OBSERVATIONS ON EXPERIMENTAL TYPHOID INFECTION OF THE GALL BLADDER IN THE RABBIT

1. Besredka''s living sensitized vaccine, given intravenously, does not produce a typhoid lesion of the gall bladder in the rabbit. 2. The first transplant of this vaccine is capable of producing this lesion. Hence this vaccine is not entirely safe to handle. 3. Regular infections of the gall bladder have not been produced by carrying a known pathogenic strain on rabbit blood agar, by successive passage through animals, or by the use of freshly isolated strains. 4. No evidence could be demonstrated in the rabbit of the immunity produced in man by vaccination with a whole killed vaccine. 5. Vaccine treatment did not cure the gall bladder lesion. 6. With the present methods of producing infections in the chimpanzee and the rabbit, neither of these animals is suitable for deciding the problems of the immunization of man by vaccines. These problems must be settled, as some of them already have been settled, by actual experience with large numbers of men kept under close observation.     

Abdominal desmoid masses in Gardner's syndrome

Abdominal masses, desmoid tumors, occur in approximately 4% of patients with Garnder's Syndrome, usually 1–3 years after total colectomy. Histologic sections usually resemble those of an infiltrating fibrous tumor, a desmoid lesion. The radiographic pattern may be similar to any diffuse abdominal retroperitoneal tumor, metastatic disease, lymphoma, or possibly retractile mesenteritis. The clinical setting usually differentiates these entities.     

Prenatal diagnosis of choledochal cyst: a case report

Choledochal cyst is one of the intra-abdominal abnormalities of the biliary ducts that present as a cystic mass in the right upper quadrant abdomen. Prenatal diagnosis has been achieved by the demonstration of a connection between a dilated common bile duct and a cystic lesion. In this report, we describe a pregnant woman in whom routine fetal anomaly scan strongly suggested a choledochal cyst at 29 weeks of gestation by demonstrating a round cystic mass in the right upper quadrant of the abdomen, completely separated from the stomach, bowel loops, and gall bladder, and which showed a connection with the dilated common bile duct.     

原发性胆囊癌的CT诊断(附56例报告)

目的：研究胆囊癌的CT诊断。资料和方法：对照病理回顾分析56例胆囊癌的CT表现。结果:胆囊壁不规则增厚32％；胆囊腔内结节21％；胆囊区肿块46％；肝侵犯52％；胆管扩张53％；胆结石27％；淋巴转移34％。结论：1、胆囊癌CT分型为厚壁型、腔内结节型、肿块型，各型为病理发展中不同的阶段。2、直接侵犯肝脏及胆管受侵扩散为胆囊癌主要转移方式。3、CT对诊断中晚期胆囊癌及判断浸润范围有价值，尤其是增强扫描。     

Primary hydatid cyst of peritoneum presented as abdominal lump: a rare presentation

The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. The differential diagnosis is cystic ovarian tumor clinically and radiologically. Peritoneal hydatid disease should be included in differential diagnosis of sonographically diagnosed pelvic cystic lesion.     

A 58‐year‐old lady presented as an emergency with right upper quadrant pain and loss of 5 stones in weight. What does the X‐ray show?

Renal cell cancers are among the great mimics in surgery as they present with myriad symptoms unrelated to the renal cancer. This patient also interestingly had an incidental finding of porcelain gall bladder.     

Sonographic features of intravascular papillary endothelial hyperplasia (Masson's tumor) in the forearm

Intravascular papillary endothelial hyperplasia, also known as Masson's tumor, is a benign, vascular lesion in which there is papillary proliferation of endothelial cells. The lesion presents as a palpable soft-tissue mass, often located within normal or dilated vascular spaces, and may be mistaken for a sarcomatous tumor on imaging. We present the case of an intravascular papillary endothelial hyperplasia in the forearm, with a remarkable appearance on color Doppler sonography, and suggest that this entity will be encountered more frequently by sonologists in the future.     

