Pneumatosis intestinalis and portal-venous gas: an unusual presentation of acute appendicitis.

Pneumatosis Intestinalis in association with portal venous gas is a very rare finding in children and young adults. When present, it is typically associated with bowel infarction and carries a poor prognosis. We present an extremely unusual case where imaging revealed extensive pneumatosis intestinalis and portal venous gas in a patient with acute appendicitis.

Cryoplasty for arterial restenosis.

OBJECTIVE: A prospective follow-up study of patients with arterial restenosis undergoing cryoplasty. MATERIALS & METHODS: Between May 2004 and June 2005, 10 patients with restenosis following ilio-femoral endovascular treatment underwent twelve cryoplasty procedures. All patients had had at least one previous episode of stenosis treated by conventional endovascular methods and had suffered further restenosis. The indications for treatment were grafts at risk (n=5) and symptomatic in-stent restenosis (n=5). Two patients underwent re-cryoplasty. Cryoplasty was performed in accordance with manufacturer's instructions using 6-8mm balloons. All patients had Doppler ultrasound evaluation at 1, 3, 6 and 12 months. RESULTS: All procedures had angiographically successful immediate outcome with <30% residual stenosis. Non flow limiting dissection was evident in two cases. In six procedures (50%), restenosis was evident within 6 months post-procedure, whilst in the other six, there was progressive restenosis appearing between 6-12 months. Five cryoplasty procedures have needed endovascular re-intervention due to symptomatic high-grade restenosis and a sixth is awaiting surgery. CONCLUSION: Cryoplasty is of no value in patients with restenosis in the iliofemoral segment with half the procedures failing within six months and all of them within the first year. Evidence to support the use of cryoplasty in the peripheral arterial restenotic lesions is lacking.

Imaging of the renal transplant: comparison of MRI with duplex sonography.

Renal transplantation is an established treatment for patients with end-stage renal disease. Many causes of graft dysfunction are treatable, making prompt detection and diagnosis of complications essential. Sensitive, noninvasive imaging procedures, which do not use iodinated contrast media, are therefore highly desirable to evaluate graft function. Duplex sonography (US) has traditionally been the initial investigation of graft dysfunction. US offers many advantages, particularly during the postoperative period, when it can be performed portably regardless of renal function and can guide percutaneous procedures. However, US lacks specificity in assessing hydronephrosis, cannot differentiate parenchymal causes of dysfunction, and may have difficulty assessing transplant vessels. Recently comprehensive magnetic resonance imaging (MRI) protocols including MR urography, gadolinium-enhanced MR angiography, and MR renography have evolved as a "one-stop" diagnostic technique in the evaluation of the entire graft and peritransplant region. Multiplanar capabilities enable MRI to identify the site of urinary obstruction and assess renal vessels in their entirety. The evolving technique of MR renography may also differentiate parenchymal causes of dysfunction. By combining these three components into a single examination, further information may be obtained regarding the graft when compared with US and other conventional studies, with improved patient convenience, less morbidity, and a potential cost saving.

Three-dimensional gadolinium-enhanced magnetic resonance breath-hold FLASH imaging in the diagnosis and staging of renal cell carcinoma.

Renal cell carcinoma accounts for 2% of all reported cancers. Its apparent incidence is increasing due to the more widespread use of cross-sectional imaging and as a result, tumours are being detected at an earlier stage. It is hoped that this improvement in early detection will result in a significant increase in survival rates. Radiological diagnosis and staging have a critical role in triaging patients' -treatment. Although computed tomography (CT) and ultrasound are well established in the evaluation of renal cell carcinoma, magnetic resonance (MR) techniques are still rapidly developing. In our institution breath-hold three-dimensional (3D) gadolinium-enhanced fast low-angled single shot (FLASH) spoiled gradient-echo sequence imaging has become an integral part of staging for renal cell carcinoma. In this article, we review our experience of the use of this emerging technique in the diagnosis and staging of renal cancer.

Anatomy of the proximal musculotendinous junction of the adductor longus muscle.

Injuries to the adductor longus commonly occur in the proximal part of the muscle tendon unit, close to the insertion site on the pubic bone. Ultrasonography, magnetic resonance imaging (MRI) and surgery have been helpful in localising the lesions, but the exact anatomy of the musculotendinous junction (MTJ) and insertion of the muscle remain unclear. We studied the anatomical features of the MTJ and measured the dimensions of the tendinous insertion into the pubic bone on 37 cadavers: 18 men and 19 women. The medial boundaries were the longest part of the tendon bilaterally in women, while the lateral aspect of the left muscle was greater in men. Tendinous fibres were predominantly found on the anterior surface, while the posterior surface consisted mainly of muscle tissue. The MTJ was clearly demarcated. There were several types of anomalies present which partially explains the difficulty in localising the site of injury and highlights the importance of individualized treatment.

The aging tendon.

After maturation tendons undergo many biochemical, cellular, mechanical and pathological changes that bring about a general decline in the structure and function of the tendon. This decline in the aging tendon is characterized by a reduced ability to adapt to environmental stress and loss of tissue homeostasis. The tendon's adaptability to these changes will decide the rate and the success of treatment of a tendon injury. This review examines these changes and also looks at how we can curtail their progression through exercise and lifestyle modification.

16PF research into addiction: meta-analysis and extension.

Meta-analysis of 34 studies on Cattell's 16PF test reveals ragged egos (C-), guilt (O), distrust (L), frustration (Q4), alienation (G-), vague identity (Q3-), alarm (H-), resentment (Q1), quasi-autism (M), scattered intellect (B-), grandiosity (E), autonomy (Q2), infantilism (I), avoidance (A-), and deviousness (N). The aberrant scores on E, G, I, Q1, and Q2 discriminate addicts from suicidals and the chronically ill or unemployed. We found nine types of addicts in our developmental study of 83 members of Alcoholics Anonymous. On the more stable second-order 16PF factors, 43% were highest on Autonomous, 37% on Desperate, 16% on Tough Poise, and 4% on Extravert. Profiles differed more by sexual preference than by gender. Recidivism was highest among homosexual men (38%) and the desperate (25%). Only the Fourth and Fifth Steps of the AA program seem crucial to recovery. Treatment programs based on these and tailored to sexual preference and the second-order personality types seem highly advisable.

16PF items discriminating recidivists and long-term recovered polyaddicts.

Responses to 65 of the 187 items on Cattell's 16PF test were skewed by 83 members of Alcoholics Anonymous. Seventeen of those items had significantly different distributions when the 18 recidivists were compared to the 8 who had remained clean of all addictive substances and compulsive behaviors during the 2-year period studied. Another 14 items had significantly different distributions when the recidivists were compared to all the others. Comparisons with non-drug-disadvantaged groups and non-AA recovering addicts are suggested in order to isolate empirical predictor items for "addictive" versus "cured" scales.