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Purpose: The success of immunotherapy with dendritic cells (DC) to treat cancer is dependent on effective migration to the lymph nodes and subsequent activation of antigen-specific T cells. In this study, we investigated the fate of DC after intradermal (i.d.) or intranodal (i.n.) administration and the consequences for the immune activating potential of DC vaccines in melanoma patients. Experimental Design: DC were i.d. or i.n. administered to 25 patients with metastatic melanoma scheduled for regional lymph node resection. To track DC in vivo with scintigraphic imaging and in lymph nodes by immunohistochemistry, cells were labeled with both [111In]-indium and superparamagnetic iron oxide. Results: After i.d. injection, maximally 4% of the DC reached the draining lymph nodes. When correctly delivered, all DC were delivered to one or more lymph nodes after i.n. injection. Independent of the route of administration, large numbers of DC remained at the injection site, lost viability, and were cleared by infiltrating CD163+ macrophages within 48 hours. Interestingly, 87 ± 10% of the surviving DC preferentially migrated into the T-cell areas, where they induced antigen-specific T-cell responses. Even though more DC reached the T-cell areas, i.n. injection of DC induced similar antigen-specific immune responses as i.d. injection. Immune responses were already induced with Conclusions: Monocyte-derived DC have high immune activating potential irrespective of the route of vaccination. Limited numbers of DC in the draining lymph nodes are sufficient to induce antigen-specific immunologic responses.

Contains fulltext : 71386.pdf (Publisher’s version ) (Closed access) PURPOSE: The purpose of our study was to evaluate the image quality and diagnostic performance of two-dimensional (D) turbo spin echo (TSE) and 3D T2-weighted TSE MR imaging in local staging of rectal cancer at 3T. MATERIALS AND METHODS: 3T phased-array MR imaging was performed in 36 consecutive patients with biopsy-proven rectal cancer. High-resolution 2D TSE images in three planes and 3D TSE images of the rectum were obtained. Two independent observers performed an image quality assessment using eight image quality characteristics. All 2D and 3D datasets were evaluated separately. MR images were prospectively evaluated by two experienced radiologists in consensus with regard to local disease. Total mesorectal excision was used as the standard of reference. The sensitivity, specificity, positive and negative predictive value, and overall accuracy were calculated. Areas under the receiver operating characteristic (ROC) curve (AUC) were determined. RESULTS: Twenty-two patients who underwent a total mesorectal excision were enrolled in this study. Significantly more motion artifacts were present with 3D TSE imaging (P=0.04). The overall sensitivity, specificity, and accuracy of muscularis propria invasion in rectal cancer using 2D T2-weighted images were 100%, 66%, and 95%, respectively. There was a statistical significant greater AUC using 2D T2-weighted images compared to 3D T2-weighted MR images (P=0.04). The ROC curves describing the results of the interpretation of 2D and 3D T2-weighted datasets regarding perirectal tissue invasion showed no statistical significant difference (P=0.41). CONCLUSIONS: In this study, high local staging accuracies with 3T 2D T2-weighted MR imaging were demonstrated. 3D T2-weighted MR imaging cannot replace 2D MR imaging for local staging of rectal cancer. However, 3D MR imaging can be used for visualization of the complex pelvic anatomy for treatment planning purposes.

PurposeTumor-specific immunomonitoring is essential to evaluate the efficacy of vaccination against cancer. In this study, we investigated the predictive value of the presence or absence of antigen-specific T cells in biopsies from delayed-type hypersensitivity (DTH) sites.Patients and MethodsIn our ongoing clinical trials, HLA-A2.1+ melanoma patients were vaccinated with mature dendritic cells (DC) pulsed with melanoma-associated peptides (gp100 and tyrosinase) and keyhole limpet hemocyanin.ResultsAfter intradermal administration of a DTH challenge with gp100- and tyrosinase peptide-loaded DC, essentially all patients showed a positive induration. In clinically responding patients, T cells specific for the antigen preferentially accumulated in the DTH site, as visualized by in situ tetramer staining. Furthermore, significant numbers of functional gp100 and tyrosinase tetramer-positive T cells could be isolated from these DTH biopsies, in accordance with the applied antigen in the DTH challenge. We observed a direct correlation between the presence of DC vaccine-related T cells in the DTH biopsies of stage IV melanoma patients and a positive clinical outcome (P = .0012).ConclusionThese findings demonstrate the potency of this novel approach in the monitoring of vaccination studies in cancer patients.

