Successful treatment of extensive splanchnic arterial and portal vein thrombosis associated with ulcerative colitis.

Venous and arterial thromboembolism is a significant cause of morbidity and mortality in patients with ulcerative colitis (UC). Arterial thrombosis of the splanchnic region is a rare event with a very high mortality rate. Furthermore, it represents a challenging complication since it tends to be overlooked and misinterpreted as a clinical exacerbation of UC. We present the case of a 62-year-old female with pancolonic UC complicated by an extensive arterial thrombosis involving the aorta, the celiac trunk, the hepatic, gastric and splenic arteries and the superior mesenteric artery. A thrombosis of the splenic vein extending into the proximal portal vein was also present. The patient was successfully treated by a combined interventional-radiological and surgical treatment. We discuss the rationale behind our management of this case and review the literature on splanchnic arterial thrombosis associated with UC.

Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography.

Preoperative knowledge of the presence of major venous anomalies facilitates the safe performance of aortic surgery. The purpose of the study was to estimate the incidence, as detected by abdominal and pelvic computed tomography (CT), of major venous and renal anomalies related to the abdominal aorta in an adult population. A total of 1822 intravenous contrast-enhanced abdominal and pelvic CT scans done in 1822 patients at two university teaching hospitals were randomly selected and prospectively reviewed (between June 1999 and March 2000) to identify major venous and renal anomalies associated with the abdominal aorta and iliac arteries. An interpreting staff radiologist then indicated on adata sheet whether any of the following anomalies were present or absent: (1) retroaortic left renal vein, (2) circumaortic left renal vein, (3) left-sided inferior vena cava (IVC) without situs inversus, (4) left-sided IVC with situs inversus, (5) duplicate IVC, (6) preaortic confluence of the iliac veins, or (7) horseshoe kidney. The CT scans reviewed had been performed for a wide variety of indications. Thirty-four scans were excluded from the study because either the anomalies we were looking for could not be assessed for technical reasons or the patient had a previous left nephrectomy and therefore assessment of the left renal vein was impossible. From this analysis we found that in an adult population, the prevalence of major venous and renal anomalies related to the abdominal aortaand iliac arteries and detected by CT scan was 5.65%. Prior to aortic surgery, preoperative knowledge of the presence of such anomalies helps with operative planning and may reduce the risk of major venous hemorrhage associated with these anomalies.

A prospective study comparing duplex scan and venography for diagnosis of lower-extremity deep vein thrombosis.

This study was designed to compare duplex scanning with contrast venography for the diagnosis of acute deep vein thrombosis of the lower extremity, both at the femoropopliteal (above-knee) and tibioperoneal (below-knee) levels. A total of 216 patients with 220 limbs suspected of acute deep vein thrombosis underwent duplex scanning followed within 24 h by ascending venography. The two studies were interpreted independently by two physicians who were blinded to the results of the corresponding alternative study. Venography was positive for deep vein thrombosis in 44.5% of cases (98/220). Duplex scanning was inadequate at the above-knee level in two cases (0.9%) and at the below-knee level in 17 cases (7.7%). Sensitivity and specificity of duplex scanning at above-knee level were 98.7% and 100% respectively while corresponding values were 85.2% and 99.2% at below-knee level. By excluding technically inadequate duplex studies, the sensitivity at below-knee level was clearly improved (93.8%). It is concluded that with meticulous technique, duplex scanning is highly accurate in diagnosing acute deep vein thrombosis of symptomatic lower extremities, avoiding contrast venography in over 90% of the cases, even at the tibioperoneal level.

Gastric toxoplasmosis in acquired immunodeficiency syndrome: antemortem diagnosis with histopathologic characterization.

Gastrointestinal symptoms attributable to Toxoplasma gondii infection are distinctly unusual, and antemortem diagnosis of gastrointestinal involvement is rarely documented, particularly in the absence of cerebral manifestations or disseminated disease. This case report describes a rare example of T. gondii infection of the stomach diagnosed antemortem in a 22-year-old Haitian woman with acquired immunodeficiency syndrome (AIDS) who presented with fever and abdominal pain. An abdominal computerized tomographic scan showed thickened gastric walls. Endoscopy showed diffusely thickened gastric folds and a fundic ulcer along the greater curvature. Light and electron-microscopic examination of gastric mucosal biopsy specimens showed active Toxoplasma infection with necrosis and intracellular trophozoites within the gastric epithelium, smooth muscle cells, macrophages, and endothelial cells. Both true cysts and pseudocysts were seen. Disseminated disease was documented by the growth of T. gondii in a tissue culture from a venous blood sample. It is concluded that some patients with AIDS, particularly those from areas endemic for Toxoplasma infection, can manifest disseminated disease in unusual locations such as the gastrointestinal tract. Documentation of active T. gondii infection based on tissue cultures of venous blood or on biopsy specimens of symptomatic extracerebral sites can lead to a rapid diagnosis of toxoplasmosis, a treatable disease.

