Intra-abdominal tuberculous peritonitis.

We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies.

Diagnosis of nonpalpable testes in childhood: comparison of magnetic resonance imaging and laparoscopy in a prospective study.

In a prospective study, the accuracy of magnetic resonance imaging (MRI) and laparoscopy in the diagnosis of nonpalpable testes was evaluated. Advantages and disadvantages of the two procedures were compared. 29 boys with unilateral nonpalpable testis underwent MRI. When MRI failed to demonstrate a testis, laparoscopy with a 1.9 mm mini-laparoscope was performed. All cases were verified by operative exploration of the inguinal region. MRI demonstrated 10 inguinal and 7 abdominal testes. MRI revealed no testis in 12 boys. The false positive rate was 32%, correct negative findings were confirmed in four patients. When laparoscopy was performed, preservable testis could be demonstrated in 8 of 12 patients (1 abdominal, 7 inguinal) which otherwise were not visible on MRI. The correct positive rate was 100%. We encountered no complications with laparoscopy. In summary, laparoscopic evaluation is recommended as the preferable method in pediatric cases of nonpalpable testes.

[Diaphragmatic ruptures: diagnosis--therapy--results, experiences with 64 patients]. / Zwerchfellrupturen: Diagnostik--Therapie--Ergebnisse, Erfahrungen bei 64 Patienten.

From 1963 to 1993, 64 Patients with traumatic lesions of the diaphragm were treated. 58 Patients were admitted after blunt trauma, 6 Patients after a penetrating trauma. 87.5% of the patients were male with an average age of 37 years. In about 80% of cases other severe traumatic lesions were noted in association. With 64% extremities, 50% abdomen, 47% thoracic cavity and 38% head injuries were concomitant lesions. Due to the association with pelvic fractures (45%) a special diagnostic emphasis on diaphragmatic ruptures is recommended. In 83% the left diaphragm is involved. Over the last years the right-sided rupture of the diaphragm were found in an increasing extent from 3.7% up to 26%. Conventional radiography with gastrographin swallow is still the essential diagnostic tool. Hospital mortality (12%) was mainly influenced by complications of concomitant injuries, i.e. cardio-pulmonary insufficiency, Shock and multi-organ-failure.