Computerized tomography in the assessment of diseases of the thorax.

Many of the diseases of the chest wall, heart, mediastinum, pleura and lungs can be successfully imaged by computerized tomography. Radiation therapy ports can be calculated and transcutaneous biopsies monitored. This paper deals with the many uses that we have had for computerized tomography in assessing diseases within the chest and thorax.     

Cloacal exstrophy in identical twins

Cloacal exstrophy occurring in identical twins is reported.     

A technique for correction of ileocutaneous stomal stenosis.

A technique for the revision of the ileal stoma is described. The technique is based on the skin flap interposition procedure reported by Smith for the prevention of stomal stenosis.     

A shielded microelectrode suitable for single-electrode voltage clamping of neurones in the CNS

The fabrication of a shielded microelectrode is described which has a time constant of about 3 μs, regardless of its depth in neural tissue. The shield is insulated from surrounding tissue with an insulation resistance which exceeds 1000 MΩ, and the insulation will withstand ±15 V. Because of its narrow profile, the electrode is suitable for in vivo intracellular recordings from motoneurones and other large neurones of the CNS. The small time constant and the high breakdown resistance of the electrode make it suitable for use with single-electrode voltage clamp circuitry to voltage clamp motoneurone somata using switching rates in excess of 30 kHz.     

Abscesses in Crohn disease: percutaneous drainage

Fifteen patients with Crohn disease underwent percutaneous catheter drainage of related abdominal abscesses. The abscesses were located in the right lower quadrant (five patients); in the quadratus lumborum and/or iliopsoas muscles (four patients); in the left paracolic gutter (two patients); and in the right gluteal muscles, the liver, the left subphrenic space, and the pelvis (one patient each). All abscesses were evacuated successfully (n = 15 of 15), and no patient required surgery for abscess drainage. Existing fistulas closed in four of seven patients; the other three patients underwent surgery for excision of diseased bowel and enteric fistulas. No patient developed an enterocutaneous fistula as a result of catheter drainage. Percutaneous abscess drainage is effective for abscesses related to Crohn disease and should be regarded as the procedure of choice. An operation for the abscess can be avoided, and early results suggest that bowel surgery may be obviated in selected patients.     

The uroradiographic evaluation of the enuretic child

The proper evaluation of the enuretic child is controversial. A standardized evaluation was devised to decrease the number of examinations done based on the extant literature. During a 5-year period 138 children were examined uroradiographically. Of these patients 21 were found to have a significant anatomic abnormality. These abnormalities were found in children with either a history of a urinary tract infection, infected urine at the time of examination or obstructive signs or symptoms. Based on these findings a simple flow sheet for the evaluation of enuretic children is presented.     

Postoperative assessment of splenorenal shunts with MRI: preliminary investigation

Magnetic resonance imaging (MRI) was performed on nine patients with hepatic cirrhosis and portal hypertension after selective distal splenorenal shunt for decompression of bleeding esophageal varices. MRI demonstrated the splenorenal anastomosis and patency of the shunt, splenic vein, and left renal vein in each case. Imaging in the transverse plane provided optimal visualization of the shunts. The authors conclude that MRI is a safe, noninvasive technique for the postoperative evaluation of selective distal splenorenal shunts.     

The surgical management of the symptomatic solitary caliceal calculus.

A solitary renal caliceal calculus may require surgical management when it becomes symptomatic or is the contributing factor in urinary tract infection. Segmental nephrotomy is an effective approach to remove a solitary calculus accurately with minimal loss of parenchyma. Calirrhaphy may be accomplished simultaneously.