Symptomatic hypoglycemia in a patient with chronic hemodialysis.

We describe the case of a 71-years-old man in chronic hospital hemodialysis who was admitted to the hospital because of symptomatic hypoglycemia. We discovered that this was due to a documented intoxication with cibenzoline, an antiarrhythmic drug, used to treat (supra-)ventricular tachyarrhythmia. In addition we made a short review of the literature concerning cibenzoline intoxication.

[A patient with Wegener's granulomatosis who worked in a foundry: a case for a causal association with silicon dioxide]. / Een arbeider in een ijzergieterij met de ziekte van Wegener: ondersteuning voor een causaal verband met siliciumdioxide.

The diagnosis Wegener's granulomatosis was made in a 42-year-old man. Occupational history revealed prolonged exposure to large amounts of silicon dioxide in dust during work in a foundry. The illness was stabilized with immunosuppressive treatment, but after one year the patient developed aseptic necrosis in both hips, which ultimately led to essential total hip arthroplasty on the left side. The patient was unable to work since the diagnosis. Similar case reports have been described, as well as a limited number of case-control studies. These indicate an association between Wegener's granulomatosis and exposure to silicon. There is growing evidence for a causal role of silicon dioxide in the pathogenesis of auto-immune disease.

A pulmonary infection caused by Coprinus cinereus (Hormographiella aspergillata) diagnosed after a neutropenic episode.

In a patient treated for a non-Hodgkin's lymphoma, a lung abscess caused by Hormographiella aspergillata (stat. anamorph. Coprinus cinereus) was diagnosed using an ultrasound-guided puncture of the lesion. The patient appeared to respond to amphotericin B, but at the same time was also recovering from her neutropenic episode. The extent to which each of these two factors explains the complete resolution of the infection is unclear. Expert classical morphological examination and molecular typing methods were needed to identify this filamentous basidiomycetous fungus.

Sonographic detection of multiple Staphylococcus aureus hepatic microabscesses mimicking Candida abscesses.

We report the sonographic, CT, and clinical findings in a patient presenting with clinical sepsis and multiple Staphylococcus aureus hepatic microabscesses. Although contrast-enhanced CT has had a higher sensitivity than sonography in detecting hepatic microabscesses in some studies, this examination was negative in our patient. On sonography, numerous small hypoechoic lesions were present. Some target-like lesions had a striking similarity to Candida albicans microabscesses. The hepatic lesions were believed to be pyogenic liver microabscesses, as several blood cultures were positive for S. aureus. Following prolonged intravenous antibiotic therapy, all the hypoechoic hepatic lesions disappeared, along with the clinical and biochemical signs of sepsis.

Hypertrophic lymphocytic gastritis with a gastric carcinoma.

Lymphocytic gastritis is a recently described gastric inflammation, characterized by an increased intraepithelial lymphocytic infiltrate mainly composed of T-lymphocytes. Endoscopically it correlates mainly with diffuse varioliform gastritis. Ménétrier's disease is a hypertrophic gastropathy with enlarged gastric folds. The histological picture is that of foveolar hyperplasia and glandular cysts of the mucosa. A few small series of lymphocytic gastritis with microscopic and endoscopic features of Ménétrier's disease have been published previously. We describe a similar case associated with a gastric adenocarcinoma.

Ultrasound-guided puncture of the gallbladder for acute cholecystitis.

We performed a US-guided aspiration of the gallbladder in 27 patients with an acute cholecystitis and severe concurrent disease, not responding to IV antibiotics and supportive therapy. Twenty six of the 27 patients improved after the procedure. One patient died 7 days after the procedure due to multi organ failure; in the others immediate surgery could be avoided. Three patients experienced local pain after the procedure; no other puncture related complications were encountered. Long-term results (mean follow up 18 months; range 2-36 months) were excellent in 20/26 survivors with no biliary complications or need for elective cholecystectomy. Six of the 26 patients needed subsequent cholecystectomy for relapse or incomplete cure.

Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: a prospective study in 144 consecutive patients.