Contains fulltext : 197157.pdf (Publisher’s version ) (Open Access) PURPOSE: The aims of this prospective study were to investigate the potential role of fluorine-18-deoxyglucose (FDG) positron emission tomography (PET) in determining the efficacy of the local tumor ablative process and to determine the added value of FDG-PET in the detection of tumor recurrence during follow-up. PATIENTS AND METHODS: Twenty-three patients with unresectable colorectal liver metastases were followed up after local ablative therapy consisting of a standard protocol including FDG-PET scanning, computed tomography (CT) scanning, and carcinoembryonic antigen measurements. The mean follow-up period was 16 months (range, 10 to 21 months). RESULTS: Ninety-six lesions was treated, 56 by local ablative treatment. Within 3 weeks after local ablative treatment, 51 lesions became photopenic on FDG-PET, while five lesions (in five patients) showed persistent activity on FDG-PET. In four of five FDG-PET-positive lesions, a local recurrence developed during follow-up; one FDG-PET-positive lesion turned out to be an abscess. None of the FDG-PET-negative lesions developed a local recurrence during a mean follow-up period of 16 months. During follow-up, 11 patients showed recurrence in the liver outside of the treated area. In all cases, previously negative FDG-PET scans became positive. Extrahepatic recurrence was encountered in nine patients during follow-up; FDG-PET showed all nine cases of tumor recurrence. There was one false-positive FDG-PET caused by an intra-abdominal abscess. In all patients, the time point of detection of recurrence by FDG-PET was considerably earlier than the detection by CT. CONCLUSION: FDG-PET seems to have a significant impact in measuring treatment efficacy directly after local ablative therapy. Furthermore, FDG-PET has an added value in patient follow-up because it reveals recurrences earlier than conventional diagnostic modalities.

PURPOSE: To evaluate the comparative accuracy of magnetic resonance (MR) imaging relative to mammography and ultrasonography (US) for assessing the extent of breast tumors. MATERIALS AND METHODS: Histologic results and preoperative imaging findings (mammography, US, MR imaging) were analyzed regarding tumor size and multifocality of 61 tumors in 60 women undergoing mastectomy for carcinoma. RESULTS: In 10% of cases, the index tumor was not seen at mammography. With US, 15% of the index tumors were not recognized, while MR imaging missed 2% of the index tumors. On mammographic and US images, tumor size was underestimated significantly (P < .005), by 14% and 18%, respectively, while MR imaging showed no significant difference in size compared with that found in a pathologic evaluation. Mammography showed 31% of the additional invasive lesions, while US showed 38% and MR imaging showed 100%. CONCLUSION: MR imaging was the most accurate of the three preoperative imaging modalities in assessing the size and nu...

Contains fulltext : 98363.pdf (Publisher’s version ) (Closed access) Retroperitoneal cystic tumours are rarely found, and of these, the most common lesion is a cystic lymphangioma. We present two postpartum patients with a cystic retroperitoneal tumour which showed spontaneous regression and a review of the literature.

To determine the value of herniography (also known as peritoneography) in the detection of groin hernias, herniographs obtained in 70 consecutive patients with clinically suspected hernias (but with a normal or inconclusive physical examination) were retrospectively evaluated. The radiologic features, complications, and final clinical outcome were reviewed. A total of 30 hernias were found. Sixteen patients underwent surgery; there were no false-positive herniographic diagnoses. No procedure-related complications occurred. These results indicate that herniography is a simple and valuable diagnostic tool in patients with unexplained groin pain or pain in the anterior abdominal wall, with an acceptably low complication rate.

Contains fulltext : 70071.pdf (Publisher’s version ) (Open Access) Autosomal dominant polycystic liver disease (PCLD) is characterized by multiple liver cysts and is caused by mutations in PRKCSH (hepatocystin). Mechanisms of cystogenesis are unknown, but previous studies have shown that hepatocystin is secreted in vitro. The goal of this study was to determine the fate of hepatocystin in vivo. Using immunoprecipitation, we determined that mutant hepatocystin is secreted from both apical and basolateral cell surface of MDCK cells stably transfected with mutant hepatocystin. Analysis of 60 cyst fluid samples from polycystic livers using Western blot, MALDI-TOF MS or nLC-MS/MS did not detect hepatocystin in liver cyst fluid. We did identify 163 ubiquitous serum proteins. No paracrine or autocrine factors were recognized. Although cyst fluids vary greatly in protein concentration, a PCLD specific protein pattern was not established. In conclusion, hepatocystin is not secreted in PCLD liver cyst fluid, suggesting that mutant hepatocystin is either not produced or degraded intracellularly. PCLD cysts develop from intralobular bile ductules and cyst fluid mainly contains common serum proteins comparable to that of other polycystic diseases. 6 p.

