Modern CT applications in veterinary medicine.

Although computed tomography (CT) is used primarily for diagnosis in humans, it can also be used to diagnose disease in veterinary patients. CT and associated three-dimensional reconstruction have a role in diagnosis of a range of illnesses in a variety of animals. In a sea turtle with failure to thrive, CT showed a nodal mass in the chest, granulomas in the lungs, and a ball in the stomach. CT of a sea dragon with balance and movement problems showed absence of the swim bladder. In a sloth with failure to thrive, CT allowed diagnosis of a coin in the intestine. CT of a puffin with failure to thrive showed a mass in the chest, which was found to be a hematoma. In a smooth-sided toad whose head was tilted to one side and who was circling in that direction, CT showed partial destruction of the temporal bone. CT of a domestic cat with listlessness showed a mass with focal calcification, which proved to be a leiomyosarcoma. CT of a sea otter showed pectus excavatum, which is caused by the animal smashing oysters against its chest. In a Japanese koi with abdominal swelling, CT allowed diagnosis of a hepatoma.     

18F-FDG PET/CT findings of a right subphrenic foreign-body granuioma

We report a case of an 85-year-old woman with a foreign-body granuloma which accumulated 18F-fluorodeoxyglucose (FDG). Unenhanced computed tomography showed a hyperdense mass with a hypodense rim in the right subphrenic space. FDG PET/CT images showed intense FDG uptake in the hypodense rim and little FDG uptake in the center of the mass, showing a ring-shaped appearance. The fusion imaging of FDG PET/CT represented the metabolic features of the foreign-body granuloma. When a ring-shaped FDG uptake is noted in the abdomen of a patient with a history of abdominal surgery, a foreign-body granuloma should be included in the differential diagnosis.     

Sternal abscess due to Bartonella (Rochalimaea) henselae in a renal transplant patient

 Bartonella henselae, previously called Rochalimaea henselae, is the causative agent of cat scratch disease (CSD) in immunocompetent subjects and bacillary angiomatosis in immunocompromised ones. Bone lesions are common in bacillary angiomatosis, but not in CSD. We present the case of a patient with a renal transplant treated by immunosuppressive therapy who developed a sternal abscess with a histological pattern of CSD. The CT pattern was that of a lytic bone lesion with adjacent fluid collection. The diagnosis was made on the basis of a polymerase chain reaction amplification performed on bone material. Bartonella henselae is a newly described bacteria that causes CSD in a normal host and bacillary angiomatosis in immunocompromised patients. We report a case of an osteolytic lesion of the sternum with adjacent fluid collection related to CSD, which occurred in a patient with a renal transplant.     

Integrated active tracking detector for MRI-guided interventions

We present a fully integrated detector suitable for active tracking of interventional devices in MR-guided interventions. The single-chip microsystem consists of a detection coil, a tuning capacitor, an intermediate frequency downconversion receiver, and a phase-locked-loop-based frequency synthesizer. Thanks to the integrated mixer, the chip output stage delivers an analog frequency-downconverted NMR signal in the frequency range from 0 to 200 kHz. The microchip, realized in a standard complementary metal oxide semiconductor technology, has a size of 1 × 2 × 0.74 mm(3) and operates at a frequency of 63 MHz (i.e., in 1.5 T clinical scanners). Tests in a standard clinical scanner demonstrate the compatibility of the complementary metal oxide semiconductor microchip with clinical MRI systems. Using a solid sample of cis-polyisoprene having a size of 1 × 1.9 × 0.8 mm(3) as internal signal source, the detector achieves a three-dimensional isotropic spatial resolution of 0.15 mm in a measuring time of 100 ms.     

Multifocal extramedullary hematopoiesis in a 15-year-old girl with beta thalassemia: A case report

Extramedullary hematopoiesis is a rare disorder in which hematopoietic cells proliferate in tissues other than the bone marrow as a result of a range of hematologic illnesses. Our case is unique in that it covers a number of extramedullary hematopoiesis sites in a 15-year-old girl, some of which are uncommon.     