The value of axillary sonography in 144 consecutive patients was prospectively studied. Abnormal lymph nodes were demonstrated in 72 axillae, only half (36 of 72) of which were clinically detected. In comparison with intraoperative findings in 47 patients with breast carcinoma, the sensitivity of sonography in detecting malignant nodes was 92%, the specificity 95%, and the positive and negative predictive value 96% and 91%, respectively. In 42 patients a sonographically guided node puncture was performed. Evidence of malignancy was found in 38 (90.5%). In 14 (33%) of them, cyto-histology pointed to a clinically undetected primary malignancy.

Mucocele of the appendix.

We describe a case of mucocele of the appendix, observed incidentally in a 42-year-old man. The plain film, ultrasound and CT features are reviewed. Adequate diagnosis and resection are important because of the risk of rupture and development of pseudomyxoma peritonei.

Transition of renal arteriovenous fistula to arteriocalyceal fistula during embolization.

Selective and superselective renal embolization is a generally accepted technique for treating traumatic or iatrogenic renal arteriovenous fistulas or arteriocalyceal fistulas. Only a minority are pure arteriocalyceal fistulas. During embolization, an arteriovenous fistula may become a frankly bleeding arteriocalyceal fistula, causing massive haematuria and necessitating further embolization.

Ultrasonographic diagnosis of hepatobiliary ascariasis.

Eight cases of hepatobiliary invasion of Ascaris lumbricoides into the hepatobiliary tract are presented. In the presence of nonspecific symptoms and biochemical test results, the diagnosis was made in seven patients by sonography. In the remaining patient, in whom the adult roundworm was not visible on sonography owing to the presence of aerobilia, the diagnosis was made at ERCP. Sonography revealed typical tubular, echogenic, filling defects along the long axis of a dilated common bile duct, sometimes exhibiting slow movements and containing a central sonolucent line. Repeated sonographic examinations accurately predicted treatment success.

Ultrasound-guided puncture of the gallbladder for acute cholecystitis.

In 18 high-risk patients with acute cholecystitis and severe concurrent disease, we aspirated the gallbladder by using a percutaneous technique under ultrasound guidance. 17 of the 18 improved after aspiration, the only complication being local pain in 2. 13 of the 17 who improved remained free from biliary infections during a mean follow-up period of 14 months. 4 had an uncomplicated cholecystectomy 6-10 weeks later for recurrent cholecystitis. Percutaneous transhepatic gallbladder aspiration is a safe and effective procedure in critically ill patients with acute cholecystitis.

Detection of colorectal cancer by routine ultrasound.

In 95 consecutive patients with proven colonic carcinoma, the tumor was detected by routine sonography in only half of the patients. However, in 22 out of 23 tumors of the right colon, a correct diagnosis was suggested by sonography (sensitivity 95.5%). Although not suitable as a first choice screening procedure for colorectal cancer, routine abdominal ultrasound can detect even non-suspected colonic tumors, especially in the ascending colon. Since the specificity of ultrasound is probably low, diagnosis must be confirmed by X-ray and/or endoscopy.

Can sonography diagnose acute colonic diverticulitis in patients with acute intestinal inflammation? A prospective study.

In a prospective study of 123 patients with clinical signs of acute intestinal inflammation, the sensitivity of ultrasonography in diagnosing acute colonic diverticulitis was 84.6% and the specificity 80.3%. The predictive value of a positive and a negative sonogram was 76.0% and 87.7%, respectively. Of the 52 patients with subsequently proven acute colonic diverticulitis, 44 presented sonographically with a thickened (greater than 4 mm) hypoechoic bowel wall. In 15 patients, enlarged fluid-filled bowel loops were also present. Air-containing diverticula were demonstrated in 3 patients, abscesses in 8 patients, and colovesical fistulae in 2 patients. Eight large abscesses were successfully treated without emergency surgery by percutaneous sonographically guided evacuation. The described sonographic abnormalities strongly suggest acute colonic diverticulitis, particularly when localized in the left lower abdomen.