[Giant haemangioma of the liver - clinical and diagnostic problems - a case report]. / Riesenhämangiom der Leber - klinische und diagnostische Probleme - ein Fallbericht.

Typical echodense haemangiomas of the liver can easily be identified by B-scan ultrasound. Atypical or giant haemangiomas of the liver, however, need to be differentiated from secondary tumours or primary liver carcinomas and cholangiocarcinomas. Until recently, computed tomography or magnetic resonance tomography were required to confirm the diagnosis, and not so rarely even a fairly risky fine-needle puncture had to be performed. Contrast media-assisted sonography, in general, offers the same scope of differentiating liver tumours as the radiographic tomography methods. Contrast media-assisted sonography is not yet widely available and has not been sufficiently evaluated. One important limitation is thought to be the lack of echo depth. We demonstrate the diagnostic value of this method in the case of a liver haemangioma measuring more than 20 cm in diameter. The resulting clinical questions are being discussed.

Subacute encephalopathy with seizures in chronic alcoholism (SESA syndrome).

Report of a case of SESA syndrome: a rare CNS complication of chronic alcoholism, known since 1981 and characterized by epileptic seizures, multiple and reversible neurological deficits, as well as PLEDs in the EEG. The MRI showed enhanced occipital signals in the T2-weighted sequence, which resolved together with the clinical findings.

Limited value of scintimammography and contrast-enhanced MRI in the evaluation of microcalcification detected by mammography.

The aim of this study was to evaluate whether scintimammography using 99Tc(m)-sestamibi or contrast-enhanced magnetic resonance imaging (MRI) can improve the specificity of mammography for the differentiation of benign and malignant breast microcalcification. From 156 consecutive patients studied with SMM, 44 patients with microcalcification on mammograms were selected for this study. Forty patients in this group also had contrast-enhanced MRI of the breast. The intensity and patterns of sestamibi uptake for scintimammography and contrast enhancement for MRI were visually determined and graded on a 5-point scale for malignancy. The results of both techniques were compared and correlated with final histopathologic diagnoses. The sensitivity and specificity of scintimammography were 63% and 85% respectively, if only those cases classified as probable or definite malignancy were considered positive. If indeterminate findings were also considered positive, the sensitivity and specificity of scintimammography were 79% and 80% respectively. Using the latter classification for MRI revealed a comparable sensitivity of 82% but a markedly lower specificity of 56%. Excluding indeterminate findings from the group of positive MRI diagnoses resulted in a specificity of 94% and a sensitivity of 64%. In conclusion, scintimammography of the breast had a comparable sensitivity but a higher specificity than MRI. The sensitivity of both techniques, however, is probably too low for routine use in the evaluation of microcalcification detected by mammography.

Role of technetium-99m sestamibi scintimammography and contrast-enhanced magnetic resonance imaging for the evaluation of indeterminate mammograms.

This study evaluated and compared technetium-99m sestamibi scintimammography (SMM) and breast magnetic resonance imaging (MRI) results in patients with indeterminate mammograms to determine whether either technique can improve the sensitivity and specificity for the diagnosis of breast carcinoma. From 123 consecutive patients who underwent physical examination, mammography, SMM, and histopathologic confirmation, a subgroup of 82 patients presenting with indeterminate mammograms was studied. Sixty-eight patients underwent contrast-enhanced MRI. SMM results were scored on the basis of the intensity and pattern of sestamibi uptake. MRI images were scored on the basis of signal intensity increase after administration of contrast material as well as the enhancement pattern and speed of gadolinium uptake. The results obtained with the two techniques were compared and related to the final histopathologic diagnoses. Considering indeterminate findings as positive, the sensitivity of SMM was 79% and the specificity, 70%. MRI displayed a sensitivity of 84% and a specificity of 49%. When indeterminate results were considered negative, the sensitivity and specificity of SMM were 62% and 83%, respectively. MRI revealed a sensitivity and specificity of 56% and 79%, respectively. The calculated sensitivities and specificities demonstrate the diagnostic limitations of both SMM and MRI in the evaluation of patients with indeterminate mammographic findings. Due to the higher specificity, SMM may be the preferred modality in the evaluation of selected patients with breast abnormalities.

[Bavaroise and an epidemic of Salmonella enteritidis]. / Bavaroise en een epidemie van Salmonella enteritidis.

In the literature an association is made between the increasing prevalence of Salmonella enteritidis in poultry products and in the isolates of patients with gastroenteritis, without sufficient evidence of a causal relationship between the increasing prevalences. A microbiological and epidemiological analysis of a food poisoning incident among 239 visitors of a restaurant by way of food specific attack rates and food specific infection rates revealed an epidemic of 70 cases of S. enteritidis enteritis. The analysis supports the causal relationship with the consumption of an infected, unhygienically prepared egg product, in this case bavaroise.

Modulation of calcium by the carcinogenic process in the liver induced by a choline-deficient diet.

A diet devoid of choline and low in methionine (CD), without any added carcinogen, has been shown to induce 100% preneoplastic nodules and more than 50% cancer in the rat liver. Attempts to understand the mechanism by which a CD diet induces liver cell cancer revealed that like chemical carcinogens, a CD diet also appears to cause alterations in DNA, perhaps mediated by free radicals. Indeed, a CD diet induces nuclear lipid peroxidation prior to the changes in DNA. The CD diet induced DNA alterations coupled with continuing liver cell proliferation may account for the induction of initiated hepatocytes by the CD diet. To gain insight into the nature of free radicals generated by the CD diet, experiments were designed to determine whether agents that modulate free radical effects influence the CD diet induced changes in the liver. We investigated the effect of Ca2+ in the modulation of CD diet induced alterations in the liver. The results show that extra Ca2+ when added to the CD diet prevented some of the early changes due to choline deficiency, such as nuclear lipid peroxidation and DNA damage, but had little or no effect on the triglyceride accumulation in the liver. Also, the same CD diet with extra Ca2+, when used as a promoter after initiation by diethylnitrosamine, decreased the number and size of early putative preneoplastic foci and nodules.