Contains fulltext : 49598.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. A study was undertaken to assess the interobserver agreement of categorizing peripancreatic collections on computed tomography (CT) using the Atlanta classification. METHODS: Preoperative contrast-enhanced CTs from 70 consecutive patients (49 men; median age, 59 years; range, 29-79 years) operated for acute necrotizing pancreatitis (2000-2003) in 11 hospitals were reviewed. Five abdominal radiologists independently categorized the peripancreatic collections according to the Atlanta classification. Radiologists were aware of the timing of the CT and the clinical condition of the patient. Interobserver agreement was determined. RESULTS: Interobserver agreement among the radiologists was poor (kappa, 0.144; SD, 0.095). In 3 (4%) of 70 cases, the same Atlanta definition was chosen. In 13 (19%) of 70 cases, 4 radiologists agreed, and in 42 (60%) of 70 cases, 3 radiologists agreed on the definition. In 21 cases (30%), 1 or more of the radiologists classified a collection as "pancreatic abscess," whereas 1 or more radiologist used another Atlanta definition. CONCLUSION: The interobserver agreement of the Atlanta classification for categorizing peripancreatic collections in acute pancreatitis on CT is poor. The Atlanta classification should not be used to describe complications of acute pancreatitis on CT.

Contains fulltext : 48236.pdf (Publisher’s version ) (Closed access) PURPOSE: To evaluate the impact of the quality of involved-field radiotherapy (IFRT) on clinical outcome in patients with advanced Hodgkin's lymphoma (HL) in complete remission (CR) after six to eight cycles of mechlorethamine, vincristine, procarbazine, prednisone-doxorubicin, bleomycin, and vinblastine (MOPP-ABV) chemotherapy. METHODS AND MATERIALS: A retrospective review of clinical and radiologic data, radiation charts, simulator films, and megavoltage (MV) photographs was performed. IFRT consisted of 24 Gy to all initially involved nodal areas and 16-24 Gy to all initially involved extranodal sites. Major violations were defined as no or only partial irradiation of an originally involved area, or a total dose

Contains fulltext : 57921.pdf (Publisher’s version ) (Closed access) We describe a 35-year-old man who was initially treated with standard inguinal orchiectomy and prophylactic radiotherapy for Stage I seminomatous germ cell tumor of the testis. We report the case because of the unique nature of the later disease recurrence, which was a solitary cranial bony recurrence that extended both intracranially and extracranially. The patient had complete remission after combined cisplatin-based chemotherapy.

A 21-year-old man was admitted because of upper abdominal pain and cholestasis. Endoscopic retrograde cholangiopancreatography was suggestive of primary sclerosing cholangitis. During follow-up the patient developed symptoms which were not compatible with primary sclerosing cholangitis, i.e. icterus and weight loss. Finally the patient died, almost three years after presentation, because of a metastatic adenocarcinoma which had arisen from biliary papillomatosis. Biliary papillomatosis is characterised by papillary adenomatous proliferation of the bile duct epithelium. It has a high chance of malignant degeneration. The only curative option would have been transplantation of the liver and biliary system, but this ought to have happened at an early stage before malignant degeneration had occurred.

In this study we analyze MR-negative malignant lesions of the breast. A total of 204 patients with palpable and/or mammographic lesions were studied. The MR technique consisted of the turbo FLASH and MP-RAGE subtraction techniques. All patients underwent surgical biopsy and/or mastectomy and all specimens were examined by the correlative radiologic-histologic mapping technique. A total of 208 lesions were evaluated; 145 turned out to be malignant and 63 proved to be benign. Six malignant lesions were misinterpreted as benign on MR imaging; thus, suspicious contrast enhancement was present in 96 % of the lesions detected by mammography, US, or clinical examination. Especially 4 of the 17 ductal carcinoma in situ (DCIS) lesions were misinterpreted (23.5 %). Despite optimal technique, 6 malignant lesions were not identified by MR imaging. The highest prevalence of these MR occult lesions was in the group of DCIS. Although MR imaging has an important role in the evaluation of breast lesions and, primarily, in ruling out malignancy, one should be aware of the fact that false-negative MR findings do occur.

