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Plain-film abdominal changes in 5 patients with severe antibiotic-related pseudomembranous colitis were found to be strikingly similar and distinct from those seen in other colitides. These consisted of moderate gaseous distension of the colon and unusual wide transverse bands of thickened bowel wall associated with giant "thumbprinting" which was universal in distribution, with minimal or absent small-bowel abnormalities. While the radiographic findings were not pathognomonic, they were highly suggestive of advanced pseudomembranous colitis when combined with the clinical data. Prompt recognition of this entity by the radiologist is extremely helpful in management, since such patients frequently present with physical findings of an acute abdomen requiring surgery.

A seriously ill patient with pseudomembranous colitis of obscure origin responsed promptly to a completely diverting ileostomy. The ileostomy was successfully closed three months later when the colon appeared to be normal. In an unusually severe case of pseudomembranous colitis, where operation is required and where pseudomembranous colitis is the sole operative finding, a completely diverting ileostomy should be considered rather than a more extensive procedure.

Following approval by an Institutional Review Board and a pilot study with adults, children aged 24 months to 71 months were encouraged to drink from a 28 fl oz flexible, plastic bottle with either a small diameter orifice (7 mm) or large diameter orifice (28 mm). The bottles contained either a low viscosity, an intermediate viscosity, or a higher viscosity liquid. Approximately 24 children evaluated each orifice/viscosity combination. The results, expressed as ml/swallow/kg body weight, showed that reducing orifice diameter reduced the volume of a swallow for the low viscosity liquid but did not appear to affect swallow volume for the intermediate or higher viscosity liquids. Additionally, swallow volume was found to be inversely related to viscosity of the test liquid.

A prospective study was undertaken to determine the incidence of upper gastrointestinal disease in 85 chronic renal failure (CRF) patients on hemodialysis. Upper gastrointestinal x-rays were obtained for 83 patients, and enlarged gastric and duodenal folds were seen in 12% (10/83) and 42% (35/83) of the cases, respectively. Panendoscopy performed on 60 persons revealed gastritis in 22% (13/60), nodular duodenitis in 60% (35/60), and esophagitis in 13% (8/60). No peptic ulcers were identified either radiologically or endoscopically. Pathologic examination of mucosal biopsy specimens demonstrated gastritis in 46% (21/46) and duodenitis in 43% (22/51) of patients. A highly significant correlation was found between endoscopic and radiologic duodenitis (P less than .0001) and also between endoscopic and pathologic duodenitis. We have demonstrated a high incidence of mucosal inflammation but not ulcer disease in CRF patients. These lesions may predispose these individuals to gastrointestinal bleeding following renal transplantation.

Nineteen patients with the Mallory-Weiss lesion diagnosed by panendoscopy are presented. This represents 10.5% of 180 acute upper-gastrointestinal bleeders. Only 36.8% of these 19 patients had a history of heavy ethanol intake and 26% had hiatus hernias. In addition to the Mallory-Weiss lesion, abnormalities in 63% were noted on endoscopy. None of the patients required surgery for control of the bleeding. Two patients were treated with selective arterial-vasopressin infusion. The importance of a high index of suspicion for this lesion in spite of the lack of a classical alcoholic or recurrent retching history and the value of intensive medical therapy, including early panendoscopy, is emphasized.

Henry Ford Hospital recently conducted a procedural costing study to determine if more accurate costs for various institutional procedures could be developed. The hospital conducted the study in two phases. The first phase looked at a specific department while phase two took a broader approach and covered the entire institution. This article examines the department-specific phase in which the diagnostic radiology department was selected as the participant. The study concluded that by allocating costs to the procedural level using relative value units and feeding this information into the case-mix system, departmental costs could be accurately identified.