Pancreatic necrosis: CT manifestations

Pancreatic necrosis is a potential sequela of acute pancreatitis, which pathologically represents a collection of devitalized tissue. Appropriate therapeutic planning requires definition of this irreversibly damaged gland, the presence of which is not consistently diagnosed on the basis of clinical and laboratory data. Over an 18-month period, 22 patients with pancreatic necrosis were studied by one or more computed tomographic (CT) examinations. Retrospective analysis showed the findings to vary with the developmental stage of the necrotizing process. During the acute phase, there was considerable morphologic overlap of necrosis and pancreatic phlegmon. Typical findings were seen in the subacute and chronic stages and included diffuse enlargement of the gland with largely decreased central density. A thick, smooth surrounding rim produced a characteristic saclike configuration. CT-guided aspiration for culture material was performed in four patients with suspected superinfection. Negative gram stain and culture results in two patients allowed surgery to be performed on a more elective basis.     

Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation

CT scans of 47 patients who had peripheral bronchogenic carcinoma contiguous to the pleural surface and who had undergone thoracotomy were retrospectively reviewed. The CT features of the primary neoplasm that were analyzed included the angle and amount of contact with the adjacent pleural surface, associated pleural thickening, fat plane between the tumor and chest wall, rib destruction, and chest wall mass. CT was of limited predictive value in separating those patients who had parietal pleural/chest wall involvement from those who did not. The combination of two or three CT findings (obtuse angle, greater than 3 cm contact with pleural surface, associated pleural thickening) resulted in a sensitivity of 87% and a specificity of 59%. The clinical symptom of focal chest pain, while not as sensitive (67%) as CT, was much more specific (94%) for parietal pleura/chest wall invasion.     

The fractionation, characterization, and subcellular localization of colony-stimulating activities released by the human monocyte-like cell line, GCT

GCT, a human monocyte-like cell line, has been shown to release biochemically distinct colony-stimulating activities (CSAs) for mouse and human marrows. These appear to be periodate-sensitive proteins with critical disulfide bonds. One, of molecular weight 145,000 daltons, stimulates macrophagic colony growth and is related to a 30,000-dalton molecule that also stimulates mouse growth. A 30,000-dalton CSA for human marrow can be separated from the 30,000-dalton mouse CSA by isoelectric focusing and gradient polyacrylamide gel electrophoresis. This distinction agrees with our previous finding of differential neutralization with anti-human urinary CSF antibody. The 30,000-dalton CSAs stimulate neutrophil, neutrophil-monocyte, and eosinophil colony growth in human marrow but only neutrophil and neutrophil-monocyte colonies in the mouse. Subcellular fractionation of GCT cells indicates that there are pools of preformed CSAs primarily associated with the cell cytosol that have similar apparent molecular weights to their secreted counterparts.     

Taux sériques du propeptide aminoterminal du procollagène III chez des sportifs soumis à un entraînement régulier

Serum Procollagen III N-terminal Propeptide (PIIINP), a marker of bone matrix turnover, was measured in 36 sportsmen undergoing intensive training, including 23 adolescent gymnasts. All values are within the range of control values for age, suggesting that PIIINP is not modified by intensive training.     

Image-guided pleural biopsies: indications, technique, and results in 23 patients

Twenty-six pleural biopsies were performed on 23 patients over a 3-year period. Twenty-three biopsies were performed guided with ultrasound; one, with computed tomography; and two, with fluoroscopy. Indications for an image-guided pleural biopsy were (a) pleural masses or thickening that were either not seen on chest radiographs or seen only on one view and (b) small or loculated pleural effusions of unknown cause with no mass seen. If only pleural fluid was present, reverse bevel needles were used for biopsy (n = 15). If a discrete pleural mass or thickening was seen with cross-sectional imaging, standard (16-20 gauge) biopsy needles were used (n = 11). In the 23 patients, biopsy results were true positive in ten (nine with malignancy, one with tuberculous pleurisy), true negative in ten (confirmed either at subsequent thoracotomy or clinical follow-up), and false negative in three. Complications were few, with a significant pneumothorax occurring in two patients (8.7%). Image-guided biopsy of small pleural lesions and small pleural effusions can be performed by the radiologist who understands the special needles and techniques involved.     

Duplex Doppler US of the kidney: differentiation of obstructive from nonobstructive dilatation

Distinction of the obstructed from the nonobstructed dilated renal collecting system is a difficult problem often requiring interventional procedures and pressure measurements. The authors prospectively performed duplex Doppler ultrasound (US) evaluations in 21 kidneys (obstructed, n = 14; nonobstructed, n = 7) immediately before percutaneous nephrostomy. In addition, ten of the obstructed kidneys were evaluated with follow-up Doppler US after percutaneous nephrostomy. Renal obstruction caused a change in the Doppler waveform detected by means of the resistive index (RI). Thirteen of the 14 obstructed kidneys had a RI value greater than .70, while none of the nonobstructed kidneys had a RI value exceeding .70. Relief of the obstruction resulted in a reduced RI; in nine of ten kidneys, the RI was less than or equal to .70 (similar to that of the nonobstructed kidneys). When a dilated collecting system is being imaged, additional evaluation with duplex Doppler US may help distinguish obstructed from nonobstructed dilatation, which may be of particular benefit in patients with conditions that usually predispose them to collecting system dilatation.     

The outcome of ankylosing spondylitis: a study of 100 patients

The outcome was studied in 100 patients with adult-onset primary ankylosing spondylitis (AS). After a mean disease duration of 16 yr, 51.5% of the patients were employed in full-time work. Cessation of work occurred at a mean disease duration of 15.6 yr, and was significantly associated with female sex, low levels of education, acute anterior uveitis, 'bamboo spine' and the co-existence of non- rheumatic diseases. Functional outcome was studied by analysing activities of daily living, and revealed similar findings in males and females. Most of the loss of function occurred during the first 10 yr of disease, and correlated significantly with the occurrence of peripheral arthritis, spinal X-ray changes of AS and development of 'bamboo spine'. After > 20 yr of disease, > 80% of the patients still complained of daily pain and stiffness, and > 60% reported daily use of drugs.