For the diagnosis of allograft artery stenosis in recipients of a renal transplant with hypertension a noninvasive investigation such as echo-Doppler is preferable to invasive methods such as angiography. Therefore we analyzed our experience with echo-Doppler diagnosis of renal allograft artery stenosis. In 131 renal transplant recipients with hypertension echo-Doppler examinations were performed. During the examinations several features indicative of stenosis were measured, and intrarenal Doppler spectra were quantitatively analyzed with a user-written program. Four patients showed signs of iliac artery stenosis. In 12 patients a renal allograft artery stenosis was suspected on echo-Doppler examination. In 8 of these 12 patients angiography was performed. All these showed a stenosis, 6 of which had more than75% stenosis. In 8 patients with normal echo-Doppler findings angiography was performed because of highly suggestive clinical signs of stenosis. In 7 of these no stenosis was found and in one a 50% stenosis was found. Comparison of quantitative Doppler spectrum features from patients with (n = 6) and without severe (75%) stenosis on angiography (n = 10) showed significant differences in several Doppler parameters. Subsequently an analysis of the best differentiation between these to groups on the basis of quantitative Doppler criteria was performed. In conclusion, echo-Doppler examinations with quantitative analysis of Doppler spectra enables reliable identification of renal allograft artery stenosis.

Spontaneous fracture of central venous catheters (CVC) has been reported. It results from repeated compression of the extravasal part of the CVC between the clavicle and the first rib. The so called pinch-off sign (POS) of the CVC as visible on a chest radiograph has been described as a warning for this complication. Fracture of CVC in patients receiving chemotherapy results in extravasation of the drug which may have serious consequences. We describe the spontaneous fracture of a CVC in two cancer patients. Subsequently we retrospectively analyzed chest radiographs for the POS of 77 cancer patients who received chemotherapy through a CVC and correlated these results with the occurence of complications related to CVC compression. In 77 patients a total of 97 CVC were implanted for a median duration of 7 months. Four CVC (4%) showed a grade 2 POS (change in course of CVC)CVC with luminal narrowing) on a chest radiograph. In three of these (75%) a compression-related complication occurred versus no compression-related complications in 93 CVC showing a POS of grade 1 (change in course of CVC without narrowing) or 0 (no change in course of CVC). The grade of POS on a chest radiograph may vary with the position of the patient, but all grade 2 POS were visible in the upright position. We recommend a chest radiograph in the upright position after placement of a CVC for grading of the POS. CVC showing a grade 2 POS should be removed or at least checked by a chest radiograph before the start of each chemotherapy infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Endosonography of the oesophagus and stomach is important for staging of carcinomas, for judging the degree of thickening of the wall, and for assessment of submucosal and intramural lesions and of space-occupying processes in extra-oesophageal and extragastric organs.

The role of herniography in patients with unexplained pain in the groin or anterior abdominal wall is discussed and referred to that of other imaging modalities. The technique of herniography, its indications and contraindications, and anatomical aspects are dealt with. A series of 81 patients who underwent herniography is presented and the results are correlated with findings at surgery.

In this article, the role of MR imaging in the management of carcinoma of the urinary bladder is reviewed and illustrated. The appearance of the normal urinary bladder and of bladder carcinoma on MR images is shown. Important factors for optimal MR imaging of urinary bladder carcinoma are reviewed. New developments such as three-dimensional and fast spin-echo sequences and the use of contrast agents, endorectal imaging, and phased array coils are discussed. Finally, the value of MR imaging in the staging of bladder carcinoma is described, and MR staging is compared with clinical staging, staging based on findings from intravesical sonography, and CT staging.

To assess the prognostic significance of histological classification, grade and stage with regard to overall survival in patients with non-Hodgkin's lymphoma (NHL).Retrospective analysis.University Hospital St Radboud, Nijmegen.All consecutive 346 patients with NHL diagnosed in the period January 1978-December 1990 were included in this one-centre study. Recorded data included histological type according to the Kiel classification, histological grading according to the International Working Formulation (IWF), Ann Arbor stage, age, sex, tumour mass, number of extranodal sites, serum LDH and ESR. Grading according to the IWF was assessed retrospectively for those patients whose primary disease had been diagnosed before 1982. The observation period ended September 1st, 1991. Overall survival was calculated according to Kaplan-Meier. The significance of the prognostic parameters was studied using both univariate and multivariate stepwise regression analysis.There were 209 men and 137 women with a median age of 56 years (range 15-85). No initial treatment was given to 8% of the patients. After a median follow-up of 52 months, 179 patients (52%) had died; the calculated median survival time was 49 months. Patients with low-grade NHL had a significantly better short-term prognosis than the remaining patients. Related to clinical stage, only patients with stage I disease had distinctly longer survival times than those with more advanced disease. Multivariate analysis revealed serum LDH, age, stage and histological classification to be the most important independent prognostic variables.Even in multivariate analysis, histological classification and Ann Arbor stage have prognostic significance with regard to overall survival in patients with NHL. However, serum LDH levels proved to be the most important prognostic parameter.

