The milk-alkali syndrome. A case report.

A case of the milk-alkali syndrome is described. The patient presented with a raised serum calcium level without hypercalciuria, nephrocalcinosis and azotaemia. The alkali used was an antacid preparation containing calcium carbonate.

Acute focal bacterial nephritis or renal abscess? A sonographic diagnosis.

The radiological and sonographic findings of acute focal bacterial nephritis in 3 patients are presented. The sonographic appearance of a poorly marginated mass in the renal cortex, with echo amplitude less than the normal parenchyma and with poor transmission, should suggest the diagnosis of acute focal bacterial nephritis in a patient with pyrexia and a tender renal mass. These features of poor echogenicity and lack of posterior enhancement contrast with the presence of patchy echogenicity and posterior enhancement found in the renal abscess. This is of surgical importance, as the management may tend to be conservative in the one and surgical in the other.

Ultrasound demonstration of valvulae conniventes in small-bowel obstruction. A case report.

Plain radiographs may on occasion be misleading in patients with intestinal obstruction, owing to the presence of fluid-filled loops of bowel. Ultrasound examination, by demonstrating fluid-filled loops, can provide a definitive diagnosis in such cases. A case report is presented.

Radiological pointers to pre-operative diagnosis of torsion of the gallbladder. A case report.

A case of torsion of the gallbladder is reviewed. The radiographic features of the case suggest that in future pre-operative diagnosis may be possible with the use of ultrasound and contrast radiography.

Percutaneous transcatheter control of traumatic haemobilia: A case report.

A case of traumatic haemobilia following closed injury is presented. A false aneurysm of the right hepatic artery was successfully treated by inadvertent subintimal stripping of the origin of the right hepatic artery.

Repeated transhepatic obliteration of gastro-oesophageal varices.

Two patients with life-threatening bleeding from gastro-oesophageal varices were treated by transhepatic obliteration of the varices. The procedure was repeated in both patients on several occasions and the bleeding successfully controlled. The procedure is reviewed and the advantages, pitfalls and limitations are discussed.

Ultrasound and barium study in the evaluation of upper abdominal masses.

Numerous radiological procedures are now available for investigation of upper abdominal masses of uncertain aetiology; however, certain limitations and pitfalls are associated with these procedures. It is suggested that the initial use of ultrasound and barium studies would frequently provide either a definite diagnosis or lead to the next appropriate line of investigation. The importance of not omitting the barium study is stressed.

A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: an interim report of a prospective trial.

A controlled, prospective study comparing streptokinase and heparin treatment has been completed in 51 patients presenting with acute proximal venous thrombosis of less than 8 days' clinical duration. Patients were studied by means of pre-treatment, post-treatment, 3- and 12-monthly phlebography and pulmonary perfusion scanning and were followed up at 3-monthly intervals. Of the 26 patients randomized to receive streptokinase, therapy was stopped in 3 because of complications. Phlebography 5 days after starting treatment showed 80--100 per cent lysis in 17 of the 23 patients who completed the course of streptokinase. Two patients later developed partial rethrombosis. One patient developed an asymptomatic pulmonary embolus during treatment. During follow-up (mean 19 months) only 1 of the 17 patients with 80--100 per cent lysis developed postphlebitic symptoms, 3 patients died of unrelated causes and 1 patient was lost to follow-up. In patients randomized to heparin therapy no significant lysis was achieved in any of the 25 patients and only 2 of these patients were found to have asymptomatic legs on follow-up. Two patients in this group died and autopsy confirmed massive pulmonary embolus during treatment. These data suggest that streptokinase is superior to heparin in the treatment of acute proximal venous thrombosis of less than 1 week's clinical duration especially if the thrombus is largely non-occlusive. It must be stressed that in order to avoid the bleeding complications of thrombolytic therapy, streptokinase must not be used within 10 days of major surgery, or even longer after vascular, neurosurgical or eye operations.

The role of thrombolytic therapy in the management of phlegmasia caerulea dolens.

Two cases of phlegmasia caerulea dolens with peripheral venous gangrene treated with streptokinase are presented. Both patients had excellent results, beyond expectation. The literature is reviewed and the symptomatology, aetiology, pathogenesis and current thoughts on treatment are discussed.

The accelerated diagnosis of jaundice with ultrasonography and narrow-needle cholangiography.

The accuracy of ultrasonography in the diagnosis of jaundice in 70 patients has been compared with that of transhepatic cholangiography and the results of surgery and liver biopsy. A simplified system of grouping the ultrasonic data is presented. The results indicate that ultrasonography is capable of differentiating obstructive from non-obstructive jaundice in 94% of cases and of defining the correct anatomical level in 85% of cases. The accuracy of narrow-needle cholangiography was 100% for obstructive jaundice and 66% normal duct entry rate for non-obstructive jaundice.

Reduction in renal size associated with complete ureteric duplication.

Ureteric duplication, whether complicated or not, is usually associated with an increased in renal length. Two cases of renal duplex with nonfunction of the upper moeity, exhibiting a reduction in renal size, are presented. The radiologic features and the cause of this reduction in size are discussed. The importance of the postmicturition radiographs in cases of urinary tract infection is stressed.

Skin necrosis after warfarin therapy.

A rare but potentially lethal complication of coumarin and its congeners is skin necrosis. A case of skin necrosis due to warfarin is reported and the literature is reviewed. It is suggested that if necrosis develops, the coumarin therapy should be terminated, and the patient should immediately be heparinized. Heparin, which never causes necrosis, can be used freely if further anticoagulation therapy is required, and may well prevent necrosis due to the thrombotic process.

Intrarenal reflux--papillary morphology and pressure relationships in children's necropsy kidneys.

A radiological study of the necropsy kidneys of 100 children was made. Morphologically it was shown that compound or fixed papillae predominate in the upper group of calyces and to a lesser degree in the lower group, whilst simple papillae occurred in the middle group. Pressure studies showed that intrarenal reflux occurred in compound papillae at lower pressure than in simple papillae and that lower pressures were required to produce intrarenal reflux in the first year of life.

Percutaneous embolization for post-traumatic renal haemorrhage.

Treatment of post-traumatic renal haemorrhage by percutaneous embolization in 9 patients is reported. Successful control of haematuria was achieved in 8 patients and 1 patient was referred for surgery. The arteriographic findings and technique are described. One patient developed hypertension but there were no other complications. Super-selective renal arterial embolism can provide definitive therapy in renal trauma, and major surgery may be avoided in most cases.

"The intraureteric diverticulum", a manifestation of ureterocoele intussusception.

An ectopic ureterocoele may present as a diverticular-like structure at the bladder base appearing during voiding cystography. The radiological appearances are described and the mechanism of formation as seen in serial 70 mm film is discussed. The conventional intravesical filling defect of an ureterocoele may not be recognised when the bladder is filled by contrast medium. This sign of extra-vesical intra-ureteric invagination is only seen during voiding.