Peripelvic extravasation in intravenous urography

The perivelvic extravasation is a rare X-ray symptom in the intravenous urography. Etiologic, diagnostic and therapeutic aspects are discussed on the basis of an own case and the present literature.     

Acute cholecystitis as a complication of sarcoidosis

Although sarcoidosis has been described affecting almost all body systems, acute cholecystitis has not previously been documented. Such a case is presented with a review of other gastrointestinal tract manifestations of the disease.     

Acute pancreatitis as a complication of polyarteritis nodosa

Summary Conclusions: Polyarteritis nodosa (PAN) must be considered as one of the rare causes of “idiopathic” acute necrotizing pancreatitis. Background: PAN is characterized by panmural inflammation of arterioles causing arteriolar ectasia, aneurysm formation, and thrombosis, resulting in organ ischemia. Methods: We report a case of necrotizing pancreatitis associated with segmental necrosis of the liver and spleen due to polyarteritis nodosa. Results: Five previously reported cases of documented acute pancreatitis secondary to PAN have been identified from the English literature. The mechanism through which pancreatic ischemia results in acute pancreatitis is unknown. Although limited pancreatic infarction is common in PAN, necrotizing pancreatitis is rare, and the poor overall prognosis of PAN is owing largely to other organ complications.     

Acute theophylline intoxication

We describe a case of intentional acute theophylline intoxication with cardiac, cerebral, and gastrointestinal features of moderate-to-severe toxicity. The unusual metabolic and hematologic sequelae included hypokalemia, hyperglycemia, metabolic acidosis, extreme neutrophilia, increased creatinine levels attributed to muscle damage, and hematuria. The implications of these unusual findings for the management of acute theophylline intoxication include the recognition that these effects can be due to intoxication per se and do not necessarily indicate a primary endocrine disorder or infection.     

Acute appendicitis as a rare complication after colonoscopy

Complications due to colonoscopy are uncommon, and acute appendicitis is a very rare complication of colonoscopy. We present the case of an 83-year-old man who underwent colonoscopy and subsequently developed acute appendicitis. In patients with abdominal pain who have had a recent colonoscopy, a high index of suspicion is necessary for the accurate diagnosis of appendicitis. Colonoscopists should be aware of this rare complication and consider it when making a differential diagnosis of post-colonoscopy abdominal pain.     

Routine intravenous urography in the investigation of hypertension

The decision to request intravenous urography in a hypertensive patient has been examined, together with the abnormalities discovered and the resulting changes in clinical management. The records of 405 hypertensive patients newly referred to a single clinic, were examined for the years 1955, 1965 and 1971. Intravenous urography was requested more frequently in younger than in older patients, and the number of requests increased with the level of diastolic blood pressure. The more recent the date of presentation, the more often was the investigation requested.Thirty-five patients had IVU abnormalities against 185 with a normal urogram. The urograms reported in 1971 were reviewed without the knowledge of the previous report and the non-agreement between the standard report and the review is discussed. Nine per cent of the patients who had an IVU in 1971 had a change in medical management as a result of the investigation.When an abnormality was detected on urography the plasma urea and presenting blood pressure were significantly higher and the patients age (adjusted for blood pressure and plasma urea) significantly lower than when the urogram was normal. Based on these results a multiple regression equation is discussed relating the presence of an abnormality (Y) to plasma urea, age and systolic blood pressure as independent variables. A value of Y can be found which would detect most of the significant abnormalities and avoid the request in several of the patients without an abnormality. These decision rules require testing in a prospective study.     

Acute Takotsubo cardiomyopathy as a complication of transoesophageal echocardiogram

A 52-year-old woman, referred for transoesophageal echocardiography, developed acute Takotsubo cardiomyopathy during the examination as a result of emotional distress beforehand. Asymptomatic left ventricular apical ballooning with severe systolic dysfunction within minutes of the emotional trigger was the first sign of any abnormality.Key words: cardiomyopathy, complication, echocardiography, imaging, Takotsubo     

Acute pancreatitis as a complication of polyarteritis nodosa.

CONCLUSIONS: Polyarteritis nodosa (PAN) must be considered as one of the rare causes of "idiopathic" acute necrotizing pancreatitis. BACKGROUND: PAN is characterized by panmural inflammation of arterioles causing arteriolar ectasia, aneurysm formation, and thrombosis, resulting in organ ischemia. METHODS: We report a case of necrotizing pancreatitis associated with segmental necrosis of the liver and spleen due to polyarteritis nodosa. RESULTS: Five previously reported cases of documented acute pancreatitis secondary to PAN have been identified from the English literature. The mechanism through which pancreatic ischemia results in acute pancreatitis is unknown. Although limited pancreatic infarction is common in PAN, necrotizing pancreatitis is rare, and the poor overall prognosis of PAN is owing largely to other organ complications.     

Acute gastrointestinal bleeding as a complication of pancreatic pseudocysts

We report on 6 patients with chronic pancreatitis and pancreatic pseudocysts, operated on for acute bleeding into the cyst. The splenic artery and vein, the renal artery, the aorta and the splenic parenchyma were identified as bleeding sites. In 4 patients the acute hemorrhage occurred during hospitalization. In all patients the operative procedure included hemostasis and/or drainage/resection of the cyst. In 3 cases an additional splenectomy was performed. None of the patients died postoperatively. In 5 patients the pancreatitis was induced by alcohol abuse. In all patients the pseudocysts were diagnosed prior to the acute hemorrhage. CT-scan and angiography were able to localize the origin of the bleeding in 2 cases.