Fab' fragments of the monoclonal antibody OV-TL 3, that recognizes an ovarian carcinoma-associated antigen (OA3), were labelled with 99Tcm using D-glucarate as a ligand. Twenty patients suspected of having primary or recurrent ovarian cancer received intravenously 1 mg of the Fab' labelled with 740 MBq 99Tcm. Both planar and single photon emission computed tomographic (SPECT) scintigraphy were performed up to 30 h after intravenous infusion. In 19 out of 20 patients surgical and histopathological evaluation was performed between 2 and 6 days postinfusion. Imaging results were compared with X-ray computed tomography (CT), ultrasonography (US) and CA 125 serum level. Blood clearance was fast with median t1/2 beta of 9.5 h. Thirty-seven per cent of the injected dose (% ID) was excreted in the urine within the first 24 h, whereas 7% ID was excreted in the 24 h faeces. In one patient with an OA3 negative ovarian carcinoma, radioimmunoscintigraphy (RIS) did not visualize the tumour. In two other patients a benign ovarian cyst was found, also showing no elevated uptake. In 13 out of 17 patients ovarian cancer lesions were detected with RIS, whereas CT and US detected lesions in, respectively, 15 and 12 patients. Of 36 surgically defined tumour deposits larger than 1 cm in diameter, 53% were detected and localized with RIS, whereas CT and US detected 61 and 40%, respectively. Radioimmunoscintigraphy with 99Tcm-OV-TL 3 Fab' is less distressing for the patients but the overall imaging performance is not improved when compared with 111In-OV-TL 3 F(ab')2.

Gross hematuria with abdominal pain may be caused by entrapment of the left renal vein between the aorta and the superior mesenteric artery. In the urinary sediment the erythrocytes are normally shaped, making a renal parenchymatous cause unlikely. Ultrasonography shows a decrease of the diameter of the left renal vein of more than 50%, in every position of the patient. Cytoscopy à chaud reveals hematuria pouring out only from the left ureter. In this paper four patients with this syndrome are presented.

The safety and diagnostic accuracy of immunoscintigraphy with the indium-111-labeled monoclonal antibody OV-TL 3 F(ab')2(111In-OV-TL 3 F(ab')2) for diagnosis and follow-up of ovarian cancer was prospectively studied in 31 patients. Planar and SPECT scintigraphy were performed up to 4 days after i.v. injection of 140 MBq 111In-OV-TL 3 F(ab')2. Surgical evaluation was possible in 22 out of 31 patients. Imaging results were compared with X-ray computed tomography, ultrasound, and CA 125 serum level using the histologically confirmed surgical findings as a "gold standard." Apart from a transient rash observed in two patients, no other immediate or delayed adverse reactions were observed. Within the surgically evaluated group, ovarian cancer lesions were detected in 16 out of 17 patients (94%). Of 45 distinct tumor deposits found at operation, 67% were detected and localized with immunoscintigraphy while X-ray computed tomography and ultrasound visualized 53% and 23%, respectively.

The case history of a young female patient is described, in whom a typical subacute thyroiditis of De Quervain was complicated by the occurrence of bilateral thrombosis of the subclavian and axillary veins. This unusual coincidence seemed to be suggestive of an association of these features with previous treatment, as 8 yr earlier she had been treated with mantle field irradiation and polychemotherapy for Hodgkin's disease. She recovered fully and at the time of the events described no relapse of Hodgkin's disease could be established.

Two cases of renal cell carcinoma, metastatic to the pancreas, are presented. The lesions were hypoechoic with ultrasound examination, and were mixed iso- and hypodense with computed tomography. Angiography was performed in one case, and showed a typical hypervascular pattern of the metastatic tumor.

