Angiographically undetected ulceration of the carotid bifurcation as a cause of embolic stroke.

The accuracy of angiographic diagnosis of carotid artery ulceration was evaluated. Of those carotid bifurcations showing ulceration at surgery, 60% were diagnosed as having ulcers at angiography. Half of the remaining ulcers occurred in smooth, benign-appearing plaques and were too small to be seen at angiography. An incorrect angiographic diagnosis of ulceration was made in 17 of 50 carotid arteries; in most cases this was due to the presence of a subintimal hematoma in the wall of the artery.     

Rectal balloon for CT of rectal cancer

The use of a balloon catheter to distend the rectum for pelvic CT in patients with rectal cancer is described. The 20-cm long balloon, inserted over a 12F catheter and inflated with 180-200 ml of water, is simple to use, well tolerated by patients and allows high-quality CT scans. Preliminary results of the presurgical staging of rectal cancer by CT with rectal balloon in a series of 15 patients show a high accuracy when comapred with the pathological findings: involvement of perirectal nodes and adjacent structures was correctly identified in all cases, while CT overestimated the invasion of perirectal fat in two cases, due to the impossibility of distinguishing neoplastic from inflammatorry tissue. The operability statement (site and dimensions of the tumour) allowed correct surgical planning in all cases. Correspondence to: M. Bellomi     

Aortal aneurysm as a cause of ileus

A 62-year-old patient presented with flatulence, abdominal distension and other symptoms of ileus. Roentgenographic finding found compression on duodenum. Blood pool scintigraphy ((99m)Tc erythrocytes) showed aortal aneurysm, while simultaneous gastric emptying study with liquid meal ((99m)Tc-S-colloid) showed dislocation of duodenum and compression from abdominal aortal aneurysm.     

Glomus tumor as a cause of coccydynia

Glomus coccygeum is a network of glomus bodies located around pericoccygeal soft tissue. The question of whether it accounts for coccydynia has been debated. We report on a patient whose preoperative symptoms suggested the impression of glomus tumor of the coccyx; pain was relieved after removal of the lesion without coccygectomy. A 57-year-old woman was referred to us with a history of a pain in the coccygeal area lasting longer than 3 years. The patient complained of sharp pain whenever pressure was applied to the coccyx. Pain was aggravated by exposure to cold. MRI revealed a coccygeal lesion measuring 2 cm with a well-circumscribed margin. The lesion was excised without removal of any portion of the coccyx. The pathology report confirmed a glomus tumor, which was an identical finding to the conventional one of the subungual region. Ten months after surgery, she had no pain on the coccygeal region and no difficulty with sitting on a chair and in performing activities of daily living. Findings reported here suggest that although most glomus bodies are normal anatomical variants, development of a glomus tumor could occur in the coccygeal region and could be a cause of coccydynia.     

Sacral haemangioma as a cause of coccydynia

We report a 55-year-old woman with coccydynia due to a sacral mass. The histological diagnosis was haemangioma. The MRI findings and the unusual location of this lesion are discussed. Received: 10 September 1997 Accepted: 17 January 1998     

Sarcoidosis as a cause of linitis plastica

We report a patient with gastric sarcoidosis. After initial pulmonary sarcoidosis, which responded to corticosteroids, the patient developed linitis plastica of the stomach which was treated by partial gastrectomy and steroids.     

Rectal intussusception and rectal prolapse: detection and postoperative evaluation with defecography

The authors studied pre- and post-operative defecograms in 20 patients with rectal intussusception and three with rectal prolapse to assess the value of defecography in detection of these conditions. Eleven patients also had solitary rectal ulcers. Two to 3 months after surgery, patients underwent defecography, and results were correlated with postoperative symptoms. In all three patients with rectal prolapse, and 13 of 20 with intussusception, findings on postoperative defecograms were normal and symptoms were gone. Abnormalities and symptoms persisted in two patients and recurred in another two. In five patients, symptoms persisted despite normal defecographic findings. In 11 patients with solitary rectal ulcers, rectal lesions were cured in nine; in two, intussusception and rectal lesions recurred. Thus, presence or absence of solitary rectal ulcer corresponded to postoperative symptoms in all cases. Symptoms and postoperative defecographic findings corresponded in 20. This study suggests that rectal intussusception and prolapse most likely lead to defecation disorders and that defecography is useful in detecting them.     

Angiodysplasia of the colon: A cause of rectal bleeding

Colonic angiodysplasia is a vascular lesion of the colon that may become the source of low grade chronic or intermittently massive rectal bleeding. It is a lesion of the elderly, almost always found in the cecum and the ascending colon. Etiology and pathogenesis are unknown. The diagnosis can be made with angiography based on the demonstration of a vascular tuft and early opacification of draining veins. Right hemicolectomy is the mode of therapy. The lesions are minute, and in resected specimens they can be found only with special vessel injection techniques. Histologically, the lesions represent clusters of dilated vessels, mostly veins, in the mucosa and submucosa of the cecum and ascending colon.