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Objective: Our purpose was to examine the clinical presentation, imaging appearance, etiology, and clinical outcome in patients who had acute thrombosis of the superior mesenteric vein with radiologically occult cause., Conclusion: The most common predisposing factors in superior mesenteric vein thrombosis with radiologically occult cause are recent abdominal surgery, infection, and hypercoagulable states. Although no correlation was noted between risk factor and outcome, the presence of bowel wall thickening and mesenteric congestion on CT or MR imaging was associated with the development of bowel ischemia. Prognosis is good in this group of patients, with a mortality of only 7%, although bowel ischemia was noted in 21%.

Purpose: To determine the clinical presentation in cases of adult intussusception demonstrated at computed tomography (CT) or magnetic resonance (MR) imaging and to correlate the imaging appearance with clinical diagnosis., Materials and Methods: Retrospective review of CT and MR images and clinical records of all patients with an intussusception demonstrated on CT or MR images from January 1, 1991, through April 30, 1998., Results: Thirty-three patients had one or more intussusceptions demonstrated on CT (n = 30) or MR (n = 3) images. Twenty-nine patients had enteroenteric intussusceptions, and four had intussusceptions involving the colon. Ten patients (30%) had a neoplastic lead point, including all four of the intussusceptions involving the colon (benign mass, n = 3; malignant mass, n = 7). In 23 cases (70%), no neoplastic lead point was identified. A variety of causes were implicated in these cases, with 16 cases (48%) classified as idiopathic. Enteric intussusceptions in the nonneoplastic group were shorter in length (median, 4 vs 10.8 cm; P = .002), smaller in diameter (median, 3 vs 4 cm; P = .002), and less likely to be associated with obstruction (4.3% vs 50%; P = .02)., Conclusion: Less than one-third of adult intussusceptions demonstrated at CT or MR imaging were caused by a neoplastic lead point. Almost half of adult cases in this series were idiopathic.

Purpose: The goal of our study was to examine the prevalence of multiple hypodense splenic nodules and their associated diagnoses and to correlate CT appearance with clinical presentation and diagnosis., Method: Records of all patients undergoing contrast-enhanced CT from July 1994 through September 1997 were reviewed. Charts and CT scans of patients with multiple (more than five) hypodense splenic nodules were then evaluated., Results: During the search period, there were 8,764 patients examined. Multiple hypodense splenic nodules were identified in 45 patients. Sixteen patients had malignant neoplasia as an etiology, with two patients having a benign tumor. Ten patients had an infectious etiology; nine patients had an inflammatory but noninfectious etiology; in eight patients, a diagnosis was not established; five of these patients were followed for > 18 months., Conclusion: Multiple hypodense splenic nodules are uncommon. Lymphoma, infection, and sarcoid were the three most common disorders in the symptomatic patient, with infection strongly correlated with a compromised immune system. In the asymptomatic patient, nonlymphomatous metastatic disease, benign tumor, and sarcoid were most common. Although overlap exists between diagnostic groups, lymphoma tends to have larger, more variable nodules, whereas infection tends to occur with smaller, more uniform nodules. Sarcoid is intermediate in appearance.

A case of haemangioma of the oesophagus is presented. The computed tomographic findings of an intramural mass with marked enhancement following intravenous contrast enable the diagnosis to be suggested pre-operatively.

Pneumatosis intestinalis (PI) is characterized by subserosal or submucosal gas-filled cysts of the gastrointestinal tract. The course may be benign or may lead to the need for urgent surgery. Knowledge of the differential diagnosis, course, and treatment modalities are key in providing optimal care to patients who present with this entity. In this article, two cases of "benign" pneumatosis seen at our institution over a one-month period are presented, along with a retrospective review of the English literature from January 1985 to March 1995. Incidence, symptoms, gross and microscopic appearance, radiographic appearance, etiology, differential diagnosis and therapy are reviewed.

Rationale and Objectives: To study the practice of obtaining serum creatinine before administering intravenous iodinated contrast medium and the costs associated with this practice., Materials and Methods: In June 1993, a questionnaire was sent to 217 physicians who are members of the Society of Uroradiology or the Society of Computed Body Tomography/Magnetic Resonance. There were 149 respondents who completed a total of 70 questionnaires, providing a response rate of 69% (149/217)., Results: The percentage of institutions that always require a serum creatinine before administering intravenous contrast medium for excretory urography, body computed tomography, and head computed tomography was 13%, 20%, and 14%, respectively. In institutions where routine serum creatinine is not required, approximately 60% request a serum creatinine in either insulin-dependent or juvenile type 1 diabetes. The mean maximal acceptable time between the serum creatinine value and contrast administration is 29 days. It takes a mean of 69 minutes to get the results of a stat serum creatinine and costs a mean of 15 dollars for the test. In patients with no risk factors, the mean for the highest serum creatinine value at which respondents still gave contrast was 2.1 mg/dL; in patients with risk factors, the mean was 1.9 mg/dL. There was no correlation between the use of serum creatinine and the number of studies performed in the institution or the type of contrast used., Conclusions: The practice of requiring a pretest serum creatinine and its interpretation regarding the use of contrast media are quite variable. In view of this disparity in opinion, development and acceptance of a list of patients who are at increased risk for contrast-induced nephropathy may be desirable.