A qualitative comparison of two contrast media for cerebral angiography with regard to contrast should, preferably, be based on a comparison made in two different hemispheres of one patient. Two problems then arise which made evaluation difficult. Vasodilation occurs after the first contrast injection as a result of which the second contrast medium to be compared flows into a dilated vascular tree. In addition, in the case of a comparison in two different hemispheres, variations of image geometry occur, resulting in differences of sharpness and contrast. The method of solving these problems is discussed and is illustrated by a comparison of two contrast media which might be expected to produce differences in contrast because of their physical properties. The results of this clinical comparison show that the expected differences can be partly demonstrated.

A total of 19 patients (7 men, 12 women) with locally advanced pancreatic adenocarcinoma were treated with six cycles of FAP (5-fluorouracil, 300 mg/m2 i.v. on days 1-5; Adriamycin, 50 mg/m2 i.v. on day 1; cisplatin, 20 mg/m2 i.v. on days 1-5). Each course was repeated every 28 days. After six cycles, the treatment was followed by irradiation amounting to 4,000 cGy (split course) in combination with 5-FU (500 mg/m2) on days 1-3 of the two irradiation periods. The median age of our patients was 55 years (range, 40-64 years). The median WHO performance status was 1, with a range of 0-2. Three (16%) complete (CR) and six (31%) partial responses (PR) were observed, as were six cases of stable disease (SD) and four of progressive disease (PD). The median duration of response was 11 months, with a range of 4-24 months, and the median survival was 14 months (range, 5-27 + months). FAP toxicity was tolerated fairly poorly. The dose-limiting toxic effect was myelosuppression, with a mean WBC nadir of WHO grade 1.6 (range, 0-3) and a mean platelet count of WHO grade 1.1 (range, 0-4). Nausea and vomiting were not dose-limiting. Complete alopecia was seen in 14/19 patients. Neuropathy was mild (WHO grade 1) in seven and moderate (grade 2) in four. Irradiation in combination with 5-FU was generally well tolerated. Due to several reasons, only ten patients could be treated with all six cycles of FAP. We conclude that in future combined modality studies, irradiation should be given after three cycles of chemotherapy, and that combined modality treatment for locally advanced pancreatic cancer is feasible and warrants further testing.

SummaryThe case history of a 34-year-old patient with precirrhotic idiopathic haemochromatosis and severe chronic steatorrhoea is presented. The pancreas had a normal appearance on ultrasonography and endoscopic retrograde pancreaticography. However, pancreatic function tests revealed significant abnormalities. The pancreatic output of trypsin, amylase, lipase and bicarbonate was deficient and basal and stimulated serum pancreatic polypeptide levels were subnormal. In contrast, the oral glucose tolerance test was unimpaired. The pancreatic insufficiency had started suddenly during a summer vacation and may have had a viral aetiology. The hypothesis is advanced that in haemochromatosis the iron-laden pancreatic acinar and PP-producing cells are more susceptible to damage by viruses than normal pancreatic cells.

A double-contrast examination of the colon was performed during diarrheal illness in 5 patients with Campylobacter infection. The findings in these 5 patients were aphthoid ulcers and stippled appearance. In 1 patient with stool culture positive for Campylobacter, double-contrast study of the colon 9 days later showed no abnormalities. In a 12-year-old boy lymphoid hyperplasia could be observed as well as the aphthoid ulcers. All the abnormalities were segmental, more often localized in the rectosigmoid. No changes were found in the ascending colon. Histopathologic studies of the biopsy specimens taken endoscopically in 3 patients showed a nonspecific inflammatory reaction.

Findings of CT of the spleen were compared with those of histologic examination in 35 patients who had Hodgkin disease. CT provides a simple way to calculate splenic size. This index is also of value in the assessment of the histologic state of the spleen. An accuracy rate of 91%, specificity of 94%, and a sensitivity of 89% in diagnosing splenic localization of lymphoma was found in this study.

Of 59 patients undergoing lymphography as part of staging for urologic tumor (bladder carcinoma, prostate carcinoma, seminomatous and nonseminomatous testicular tumors), histological material was obtained in 38. Lymphography was shown to have a specificity of 95%, a sensitivity of 81%, and an overall accuracy of 89%. When lymph node regions were considered, the specificity was 99.2%, sensitivity 59%, and overall accuracy 91%. Causes of discrepancies between radiography and histology are evaluated and receiver operating characteristic curves are demonstrated.

An abnormal high union of the common bile duct and the main pancreatic duct, without accompanying cystic dilatation of the bile ducts, is a rare occurrence. A case of obstructive jaundice due to bile duct carcinoma in connection with this anomaly is reported.

