Polar infarct in a transplanted kidney: Cause of a pseudomass

Ultrasonography has become fairly standard for assessing common complications of renal transplantation such as hydronephrosis, urinomas, and lymphoceles. Infarctions are a less common complication that may occur in the setting of transplant rejection. We report a case in which an apparent solid mass on sonography proved to represent normal residual renal parenchyma in a kidney with a small shrunken lower pole due to infarction.     

Acute cerebral infarction in monkeys: an experimental study using MR imaging

Magnetic resonance (MR) imaging was performed in five monkeys with experimentally induced acute cerebral infarction to define the MR imaging features and correlate these with computed tomographic (CT) findings, laboratory analysis, and histopathologic studies. Acute infarct (2-4 hours after embolization) was generally visible on MR images but not on CT scans. CT at 24 and 48 hours did show the infarcts. In all cases the infarct was more clearly depicted with MR imaging and was visualized as an area of high signal intensity on T2-weighted images. Spectrometric nuclear MR measurements of the postmortem cerebral tissue confirmed prolongation of both T1 and T2 values similar to that calculated from MR images. At postmortem laboratory testing, the area of infarction detected with MR imaging had decreased specific gravity and increased water content, reflecting edema.     

Cochlear implant candidates: assessment with CT and MR imaging

Eighty-seven patients with severe to profound hearing loss were evaluated for possible placement of a multichannel cochlear implant hearing device. After initial clinical screening, 42 patients underwent computed tomographic (CT) examination. Five of these patients were also examined with magnetic resonance (MR) imaging. Twenty-two patients received implants. CT of the middle and inner ear was normal in 24 patients (57.1%) and showed labyrinthine ossification in 12 (28.6%), cochlear or fenestral otosclerosis (or both) in four (9.5%), and congenital cochlear malformation in two (4.8%). The information provided by CT was used to (a) exclude patients in whom multichannel cochlear implantation would most likely be unsuccessful (owing to obliterative labyrinthine ossification, or congenital cochlear malformation, severe cochlear, or fenestral otosclerosis), (b) help select the best ear for implantation, and (c) provide a preoperative picture of normal variants and avoidable surgical pitfalls. MR experience is limited but assessment of the size of the cochlear nerve and the membranous labyrinth is possible with this modality and may provide additional information in the evaluation of these patients.     

Endometrial carcinoma staging by MR imaging

The potential of magnetic resonance (MR) imaging in the detection of endometrial carcinoma and in the assessment of its extent was evaluated prospectively in 51 patients clinically suspected of having the disease. MR imaging findings were compared with the results of surgical-pathologic staging and lymph node sampling following hysterectomy. Histologic findings showed 45 patients to have endometrial carcinoma, three to have no residual tumor after dilatation and curettage, and three to have adenomatous hyperplasia of the endometrium. MR imaging demonstrated an endometrial abnormality in 43 of the 51 patients (84%). Endometrial carcinoma could not be differentiated from adenomatous hyperplasia or blood clots. Therefore, MR imaging was not specific for tumor detection, and histologic diagnosis remains essential. The overall accuracy of MR imaging in staging endometrial carcinoma was 92%; its overall accuracy in demonstrating the depth of myometrial invasion was 82%. Demonstration of lymphadenopathy and adnexal or peritoneal metastases by MR imaging was suboptimal.     

THE INCLUSION OF CAPITATION REIMBURSEMENT IN SOLO PRACTICE

Capitation reimbursement has been an integral part of prepaid group practices in both medicine and dentistry, and claims have been made for its ability to influence the delivery of services favorably. Experts have suggested that if capitation is implemented, more preventive care will be provided, more diagnostic services will be provided, there will be better continuity of care, utilization of high-cost services will be reduced, and clinical outcome will be improved. This study focused on the dominant mode of practice in dentistry, the general, solo practitioner, to determine if these contentions held. A sample of 245 patients whose care was paid for by a capitation mechanism was matched to a sample of 245 similar patients whose care was paid for on a standard fee-for-service basis--all from three dentists' practices. All services in all years of care for each patient were analyzed. It was determined that the rate of restorations was lower, while rates of diagnostic testing and prophylaxis were higher for capitation patients. Continuity was also better under capitation, but rates of extractions were virtually identical for the two groups.     

Acute granulomatous disease of the liver

Summary Although the medical literature stresses the chronic nature of hepatic granulomas, we encountered, during a time span of several months, 2 patients with an acute febrile illness and hepatic involvement. Liver biopsy in both revealed epithelioid and mononuclear cell granulomas throughout the liver. Both patients had lymphocytosis and atypical forms in the peripheral blood. Heterophile antibody titers, performed multiple times in the course of their illnesses, were normal. Both patients recovered, 1 after 3 weeks and 1 after 6 weeks.Prior to our experience with these patients, we encountered 2 other patients who had similar clinical and laboratory findings. Because we were not sufficiently aware of the diagnostic possibilities, and because they were getting better, liver biopsy was not performed. Only after the third case was encountered were our suspicions aroused.There is one similar report in the literature. The clinical and laboratory features in their patients and in ours suggest an infectious mononucleosis-like illness. Similar biopsy findings are occasionally encountered in heterophile antibody-positive infectious mononucleosis. Our cases may be a new disease entity or a variant of one previously described.