Enterogastric reflux mimicking gallbladder disease: detection, quantitation and potential significance.

OBJECTIVE: Visualization of enterogastric reflux (EGR) may be present during hepatobiliary imaging. Reflux of bile may damage the gastric mucosa, altering its function, and cause such symptoms as epigastric pain, heartburn, nausea, intermittent vomiting and abdominal fullness. These symptoms also are associated with gallbladder disease. The aim of this study was to quantitate the EGR index (EGRI) and to determine if a difference exists in normal and abnormal responses using standard cholecystokinin (CCK)-augmented hepatobiliary imaging. METHODS: This study used 129 patients. LAO dynamic data on a 128 x 128 matrix at a rate of 1 frame/min were obtained. After the gallbladder ejection fraction (GBEF) was determined, the EGRI (%) was calculated by relating the counts in the gastric ROI to the counts in the hepatobiliary ROI at a specified time. The results were compared with the patient's final clinical diagnosis. RESULTS: Normal responders (GBEF > or = 35%) had a higher EGRI than abnormal responders with a P = 0.001 EGR observed in 75 patients (58.1%). Significant reflux (EGRI > or = 14.2% at 15 min) was observed in 29 additional patients (22.5%). Patients with EGRI > or = 24.5% showed a strong association with the pathophysiologic syndrome of gastritis, alkaline reflux, gastric ulcer and gastro esophageal reflux disease. There was no EGR observed in the remaining 25 patients (19.4%). CONCLUSION: This simple addition to the CCK-augmented hepatobiliary imaging may both detect and quantitate abnormal EGR as the cause of the patient's symptoms in the presence of a normal GBEF result, and/or those patients with risk factors for gastritis.

Isocratic, simultaneous reversed-phase high-performance liquid chromatographic estimation of six drugs for combined hypertension therapy.

We report an isocratic, HPLC procedure for assay of the orally administered hypertension drugs [atenolol, amlodipine, nifedipine, nitrendipine, nimodipine and felodipine given in retention order] of which atenolol, an aryloxypropanolamine beta-blocker is administered with anyone of the other five dihydropyridine calcium channel blockers in combined hypertension therapy. The drugs were dissolved in methanol and 20 microliters of a mix of the drugs was injected onto a reverse phase JASCO-metaphase ODS (250 x 4.0 mm) 5 mu column. Any one of the six drugs could be used as the internal standard. The drugs were resolved by elution with a pH 4.5 equivolume mobile phase of acetonitrile-0.01 M KH2PO4, with pH adjustments done with H3PO4 (flow-rate 1.5 ml min-1). The column effluent was monitored at 250 nm. The detector response (peak height ratio) was linear in the dynamic range of 25-3200 ng ml-1 of these drugs, with the detection limits at approximately 15 ng ml-1. Full statistical evaluation of the data including linear regression (least-square fit) analysis was performed. The suggested procedure has the advantage that all the five dihydropyridine derivatives can be quantified alone or in formulation with atenolol.

Optic neuritis: imaging with magnetization transfer.

OBJECTIVE: Our objective was to prospectively examine the optic nerves in patients with clinically severe unilateral optic neuritis, using routine spin-echo and magnetization transfer MR imaging. SUBJECTS AND METHODS: For 39 patients with such lesions, we calculated the magnetization transfer ratio along the involved intraorbital optic nerve and along the asymptomatic contralateral optic nerve in a mirror-image location. Magnetization transfer ratios were correlated with the imaging findings on routine spin-echo MR imaging. RESULTS: Magnetization transfer ratios were decreased in 33 of the 39 clinically symptomatic optic nerves, including 12 of the 18 clinically symptomatic optic nerves in which no abnormality was seen on routine spin-echo MR images obtained before and after administration of gadopentetate dimeglumine. CONCLUSION: Magnetization transfer imaging reveals intraorbital optic nerve abnormalities in patients with optic neuritis even when such lesions are otherwise occult on routine magnetization transfer imaging.

Gallbladder visualization on routine lung perfusion imaging.

OBJECTIVE: Two routine lung SPECT studies showed what appeared to be uptake within the gallbladder. This finding was confirmed on coronal views and three-dimensional reconstruction. There was no contamination or problem with the radiopharmaceutical quality control. The patients had not had any prior nuclear procedures. Gallbladder visualization on routine lung imaging has not been previously observed. The purpose of this study was to ascertain the incidence of gallbladder uptake and to determine a possible mechanism. METHODS: Fifty-four patients referred for routine lung perfusion imaging were examined. At the end of the lung imaging, an anterior and/or right lateral 3-5 minute view of the abdomen was obtained. Patients too ill for additional imaging or those with prior cholecystectomies were excluded. RESULTS: Nineteen of the 54 patients showed activity within the gallbladder. Activity within the gut, kidneys, and urinary bladder also were observed. CONCLUSION: Gallbladder activity after Tc-99m macroaggregated albumin injection for lung perfusion studies, is a fairly common finding.

Isolated rhombencephalosynapsis diagnosed by magnetic resonance imaging.

A case of human rhombencephalosynapsis diagnosed in vivo by magnetic resonance imaging (MRI) is presented that demonstrates fusion of the dentate nuclei and agenesis of the cerebellar vermis. To our knowledge, this condition in its isolated form has been previously diagnosed only at necropsy. The developmental features of the cerebellum are discussed and correlation with cerebellar function is also presented. Recognition of this anomaly in the living patient may be useful in further understanding the clinical significance of segmentation of the rhombencephalon.

Brain death: confirmation by radionuclide cerebral angiography.

Dynamic radionuclide cerebral angiography was performed in 14 patients with suspected brain death. In 10 of 14 patients, no intracranial arterial perfusion was demonstrable, thus confirming brain death. In four patients, faint venous activity was seen in the sagittal sinus only. All these patients also eventually died. Radionuclide cerebral angiography provides a simple and noninvasive means to confirm brain death in critically ill patients maintained on life support systems particularly when an electroencephalogram and four vessel contrast angiography may be either impractical or equivocal.