Hypertrophic lymphocytic gastritis with a gastric carcinoma.

Lymphocytic gastritis is a recently described gastric inflammation, characterized by an increased intraepithelial lymphocytic infiltrate mainly composed of T-lymphocytes. Endoscopically it correlates mainly with diffuse varioliform gastritis. Ménétrier's disease is a hypertrophic gastropathy with enlarged gastric folds. The histological picture is that of foveolar hyperplasia and glandular cysts of the mucosa. A few small series of lymphocytic gastritis with microscopic and endoscopic features of Ménétrier's disease have been published previously. We describe a similar case associated with a gastric adenocarcinoma.

Ultrasonographic diagnosis of hepatobiliary ascariasis.

Eight cases of hepatobiliary invasion of Ascaris lumbricoides into the hepatobiliary tract are presented. In the presence of nonspecific symptoms and biochemical test results, the diagnosis was made in seven patients by sonography. In the remaining patient, in whom the adult roundworm was not visible on sonography owing to the presence of aerobilia, the diagnosis was made at ERCP. Sonography revealed typical tubular, echogenic, filling defects along the long axis of a dilated common bile duct, sometimes exhibiting slow movements and containing a central sonolucent line. Repeated sonographic examinations accurately predicted treatment success.

Ultrasound-guided puncture of the gallbladder for acute cholecystitis.

In 18 high-risk patients with acute cholecystitis and severe concurrent disease, we aspirated the gallbladder by using a percutaneous technique under ultrasound guidance. 17 of the 18 improved after aspiration, the only complication being local pain in 2. 13 of the 17 who improved remained free from biliary infections during a mean follow-up period of 14 months. 4 had an uncomplicated cholecystectomy 6-10 weeks later for recurrent cholecystitis. Percutaneous transhepatic gallbladder aspiration is a safe and effective procedure in critically ill patients with acute cholecystitis.

Detection of colorectal cancer by routine ultrasound.

In 95 consecutive patients with proven colonic carcinoma, the tumor was detected by routine sonography in only half of the patients. However, in 22 out of 23 tumors of the right colon, a correct diagnosis was suggested by sonography (sensitivity 95.5%). Although not suitable as a first choice screening procedure for colorectal cancer, routine abdominal ultrasound can detect even non-suspected colonic tumors, especially in the ascending colon. Since the specificity of ultrasound is probably low, diagnosis must be confirmed by X-ray and/or endoscopy.

The impact of routine admission abdominal sonography on patient care.

In a prospective study of 1000 consecutive patients, abdominal sonography added diagnostic information to that available by history and physical examination in 8.9%. The yield ranged from a high of 27.4% in patients with acute abdominal symptoms to a low of 2.7% in screening sonograms of patients without abdominal symptoms. Sonographically guided biopsy-proven diagnoses were obtained in 6.6% of the patients and were clinically not suspected in 4.4%. The percentage of false-positive and false-negative sonographic studies was 0.5% and 1.1%, respectively. Sonography shortened the duration of hospitalization in 15.3%.

Dilated abdominal paraaortic lymphatic duct: a possible pitfall in retroperitoneal US.

Three cases of dilated abdominal left paraaortic lymphatic duct are described. The diagnosis was established by means of sonography and confirmed with lymphography in all three patients. A sonographically guided puncture of the lymphatic duct was performed in one patient. Dilatation of these lymphatic ducts was possibly the consequence of previous upper abdominal surgery in two patients and a coronary bypass operation in one.

The role of desferrioxamine in dialysis-associated mucormycosis: report of three cases and review of the literature.

We report 3 patients on maintenance hemodialysis who developed a fulminant, disseminated and fatal form of mucormycosis. The diagnosis was made by microscopy and culture in 1 case, yielding Rhizopus rhizopodiformis, and by post-mortem microscopy in the two other cases. These patients were receiving desferrioxamine (DFO) for aluminum overload and had no iron-overload. Ten similar patients, all (with only one possible exception) receiving DFO, have been reported from American centers. The mechanism by which DFO could precipitate mucormycosis is unsettled. The explanation might be that DFO acts as a siderophore to the Mucorales fungi. High serum levels of DFO in renal failure could enhance this mechanism. Epidemiological data, provided from an inquiry in 25 Flemish dialysis centers, support the association between DFO treatment and dialysis-associated mucormycosis.

Primary malignant melanoma of the gallbladder, metastatic to the common bile duct.

A primary malignant melanoma of the gallbladder, metastatic to the common bile duct, is reported. Both tumor sites were first visualized by abdominal sonography. The presence of the common bile duct metastasis was confirmed by endoscopic retrograde cholangiopancreatography. Histologic evidence is presented that the primary tumor did arise in the gallbladder and that the metastasis to the common bile duct most likely occurred as a consequence of mucosal implants from tumor cells that were shed in the bile.

Partial splenoportal and superior mesenteric venous thrombosis. Early sonographic diagnosis and successful conservative management.

A 61-yr-old woman presented with acute severe pain in the upper abdomen. Within a few hours after admission, diagnosis of partial splenoportal and superior mesenteric venous thrombosis was made by ultrasonography. This thrombosis appeared to be the first sign of a previously unsuspected essential thrombocythemia. Early sonographic diagnosis made possible the prompt institution of conservative treatment. Total thrombosis of the splenoportal system could be prevented. Major surgery was avoided and the outcome was uneventful.

Unipuncture membrane plasmapheresis.

A simple method of plasma exchange is presented that uses a hollow-fiber plasma filter together with conventional unipuncture dialysis equipment. The procedure was well tolerated for eight biweekly sessions in a patient with metastatic breast cancer.