THE FILLING AND EMPTYING OF THE GALL BLADDER

As a result of the control of the flow of bile into the duodenum largely by tonus and movements of the duodenum, bile intermittently enters the gall bladder where it is concentrated and undergoes other changes. The gall bladder empties itself of its content through the cystic duct (1) by the washing out of its contents by bile from the liver, (2) by the elasticity or contractile mechanism of its walls, and (3) by variations of intraabdominal pressure due to respiratory movements, contiguous organs, etc. A fourth manner of emptying of the gall bladder is by absorption of a portion of its content through its walls. The gall bladder is never entirely empty but tends to come to a state of partial collapse, when its contents are under minimum pressure. We have been unable to demonstrate rhythmic contractions of the gall bladder due to its musculature. If they are present they may aid but they are not essential for its emptying or filling. Experimentally, in the dog, a rubber bag which was substituted for the gall bladder functioned in a manner very similar to that of the normal gall bladder as shown by cholecystographic studies. The concentrating function, however, was absent.     

Pituitary adenomas

Pituitary adenomas are by far the most common sellar tumor and magnetic resonance imaging is the modality of choice for their detection and characterization. However, most of these neoplasms are asymptomatic and frequently incidentally visualized. One also has to be aware of common other incidental findings and normal age-related changes in the appearance of the gland. By convention, 10 mm is used as the size threshold to separate macroadenomas from microadenomas. For microadenomas, imaging is primarily used for lesion detection and localization, whereas with macroadenomas, the goal is to establish whether the mass represents a pituitary tumor or some other lesion and to precisely delineate its extent.     

腹膜后纤维化16例误诊分析

目的分析腹膜后纤维化(retroperitoneal fibrosis, RPF)误诊原因,提高临床医生对本病的认识。方法回顾分析我院16例RPF误诊病例资料。结果 16例均以腰背部疼痛不适为主要症状,伴恶心、呕吐2例,血尿4例,伴肾区叩击痛11例,触及上腹部包块7例,伴腹胀6例,下肢水肿3例。CT扫描16例均见腹主动脉周围有低密度灶包裹,边界不清,6例累及髂血管,4例累及下腔静脉;8例腹主动脉管壁不规则增厚,正常结构消失,管腔轻度狭窄;10例出现肾积水,4例病变侵犯输尿管,病灶以上段输尿管明显扩张、包埋段输尿管显示不清;7例行增强CT扫描,病灶强化不明显或稍强化。误诊为腹主动脉大动脉炎8例、输尿管肿瘤及腹部包块性质待查各4例。16例均行手术治疗,经术中病理均诊断为RPF,予手术缓解输尿管梗阻及周围组织血管压迫,术后予抗生素、糖皮质激素等治疗后出院,随诊1年均未见复发。结论当临床遇及腰背痛、腹膜后组织肿物或不明原因出现尿路梗阻症状患者,CT检查发现有异常密度灶包绕腹膜后大血管,并伴肾积水、输尿管扩张征象时,应想到本病可能,及时行CT增强扫描,结合患者症状体征及相关检查结果,综合分析病情,仔细鉴别诊断,必要时可行手术病理检查明确诊断。     

下肢肌间弥漫性腱鞘巨细胞瘤的诊断学特征分析

目的探讨临床表现为下肢肌肉内孤立性病变的弥漫性腱鞘巨细胞瘤的临床诊断学特征。 方法回顾性分析1例临床表现为左下肢关节外孤立性病变的弥漫性腱鞘巨细胞瘤患者的临床资料,并复习相关文献。 结果患者临床表现为左下肢进行性增大的无痛性肿块,血液、生化、免疫检查等实验室检查无异常发现。超声及血流多普勒检查示左侧大腿根部实性占位,内部血流信号丰富,电子计算机断层扫描示左大腿根部实性占位,下肢磁共振检查示肌间肉瘤病灶,正电子发射断层显像/X线计算机体层成像示局部氟化脱氧葡萄糖异常浓聚。手术行包膜外正常组织内完整切除肿块,术后病理检查结合术中病灶生长方式明确为弥漫性腱鞘巨细胞瘤。 结论弥漫性腱鞘巨细胞瘤可以表现为肢端孤立的关节外占位性病变,影像学检查极易因其特殊的生长方式及内部结构而倾向于恶性结果,完整的手术切除及病理学检查可以对该类病变进行治疗并明确病因。     

Assessment of the vascularity of a left ventricular mass using myocardial contrast echocardiography.