Fourteen patients underwent magnetic resonance imaging (MRI) examination (16 studies) and clinical evaluation concurrently. MRI studies included gadolinium enhancement and TI-weighted fat-suppressed spin echo. Separate investigators determined the severity of disease on MR images and on clinical evaluation in a blinded fashion. MRI studies were evaluated for percentage of mural contrast enhancement, wall thickness, and length of diseased bowel. An MR product was generated using these parameters. Clinical evaluation used the Crohn's Disease Activity Index (CDAI) and modified Index of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD). Linear correlation was found between the MR product and clinical indexes of disease activity. The correlation between MR product and the modified IOIBD index was statistically significant (R(2) = 0.633, p = 0.0012). The correlation of MR product and CDAI was less close (R(2) = 0.274, p = 0.0373). Among individual MR parameters, length of diseased bowel showed the greatest correlation with CDAI (R(2) = 0.537, p = 0.012). Percentage contrast enhancement and bowel wall thickness showed significant correlation to the modified IOIBD index (R(2) = 0.739, p = 0.021) but not to the CDAI (R(2) = 0.004, p = 0.825). The results of this study show that the product of mural contrast enhancement, wall thickness, and length of diseased bowel correlated with clinical indexes of disease activity in Crohn's disease. Our findings suggest that MRI may be useful in evaluating the severity of Crohn's disease and may provide information complementary to clinical evaluation.

Focal nodular hyperplasia (FNH) is a benign liver condition, which generally does not contain fat. In this report we describe an unusual case in which multiple areas of FNH were surrounded by prominent peripheral fatty infiltration.

An ergonomically simple prototype workstation with two 900 x 1,100-pixel monitors capable of displaying eight full-resolution computed tomography (CT) images in 0.2 seconds, was compared with film for interpretation of computed tomographic images of the chest and abdomen. The hardware platform for this workstation cost less than $11,500 in 1993. A repeated-measures experiment was used to generate average interpretation times of 6.17 minutes for the workstation and 6.03 minutes for the film, including loading and unloading films, with three of the four subjects averaging about a minute longer for each workstation interpretation. All dictated reports were of clinically acceptable accuracy. All radiologists stated that workstations based on this design would be an acceptable clinical tool. However, observation suggested human working-memory strain among infrequent CT readers that could indicate the need for additional training. These data suggest that low-cost workstations can have practical application in interpretation of digital medical images such as CT, with the possibility of small increases in interpretation time.

Purpose: To determine the prevalence of significant variations in liver-colon anatomy in an unselected patient population and evaluate the potential effect of these variations on liver-related interventional procedures., Patients and Methods: All abdominal computed tomographic (CT) scans were reviewed prospectively over a 4-month period. Cases that revealed variant hepatocolic anatomy were selected and analyzed for the position of the colon, gallbladder, and duodenum; liver morphology; and the anatomic relations of the right portal vein., Results: Seventeen (3.3%) of 517 abdominal CT scans demonstrated variant hepatocolic anatomic relations. In seven cases, liver lobar morphology was normal, but the colon was interposed between the chest wall and the liver. The remaining 10 cases were characterized by hypoplasia or aplasia of one or both segments of the left lobe. In these cases the right portal vein was anteriorly exposed and was close to the gallbladder and transverse colon. In all 17 cases it was qualitatively judged that technical modifications might be needed in the performance of various interventional procedures, including percutaneous biliary drainage, biopsies, and transjugular intrahepatic portosystemic shunt creation., Conclusion: Variations in liver-colon anatomic relations in isolation or secondary to hepatic developmental anomalies may have a significant potential impact on the performance of various fluoroscopically guided hepatobiliary interventional procedures.

The computed tomographic (CT) findings of a right and left paraduodenal hernia are described. In the right paraduodenal hernia the major findings consist of encapsulation of small bowel loops in the right mid-abdomen with looping of arterial and venous jejunal branches behind the superior mesenteric artery. The findings of the left paraduodenal hernia are less specific and involve encapsulation of bowel loops at or above the level of the ligament of Treitz with intermittent dilatation.

