Adult Burkitt's lymphoma presenting as intussusception: first UK case report.

Colonic intussusception is rare in adults and can present with non-specific symptoms that can make diagnosis difficult and delayed. Unlike in children, it is commonly due to a pathological lead point that is often malignant. This case is the first reported case of adult intussusception due to Burkitt's lymphoma in the UK. We describe the case of a 22-year-old woman who presented with 4-week history of intermittent epigastric pain. On the third hospital admission, the diagnosis was made by abdominal computed tomography, which showed the 'target' sign, suggestive of intussusception. A right hemicolectomy was performed and histology later confirmed Burkitt's lymphoma. This case demonstrates the difficulty in diagnosing intussusception in adults, which must be considered in recurrent abdominal pain when more common causes have been ruled out. The rare diagnosis of Burkitt's lymphoma made early diagnosis and treatment important.

Multiphase multidetector CT in the diagnosis of haemobilia: a potentially catastrophic ruptured hepatic artery aneurysm complicating the treatment of a patient with locally advanced rectal cancer.

Acute haemobilia is an unusual and potentially catastrophic cause of gastrointestinal bleeding. We describe such a case presenting as a rare complication of a hepatic artery aneurysm following the development and successful treatment of subacute bacterial endocarditis during a radical downstaging chemoradiotherapy regime for locally advanced rectal cancer. We suggest that multiphase multidetector-row CT can have an important role in the diagnosis of acute haemobilia and discuss imaging findings associated with the condition. This case raises awareness of benign conditions mimicking malignancy in oncological patients and reinforces the importance of reviewing historical imaging.

Three-day regimen improves faecal tagging for minimal preparation CT examination of the colon.

This study set out to determine whether extending the length of oral contrast administration in minimal preparation CT of the colon improves faecal tagging. Two cohorts of 50 patients each were compared, one with a 2-day the other with a 3-day faecal tagging regimen. The degree of faecal tagging was graded by two blinded observers. The 3-day regimen showed significantly better tagging in the rectum and sigmoid colon (p = 0.006 and p = 0.009, respectively, using the Mann-Whitney test). The percentage of patients who had faecal tagging in the sigmoid colon graded as "complete" was 64% for the 3-day regimen as opposed to 34% for the 2-day regimen. The corresponding percentages for the rectum were 64% for the 3-day regimen and 36% for the 2-day regimen. Extending the length of oral contrast administration from 2 to 3 days significantly improves the quality of faecal tagging in the rectum and sigmoid colon.

Imaging of obstructed defecation.

Constipation is a common problem in the western world, which occurs as a consequence of impaired colonic transit and/or due to obstructed defecation. Imaging plays an important role in distinguishing structural from functional causes of constipation. In this article a description of common imaging techniques for diagnosing structural causes of constipation with illustrations of abnormal defecographic findings in patients with obstructive defecation are presented.

Subacute progressive ascending myelopathy following spinal cord injury: MRI appearances and clinical presentation.

STUDY DESIGN: Retrospective Case Review. OBJECTIVES: To describe the clinical presentation and course of patients with magnetic resonance imaging (MRI) features of subacute progressive ascending myelopathy (SPAM). A rare complication of spinal cord injury. SETTING: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. MATERIALS AND METHODS: A retrospective review of the case notes and MRI studies of 11 cases with typical MRI features of ascending myelopathy presenting to a tertiary Spinal Injuries centre over a 15-year period. RESULTS: Eleven patients were identified with MRI features typical of SPAM, a median of 13 days (mean 24, range 4-86 days) following cord injury. The median number of cord segments involved above the initial insult was 6 (mean 6.2, range 4-11). MRI appearances include extension four or more segments cephalad to the initial cord injured segment, cord expansion and increased intramedullary T2 signal with a rim of cord sparing peripherally. Cord changes and neurological deficits improved over time but did not return to the initial injured level on MRI. One patient died (mortality 9%). CONCLUSION: SPAM is a rare cause of neurological deterioration following spinal cord injury but may remain subclinical. SPAM most commonly presents as neurological deterioration but may present with shoulder pain, respiratory deterioration or remain subclinical. There are characteristic MRI appearances. It can be fatal.