In addition to a thrombus, an intracardiac mass lesion can represent a primary cardiac tumor, or a metastatic lesion to the heart. The echocardiographic appearance and location of the mass, as well as the associated clinical scenario provide useful clues regarding cause, but these echocardiographic features alone may not always be diagnostic. Because most benign cardiac tumors are relatively avascular, the vascularity of a mass may be a feature that can help differentiate benign from malignant tumors. We present a case of a patient with a history of malignant melanoma who was found incidentally to have a cardiac mass on echocardiography. Contrast echocardiography (CE) was used to evaluate the vascularity of the mass. This case is compared with another patient with an apical thrombus, which represents an "avascular" intracardiac structure.     

Hepatic angiomyolipoma

The imaging and pathological appearances of a hepatic angiomyolipoma are presented. On ultrasound (US), the mass was well-defined and echogenic. On computed tomography (CT), the lesion appeared of soft tissue density with peripheral foci of lower density. The case illustrates the difficulty of detecting the fatty content of a tumor by CT when the fatty content represents only a small portion of the lesion. Fine-needle aspiration (FNA) cytology and needle biopsy did not yield diagnostic material, and the tumor was resected.An invited commentary on this article follows on pp. 552–553.     

North American blastomycosis

Pulmonary blastomycosis may present as a mass that resembles a lung tumor on radiographs. Blastomycosis should be suspected if the patient has an associated skin lesion and known risk factors, such as living in or visiting endemic areas or participating in activities that involve frequent contact with soil. If these risk factors are kept in mind, the diagnosis of blastomycosis may be established before a thoracotomy is performed unnecessarily.     

Polycythemia vera and other polycythemic states

The diagnosis of polycythemia requires an accurate and independent assessment of both plasma volume and red blood cell mass. Patients with an increased red cell mass (absolute polycythemia) may be hypoxic or have an erythropoietin-secreting tumor or space-occupying lesion compressing the kidney. Those with a reduced plasma volume (relative polycythemia) most often are tobacco smokers, are taking diuretic or cardiac medications, or ingest increased quantities of caffeine-containing beverages. On the other hand, polycythemia vera is a systemic disease with multiple complications, which is best diagnosed through a complex of findings as outlined by the Polycythemia Vera Study Group.     

人体正常,异常组织结构声学密度定量的初步研讨

用ＨＰ５５００彩超仪，以背向散射积分（ＩＢＳ）为基础的声学密度定量（ＡＤ）方法；研讨人体正常与异常组织结构的ＡＤ值及临床应用范围。正常组５０个取样区，１５０个测值；异常组实性，囊性病变或肿瘤１１例，共５０个参数。ＡＤ测值结果：正常肝平均值２１．０ｄＢ，肾锥体最低１３．２ｄＢ，眼球后组织最高５４．３ｄＢ；尿液９．２ｄＢ；血液１５．０～１７．２ｄＢ；混合性胃内容物２６．５ｄＢ；含气的胃窦４０．０ｄＢ。异常组肝小血管瘤，胆囊息肉，脂肪肝，子宫肌瘤及其他肿瘤与正常ＡＤ值参数不同。故ＡＤ检测含微弱不同成份的结构，定量参数不一；可提示性质不同的溶质或组织；结合２Ｄ图像能辅助定性与鉴别诊断，应用范围广     

Testicular tumors of germ cell origin. 1. Epidemiology, pathogenesis, clinical presentation, and diagnosis

Germinal testicular tumors occur in all age-groups but are most prevalent in men 20 to 34 years old. Tumor development has been associated with incompletely descended testis, "dysgenetic" testis, tumor in the contralateral testis, and trauma. Testicular tumor most often presents as a painless enlargement and induration. Examination should be meticulous and thorough. Any testicular or scrotal mass should be considered neoplastic until proven otherwise. When a testicular or intrascrotal mass presents a diagnostic dilemma, the lesion should be explored through an inguinal exposure. This surgical maneuver spares the patient an unnecessarily long and uncertain follow-up.     

