Diagnosis and staging of renal cell carcinoma: a comparison of MR imaging and CT.

MR studies were performed in 36 patients with proven renal cell carcinoma. In 27 patients in whom a radical nephrectomy was performed, MR studies were reviewed and compared with CT and pathologic findings. Renal cell carcinomas had a varied MR signal with the most common appearance being a mass with an intensity intermediate between the renal cortex and the medulla on T1-weighted images and hyperintense on T2-weighted images. MR was similar to CT in staging renal cell carcinomas (74% for MR vs 67% for CT). Neither CT nor MR was reliable in differentiating stage I from stage II lesions. MR clearly showed venous invasion without the use of IV contrast medium and was superior to CT in differentiating lymphadenopathy from small vascular structures. Because of the limited availability, longer imaging time, and more stringent patient requirements (patients with pacemakers, intracranial aneurysm clips, life-supporting systems, and severe claustrophobia need to be excluded), the authors recommend MR only for patients with known contraindications to iodinated contrast medium, patients with prior suboptimal bolus-contrast CT studies, or patients in whom the CT findings are equivocal.

Value of sonographic screening for gallstones in patients with chest pain and normal coronary arteries.

The prevalence of sonographically detectable gallstones in patients with chest pain and normal coronary arteries was compared with the prevalence of gallstones in patients referred to sonography for nonbiliary disease. Among 545 patients with chest pain and normal coronary arteriograms, 101 (18.5%) were referred for sonographic examination of the gallbladder. This test group was compared to a matched control group (n = 101) undergoing abdominal sonography for nonbiliary disease. Six patients (5.9%) in the test group and eight patients (7.9%) in the control group were found to have gallstones by accepted sonographic criteria. Studies based on oral cholecystogram screening of healthy populations have claimed a prevalence of cholelithiasis of 2.3%-6.2% for males and 2.3%-12% for females. The authors were unable to demonstrate a higher prevalence of sonographically identified gallstones in patients with chest pain and normal coronary arteries than in patients examined for nonbiliary disease. The frequency of gallstones in this test group is comparable to that reported for a screened population of healthy men and women.

Intravenous cholecystokinin octapeptide: its effect on the sonographic appearance of the file ducts in normal subjects.

The response of the common hepatic duct to an intravenous injection of sincalide (0.04 mcg/kg over 1 min) was assessed in 15 healthy volunteers. Ultrasound examinations performed at 5-minute intervals for 1 hour revealed a mean maximal decrease in gallbladder volume of 59%. The internal diameter of the duct was unchanged in 13 of 15 subjects, and decreased by 1 mm in the remaining 2 subjects. It is concluded that, in normal subjects, there is no significant change in the internal diameter of the common hepatic duct in response to an intravenous dose of sincalide sufficient to effect gallbladder contraction.

Cerebrospinal fluid pleocytosis after seizures.

Cerebrospinal fluid (CSF) pleocytosis after seizure activity has been anecdotally reported for many years, but it has not been well documented. We reviewed the records of all adult patients admitted to Grady Memorial Hospital from November 1979 through October 1980 with the diagnosis of seizure. Of 102 patients whose CSF was examined, 35 (34%) had pleocytosis; in 31 (30%) there was no explanation for the pleocytosis despite laboratory and radiologic tests to rule out established causes. For those patients without an identifiable cause of pleocytosis the mean number of white cells was 72/cu mm with a median of 10 and a range from 3 to 464. A predominance of polymorphonuclear leukocytes (PMNs) was found in 57% of the initial CSF examinations. Eighty-six percent of patients with seizures due to ethanol withdrawal had a PMN predominance in their CSF, and 88% of patients with seizures due to a recent or remote cerebrovascular accident had a mononuclear cell predominance. The pleocytosis was usually transient; normalization of the CSF was associated with the rapid recovery of the patient. We conclude that an abnormal CSF leukocyte count may be entirely attributable to seizure activity, although the mechanism is unknown. Before assigning this cause, however, a thorough search is imperative to rule out treatable disorders that may cause CSF pleocytosis.

The influence of chronic administration of hypnotics and analgesics on rate of recovery from inhalation anesthesia in rats.

A series of groups of Sprague-Dawley rats were given either secobarbital, phenobarbital, morphine, pentazocine, diazepam, methotrimeprazine, or saline (control) intraperitoneally on 4 consecutive days and then, on day 5, anesthetized with chloroform, trichlorethylene, fluroxene, halothane, methoxyflurane, enflurane, isoflurane, bromotrifluorocyclobutane, or chlorotrifluorocyclobutane. One control group received neither pretreatment nor anesthetics and another was given pretreatment but no anesthetics. The factor of "enzyme induction" is also evaluated, as are SGPT elevation and liver and kidney lesions. If enzyme induction occurred with the drugs used for pretreatment, the anesthetics suppressed the expected response. SGPT levels were generally within normal range. The combinations of all pretreatments with enflurane, halothane, or methoxyflurane had the fastest recovery; recovery was slower with the other anesthetic agents, but none of the prior chemotherapeutic drugs accelerated recovery from the inhalation anesthetics.