Thyrotoxicosis: a rare presenting symptom of Hurthle cell carcinoma of the thyroid

Hurthle cell carcinoma of the thyroid is a rare type of thyroid neoplasm. The most common clinical presentation is a single palpable thyroid nodule. The neoplasm typically presents as a nonfunctioning or cold nodule on a Tc-99m sodium pertechnetate or radioiodine thyroid scan. We report a case of Hurthle cell carcinoma of the thyroid in a woman presenting with thyrotoxicosis. The Tc-99m thyroid scan was also interesting in that the nodule was a hot or hyperfunctioning area, resulting in a rare scintigraphic finding in a rare tumor. Clinicopathologic aspects and related issues are further discussed.     

Retained surgical sponges: CT and US appearance

The computed tomographic (CT) and ultrasonographic (US) appearances of retained surgical sponges are described. In each case, the presence of a sponge was confirmed at repeat operation. CT examinations were performed in nine patients. In six cases, a low-density mass was demonstrated; in two cases, a complex mass with areas of both low and medium density was seen. The remaining case was a high-density mass. After intravenous administration of contrast material, dense and prolonged enhancement of the rim of the mass was noted in five of eight cases. Calcification was found in four cases, and spongiform gas in one. US performed in six patients revealed an echogenic area with strong acoustic shadowing in three cases and a complex mass, a hypoechoic mass, and a cystic mass with irregular internal echoes in one case each. Granuloma caused by a retained surgical sponge should be considered as a cause of an abdominal mass in patients with a history of prior abdominal surgery.     

Low dose X-radiation adaptive response in spleen and prostate of Atm knockout heterozygous mice

PURPOSE: To investigate the effect of being heterozygous for a knockout mutation in the ataxia telangiectasia (Atm) gene on radiation adaptive response. MATERIALS AND METHODS: DNA recombination, as measured by pKZ1 inversion frequency, was quantified by histochemistry in Atm knockout heterozygous prostate and spleen 3 days after treatment with a priming dose of 0.01 or 10 mGy X-radiation 4 h prior to a challenge dose of 1,000 mGy. RESULTS: In spleen and prostate, a single dose of 0.01 mGy caused an induction in inversion frequency but a dose of 10 mGy prevented the induction of a proportion of endogenous inversions. Both doses induced an adaptive response, of similar magnitude, to a subsequent high challenge dose for chromosomal inversions in both spleen and prostate. The adaptive response completely prevented the induction of inversions from a 1,000 mGy challenge dose and also a proportion of endogenous inversions. The adaptive responses and distribution of inversions across gland cross-sections observed here in Atm knockout heterozygote prostate were similar to those induced in Atm wild-type prostate in a previous study. CONCLUSIONS: Being heterozygous for a knockout mutation in the Atm gene does not affect the endogenous pKZ1 inversion frequency, the inversion response to single low radiation doses used here, or the induction of a radiation adaptive response for inversions in pKZ1 mouse spleen or prostate.     

Ankylosing spondylitis in women: comparison of scintigraphic results with clinical and roentgenologic findings

Since ankylosing spondylitis (S.a.) tends to be milder and less progressive in women than in men, there are great difficulties in diagnosing S.a. in female patients. The role of scintiscanning for investigation of S.a. in women is discussed by few examiners only, especially there are no investigations of quantitative sacroiliac scintigraphy in large groups of female patients. Quantitative sacroiliac scintigraphy was performed in 19 female patients with S.a. and in 30 control subjects. The sacroiliac/sacrum ratio (Index ISG/sacrum) was calculated. Significantly increased uptakes were found in the patient group compared with the controls. Especially in the early periods of S.a. the activity index was highest. When history and physical examination lead to a suspicion of S.a. and there is no verification by roentgenographic studies, sacroiliac joint scintigraphy is indicated. If clinical and laboratory findings are respected in each patient, quantitative sacroiliac scintigraphy is useful for the early diagnosis of S.a. in female patients.     

