Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.     

Medical surveillance for antineoplastic-drug handlers

Elements of a medical surveillance program are described, with emphasis on a program for antineoplastic-drug handlers in a hospital setting. There are four data-gathering elements in any medical surveillance program: the history (medical and occupational), the physical examination, laboratory studies, and biological monitoring. Of these, the most useful and cost-effective is the history. The physical examination and laboratory tests should focus on the target organs of the hazardous agent in question. When results of biological monitoring are available for an unexposed control population, results for a group of exposed workers may be interpreted as greater than, similar to, or less than what was expected; thus, groups of unacceptably exposed workers may be identified. For antineoplastic-drug handling, the most important controls are use of a biological-safety cabinet and a worker education program. Estimating the average number of hours of drug handling per shift may serve as a surrogate measure of the potential exposure dose. Health-care professionals examining and testing workers who handle antineoplastic agents should give special emphasis to the skin and the hematopoietic, hepatic, renal, and urinary systems. Because of problems with assay sensitivity, cost, and interpretation of results, biological monitoring is not considered necessary in every medical surveillance program for antineoplastic-drug handlers. The Occupational Safety and Health Administration currently recommends that a permanent registry be maintained of all employees who routinely handle antineoplastic agents. Because of their opportunity for exposure to potentially hazardous drugs, pharmacy professionals should take a leading role in establishing surveillance programs that complement existing drug-handling practices and worker education programs.     

Solitary bronchioloalveolar carcinoma: CT criteria

The computed tomographic (CT) scans of 30 patients with solitary bronchioloalveolar carcinoma were reviewed. Common features at CT included the peripheral or subpleural location of a pulmonary mass (25 cases), pseudocavitation (18 cases), heterogeneous attenuation (17 cases), irregular margins forming a star pattern (22 cases), and pleural tags (21 cases). Using these CT criteria, four independent observers attempted to identify cases of bronchioloalveolar carcinoma from a larger sample of lung cancers and benign lesions by categorizing a series of test cases into four probability categories. Although the bronchioloalveolar carcinomas were correctly ranked in the two highest probability categories 75% of the time (in 45 of 60 cases), there was considerable overlap with other lung lesions, particularly with adenocarcinoma and large cell undifferentiated carcinoma. However, even though the typical features of bronchioloalveolar carcinoma are not invariable or highly specific, they are characteristic enough to suggest the diagnosis.     

Hepatic artery thrombosis resulting in gas gangrene of the transplanted liver.

Early hepatic artery thrombosis after orthotopic liver transplantation results in massive injury to hepatocytes and the bile duct epithelium. In the fulminate form, impaired liver synthetic function is expressed by encephalopathy and coagulopathy. Ischemic bile duct injury is associated with the disruption of the biliary anastomosis, bile duct strictures, and intrahepatic bilomas. The inability of the liver macrophages to clear translocated portal blood intestinal pathogens results in persistent bacteremia and sepsis. The major radiologic finding is the radiographic evidence of gas gangrene of the liver graft. Early recognition and correct interpretation of the radiologic findings, immediate removal of the liver graft, and placement of the patient on venous-venous bypass or total hepatic devascularization while a new liver is being procured and retransplantation are the only hope for survival.