High-resolution echography of the neck. Preoperative evaluation of lymph node metastases in patients with thyroid carcinoma

Twenty-six patients with papillary and 4 with medullary thyroid carcinoma were examined by HRUS before surgery in order to evaluate its accuracy in detecting lymph node metastasis (N) of the neck from thyroid carcinoma. All patients underwent total thyroidectomy and nodal dissection. HRUS was accurate in 73% of cases in N staging, while clinical staging was accurate in 60% of cases only. In 50% of patients HRUS provided with interesting additional information, such as disclosing lymphadenopathy in 8 patients with no clinical evidence, proving nodal involvement in 5 cases, and showing extranodal extension in 5 cases. HRUS allowed the observation of anechoic necrotic areas and microcalcified nodes. On the other hand, according to our results, HRUS cannot either discriminate metastatic from benign nodal involvement, or identify mediastinal adenopathy. False negatives are possible due to micrometastatic areas in normal size nodes. Nevertheless, HRUS proved to be a valuable aid to complete clinical examination of the neck, and a good guide for the surgeon during nodal neck dissection.     

Magnetic resonance spectroscopy in Parkinson's disease and parkinsonian syndromes

This paper looks at the use of magnetic resonance spectroscopy (MRS) for diagnostic and research purposes in Parkinson's disease and parkinsonian syndromes. The review considers both proton MRS (1H MRS) and phosphorus MRS (31 P MRS) studies. MRS is useful for diagnostic purposes, helping to differentiate Parkinson's disease from other parkinsonian syndromes. Even more usefully, MRS can be used for non invasive in vivo human research.     

Three-dimensional surface reconstruction of the carpal bones from CT scans: transaxial versus coronal technique

Computer methods for reconstruction of three-dimensional (3-D) images from standard CT scans have been developed. The process does not require special computer knowledge and can be performed with a unmodified CT scanner. 3-D images are especially valuable for conveying information to nonradiologist physicians, who are unfamiliar with the numerous slice-format images produced in a standard CT examination. The utility of these methods for clarification of areas of complex skeletal anatomy has been previously demonstrated in the literature. We performed 3-D imaging on a normal isolated cadaver hand and on a patient with scaphoid fracture. In both cases the 3-D images obtained had excellent osseous anatomical detail. A method of acquisition of high quality wrist CT scans, suitable for 3-D processing, is suggested.     

CT demonstration of portal and superior mesenteric vein thrombosis in hepatocellular carcinoma

Three cases of hepatocellular carcinoma in which computed tomography (CT) demonstrated thrombosis of the portal vein are reported. In one patient, extension of the thrombus into the superior mesenteric vein was identified as well. The outstanding CT features of portal vein thrombosis were: (a) enlargement of the vein, (b) intraluminal low density area, and (c) hyperdense peripheral ring due to the enhancement of the venous wall. These findings may be useful in differentiating hepatocellular carcinoma from hepatic metastases.     

The computer and stereotactic surgery in neurological surgery

The technical aspects, current uses, and future clinical applications of stereotactic surgery and three-dimensional imaging in neurological surgery are reviewed.     

An Unusual Cause of Mechanical Dysphagia: An Agglomerate of Calculi in a Tonsillar Residue

We report the case of a 68-year-old man affected by severe oropharyngeal dysphagia for solid food, who had undergone tonsillectomy when he was 22 years old. Videolaryngoscopy revealed a smooth-surfaced, elongated overgrowth on the left lateral pharyngeal wall that protruded toward the left pyriform fossa and impeded the transit of solid boli. A computed tomography scan showed that the solid content of the lesion was markedly inhomogeneous and denser than the surrounding soft tissues. The mass was removed by means of direct pharyngoscopy under general anesthesia. It was found that it arose from the inferior pole of the left tonsillar fossa and had a central cavity filled with caseum and multiple calculi. Histopathologic examination showed that its soft tissue component consisted of lymphoid tonsillar tissue. The operation totally resolved the swallowing disturbance. This case report highlights that tonsilloliths in a tonsillar residue should be considered in the differential diagnosis of mechanical oropharyngeal dysphagia, even in tonsillectomized patients.     

Intestinal interposition: the prevalence and clinical relevance of non-hepatodiaphragmatic conditions (non-Chilaiditi forms) documented by CT and review of the literature

Purpose

This study was done to assess the prevalence and clinical impact of non-hepatodiaphragmatic interpositions in a sample of adult patients undergoing computed tomography (CT) for a variety of medical reasons.

Materials and methods

From November 2008 to April 2009, two observers jointly examined the cases of intestinal interposition in 4,338 adults undergoing CT investigations. This study sought to identify not only hepatodiaphragmatic intestinal interpositions, defined as Chilaiditi, but also other forms of intestinal interposition, which we termed non-Chilaiditi. The latter were divided into five different classes on the basis of their anatomical relationships: splenorenal, retrogastric, hepatocaval, retrosplenic, and retrorenal. Moreover, a questionnaire investigating the clinical symptoms reported to be associated with Chilaiditi syndrome was given to patients exhibiting any form of intestinal interposition and to a control sample. Finally, clinical data related to the three groups were compared.

Results

Of the 4,338 patients examined, 130 (3%) were found to have intestinal interposition, for a total of 143 forms: 90 Chilaiditi and 53 non-Chilaiditi. Of the latter, 30 were splenorenal, 12 retrogastric, five hepatocaval, four retrosplenic and two retrorenal. Statistical analysis showed that the Chilaiditi group suffered most symptoms (24.4%), followed by the non-Chilaiditi group (18.9%) and control cases (10.8%). Our results were validated using the ??² test of significance.

Conclusions

The number of non-Chilaiditi cases amounted to just over half the number of Chilaiditi cases, with the splenorenal form being by far the most frequent. Statistical analysis showed that patients with non-Chilaiditi forms of intestinal interposition had more symptoms than did controls.