An evidence-based review for the management of cystic pancreatic lesions.

The incidental finding of pancreatic cysts is becoming more common because of the increased use of cross-sectional imaging. As a result, the perspective from historical series of symptomatic patients is not always applicable to the current cohort of patients with cystic lesions in their pancreas. In this review, the characteristic radiological features that aid diagnosis are highlighted, and the complementary role of different imaging methods and the appropriate use of tissue sampling are identified. Based on the literature regarding the diagnostic role of imaging in characterizing cystic pancreatic lesions, it is possible to recommend a practical imaging algorithm for the diagnosis of cystic pancreatic lesions.

Causes of lumbosacral plexopathy.

The lumbosacral plexus represents the nerve supply to the lower back, pelvis and legs. This review will focus on diseases and disorders affecting the pathway as demonstrated by magnetic resonance imaging (MRI) and computed tomography (CT). We stress the need to review the lumbosacral plexus in patients with non-specific symptoms such as back, hip, pelvic pain, and in those who present with sciatica unaccompanied by demonstrable intervertebral disc prolapse. We illustrate that the imaging appearances may be non-specific and re-inforce the importance of the clinical history and the use of tissue sampling to achieve an accurate diagnosis.

X-ray diffraction study of human serum.

Blood serum from people suffering from cancer and healthy subjects was subjected to a comparative study by X-ray diffraction. The diffraction patterns were referred to that of pure water. The patterns obtained for blood serum of healthy subjects were similar to that of pure water, while those of cancer patients (two kinds of cancer changes) were different. The former similarity is accounted for by the dominant interaction of water molecules in healthy blood serum with non-polar side chains of amino acids, stabilising the serum structure. In samples from cancer patients the structure of water in blood serum is destroyed because of enhanced interactions of water with polar molecules of conformationally changed proteins. This observation suggests X-ray examination of blood serum from cancer patients and healthy subjects, indicating X-ray diffraction as a diagnostic tool for the occurrence of cancer. The results of this work have shown that the presence of protein affected by cancer has a destructive effect on the structure of water in human serum. The results reported confirm the earlier finding relating cancer changes to optical circular birefringence effects.

The incorporation of various porphyrins into blood cells measured via flow cytometry, absorption and emission spectroscopy.

The incorporation of the five following porphyrins: meso-tetra(4-phenyl)porphyrin (TPP); meso-tetra(4-sulfonato-phenyl)porphyrin (TPPS4); meso-tetra(4-naphthyl)porphyrin (TNP); tri-sulfo-tetra-phenyl porphyrin (TPPS3) and tetra-sulfonato-naphthyl porphyrin (TNPS4) into human blood cells was investigated using flow cytometry, and absorption and emission spectroscopy. The percentage of stained cells, measured in a fluorescence cytometer, provided information on the efficiency of incorporation of fluorescent dye molecules into different types of cells. The yield of the incorporation of a dye was dependent on the type of dye and the solvent used for cell incubation. The degree of dye aggregation and ionization varied with the incubation medium, but dye molecules incorporated into cells seemed to be restricted to those in the monomeric state, exhibiting similar fluorescence yield. Of the three sulfonated porphyrins investigated only TPPS4 was efficiently incorporated into leukocytes. In the incubation solvent, this dye was in monomeric and neutral form. TPPS3 which was also in monomeric form, practically was not incorporated into cells. TPP and TNP dissolved in 5% aqueous dimethyl sulfoxide were present mostly in aggregated forms but they penetrated the cells with a high efficiency.

The influence of the presence of lipid on the aggregation of 8,12-diethyl farnesyl bacteriochlorophyll c located in adsorbed layers and monolayers.

