Skeletal metastases from hepatoma: frequency, distribution, and radiographic features

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.     

Inferior vena caval filters: noninvasive evaluation

Transvenous inferior vena caval filters were placed in 32 patients (21 bird's nest [BN] and 11 Kimray-Greenfield [K-G] filters). Positive contrast cavography was performed before and immediately after filter placement as well as during long-term follow-up studies. In 23 patients, computed tomographic (CT) scanning was also performed; in 10 patients, real-time ultrasound (US) study was used as an adjunct. CT scans of the BN filter showed one case of hemorrhage and one case of air embolism, both of which were not recognized at cavography. CT scanning of the K-G filter demonstrated two cases of deep penetration of the prongs and one large retroperitoneal hematoma. Real-time US scanning played a major role in checking the final position of the filter and in determining its stability during repositioning of the upper prongs of one BN filter. Noninvasive examinations, including CT and US scanning, are valuable adjuncts in immediate and long-term follow-up study of patients with inferior vena caval filters.     

Ovary volume in young and premenopausal adults: US determination. Work in progress

Normal adult ovary volume determined by ultrasonography (US) is often stated to be less than 6 cm3. This is based on data from teenagers and young adults aged 12-20 years. Recently, the mean normal volume determined by US was reported to be considerably higher. We measured the volumes of 28 ovaries from 15 healthy young adults and found them to range as high as 13.84 cm3, with an average of 6.48 cm3.     

Transient hypertension after percutaneous transluminal renal artery angioplasty

A retrospective analysis of 128 technically successful percutaneous transluminal renal angioplasty (PTRA) procedures was performed. After the procedures, transient systemic hypertension (TSH) developed in 39 patients. The phenomenon usually occurred within 30 minutes of balloon dilation and always within 2 hours of PTRA. TSH lasted less than 5 hours in 35 patients and never persisted for more than 24 hours. TSH is a self-limiting process and should not be confused with the more sustained hypertension that arises from a complication of balloon angioplasty.     

Comparison of media for optimal recovery of<Emphasis Type="Italic">Candida albicans</Emphasis> and<Emphasis Type="Italic">Candida glabrata</Emphasis> from blood culture

Background Candida spp., mainlyCandida albicans, are frequently responsible for complications in immunocompromised patients. There are limited data comparing recovery efficiency using simple non-selective basal broth media. Aim To compare several commercially available basal growth media to determine the medium that gave highest yeast proliferation. Method Eight commercially available non-selective basal broth culture media were evaluated for optimum recovery of clinicalC. albicans andC. glabrata. They included nutrient broth (NB), nutrient broth no. 2 (NB2), Todd-Hewitt (TH) broth, tryptone soya broth (TSB), tryptone soya broth supplemented with yeast extract (0.5% w/v [TSBYE]), brain heart infusion broth supplemented with yeast extract (0.5% w/v [BHIYE]), salt meat broth (SMB) and 0.1% [w/v] peptone saline (PS). Differences in cell density were evaluated by spectrophotometrical analysis. Results TSBYE>BHIYE>TSB>TH>NB2>NB>SMB>PS for the optimum proliferation of cells in vitro. Either TSBYE or BHIYE broth may be employed as suitable basal broth media for growth ofC. albicans andC. glabrata. NB should be considered the least suitable medium for routine use when others are available. Conclusion These data may be of value to laboratories setting up simple blood culture systems to detectCandida spp., particularly in developing and underdeveloped countries.     

Clinically occult, noncalcified breast cancer: serial radiologic- pathologic correlation in 27 cases

A serial radiographic-pathologic correlation based on specimen radiography was performed on 27 consecutive, clinically occult, noncalcified breast cancers to determine the frequency of and correlation between appearances at mammography, pathologic diagnoses, and the features of the histologic margins. Twenty (74%) of the lesions were infiltrating ductal cancers, five (19%) were intraductal cancers, and two (7%) were medullary cancers. Forty-one percent of these malignancies contained microscopic calcifications. Lesions demonstrated at mammography in these 27 cases consisted of a well-defined round mass (n = 1); well-defined lobulated masses (n = 2); indistinct round, oval, or lobulated masses (n = 7); irregular or mixed lesions (n = 7); spiculated masses (n = 9); and architectural distortion (n = 1). Histologic margins of infiltrating and intraductal cancers, created by several types of tumor-fat interfaces and surrounding reactive fibrosis, correlated with these radiographic appearances. Serial specimen radiographic-pathologic correlation can improve our understanding of the appearance of early breast cancer at mammography.