In vivo dosimetry with thermoluminescent dosimeters in external photon beam radiotherapy

The ultimate check of the actual dose delivered to a patient in radiotherapy can only be achieved by using in vivo dosimetry. This work reports a pilot study to test the applicability of a thermoluminescent dosimetric system for performing in vivo entrance dose measurements in external photon beam radiotherapy. The measurements demonstrated the value of thermoluminescent dosimetry as a treatment verification method and its applicability as a part of a quality assurance program in radiotherapy.     

"Scrotal varicocele, exclude a renal tumour". Is this evidence based?

A scrotal varicocele is a common finding during both a scrotal clinical examination or during the course of a scrotal ultrasound examination and invariably found in the left hemiscrotum. Traditionally when a scrotal varicocele is found, the referring clinician requests a renal ultrasound examination or the sonographer extends the examination to include a renal examination; to exclude a retroperitoneal or renal tumour as the cause for the varicocele. The present article examines the relevance of performing the extended ultrasound examination by reviewing the pathophysiological pathways for the development of a varicocele in the presence of a renal or retroperitoneal tumour; the prevalance of co-existing renal or retroperitoneal tumours and a varicocele; and the male population in whom this extended examination may be necessary. The conclusion from available evidence suggests that a retroperitoneal tumour will manifest in other ways before the development of a varicocele, the young patient with a varicocele will almost never have a retroperitoneal tumour, and only when a varicocele develops in an older patient will an extended examination be relevant. Even then it will be a rare finding and there will be other clinical manifestations of the primary tumour.     

Floating fat in the wrist joint and in the tendon sheaths

A traumatic fat effusion in a tendon sheath is an unreported entity. We report on the clinical and imaging features, including radiography and computed tomography (CT), of a fat-density effusion in the wrist joint and tendon sheaths of the extensor pollicis longus, extensor carpi radialis longus, and extensor carpi radialis brevis in a 28-year-old patient after a roller-skating accident. Radiographs showed a fracture of the distal radius and a wrist joint effusion. Preoperative CT examination exhibited two distinct layers resulting in a fat-fluid level pathognomonic of lipohemarthrosis in the radiocarpal joint. In addition, a fat-density effusion was noted in the sheaths of the second and third compartment extensor tendons. The lipohemarthrosis depicted on imaging classically results from the extrusion of fat from bone marrow into the joint space after an intraarticular fracture. Similarly, a traumatic fat effusion in a tendon sheath presents characteristic imaging features that may help to diagnose a potentially overlooked fracture.     

Pineal cystic germinoma with syncytiotrophoblastic giant cells mimicking MR imaging findings of a pineal cyst

We report a case of precocious puberty in a 4-year-old boy. Contrast-enhanced T1-weighted MR imaging suggested a pineal cyst with enhancement of the slightly thickened wall and focal wall irregularity. Three-dimensional constructive interference in a steady-state imaging revealed a focal lobulation and a nodule-like area in the lesion. The lesion mimicking a pineal cyst proved to be a germinoma with syncytiotrophoblastic giant cells, on the basis of biopsy and tumor marker results.     

Renal Cell Carcinoma in a Horseshoe Kidney and Preoperative Superselective Renal Artery Embolization: A Case Report

Only rarely is renal cell carcinoma encountered in a horseshoe kidney. This is a case report on renal cell carcinoma in a horseshoe kidney, in which superselective renal artery embolization was performed preoperatively. CT and digital subtraction angiography revealed a horseshoe kidney with a 3-cm tumor in the left side. Superselective renal artery embolization of the tumor was performed as a prerequisite procedure for the organ-preserving surgery of simple enucleation. Preoperative superselective renal artery embolization can be an effective tool to facilitate organ-preserving surgery in a horseshoe kidney.     