The photoacoustic spectra and time-resolved delayed luminescence spectra in the microsecond time range were measured for layers of 8,12-diethyl farnesyl bacteriochlorophyll c adsorbed on quartz supports by solvent evaporation and as Langmuir-Blodgett monolayers. Both types of model system were also investigated with the addition of lipid. The data showed a very strong influence of lipid addition on pigment aggregation. In samples with synthetic and natural lipid addition, the pigments were found to be predominantly in the monomeric and dimeric states, whereas in the same type of sample without lipid, the pigments were aggregated to a higher degree. The influence of the presence of lipid on the aggregation of bacteriochlorophyll c in monolayers and adsorbed layers may also suggest that the contact of various pigment molecules with the lipids surrounding the chlorosome may influence the formation of various pigment aggregates in vivo. The synthetic lipid L-alpha-phosphatidylcholine dipalmitoyl and the natural lipid L-alpha-phosphatidylcholine type IVS from soy beans were used. In the latter case, only adsorbed layers were investigated. Our interpretation is preliminary as only one 8,12-diethyl farnesyl bacteriochlorophyll c homologue was present in our systems.

Photoelectric properties of chlorophyll and carotene solutions in nematic liquid crystal located between semiconducting electrodes.

The photopotential and photocurrent generation for chlorophyll a, beta-carotene and a mixture of these pigments dissolved in nematic liquid crystal and located between transparent semiconducting electrodes were measured. Both pigments exhibit photopotential and photocurrent generation. From the photocurrent amplitudes it follows that the efficiency of electron transfer to a semiconducting electrode from beta-carotene is higher than from chlorophyll alpha. The photocurrent amplitude of the pigment mixture is slightly lower than that calculated as a sum of amplitudes of pigments located in separated cells. This difference can be explained by secondary effects, such as competition between carotene and chlorophyll molecules in a process of adsorption on a semiconducting electrode. Therefore it seems that no charge transfer complexes of chlorophyll and carotene are formed in the investigated model system.

Melanin-porphyrin interaction monitored by delayed luminescence and photoacoustics.

Even though melanin is commonly viewed as a photoprotective agent, the molecular mechanism of the melanin-related photoprotective action remains unclear. We studied the interaction of a synthetic dopa melanin with positively and negatively charged porphyrins using an array of spectroscopic techniques. Thus absorption, fluorescence, time-resolved delayed luminescence in the microsecond time range, and photoacoustic spectra at different modulation frequencies of both porphyrins and their mixtures with dopa melanin were measured in buffered aqueous solution at room temperature. It has been confirmed that dopa melanin forms a complex with the cationic porphyrin in its ground state, which significantly modifies the optical properties of the dye molecule. Although no such complex can be detected for the anionic porphyrin, some interaction between melanin and the porphyrin molecule can be detected in its excited state. Both porphyrins show delayed luminescence with a decay time of 35-38 microseconds, which is substantially reduced by melanin. Our photoacoustic measurements indicate that upon photoexcitation, melanin efficiently liberates heat. Our data also suggest that the thermal properties of melanin can be modified by porphyrins, particularly by the cationic form of the dye. The ionic complexes of dopa melanin with the positively charged porphyrin exhibit properties typical for a supermolecular system that liberates heat as a whole.

Incorporation of stilbazolium merocyanines into human leukocytes measured by flow cytometry.

Human peripheral blood leukocytes were incubated with thirteen various merocyanines of the stilbazolium betaine type and the fluorescence intensities of the cells were measured by flow cytometry. The fluorescence intensity of lymphocytes, monocytes and granulocytes depended on the time and temperature of incubation with the dyes. An increase in the incubation temperature enhanced the fluorescence intensity whereas washing of the cells after incubation had little influence on the observed emission. This points to incorporation of the dye molecules into the cell membrane. From the measured fluorescence intensities corrected for relative fluorescence yields, the relative efficiencies of incorporation into the cells of the various merocyanines tested were evaluated. The efficiency was dependent on the type of the cells and the lenght and side groups of the merocyanine molecules studied.