Postseptal cellulitis: CT in diagnosis and management

Thirteen orbital computed tomographic (CT) scans were obtained in 12 patients with postseptal (orbital) cellulitis. Sinus radiographs, which were also obtained, were not helpful in diagnosis or management. The location and extent of the inflammatory process was accurately demonstrated with axial CT scans in all cases. A protocol using CT in the management of postseptal cellulitis is proposed.     

In vitro tests that predict tumor-associated idiotype levels in the serum of patients with B cell lymphomas and leukemias

The presence of circulating tumor idiotype interferes with the in vivo effectiveness of anti-idiotype antibodies. We developed two assays that permit identification of patients with high levels of serum idiotype without the need for first producing an anti-idiotype antibody. A cell suspension made from the tumor was cultured for seven days with or without phytohemagglutin (PHA) and/or phorbol myristic acetate (PMA). Ig secretion in vitro by patients' tumor cells varied. In 4 patients, no secretion in vitro occurred, 5 patients had low levels, and 5 patients had high levels of Ig secretion. In three patients, Ig secretion occurred only after stimulation with PHA, PMA, or both. Spontaneous or induced immunoglobulin secretion in vitro is related to the levels of tumor idiotype secretion that exist in vivo. Eight patients with serum idiotype levels greater than 100 micrograms/mL (mean 265 micrograms/mL), had a minimum of 1.0 microgram/10(6) cells of idiotype secretion in vitro. Nine patients with serum idiotype levels less than 30 micrograms/mL (mean 3.7 micrograms/mL), had less than or equal to 0.5 microgram/10(6) cells of idiotype secretion in vitro. In another assay, the levels of IgM kappa and IgM lambda in patients' sera were compared with those in normal serum. An imbalance in the relative amounts of IgM kappa and IgM lambda indicated high levels of circulating idiotype in the serum, but this assay was less sensitive than the in vitro secretion assay and limited to IgM-secreting tumors. These assays will be useful for future clinical studies using anti- idiotype antibodies.     

Esophagogastric polyps: radiographic and endoscopic findings

Radiographic, endoscopic, and pathological findings were correlated in 20 patients with polypoid esophagogastric lesions. In 16 patients, pathological examination showed chronic inflammatory change and epithelial hyperplasia; the polyp was located on the gastric side of the squamocolumnar junction, usually in association with a prominent gastric fold, and probably represented a localized form of gastritis. In the other 4 patients, the lesion was adenocarcinoma. An inflammatory esophagogastric polyp may be differentiated from polypoid carcinoma when adequate radiographs are available and specific diagnostic criteria are followed. Endoscopic biopsy is recommended if the lesion does not fulfill the criteria of an inflammatory esophagogastric polyp.     

Dacryocystography: comparison of water-soluble and oil-based contrast agents

Dacryocystography has been widely used in the assessment of the nasolacrimal duct system, particularly in patients with epiphora. Our study was undertaken to evaluate image quality and level of patient discomfort during examinations with water-soluble contrast agents (iohexol [Omnipaque 240], iopamidol [Isovue 200 and 300], and 52.7% diatrizoate meglumine and 26.9% iodipamide meglumine [Sinografin]) compared with the iodized oil-based contrast agent Lipiodol. Fifty-five dacryocystograms were obtained from 41 consecutive patients. The procedure was performed first with a water-soluble contrast agent, then repeated with Lipiodol. A distention technique was used with conventional radiography. Patients were asked to evaluate their level of discomfort (none, mild, moderate, severe). The images were evaluated separately by two radiologists, blinded to which water-soluble agent was employed, and the images were graded on a five-point scale. Images obtained with Lipiodol were significantly better than those with other agents (P less than .02), and image quality deteriorated as iodine concentration decreased. Use of Isovue 300 and Sinografin produced significantly more patient discomfort (P less than .03) than the use of other agents. The authors conclude that, in most instances, Lipiodol is the contrast agent of choice with regard to both highest level of patient comfort and greatest conventional radiographic image quality among the agents compared.