Gaschromatographie für gerichtsmedizinische Zwecke

Zusammenfassung Von 6 Fällen, bei denen die gaschromatographische Methode zur Begutachtung angewendet worden ist, wurde berichtet. Sie ist folgendermaßen angewendet worden: Nachweis von Äther in der Watte, Bromural in erbrochener Masse, E 605 im Magenspülwasser, Procain an der Injektionsstelle, Doriden, das in unbekanntem Pulver enthalten war, und Endrin im Magenspülwasser. Bei richtiger Versuchsanordnung und Vorbehandlung wie durch Dünnschichtchromatographie kann die Isolierung und Identifizierung der verschiedenen Gifte möglich gemacht werden.

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Summary Out of the cases of toxicological identification which were carried out utilizing gas chromatography in our department, relatively interesting six cases are selected and reported in this paper. Three kinds of apparatus equipped with a hydrogen flame ionization detector (a Shimadzu model GC 1B, a Hitachi model KGL-2A, and a Yanagimoto model GCG-3D) were used for the experiments. The liquid phases of column packings and operating conditions were shown in each chromatogram.In each case we described the states of affairs, the materials for investigation, and procedures of examination. The materials were in the first place extracted directly by acetone or ether or by Stas-Otto's method and then injected into the apparatus. In some cases thin layer chromatography was performed as a preliminary treatment.The poisons which had been detected were 1. ether from the absorbent cotton in a case of rape, 2. bromvalerylurea from the vomitted matter of a man in a suicidal case, 3. ethylparathion from the liquid of gastric lavage of a woman in a suicidal case, 4. procaine from the injected muscle in a case of fatal procaine penicillin shock, 5. gluthethimide (doriden) from the unknown powder found beside a comatose woman in a suicidal case, and 6. endrin from the liquid of gastric lavage of a man in a suicidal case.

     

Fluctuation of adenosine concentration by modes of intravenous infusion based on mathematical simulation and experiments

OBJECTIVE: Adenosine, which has been used for a myocardial perfusion scan, shows rapid clearance from blood because of its short half-life of <10 seconds. This simulation study evaluates influences of modes of radionuclide injection on ventricular adenosine concentration when one intravenous injection line is used. METHODS: Assuming that radionuclide injection is a unit impulse, time-activity curves were measured in the left ventricle (LV) and fitted by a gamma function. Typical patterns of concentration fluctuation when adenosine infusion was temporarily modified were calculated by the convolution integral of input function and unit impulse response. Variation of concentration was measured by experiments using continuous 99mTc injection and co-infusion of water via a three-way stopcock. Modes of co-infusion with various infusion speeds and volumes were examined. RESULTS: Intermission of adenosine infusion and rapid displacement by radionuclide co-injection significantly influenced the adenosine concentration in LV. Intermission of adenosine infusion for 2 seconds caused a 15% decrease in the adenosine concentration in the left ventricle. When a square-shaped input was assumed, a three-fold higher concentration of adenosine for 3 seconds created by radionuclide injection resulted in a +42% increase in the LV concentration. Based on a measured input function, radionuclide injection using three-way stopcock through one route caused a two- to three-fold increase in the steady concentration in the vein just after injection. When 0.5 ml of radionuclide was slowly co-injected, with three ways opened, it caused a relatively low fluctuation, creating a +34% to -47% change in concentration of LV. A flush of radionuclide with physiological saline significantly increased the adenosine concentration in LV, when short half-lives were assumed. CONCLUSION: An intravenous adenosine and radiopharmaceutical injection in the same line is feasible. However, the fluctuation of concentration depends significantly on the mode of injection. To minimize the fluctuation, a slow injection of a small volume of a myocardial imaging agent via a co-injection route, with three ways opened, is recommended.     

Computed tomography fluid-fluid level in bone metastasis

Fluid-fluid levels have been reported in a variety of primary bone and soft-tissue tumours, most frequently in aneurysmal bone cysts, but have never been reported in a metastatic bone lesion. To emphasize such a possibility the authors present a case in which serial computed tomography demonstrated a pulmonary nodule, paratracheal adenopathy and a fluid-fluid level within a rib lesion. Further investigation confirmed a rib metastasis from primary carcinoma of the bronchus.     

