Bladder diverticulum simulating a pelvic metastasis on a Tc-99m HDP bone scan.

Carcinoma of the prostate was diagnosed in a 74-year-old man. A Tc-99m HDP bone scan was performed as part of the initial staging process. The findings on the bone scan were normal except for an area of increased tracer uptake projected over the left sacroiliac joint, which was seen best on the anterior view. When this was investigated further, the findings of a plain radiograph were inconclusive. Computed tomography showed a large diverticulum projecting from the left side of the bladder; the tracer retained within this diverticulum had produced the findings on the bone scan.

Core biopsy of the bowel wall: efficacy and safety in the clinical setting.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and complications of percutaneous 18-gauge core biopsies of lesions of the bowel wall using CT and sonographic guidance. A retrospective study was made of 15 biopsy procedures performed on 12 patients with suspected neoplasia of the gastrointestinal tract. The biopsies were performed when there were no sites of metastatic disease more readily accessible to biopsy and the lesion was inaccessible to endoscopic techniques or when the endoscopic biopsy findings were negative. CONCLUSION: Three biopsy procedures provided inadequate samples and the biopsies were repeated, giving a total of 15 biopsy procedures. A tissue diagnosis was made in all 12 patients. All procedures were well tolerated, and no immediate or delayed complications occurred. Percutaneous core biopsy of bowel wall masses is a safe technique that allows a histologic diagnosis to be obtained in difficult cases when other methods cannot provide an adequate tissue sample.

Incisional hernia: an unusual cause of acute pain and swelling following renal transplant.

We present a case in which a strangulated incisional hernia following a renal transplant was sonographically diagnosed. The patient presented with acute pain and swelling over the transplant site 6 weeks after surgery. Sonograms showed a normal-sized kidney with normal echotexture, no evidence of hydronephrosis, and no perinephric collections. Color Doppler sonography and spectral analysis demonstrated normal blood flow throughout the kidney. Sonograms showed that the palpable mass was a dilated loop of fluid-filled small bowel. Sonography allowed the correct diagnosis to be established, and early surgical intervention allowed revascularization of viable bowel.

Pain after small bowel meal and pneumocolon: a randomized controlled trial of carbon dioxide versus air insufflation.

AIM: To determine whether the use of CO2 rather than air insufflation results in less pain and/or distension in patients undergoing small bowel meal (SBM) and pneumocolon (PC). MATERIALS AND METHODS: One hundred patients for SBM and PC were randomized to receive either air or carbon dioxide (CO2) as the insufflating gas. Both the patient and radiologist were blinded to the gas being used. Patients were given a questionnaire to complete the following day. The degree and duration of abdominal pain and swelling were scored on a visual analogue scale from 0 to 100. RESULTS: Seventy-nine patients replied. The mean pain score was 28.1 for patients receiving air and 20.35 for those receiving CO2 (P < 0.05). The duration of pain was 9.0 h in the air group and 6.0 h in the CO2 group (P < 0.05). The mean abdominal swelling score was 27.1 for patients receiving air and 17.1 for those receiving CO2 (P < 0.05). The duration of swelling was 8.8 h in the air groups and 7.3 h in the CO2 group (P = 0.16). CONCLUSION: In patients presenting for SBM and PC, the severity and duration of abdominal pain and distension are significantly reduced by the use of CO2 rather than air.

Sudden increase in isolation of group B streptococci, serotype V, is not due to emergence of a new pulsed-field gel electrophoresis type.

Until recently, group B streptococcus, serotype V (GBS-V), was an infrequent cause of disease. It is now recognized as a significant cause of infections in both children and adults. To determine if this increase was due to the recent introduction and spread of a single clone of GBS-V, we analyzed, by pulsed-field gel electrophoresis (PFGE), the SmaI chromosomal DNA digests of 45 bacteria: 41 isolated from human infections between 1986 and 1996 in the United States, 2 from human infections in Argentina, and 2 from naturally infected mice. Seventeen patterns were found and arbitrarily designated patterns A to Q. Pattern N constituted 24 (53%) of the isolates and was found in all of the years tested and from all surveillance areas, as well as in both isolates from Argentina, and was very similar to the GBS-V isolated from a mouse. Pattern P was found in three isolates, pattern F was found in two, and the remaining patterns were found in one isolate each. We concluded that the majority of isolates of GBS-V are of one PFGE subtype and that this subtype was predominate before the increase in disease caused by GBS-V and that GBS-V disease is caused by several different subtypes.