diffuse rather than focal accumulation of radioactivity was seen by the gamma camera technique, indicating that the plasmin test is not based on the detection of hot spots.

High pressure liquid chromatographic determination of mono- and disaccharides in presweetened cereals: Collaborative study.

A collaborative study was conducted using a modified AOAC method (sugars in chocolate) for the determination of fructose, glucose, sucrose, and maltose in presweetened cereals by high pressure liquid chromatography (HPLC). Eight samples consisting of 6 products were analyzed in duplicate by the HPLC method and the AOAC Lane-Eynon method. The AOAC method was modified to use water-alcohol (1 + 1) and Sep-Pak C18 cartridges for sample cleanup. The HPLC results indicate precision comparable to the lane-Eynon method and the chocolate method. The modified HPLC method has been adopted official first action.

[The ketone bodies in the hemolymph of Biomphalaria glabrata under starvation and infection with Schistosoma mansoni (author's transl)]. / Der Einfluss von Hunger und Infektion mit Schistosoma mansoni auf den Ketonkörpergehalt der Hämolymphe von Biomphalaria glabrata.

The metabolism of the snail Biomphalaria glabrata stressed by five days' starvation as well as by infection with Schistosoma mansoni was examined with regard to the metabolism of ketone bodies. Previous studies in the metabolism of this host--parasite relationship always resulted in changes in the same direction with starvation as well as with infection. Contrary to that the concentration of acetoacetate and beta-hydroxybutyrate measured in the hemolymph decreased significantly with starvation but increased significantly with infection. The following problems concerning the ketone body metabolism are discussed: on the one hand the differences between infected and starved snails, and on the other hand the differences between the snails and the mammals as well as in the invertebrates so far investigated.

A model for plate tectonic evolution of mantle layers.

In plate tectonic theory, lithosphere that descends into the mantle has a largely derivative composition, because it is produced as a refractory residue by partial melting, and cannot be resorbed readily by the parent mantle. We suggest that lithosphere sinks through the asthenosphere, or outer mantle, and accumulates progressively beneath to form an accretionary mesosphere, or inner mantle. According to this model, there is an irreversible physicochemical evolution of the mantle and its layers. We make the key assumption that the rate at which mass has been transferred from the lithosphere to the mesosphere is proportional to the rate of radiogenic heat production. Calculations of mass transfer with time demonstrate that the entire mass of the present mesosphere could have been produced in geologically reasonable times (3 x 10(9) to 4.5 x 10(9) years). The model is consistent with the generation of the continental crust during the last 3 x 1O(9) years and predicts an end to plate tectonic behavior within the next 10(9) years.