Percutaneous transluminal angioplasty of the branches of the aortic arch

Percutaneous transluminal angioplasty (PTA) takes its stable position in the therapy of obliterating arterial diseases. Its indication areas considerably extend. The authors present a survey of their experience and the results of PTA of arteries supplying the brain and upper extremities. This surgery was made in 29 patients on 31 arteries. The authors consider PTA on a. subclavia as a method of choice. In the angioplasty on a. vertebralis there is a very low risk in correctly indicated cases. An atherosclerotic stricture of a. carotis interna is not considered suitable for PTA for the risk of embolism from the exulcerated plaques. However, the method may be used with advantage in the stenosis based on fibromuscular dysplasia and in some cases of early restenoses in a. carotis interna after previous endarterectomy. The authors arrive at the conclusion that PTA, if correctly indicated, is a safe method even in arteries supplying the brain and upper extremities. No complication was observed in the reported group.     

A cluster of childhood leukaemias near two neighbouring nuclear installations in Northern Germany: prevalence of chromosomal aberrations in peripheral blood lymphocytes

Purpose : Between 1990 and 1991 a leukaemia cluster was observed in children living close to the combined site of a nuclear power plant and a nuclear research facility in Elbmarsch, a region in Lower Saxony (Germany). We aim to investigate the prevalence of presumably radiation-induced chromosomal aberrations in peripheral blood lymphocytes of children in Elbmarsch and children of a control region in order to find out whether there was an uncontrolled release of radioactive material which resulted in a substantial exposure. Materials and methods : The frequency of dicentric and ring chromosomes in lymphocytes of the peripheral blood in 42 children in Elbmarsch and 30 children in Plön was investigated. Children in both groups had been permanent residents of the study area. Results : The mean frequency of dicentric and ring chromosomes in Elbmarsch was 14/32580 cells (=0.430 ×10 -3 ; 95% CI 0.24-0.70 ×10 -3 cells), and in Plön it was 17/24065 cells (=0.706 ×10 -3 ; 95% CI 0.42-1.10 ×10 -3 cells). Conclusions : No difference in the frequency of dicentric and ring chromosomes was observed between children in Elbmarsch living close to a combined site of a nuclear power plant and a nuclear research facility and children living in the control area Plön. The power of the study to detect a threefold or higher increase in the aberration frequency was at least 0.86.     

A cluster of childhood leukaemias near two neighbouring nuclear installations in Northern Germany: prevalence of chromosomal aberrations in peripheral blood lymphocytes

PURPOSE: Between 1990 and 1991 a leukaemia cluster was observed in children living close to the combined site of a nuclear power plant and a nuclear research facility in Elbmarsch, a region in Lower Saxony (Germany). We aim to investigate the prevalence of presumably radiation-induced chromosomal aberrations in peripheral blood lymphocytes of children in Elbmarsch and children of a control region in order to find out whether there was an uncontrolled release of radioactive material which resulted in a substantial exposure. MATERIALS AND METHODS: The frequency of dicentric and ring chromosomes in lymphocytes of the peripheral blood in 42 children in Elbmarsch and 30 children in Pl?n was investigated. Children in both groups had been permanent residents of the study area. RESULTS: The mean frequency of dicentric and ring chromosomes in Elbmarsch was 14/32580 cells (=0.430 x 10(-3); 95% CI 0.24-0.70 x 10(-3) cells), and in Pl?n it was 17/24065 cells (=0.706 x 10(-3); 95% CI 0.42-1.10 x 10(-3) cells). CONCLUSIONS: No difference in the frequency of dicentric and ring chromosomes was observed between children in Elbmarsch living close to a combined site of a nuclear power plant and a nuclear research facility and children living in the control area Pl?n. The power of the study to detect a threefold or higher increase in the aberration frequency was at least 0.86.