Calcified rims. Uncommon radiologic finding and potential pitfall due to organization of deposits of oyster shell tablets.

In a patient undergoing double-contrast barium enema (DCBE) for evaluation of recent onset of diarrhea, a curvilinear strand of calcifications outlining a filling defect of the cecum, initially thought to represent a neoplasm, later was discovered to be due to precipitation and organization of orally ingested calcium in an adherent fecalith. Colonoscopy and repeated x-ray evaluation avoided the pitfall. This case illustrates the need for analysis and correlation of the type of calcifications characterizing a mass in light of the clinical history. Errors in interpretation can be avoided by asking the patient about oral medications and obtaining delayed films. Colonoscopy may be the diagnostic test in doubtful cases.

Noncirrhotic portal hypertension in Felty's syndrome.

A case of Felty's syndrome with nodular regenerative hyperplasia of the liver, presinusoidal portal hypertension, and bleeding esophageal varices is reported. Increased splenic blood flow may be a contributing factor to the development of the regenerative nodules. The portal hypertension is postulated to be a result of intrahepatic vascular compression.

Gastrocolic fistula secondary to benign gastric ulcer not operated upon: case report and review of literature.

A case report and review of the literature of benign gastric ulcer complicated by gastrocolic fistula are presented. Twenty-seven percent of patients were found to be receiving ulcerogenic medications. Only 15% of patients had previous histories of ulcer disease. Parameters most suggestive of a neoplastic process included palpable abdominal mass and unexplained anemia. Diagnosis is established by barium enema. Endoscopic biopsy and cytologic studies are useful in differentiating benign from malignant processes. Surgical management of benign ulcers complicated by fistula results in more than 90% survival.

Gastric secretory function in patients with chronic renal failure undergoing maintenance hemodialysis.

Gastric secretion was evaluated in 9 male patients with chronic renal failure on maintenance hemodialysis. Five secreted low or normal quantities of acid and 4 exhibited hypersecretion, 2 of whom had associated peptic ulcer disease. Serum gastrin responses to a protein meal were comparable to control subjects. Calcium infusion in two basal hypersecretors depressed acid secretion. The only statistically significant correlation observed was between basal acid output ans serum levels of parathormone. These studies suggest that while acid secretory abnormalities vary in patients with chronic renal failure on hemodialysis, there is no apparent sensitivity of the gastrin-secreting cells to protein or calcium ion which might account for acid hypersecretion. Secondary hyperparathyroidism may influence the occurrence of acid secretory abnormalities.

Pancreatic ascites: successful treatment with pancreatic radiation.

A 51-year-old man with clinical and laboratory findings consistent with the diagnosis of pancreatic ascites is reported. Response to usual medical measures was inadequate. Single-dose irradiation to the pancreatic area (550 rads) resulted in marked improvement in his ascites. Operative pancreatogram months later revealed no evidence of ductal leakage. Low-dose pancreatic irradiation may be a unseful therapeutic adjunct in the older, high-risk patient with pancreatic ascites in whom surgery is not considered feasible.

Syphilitic gastropathy.

A case study of a 22-year-old male with periumbilical, postprandial pain, partially relieved by antacids is presented. Abnormalities demonstrated on upper-gastrointestinal series and a positive FTA-ABS suggested gastric lues. This diagnosis was confirmed by demonstrating spirochetes in gastric mucosa, both by silver impregnation and fluorescent techniques specific for Treponema pallidum.