Thyroglossal duct cyst presenting as an anterior tongue fistula.

An unusual case of thyroglossal duct cyst occurring in the tongue base and fistulizing to the anterior tongue is presented. No previous descriptions have been found in the literature associating this embryological remnant with fistulization to the anterior tongue. The treatment was successfully accomplished through a combined transhyoid and intraoral approach.

Hydrophilic microporous polyurethane versus expanded PTFE grafts as substitutes in the carotid arteries of dogs. A limited study.

A novel, microporous, hydrophilic polyether urethane-urea (PEUU) vascular graft was compared with expanded PTFE in the canine carotid artery. At implantation times ranging from 4 h to 6 months, all the PEUU grafts were found to be occluded while of the PTFE grafts, only those implanted for 1 week and 6 months were blocked. Histopathological analysis of the explanted grafts and their capsules revealed an ongoing inflammatory reaction at the anastomotic sites of the PEUU grafts.

Methysergide-induced lower extremity arterial insufficiency.

Lower extremity arterial insufficiency, a relatively common complication of ergotamine ingestion, is a rare complication of methysergide therapy for migraine headaches. Methysergide causes one of two typical angiographic patterns: intra-abdominal extrinsic compression of the aorto-iliac vessels in patients with retroperitoneal fibrosis, or marked diffuse bilateral spasm of the superficial femoral arteries in those without retroperitoneal fibrosis. We report a patient with methysergide-induced bilateral lower extremity arterial spasm and review the relevant literature. When one of the above arteriographic patterns is recognized, methysergide ingestion should be considered as a possible etiology.

Neurologic sequelae following transcatheter embolization to control massive perineal hemorrhage.

A case of exsanguinating perineal hemorrhage resulting from rupture of a pseudoaneurysm of the right internal pudendal artery is presented. Transcatheter embolization of Gelfoam and wire coils proved to be life saving, but subsequent neurologic sequelae developed, including loss of sensation over the right side of the scrotum, penis, and medial thigh. Urinary incontinence developed as well. Fortunately, the paresthesias were temporary.

Prophylactic antihistamines in the management of radiographic contrast reactions.

Two hundred and twenty consecutive patients, referred for intravenous pyelography, were assessed for adverse reactions. The effect of prophylactic antihistamines was evaluated. Patients were divided randomly into control, saline or chlorpheniramine treated groups. Changes in serum total haemolytic complement (CH50) and immune complexes (IC) at times 0, 1, 5, 10 and 20 min after injection of radiocontrast material were assayed. Forty-two of the 220 patients suffered reactions, classified clinically into allergic and non-allergic types. There was no difference in the incidence of allergic reactions between control and saline groups. However, significantly less (P less than 0.05) allergic reactions were noted in the antihistamine pre-treatment group. Depressed CH50 occurred in forty-three, of eighty-eight patients tested and persisted for at least 20 min in twenty-two. There was no correlation between CH50 depressions and clinical symptoms. The IC remained unchanged throughout. In conclusion, prophylactic antihistamines may diminish the incidence of allergic reactions. Complement activation occurs in a large number of patients, unrelated to symptomatology, and does not appear to be the only factor responsible for adverse reactions.

Radionuclide detection of iatrogenic arteriovenous fistulas of the genitourinary system.

Radionuclide angiography is a valuable screening test for arteriovenous (AV) fistulas. Seven iatrogenic AV communications of the genitourinary system were initially diagnosed by radionuclide imaging, and untreated patients are being followed up by yearly nuclear examinations. Contrast arteriography is reserved for patients requiring interventional therapy and for symptomatic patients with a negative radionuclide study.

Comparative accuracy and complementary use of 67Ga-citrate imaging and ultrasound in the diagnosis of abdominal abscesses.

Ultrasound and 67Ga-citrate imaging were used simultaneously for the evaluation of 26 suspected cases of abdominal abscess. Scintiscanning and ultrasonography identified respectively 92% and 69% of the abscesses. Jointly, both modalities detected all 13 abscesses and we suggest an integrated approach in the evaluation of such cases.

Some normal variations of knee arthrograms and their anatomical significance.

Knees obtained after amputation were fixed with formalin after the joint space was distended with air. The joints were then either dissected or frozen and sectioned vertically with a band saw in planes comparable to those visualized during arthrography. By comparing these anatomical specimens and arthrograms, the anatomical explanations for some normal variations visible or arthrograms could be identified. These variations included the appearance of the popliteus tendon and the posterior part of the lateral meniscus, the air-filled cul-de-sac posterior to the medial meniscus, and the interconnections of the joint space and the gastrocnemius and semimembranosus bursae.

More causes of button sequestrum.

Two cases illustrating the association of button sequestra with Paget's disease and multiple myeloma are presented, followed by a brief review of the roentgenologic skull manifestations of these diseases. The number of conditions having button sequestra now stands at thirteen. The sign has no specific diagnostic significance.