Pleural body cavity-based lymphoma.

We report a case of recurrent body cavity-based non-Hodgkin's lymphoma in a patient with advanced acquired immunodeficiency syndrome who presented with bilateral pleural effusions, without evidence of an associated tumor mass. The lymphoma cells were large and pleomorphic, lacking pan-T- and pan-B-cell markers, but expressing activation markers (CD30, CD38, and HLA-DR). The purpose of this article is to discuss the radiological-pathological correlation of body cavity-based lymphoma with a review of the entities that should be included in the differential diagnosis of patients with malignant pleural effusions.

Coronary arteries: retrospective cardiac gating technique to reduce cardiac motion artifact at spiral CT.

Coronary artery calcification is a marker of atherosclerosis. Detection and quantification has previously been accomplished with electron-beam computed tomography (CT). Use of spiral CT for this application has been limited by cardiac motion. The authors evaluated a retrospective cardiac-gated postprocessing technique that necessitates no modification of scanner hardware or software. At spiral CT in 26 patients, motion artifact was reduced, coronary arteries were consistently visualized, and quantification of calcification could be performed in those patients with prominent deposits. Coronary artery calcification screening can therefore be offered in sites that have access to only spiral CT.

Advances in cardiac imaging.

Silent myocardial ischemia is the most important target of a variety of imaging modalities. The ultimate technology would include anatomic, functional, and myocardial perfusion information. Ultrafast computer tomography, as this time, is the best modality for studying the coronary arteries. Positron Emission Tomography remains the gold standard for studies of myocardial blood flow and myocardial utilization.

Laparoscopic-assisted sigmoid colectomy and low anterior resection.

Laparoscopic-assisted sigmoid colectomy or low anterior resection was undertaken in 30 selected patients. The median age was 51 (range, 30-85) years. Eight patients had previous abdominal surgery: four hysterectomies, two appendectomies, and two cholecystectomies. There was no mortality. Complications occurred in three patients. One patient developed a wound infection, there was one iliac artery injury, and one postoperative bleed, which did not require transfusion. Eighteen patients were operated on for primary cancer of the colon and 12 patients for benign disease. Technical aspects are described in detail. The average hospital stay was four days with most patients receiving oral analgesics by the second postoperative day. Laparoscopic colon resection can be an alternative to open surgery.

Ulcerative disease of the anorectum in the HIV+ patient.

Ulcerative processes are the most disabling of anal diseases in HIV+ patients. The spectrum ranges from "benign" fissures to invasive ulcerative processes. It is important to recognize their salient features in order to effectuate proper management. Since 1989, 74 HIV+ patients with ulcerative anal disease were evaluated. Of 33 patients with benign fissures, 13 had sphincterotomy, with symptomatic relief in 12 and healing in 11. Ten had improvement with standard conservative treatment, and 10 did not return for re-evaluation. Of 41 patients with "idiopathic" anal ulcers, 34 underwent operative evaluation, biopsy, viral culture, and debridement. Thirty had significant pain relief, and 17 showed variable evidence of healing. Four patients with intractable pain had injection of Depo-Medrol (The Upjohn Co., Kalamazoo, MI) into the bed of the ulcer with significant pain relief. One patient was diverted. We propose that anal ulcerative disease be classified as benign lesions and therefore treated as if the patient were HIV negative. In those patients with HIV-associated anal ulcers, evaluation under anesthesia, biopsy, culture, and debridement should be performed and therapy directed against any neoplastic or viral agents found. Those patients with no identifiable agents may be helped with aggressive debridement or intralesional steroid therapy. This approach allows safe and effective treatment in most patients.

Coronary artery diameter and coronary risk factors: a study with ultrafast computed tomography.