Ninety-one patients with non-Hodgkin lymphoma (NHL) were subjected to computed tomography (CT) and lymphography. Both examinations agreed in 74 patients (81%) with regard to the infradiaphragmatic lymph nodes. In patients undergoing CT prior to lymphography, the concordance amounted to 75 per cent. When lymphography was the initial examination, the concordance amounted to 86 per cent. Lymphography was abnormal in 30 per cent of the patients with a normal CT scan and in 93 per cent of those with an abnormal CT scan as the first examination. CT was abnormal in 4 per cent of patients with a normal lymphogram and in 84 per cent of those with an abnormal lymphogram as the first examination. CT did not detect mesenteric or retrocrural lymph node enlargement in the absence of retroperitoneal lymph node involvement. Eleven patients had extranodal manifestations of the disease (excluding liver and spleen), and 3 were detected primarily with CT. Lymphography is the most complete examination for the infradiaphragmatic lymph nodes for staging purposes. Although CT outlined the disease better, it changed the lymphographic diagnosis in only 2 per cent of the patients. Lymphography modified the CT stage in 15 per cent of the patients. When abdominal CT is performed first, in staging patients with NHL, lymphography will only yield additional information when CT is normal or equivocal.

Osteochondral fracture of the trochlea tali, which can result in osteochondritis dissecans of this trochlea, is often not recognized as such and therefore not adequately treated. The nonrecognition is mainly due to the fact that the fracture can either remain asymptomatic or produce symptoms of inversion-distortion; to a lesser degree it is also due to the fact that the lesion is not identified in the radiograph. In view of these facts it would seem necessary in all cases of distorsion to make an X-ray examination of the ankle, ascertaining that the trochlea tali is adequately visualized. Unless the symptoms abate within a week, radiological examination should be repeated. The same applies to patients whose initial recovery is followed by a relapse of symptoms. Surgical treatment of choice for osteochondral fractures. The symptomatology and therapeutic results in 46 osteochondral fractures studied were in agreement with data from the literature. Therapeutic results can be improved by earlier diagnosis and more adequate treatment of the condition.

Computed tomography of the spleen was correlated with histologic examination or clinical data in 53 selected patients with non-Hodgkin lymphoma. Calculation of the splenic index with CT by multiplying spleen length, width and thickness is a simple and rapid procedure for defining splenic size in vivo. A good correlation was found between size of the spleen, as estimated by splenic index calculation, and the proven or probable histologic state of the spleen.

Direct portography using the percutaneous, transhepatic approach provides a rapid and accurate visualization of the portal, splenic, and superior mesenteric veins. In 7 patients with a malignant tumor of the pancreatobiliary region and in 1 patient with pancreatitis, the method was reliable in predicting resectability of the lesion.

Pseudoxanthoma elasticum is an hereditary disease of elastic fibres affecting the skin, eyes and the cardio-vascular system. The radiologist should be familiar with this disease; the vascular changes can lead to bleeding from the gastrointestinal tract, which can be elucidated angiographically. There may also be circulatory disturbances in the extremities associated with early and pronounced calcification of the media and intima.

The accuracy in the diagnosis of gastric cancer was investigated in 188 histologically proven cases, including 12 cases of early gastric cancer. One hundred and sixty-five of 167 patients (99%) were recorded radiologically as having a gastric lesion. The initial diagnosis was carcinoma in 144 patients (86%), and benign lesion in 21 cases (13%). In 2 cases (1%) no abnormalities were seen. In 3 out of 9 patients with a partial gastrectomy (33%) an incorrect diagnosis was made. In 11 of 12 patients with early gastric cancer the radiologic examination revealed abnormal findings, but 7 of these were incorrectly interpreted as benign. A retrospective analysis of the radiologic examination in which no malignancies were reported showed that inadequacy of the examination technique and misinterpretation of radiologic signs of malignancy were the main causes of failure in diagnosing of malignancy. The rate of misinterpretation of malignancy as a benign lesion (13%) justifies the endoscopic control of every radiologically detected abnormality. The high sensitivity in detecting a lesion indicates, however, that a biphasic radiologic examination is a safe screening method in gastric cancer. Endoscopy with biopsy showed a lesion in 156 out of 160 patients (98 %), but in 11 of these (7%) the initial examination did not yield histologic proof of malignancy. In 4 patients (2%) no abnormalities were observed by endoscopists. One hundred and forty-nine patients were examined with both radiology and endoscopy with biopsy. A malignant lesion with recognition of its malignant character was defined in 144 cases (97%).

