An alternative approach to the inaccessible intradiverticular papilla.

BACKGROUND: In patients with a narrow-necked juxtapapillary diverticulum the endoscopic cannulation of the papilla of Vater and the subsequent biliary therapy is sometimes impossible. PATIENTS AND METHODS: Three patients referred for endoscopic retrograde cholangiography and stone extraction were included. Earlier attempts to cannulate failed because visual control was impeded by narrow-necked juxtapapillary diverticula with the papilla located in the fundus. Endoscopic balloon dilation of the narrow diverticular neck, using a 15-mm stone retrieval balloon, was carried out. RESULTS: In all three cases the papillary orifice was readily brought into view after balloon dilation of the diverticular opening. Subsequent endoscopic treatment to the bile duct was successful without any complications. CONCLUSION: Balloon dilation of a narrow-necked juxtapapillary diverticulum is a safe and easy procedure, which facilitates both cannulation of the papilla and subsequent biliary endoscopic treatment.     

Homozygous cystinuria and the oculo-cerebro-renal dystrophy of Lowe in same family

The mother and daughter in a family had homozygous cystinuria and were also heterozygous carriers of the oculo-cerebro-renal dystrophy of Lowe. The daughter was also epileptic. The son had Lowe's syndrome and the father an increased urinary excretion of cystine and lysine. This evidence together with other case reports suggests that the defect in cystinuria and that of Lowe's syndrome may be connected.     

Release of biochemical markers of damage to neuronal and glial brain tissue is associated with short and long term neuropsychological outcome after traumatic brain injury

OBJECTIVES: The present study aimed at the analysis of release patterns of neurobiochemical markers of brain damage (neuron specific enolase (NSE) and protein S-100B) in patients with traumatic brain injury and their predictive value with respect to the short and long term neuropsychological outcome. METHODS: Serial NSE and S-100B concentrations were analysed in blood samples taken at the first, second, and third day after traumatic brain injury. In 69 patients who fulfilled the inclusion criteria (no history of neurological or psychiatric disorder or alcohol or drug dependency, blood sampling according to the scheduled time scale, aged between 16 and 65 years) standardised neurological examinations and qualitative and quantitative evaluation of CT were performed. Comprehensive neuropsychological assessment was performed in 39 subjects 2 weeks after admission and in 29 subjects at a 6 month follow up examination. RESULTS: Most patients presented with minor head injuries (GCS>/=13) at the time of admission. Six months later most patients were fully independent in activities of daily living. Two thirds of the patients, however, still had neuropsychological dysfunction. Patients with short and long term neuropsychological disorders had significantly higher NSE and S-100B serum concentrations and a significantly longer lasting release of both markers. A comparative analysis of the predictive value of clinical, neuroradiological, and biochemical data showed initial S-100B values above 140 ng/l to have the highest predictive power. CONCLUSIONS: The analysis of post-traumatic release patterns of neurobiochemical markers of brain damage might help to identify patients with traumatic brain injury who run a risk of long term neuropsychological dysfunction.     

Urinalysis and the plain abdominal radiograph in the diagnosis of ureteric colic

Objectives : 1. To investigate the diagnostic accuracy of urinalysis and the plain abdominal radiograph in predicting positive intravenous pyelography for patients with a history and examination suggestive of ureteric colic. 2. To examine the disposition of patients presenting to the emergency department with ureteric colic. Methods : A retrospective cohort study set in a tertiary referral hospital emergency department over a 12‐month period was conducted. Three hundred and eighteen patients who presented with a provisional diagnosis of ureteric colic and had intravenous pyelography were identified from radiology department logs and emergency department discharge International Classification of Disease‐9 codes. Results : Three hundred and eighteen patients were identified. Sixty‐nine per cent had positive intravenous pyelography. Sensitivity and specificity of: urinalysis were 93% and 41%; abdominal X‐ray, 57% and 83%; and urinalysis plus abdominal X‐ray, 99% and 36%, respectively. Seventy‐seven per cent were admitted to the emergency department observation ward. Twenty‐seven per cent were subsequently admitted under the hospital’s urology service. Conclusions : Sex, haematuria and the presence of a calculus on abdominal X‐ray were all significant predictors of positive intravenous pyelography. Haematuria was sensitive but not specific for positive intravenous pyelography. The addition of the abdominal X‐ray marginally improves the diagnostic accuracy.     

Double contrast enema and colonoscopy in polyp detection.

The diagnostic accuracy of double contrast enema was assessed by colonoscopy of 250 consecutive patients with polypoid lesions that were observed at double contrast enema. The enema method detected 90% of all existing polypoid lesions, and gave false positive results in less than 3.5% Colonoscopy revealed 91% of the lesions. Double contrast enema is suitable as a screening procedure and, when used in combination with colonoscopy, only very few polyps will escape detection. The large number of neoplastic polyps detected in this retrospective series emphasises the necessity for a careful radiographic technique combined with colonoscopy to disclose and treat these potentially malignant lesions of the colon.