Coronary artery dilation has been described as an early effect of atherosclerosis. No noninvasive technique has been available to measure coronary size. In this study coronary diameters were measured in 100 asymptomatic subjects (89 men and 11 women, mean age 40 +/- 6 years) by means of ultrafast computed tomography (UFCT), with 3 mm thick ECG gated scans. Subjects without evidence of coronary calcium were studied. The diameter of the left main (LD) and right (RD) coronary arteries were measured. Total coronary diameter, TD = LD + RD, was determined, and univariate analysis was performed with respect to total, high-density lipoprotein and low-density lipoprotein cholesterol, mean blood pressure, age, body surface area, and triglycerides. Mean LD was 4.23 +/- 0.85 mm, and mean RD was 3.06 +/- 1.08 mm. TD increased with body surface area (p < 0.001). No other variable showed any significant effect on TD in this group without evidence of atherosclerosis. UFCT can be used to noninvasively measure coronary artery diameters and may be a useful technique to detect early changes of atherosclerosis in individual patients and in population studies.

Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women.

Coronary artery calcium is a marker of atherosclerosis in asymptomatic subjects. Ultrafast computed tomography (CT) can detect and quantify coronary calcium, simply and noninvasively, with greater sensitivity than can other techniques. The prevalence and extent of coronary calcium in a large population of asymptomatic men and women were measured and compared. Coronary calcium studies were performed in an asymptomatic population of 1,396 male and 502 female subjects (age range 14 to 88 years). The prevalence of calcium, and the distribution of total calcium scores (which reflect the amount of calcium present) were determined and compared for men and women at 5- and 10-year intervals. The prevalence of calcium in women was half that of men, until the age of 60 years when the difference diminished. The mean total calcium score distributions of men between the ages of 40 and 69 years were virtually identical to those of women between the ages of 50 and 79. The quantitative data obtained by Ultrafast CT showed very close agreement with autopsy studies of coronary calcium. Ultrafast CT is a sensitive technique to measure coronary calcium in both men and women. The differences in prevalence and extent of coronary calcium appear to be parallel to those observed in the clinical incidence of coronary artery disease in men and women. Ultrafast CT may have a greater impact on the treatment of women than of men, because it can be used to provide objective evidence of coronary atherosclerosis.

Primary squamous-cell carcinoma of the small bowel. Report of a case.

This is the first case report of a primary, pure squamous-cell carcinoma of the small bowel. Small bowel cancer represents only 1 to 2 percent of all gastrointestinal malignancies. Over 35 different histologic types of small bowel tumors have been described. By far, most small bowel epithelial tumors are metastatic. A 65-year-old white female presented with abdominal pain, melena, and hematochezia and was found to have a 5.5-cm, ulcerated, well-differentiated, keratinizing, squamous-cell carcinoma of the terminal ileum.

Splenic trauma as a complication of colonoscopy.

Thirteen cases of splenic injury during colonoscopy have been reported. We report the first case associated with colonic perforation and discuss the risk factors and etiology.

New technique for Hartmann's reconstruction.

Since the introduction of Hartmann's operation and its broader applications, restoration of intestinal continuity has posed technical challenges and significant morbidity. We describe a technique for Hartmann's reconstruction, utilizing a circular anastomotic stapling device that is simple and fast and that minimizes the potential for contamination, in which the bowel lumen remains closed at all times.

Comparison of serial quantitative evaluation of calcified coronary artery plaque by ultrafast computed tomography in persons with and without obstructive coronary artery disease.

Coronary artery calcium indicates atherosclerosis. Ultrafast computed tomography (CT) can noninvasively visualize and quantify coronary calcium, permitting the natural history of calcified plaque to be studied. This pilot study evaluates the ability of ultrafast CT to follow the progression of calcified plaque within the coronary arteries in patients with and without obstructive coronary artery disease (CAD). Twenty-five subjects had serial ultrafast CT scans of the coronary arteries a mean of 406 days apart. Changes in the number of calcific deposits, calcified plaque area and volume, calcium density and total calcium score were measured. In the 20 patients with calcium on the first study, there were statistically significant increases in mean peak CT number, total calcified plaque volume, total calcified plaque area and total calcium score (p less than 0.0001 for all). Subjects with proved obstructive CAD (n = 10) on angiography had a 48% increase in calcified plaque volume compared with 22% in asymptomatic subjects (n = 10). Comparison of serial studies showed that smaller calcific deposits often coalesced into single larger calcific deposits. Ninety-eight percent (235 of 241) of deposits identified on the first study were accounted for on the second study. Patients with obstructive CAD had a higher number of new calcific deposits than did those in the asymptomatic group (55 vs 18, p = 0.058). Serial ultrafast CT accurately tracks the progression of coronary artery calcium. It is a useful technique for assessing changes in calcified plaque formation in both asymptomatic subjects and in patients with obstructive CAD. It may be useful for studying the natural history of CAD and the effects of intervention on the course of CAD.