The role of MR imaging in soft tissue tumor evaluation: perspective of the orthopedic oncologist and musculoskeletal pathologist

Soft tissue masses are common in both children and adults. Clinicians must evaluate patients carefully to avoid management errors. The most effective management decisions are made when a working group composed of clinicians, radiologists, and pathologists participates in the interpretation of the imaging studies. Plain-film radiographs and MR imaging scans are the two main imaging modalities used in patients with soft tissue masses. The working group assimilates the clinical and radiographic data to determine if they can identify the nature of the soft tissue mass. When the group can assign a definitive diagnosis, the lesion is designated as a determinate lesion. Determinate lesions include lipomas, ganglions, hemangiomas, neurofibromas, diabetic myonecrosis, muscle tears, myositis ossificans (heterotopic ossification), and pigmented villonodular synovitis. When the process cannot be identified, the lesion is classified as indeterminate. All soft tissue sarcomas are indeterminate lesions. Many benign lesions are also indeterminate. Common examples include schwannomas, myxomas, and giant cell tumor of tendon sheath. Based on the clinical and radiologic features, these diagnoses may be suspected, but because of the inability to distinguish them from sarcomas based on the MR imaging features, they are usually classified as indeterminate. When lesions are judged to be determinate, observation or excisional biopsy are the two major treatment choices. When lesions cannot be identified on the imaging studies, incisional or needle biopsy is performed to establish a diagnosis. Once a diagnosis is made, the proper management choice can be selected. Inappropriate excisional biopsy is the major treatment error in the management of soft tissue tumors. When a high-grade soft tissue sarcoma is resected with multiple positive margins, the risk of local failure after definitive resection is much higher than if the patient had been treated initially with only a needle or incisional biopsy. Also, if a major complication, such as an infection, a major wound-healing problem, or contamination of the major neurovascular structures, occurs at the time of incisional biopsy, amputation of the limb may be necessary. Inappropriate excisional biopsy can occur when a surgeon is not familiar with the features of sarcomas or when a radiologist mistakenly interprets the signal features as a benign lesion.     

Possibilities of laparoscopic decompression of the gallbladder in middle-aged and elderly patients with diseases of the biliary tract]

It is established that laparoscopic cholecystostomy presents the most acceptable method of gall bladder decompression in acute cholecystitis patients of advanced age comprising a high-risk group for surgery. Cholecystostomy efficiency reaches 97.2%. In case the procedure is not feasible in acute cholecystitis patients with intrahepatic position of the gall bladder or perivesicular adhesions the preference should be given to transhepatic drainage of the gall bladder whose effectiveness is 88.5%. An expedient method of laparoscopic decompression of the biliary tracts in mechanical jaundice due to tumor obstruction of the terminal part of the common bile duct is the formation of an external biliary fistula and "continuous" direct drainage of the gall bladder warranting satisfactory results in 93.3 and 100% of cases, respectively. Patients with a 1.5-week history of mechanical jaundice are not recommended transhepatic drainage, in longer duration of the jaundice (more than 1 month) it becomes contraindicated.     

Wilms' tumor in a multilocular cyst of the kidney (cystic Wilms' tumor).

A 2-year-old boy had a Wilms' tumor of the left kidney that appeared during physical examination as an abdominal mass and on gross examination as a multilocular cyst. Multilocular cyst of the kidney is a rare but distinctive congenital lesion. Its true biologic behavior is unknown. Although simple nephrectomy is sufficient for most lesions, more aggressive procedures are recommended for those lesions that contain Wilms' tumor (cystic Wilms' tumor).