Thirty-two patients with proven progressive metastatic renal cell carcinoma were treated with the combination of 0.1 mg/m2 (2 X 10(6) IU/m2) r-interferon (r-IFN)-gamma and 6 micrograms/m2 (2 X 10(6) IU/m2) r-IFN-alpha. In case of progressive disease (PD) or stable disease (SD), after 8 weeks, the dose of r-IFN-alpha was escalated by 6 micrograms/m2 every 2 weeks until the maximum tolerable dose was reached, while r-IFN-gamma was maintained at the low dose. The rationale for this study is provided by the dose-related efficacy of IFN-alpha as a monotherapy, the potent immunostimulatory activity of IFN-gamma, and the alleged synergistic effect of the combination. Fourteen patients are evaluable for 8 weeks of low-dose combination treatment (7 X SD, 5 X PD, 2 X early progression), while so far 6 of 24 patients (25%) who started dose escalation of IFN-alpha have reached a partial response. These data indicate better efficacy with higher doses of IFN-alpha. Because of the infrequent administration and the relative low doses, compared to other trials, the treatment regimen was well tolerated. Although preliminary results are promising, definite efficacy remains to be proven.

Lymphography and abdominal CT were performed in 78 patients staged for Hodgkin's disease. In 82% of all patients, both examinations agreed on the presence or absence of lymph node involvement. In the group of 39 patients undergoing lymphography prior to CT, the agreement was 90%. In the group of 39 patients with lymphography following CT, the agreement was 74%. In 50% of the patients with discrepant findings, lymphography revealed abnormal nodes compared with CT. Lymphography was abnormal in 26% of patients with a normal CT scan as the first examination, and in 9% of patients with a normal CT scan as the second examination. It is concluded that lymphography is more reliable than CT in the examination of the abdomen. CT performed after a normal or an abnormal lymphogram adds little additional information. When CT is preferred as the initial investigation in staging Hodgkin's disease, lymphography only adds significant information if the CT scan is normal or equivocal.

To avoid the disadvantages of intravenous urography (IVU) and urethrocystoscopy (UCS), we investigated prospectively their replacement by ultrasound, performed during one visit in the outpatient department, in the evaluation of patients with symptoms of prostatism. One hundred twenty patients (aged 44-89 years) were included in this study. All patients underwent two main diagnostic procedures: ultrasound of the kidneys and bladder and transrectal ultrasound of the prostate (procedure A1) This was compared with IVU and UCS (procedure A2). Following procedure A1, the main diagnoses made were benign prostatic hypertrophy in 84 patients, prostatitis in 24 patients, and prostatic cancer in 12 patients. By following procedure A2, the diagnosis was changed in 20 cases. Fourteen patients had a bladder neck sclerosis, and six had a urethral stricture. There was no relevant diagnostic difference between IVU and ultrasound of the kidneys and bladder. Ultrasound of the prostate gives better information on prostatic abnormalities than does IVU or UCS. A patient with prostatism can be screened completely during one visit at the outpatient department. Only for detection of bladder neck sclerosis and urethral strictures does UCS remain preferable.

This article describes the occurrence of an unusual radiating pattern of calcification in the center of large radiolucent gallstones. The radiographic findings are attributed to calcium deposition within the fissures of biliary calculi.

Lymph node calcification in malignant lymphoma is an uncommon radiologic finding. Eight cases are added to the 61 cases of lymph node calcification following radiation therapy for Hodgkin's disease, assembled from the literature. The typical radiographic appearance of punctate calcifications, usually found in the upper mediastinum, at times together with egg-shell type calcification, is confirmed. The mean time before appearance of calcification was 3 years after initial treatment. The calcification seems to be associated with a good prognosis and long-term survival. In addition, the radiologic and clinical findings in a patient with non-Hodgkin's lymphoma who developed calcifications in the involved area after treatment are presented.

Neonatal Adrenal Haemorrhage (NAH) is a condition, which often presents with a palpable abdominal mass and prolonged jaundice. Supra-renal calcifications, seen on routine X-ray films, often result from adrenal haemorrhage in early life. Disturbed renal function at the ipsilateral side, as can be seen from excretory urography and renal scintigraphy, is a much less known condition in association with NAH. The case history of three patients is described. The presentation, diagnostical approach and course of NAH is discussed. Echography is the most important diagnostic tool. Echographic follow up discriminates NAH from other conditions presenting with a palpable abdominal mass and allows for a waiting attitude.