Continuous arteriovenous rewarming: experimental results and thermodynamic model simulation of treatment for hypothermia.

We evaluated a technique for treating hypothermia that uses extracorporeal circulation but does not require heparin or pump assistance. Hypothermia to 29.5 degrees C was induced in eight anesthetized dogs, and thermistors placed in the pulmonary artery, liver, bladder, esophagus, rectum, muscle, and skin. Four experimental animals were rewarmed by creating a fistula which connected arterial and venous femoral lines to an interposed counter-current heat exchanger. External rewarming was used in four controls. Bleeding time (BT), coagulation profile (PT, PTT, TT), and cardiac output (CO) were measured during rewarming. Core temperature (T) rose significantly faster with CAVR (0.00001). Average time to rewarming was 45 min, vs. 4 hrs in controls. Haptoglobin, platelet, fibrinogen, and fibrin split product levels were unaffected. Continuous arteriovenous rewarming (CAVR) improved T, CO, BT, and coagulation profile faster than any method yet reported not requiring heparin or cardiac bypass. The application of CAVR in post-traumatic hypothermia warrants further investigation.

World Health Organization--basic radiographic system (WHO-BRS) unit: experimental clinical evaluation.

The basic radiographic system (BRS) is a simplified version of a standard radiographic unit designed by the World Health Organization and the Pan American Health Organization. The design of the BRS includes the requirement that it should be able to perform routine radiographic examinations with a minimum of operator training. This report describes the performance of a BRS manufactured by Siemens. The physical parameters of this BRS were very good and operation should require a minimum of training. A small number of BRS films were compared with films obtained using the standard equipment in the department. The BRS films were generally regarded as satisfactory. Radiation exposure to patients is equal to, and in some cases less than, exposures with conventional X-ray units.

Quantification of coronary artery calcium using ultrafast computed tomography.

Ultrafast computed tomography was used to detect and quantify coronary artery calcium levels in 584 subjects (mean age 48 +/- 10 years) with (n = 109) and without (n = 475) clinical coronary artery disease. Fifty patients who underwent fluoroscopy and ultrafast computed tomography were also evaluated. Twenty contiguous 3 mm slices were obtained of the proximal coronary arteries. Total calcium scores were calculated based on the number, areas and peak Hounsfield computed tomographic numbers of the calcific lesions detected. In 88 subjects scored by two readers independently, interobserver agreement was excellent with identical total scores obtained in 70. Ultrafast computed tomography was more sensitive than fluoroscopy, detecting coronary calcium in 90% versus 52% of patients. There were significant differences (p less than 0.0001) in mean total calcium scores for those with versus those without clinical coronary artery disease by decade: 5 versus 132, age 30 to 39 years; 27 versus 291, age 40 to 49 years; 83 versus 462, age 50 to 59 years; and 187 versus 786, age 60 to 69 years. Sensitivity, specificity and predictive values for clinical coronary artery disease were calculated for several total calcium scores in each decade. For age groups 40 to 49 and 50 to 59 years, a total score of 50 resulted in a sensitivity of 71% and 74% and a specificity of 91% and 70%, respectively. For age group 60 to 69 years, a total score of 300 gave a sensitivity of 74% and a specificity of 81%. The negative predictive value of a 0 score was 98%, 94% and 100% for age groups 40 to 49, 50 to 59 and 60 to 69 years, respectively. Ultrafast computed tomography is an excellent tool for detecting and quantifying coronary artery calcium.

Diagnostic imaging today.

The uses of various imaging modalities in the brain, spine, pelvis, chest, and abdomen are described. The author explains his rationale for choosing one modality over another and how newer imaging techniques will be used in the future.