Colorectal hemangioma: radiologic findings

The authors correlated radiographs with the clinical and histologic data of 12 patients with colorectal hemangioma. All patients presented with rectal bleeding, which was chronic in seven. Phleboliths were also visible in seven cases, which correlated with chronic bleeding in five. On barium studies, three masses were soft and three produced rigid narrowing. The atypical features of rigid luminal narrowing, which might mimic a carcinoma, and hypovascularity correlated with chronic bleeding or visible phleboliths, which suggest the correct diagnosis of colorectal hemangioma.     

Simultaneous measurement of gallbladder emptying with cholescintigraphy and US during infusion of physiologic doses of cholecystokinin: a comparison

Both ultrasonography (US) and cholescintigraphy are used to study gallbladder dynamics. The present study was undertaken to determine whether the two methods provide the same or different information relating to gallbladder emptying. Emptying was simultaneously studied with both methods during infusion of graded physiologic doses of cholecystokinin (CCK) in six healthy subjects. Infusion of stepwise increasing doses of CCK, ranging from 0.03 to 0.5 Ivy dog units per kilogram of body weight per hour (IDU/kg.h), induced significant dose-related increases in plasma CCK, decreases in gallbladder volume assessed with US, and gallbladder emptying assessed with cholescintigraphy. The threshold dose for inducing significant gallbladder emptying was 0.13 IDU/kg.h, as determined with both techniques, indicating similar detection limits. There was a highly significant correlation between decreases in gallbladder volume and decreases in radioactive counts over the gallbladder region, with a tendency toward greater gallbladder responses at sonography during the early phase of gallbladder contraction and toward greater responses at cholescintigraphy during the later phase of gallbladder contraction. It is concluded that these methods can be used interchangeably for the quantitation of gallbladder emptying.     

MR imaging of blood vessels using three-dimensional reconstruction: methodology

Multisection, dual-echo magnetic resonance (MR) transaxial images of blood vessels contain both anatomic and qualitative information about flow. Even so, the images are produced as a series of two-dimensional tomographic sections from which full visualization of connected structures is difficult. A computer algorithm was developed that automatically detects flowing blood based on pixel intensity and calculated T2 and provides reconstructed views of vessels while analyzing and displaying flow characteristics. Images of abdominal vessels, aortic aneurysms, and the heart were encoded by flow and color to demonstrate depth. In addition, these data were reconstructed to derive a more accurate assessment of patency. With this technique, transaxial images can be used to analyze flow patterns, determine patent areas, and visualize all levels of vessels in a single image.     

Regional myocardial dysfunction: evaluation of patients with prior myocardial infarction with fast CT

A prototype ultrafast cine computed tomographic (CT) scanner, designed specifically for cardiac imaging, was used to evaluate a preliminary series of patients with prior myocardial infarction (n = 21) and a control group without coronary artery disease (n = 5). Multilevel 50-msec CT scan exposures were obtained during peripheral intravenous bolus injections of contrast medium. A comparison was made between cine-CT scans and standard left ventriculographic images in assessing segmental left ventricular motion. Results indicate that cine CT, performed at sufficiently rapid speeds (20 scans per second) to allow useful analysis of regional ventricular wall motion, can provide adequate image quality. Analysis of 110 segments revealed a good correlation (90.9%) between the two techniques in characterizing normal from abnormal regional wall motion. Cine CT, based on this initial study, demonstrates considerable potential for evaluating not only cardiac chamber dimensions but also segmental wall dynamics.     

Escherichia coli meningitis during bacteremia in the Ibrahima-Diop-Mar infectious diseases clinic, Dakar Fann National Hospital Center (Senegal)

OBJECTIVES: The aim of this study was to describe epidemiological, clinical, and bacteriological aspects of Escherichia coli bacteremia and meningitis in the Ibrahima-Diop-Mar infectious diseases clinic, Dakar Fann National Hospital Center (Senegal). MATERIALS AND METHODS: Data was collected from the bacteriology laboratory and hospitalization files. RESULTS: 57 cases of E. coli bacteremia were reported. Among them, 10 were associated with meningitis. AIDS was diagnosed in 74% of the cases. The global lethality rate was 47% but this rate was higher in cases of associated meningitis (80 vs 37%) and in AIDS patients (50 vs 27%). Ceftriaxone, aztreonam, gentamicin, and ciprofloxacin were active on more than 95% of strains but cotrimoxazole was active on only 49% of the strains. Resistance to cotrimoxazole was higher among E. coli strains isolated from AIDS patients (62 vs 13%). CONCLUSION: The low susceptibility to cotrimoxazole might increase the incidence of E. coli infections among patients with AIDS. It is therefore important to find an alternative to cotrimoxazole chemoprophylaxis.     

Current aspects of pediatric and adult tetanus in Dakar

OBJECTIVE: This retrospective study was undertaken to assess epidemiological and clinical aspects as well as outcome of tetanus cases in patients over 28 days of age, so as to issue recommendations. PATIENTS AND METHODS: This study included patients admitted to the Fann teaching hospital in Dakar from 2001 to 2003. Age, sex, portal of entry, clinical signs, delay from onset to admission, stage and outcome of the tetanus were recorded. RESULTS: 410 cases of tetanus were observed. The sex-ratio was 2.41. The mean age was 20 years [range 2 months-89 years]. Sixty-two percent of the patients were between six and 30 years of age. Most of the patients were workers and craftsmen (58%) or pupils (19%). A wound was the most frequent portal of entry (73%). Tetanus was localized in four out of 406 cases. The global mortality rate was 22%; but it was higher when tetanus was stage III and in case of complications. CONCLUSION: According to these results, it seems necessary to include booster doses in the Expanded Immunization Program, and to implement better prevention strategies targeting people not taken into account in this program. In addition, health care providers should check out the immunization status of their patients and accordingly offer an update or a full course of active immunization.     

Current aspects of Salmonella bacteremia cases in the Ibrahima Diop Mar Infectious Diseases clinic, Fann National Hospital Center (Senegal)

OBJECTIVE: The aim of this study was to describe epidemiological, clinical and bacteriological aspects of Salmonella bacteremia in the Fann university hospital infectious diseases clinic. PATIENTS AND METHOD: This study was carried out on data recorded between January 1, 1996 and December 31, 2003. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Research of strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Fifty five cases of Salmonella bacteremia were recorded as follows: S.Typhi bacteremia (32 cases), S. Paratyphi C bacteremia (4 cases), S. typhimurium bacteremia (9 cases), S. enteritidis bacteremia (32 cases) and S. spp bacteremia (8 cases). All the strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin+clavulanic acid and 90 % of them were susceptible to cotrimoxazole. Bacteremia occurred in 50 HIV infected patients (49%). Salmonella other than Typhi bacteremia were more often present in patients with HIV (81% vs 36% in patients without HIV infection) (P = 0.00001). The lethality rate was 42%. This rate was higher in patients with HIV (56 vs 23% in patients without infection) (P = 0.002). CONCLUSION: The lethality rate of Salmonella bacteremia is high, especially in AIDS patients. Therefore, priority must be given to prevention and chemoprophylaxis with cotrimoxazole should be a good way to reduce the incidence of bacteremia in AIDS patients.