The radiological investigation of suspected lower limb deep vein thrombosis.

A postal survey was performed to determine the current practices and attitudes of radiologists towards the imaging of suspected lower limb deep vein thrombosis (DVT). One hundred and twenty-seven departments responded to a questionnaire sent in March 1996. The results show that 87% of hospitals possess colour Doppler ultrasound (CDUS) machines and that 46% of departments perform ultrasound as the first line investigation in over 90% of cases. Thirty per cent of departments considered calf vein visualization to be generally adequate and 34% thought that clinicians in their hospitals invariably anticoagulated patients with isolated calf thrombus. In hospitals where venography was routinely used as the first line investigation, the most common reasons were: the perceived inferiority of ultrasound (US) in demonstrating below-knee clot, its time-consuming nature and the limited access to suitable ultrasound machines. The widespread use of ultrasound is encouraging, however, there are clearly diverse views. A significant minority of departments depend principally upon venography in the diagnosis of DVT.

Energy balance in asymptomatic HIV infection.

OBJECTIVES: Body weight is regulated by the balance between energy intake and energy expenditure, but the influence of HIV infection on energy balance has not been fully examined. The main objectives of this study were (1) to assess the effect of HIV on energy balance, (2) to examine the relationship of parameters of immunodeficiency to energy balance, and (3) to examine the interrelationship of different components of energy balance in asymptomatic HIV-seropositive men. DESIGN: A cross-sectional study of nutrition and metabolism in asymptomatic HIV-seropositive men METHODS: Components of energy balance were examined in 104 asymptomatic HIV-seropositive men (CD4 count 4-482 x 10(6)/l) and 57 age-matched HIV-seronegative male controls. Energy and protein intake were measured using 5-day diaries, and small bowel absorption and permeability was assessed using four sugar probes. Resting energy expenditure was calculated from indirect calorimetry and nitrogen loss estimated from 24 h urine collection. Four methods were used to assess the effect of HIV infection on body composition (anthropometry, dual energy X-ray absorptiometry, bioelectrical impedance and 24 h urine creatinine). RESULTS: Resting energy expenditure per kilogram of fat-free mass was raised (P < 0.0001), fat mass was decreased (P = 0.001), fat-free mass was increased (P = 0.05), energy intake was higher (P = 0.05), absorption of L-rhamnose (P = 0.01) and 3-O-methyl-D-glucose was decreased (P = 0.003), and small bowel permeability was increased (P < 0.0001) in HIV-seropositive men compared with HIV-seronegative controls. HIV-seropositive subjects with a CD4 count less than 100 x 10(6)/l had decreased absorption of L-rhamnose (P < 0.05), D-xylose (P < 0.05) and 3-O-methyl-D glucose (P < 0.05) compared with HIV-seropositive subjects at higher CD4 counts, and had a similar resting energy expenditure to HIV-seronegative controls. Protein intake, carbohydrate, fat and protein oxidation. 24 h nitrogen excretion and appendicular muscle mass were similar in HIV-seropositive men and controls. CONCLUSION: HIV infection exerts a direct effect on parameters of energy balance that varies with the severity of immunosuppression.

Allergic broncho-pulmonary aspergillosis: the radiological appearance during long-term follow-up.

The radiographs of 100 patients with allergic bronchopulmonary aspergillosis were examined to assess the type and distribution of abnormalities seen during long-term follow-up. Lobar shrinkage occurred almost exclusively in the upper zones but other abnormalities were distributed throughout both lungs. Bronchial wall thickening was the commonest lesion observed and was usually a permanent finding. Consolidation was commonest in the perihilar regions, persisted for up to 20 weeks when transient and was a permanent finding in 10 patients. Dilated bronchi were noted to change in calibre with exacerbations and remissions of the condition. Episodes of transient collapse were segmental, lobar or involved a whole lung. Permanent collapse was always segmental. Massive shadowing, band shadows and 'gloved fingers' were seen less frequently than expected and cavitation was rare. In some patients the chest radiograph was normal between exacerbations of the disease.

Radiographic abnormalities of the duodenum in cystic fibrosis.

Radiologically demonstrable abnormalities of the duodenum are common in cystic fibrosis and are most prevalent in the second part of the duodenum. Out of 14 upper gastrointestinal barium studies performed on patients with cystic fibrosis over a period of 10 years, radiographic abnormalities of the duodenum were found in 12, an incidence of 86%. The abnormalities consisted of thickened mucosal folds, nodular indentations and effacement of the normal mucosal pattern. A duodenal stricture that was radiologically similar to a carcinoma presented as pyloric obstruction in one patient and this resolved on medical treatment. We conclude that barium studies in patients with cystic fibrosis may uncover unsuspected abnormalities of the duodenum, that these form part of the syndrome and that invasive treatment is not indicated.

Massive pulmonary calcification in two infants with congenital cardiac lesions.

Two infants with congenital heart disease and radiographically demonstrated pulmonary calcification are described. One infant also suffered from idiopathic hypercalcaemia and subcutaneous fat necrosis. Diffuse radiographic pulmonary calcification in infants has not been reported previously. The possible aetiology is discussed.