A combination of small bowel imaging methods: conventional enteroclysis with complementary magnetic resonance enteroclysis.

AIM: The aim of this prospective study was to evaluate the overall findings of conventional enteroclysis (CE) with complementary magnetic resonance enteroclysis (MRE) in small bowel disease. METHODS: The study included 32 patients referred from various clinical departments, with known or suspected small bowel disease and abnormalities on CE. Immediately after CE, true fast imaging with steady-state precession (true FISP), and unenhanced and gadolinium-enhanced T1-weighted fast low-angle shot (FLASH) sequences with fat saturation were obtained. Mucosal, mural and luminal changes of the small bowel were evaluated by each technique. In addition, bowel wall thickening, bowel wall enhancement and perienteric changes were assessed by MRE. The radiological findings obtained were evaluated together as a combination, and the role of MRE in the determination of the activity and complications of the small bowel disease was assessed. Radiological findings were correlated with clinical evaluation and follow-up in all cases, including endoscopy in 14 cases and surgery in 5 cases. RESULTS: MRE provided important supplementary mural and extramural information, including degree of pathological wall thickness, mural enhancement pattern associated with disease activity, perivisceral collection, abscess formation, mesenteric fibrofatty proliferation, lymphadenopathy and increase in perienteric vascularity. Short strictures were not revealed on MRE; however, for patients with a history of abdominal malignancy, MRE helped characterize the level of any obstruction and the extent of the disease. CONCLUSION: We recommend MRE for patients who have findings of advanced inflammatory bowel disease or neoplasm on CE examination. The combination of these two techniques can provide important information on the degree and extent of the disorder.

Retroperitoneal fibrosis caused by pergolide in a patient with Parkinson's disease.

Retroperitoneal fibrosis (RPF) is an uncommon disorder that may cause ureteric obstruction with renal damage. Pergolide, a dopaminergic agonist used in the treatment of Parkinson's disease, has rarely been related to the development of RPF. We report on a 78-year-old woman with Parkinson's disease who presented with hydroureteronephrosis and developed RPF and serosal fibrosis during treatment with pergolide. Following discontinuation of pergolide therapy and placement of a double-J stent, her renal function improved. Inflammatory markers returned to normal limits within two months and the retroperitoneal fibrotic mass became smaller.

Carotid pulsatility indices in surgical menopause.

A large body of literature is available concerning association of hormone replacement therapy (HRT) and postmenopausal women; to our knowledge, only few publications in purely surgical menopausal women. The aim of this study was to evaluate pulsatility indices (PI) of internal carotid arteries in two groups of surgical menopausal women who underwent HRT vs who did not. Measurements of the PIs of internal carotid arteries in both Groups were performed with color Doppler ultrasound. Measurements of the untreated group (n = 38, mean age = 47.10 +/- 2.45, group 1) were compared to those of treated group (n = 42, mean age = 47.35 +/- 2.37, group 2). A statistically significant increase in PIs of the carotid arteries were observed in Group 1 as compared to Group 2 in post-operative follow-up (p < 0.001). Pre- and post-operative PIs in Group 1 measured at significantly different values pre- and post-operatively (right, 0.73 +/- 0.031 vs 0.80 +/- 0.049; left, 0.73 +/- 0.030 vs 0.80 +/- 0.052) (p < 0.001). No such pre- and post-operative difference in PIs were noted among patients in Group 2 (right, 0.74 +/- 0.046 vs 0.73 +/- 0.044, p = 0.200; left, 0.73 +/- 0.04 vs 0.73 +/- 0.04, p = 0.504). When comparing both groups, no statistical difference was noted pre-operatively (right, p = 0.501; left p = 0.625); however, postoperative PIs did reveal a statistically significant difference (p < 0.05). Pre- and post-operative side-to-side differences in the PIs of internal carotid arteries were not statistically significant (group 1, 0.158 vs 0.211; group 2, 0.152 vs 0.356). In surgical menopausal women, the beneficial effects of HRT are in concordance with previous studies in terms of PI, which were performed with natural menopausal women.

Bone marrow changes adjacent to the sacroiliac joints after pelvic radiotherapy mimicking metastases on MRI.

Radiation-induced changes in the sacroiliac joints mimicking metastases on MR images were evaluated. Twelve patients who received radiotherapy to the pelvic region due to pelvic malignancy were included in the study. All patients had undergone external beam radiation therapy to the pelvic region, and 2 patients received supplementary internal radiation. The changes in the sacroiliac joints were evaluated. Computed-tomography-guided core bone biopsy from the bone marrow was taken from their corresponding MR sections in 5 of the patients. T1 hypointense and T2 hyperintense areas with ill-defined margins in the bone marrow adjacent to the sacroiliac joints were observed in all patients. On bone scintigraphy all the lesions demonstrated increased activity. Other radiological modalities excluded fracture, soft tissue mass, and osseous destruction. Bone biopsies demonstrated peritrabecular fibrosis and inflammatory cell infiltration. Patients receiving radiotherapy to the pelvis may demonstrate T1 hypointense/T2 hyperintense, ill-defined postradiotherapeutic benign changes in the sacroiliac joints. In the absence of any other signs of disease progression and when the imaging pattern is typical, close radiological follow-up should be sufficient to rule out metastases.

Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings.

The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty-four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by chi2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.

Posttraumatic high-flow priapism treated by N-butyl-cyanoacrylate embolization.

A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.

Persistent nonmigrated ventral primitive ophthalmic artery. Report on one case.

A case of aberrant anterior cerebral artery origin of the ophthalmic artery is presented. This indubitable radiological demonstration of such variation highlights some hypothetic steps in the embryogenesis of the ophthalmic artery.

Cavernous hemangioma of the kidney. Case report.

Renal hemangiomas are rare neoplasms of the kidney, and the number of cases reported in the literature are about 200 since the original description by Virchow in 1867. Among these, only a few have been examined by the combination of ultrasound, computed tomography, and angiography. We present a demonstrative case diagnosed at our clinic and review the corresponding literature.