Air-contrast barium enema studies after flexible proctosigmoidoscopy: randomized controlled clinical trial.

The authors performed a randomized clinical trial to determine the effect of flexible proctosigmoidoscopy (FPS) on the quality of air-contrast barium enema (ACBE) studies performed on the same day and whether it mattered if air or carbon dioxide was used for endoscopic insufflation. One hundred twenty-one patients were randomly assigned to one of the following groups: Same-day studies were performed, with air used for insufflation, in group 1; same-day studies, with carbon dioxide, in group 2; and separate-day studies in group 3. Scout images obtained before the ACBE study were graded for the amount of air seen, and ACBE studies were graded for overall quality; each was graded on a scale of 0-3 in a blinded fashion. The air score was significantly greater in group 1 (2.69) than in group 2 (2.01) (P less than .001), which in turn was significantly greater than in group 3 (1.53) (P less than .01). The ACBE quality scores in the three groups were not significantly different. The authors conclude that FPS can be done before ACBE examination without impairing the quality of the ACBE study. Although carbon dioxide insufflation results in less intestinal air after FPS, the quality of the ACBE study is not affected.

Universal spondylodiscitis in a patient with erosive peripheral arthritis and apatite crystal deposition.

A patient with erosive peripheral arthritis in whom vasculitis and monoclonal IgG kappa paraprotein were associated with sacroiliitis and widespread destruction of intervertebral discs is reported. Crystals resembling apatite were identified in intervertebral disc material, and we postulate that the discitis was accelerated by apatite deposition. Our case illustrates a unique example of axial involvement in rapidly progressive joint disease.

Metacarpophalangeal arthropathy associated with manual labor (Missouri metacarpal syndrome). Clinical radiographic, and pathologic characteristics of an unusual degeneration process.

We describe 7 manual laborers with painful, palpably enlarged metacarpophalangeal joints. Characteristic radiographic changes were joint space loss, prominent osteophytes, and cystic metacarpal heads most prominent in the second and third metacarpophalangeal joints. In 3 of 4 patients, joint biopsy specimens showed subsynovial fibrosis and villous hyperplasia. All 7 patients had similar backgrounds of heavy work demanding sustained gripping motions of both hands, for periods that exceeded 30 years. We designated their condition metacarpophalangeal arthropathy associated with manual labor.

Gated cardiac tomographic visualization of coronary artery calcification.

Coronary artery calcification (CAC) is usually detected by fluoroscopy or on cine films during coronary angiography, but measurement of the calcification is not possible. Gated tomography of the heart provides a full sized image with high contrast spatial resolution of 0.1 mm and low contrast spatial resolution of 0.76 mm. The radiation exposure to the heart is between 1-5% of that experienced with coronary cinefluorography . Measurement of the diameter of calcium deposits is possible and calcium that could be related to arterial stenosis may be identified.

Concentration of 99mTechnetium polyphosphate in fibrothorax following pneumonectomy.

Following the injection of 99mTechnetium-polyphosphate for bone scanning, a diffuse accumulation of radioactivity in post-pneumonectomy fibrothorax was demonstrated in 3 patients. This substantiates the nonspecificity of the localization of 99mTc-phosphorus compounds, and underlines the need for close clinical correlation in the accurate interpretation of such scans.

Intrarenal reflux and renal damage.

The retrograde flow of dye from the calices into the collecting tubules (intrarenal reflux) seen during cystrography in children and its effect on the kidneys were evaluated. A retrospective analysis was made of 175 patients with excretory urograms revealing cortical atrophy. Of these patients 68 per cent had cystograms revealing vesicoureteral reflux. Intrarenal reflux was seen in 8 patients less than 6 years old, an incidence of 13.5 per cent in that age group. There was a high correlation, 7 of 8 or 87.5 per cent, between the areas of intrarenal reflux, and associated renal cortical atrophy and calicectasis. Intrarenal reflux provides a pathway by which bacteria and hydrostatic pressure may produce injury to the renal parenchyma. The presence of intrarenal reflux is an absolute indication for ureteroneocystostomy.