Mucoceles of the appendix are a rare group of lesions thought to occur as a sequelae of luminal obstruction as well as certain benign and malignant neoplasms of the appendix. Early, preoperative diagnosis is rare. We report a case of an appendiceal mucocele in which the diagnosis was suggested by computed tomographic imaging and colonoscopy, and confirmed at surgery. Radiologic, endoscopic, and pathologic correlations of this rare entity are discussed.

A 45-year-old patient with focal intrahepatic extramedullary hematopoiesis is presented in which the liver was imaged by CT, ultrasound, and MR. The appearance of the lesions on MR consisted of slightly increased signal on T2-weighted images with heterogeneous enhancement of some of the lesions during bolus infusion of gadolinium. The T1-weighted images postgadolinium showed no delayed enhancement.

A unique case of an infarcted carcinoid of the appendix is presented in which the computed tomography (CT) and clinical findings mimicked an appendiceal abscess. Though unusual, this possibility and appearance should be familiar to the radiologist particularly if percutaneous drainage is considered.

Diverticula of the female urethra can be difficult to diagnose. Invasive contrast studies (voiding cystourethrography or double-balloon urethrography) or urethroscopy are frequently required for definitive diagnosis. Although transabdominal sonography has been able to visualize large diverticula, this technique has not proved useful in routine screening. In this study, we examined the use of higher frequency (5 MHz) near-focus endovaginal or transperineal sonography for the diagnosis of urethral diverticula. Five patients with radiographically proved (three with double-balloon urethrography and two with voiding cystourethrography) urethral diverticula were examined with endovaginal (two cases) or transperineal (four cases) sonography. In all five cases, sonography showed the diverticula previously demonstrated on the contrast study. The spatial relationship of the diverticula to the urethra, an important consideration at surgery, was shown more clearly by sonography than by contrast radiography. These findings suggest that sonography may be useful as a noninvasive screening technique for urethral diverticula.

An unusual case of intrahepatic hepatic artery aneurysm (IHAA) is presented, in which the diagnosis was initially suspected on computed tomography (CT) and confirmed on color-flow Doppler ultrasound (US). The literature regarding this entity, as well as the utility of color-flow Doppler US in this setting are discussed.

The release of the lysosomal enzyme beta-glucuronidase from granulocytes follows incubation in vitro with complement-activated zymosan particles. Release of beta-glucuronidase is inhibited by isoproterenol, histamine, and prostaglandin E1. This in vitro model was used to study the effect of incubating a live, bivalent (A + B) influenza vaccine on the granulocyte response to the agonists described. After incubation in vitro with the live, bivalent influenza vaccine, there was a significantly impaired granulocyte reponse to all 3 agonists. The change in the response of polymorphonuclear leukocytes to isoproterenol was similar to an impairment in beta-adrenergic response found during respiratory infections in vivo. The viral-induced changes in the granulocyte response to isoproterenol may reflect similar alteration in other tissues, such as variable control of the airways and provide one explanation for the occurrence of airway dysfunction during respiratory infections.

Although meningococci are susceptible to the tetracyclines by testing in vitro, oxytetracycline (OC) and doxycycline (DC) have failed to eliminate carriage, whereas minocycline (MC) has been effective. Because these congeners differ in lipophilicity, they and tetracycline (TC) were studied in volunteers by assay of serum, saliva, and tears obtained after 5 days of treatment. OC and TC were undetectable or attained concentrations subinhibitory for meningococci in saliva and tears. The concentrations of MC in saliva and tears were equal to or greater than the average minimal inhibitory concentration as long as 12 h post-dose. Near inhibitory concentrations resulted with DC at 100 mg/day; yet, doubling the dose to 100 mg/12 h did not yield concentrations that exceeded the average minimal inhibitory concentration for meningococci. The previous reports of failure or meager entry of DC and MC into saliva probably reflected extraction of these drugs in the paraffin chewed by subjects to stimulate salivary flow. The efficiency of entry of the tetracyclines into the secretions of the noninflamed upper respiratory tract correlates with lipophilicity at physiological pH, enabling prediction of meningococcal chemoprophylactic efficacy.

Sunburn, wrinkling and malignancies are the frequent results of excessive sun exposure. Photosensitivity and photoallergic or phototoxic reactions are less commonly observed. Sunscreens containing para-aminobenzoic acid (PABA), PABA esters and benzophenones offer substantial protection, allowing even fair-skinned persons to participate freely in outdoor activities. These products are now rated and assigned a sun protection factor (SPF). Their routine use should be encouraged.

The efficacy of a monovalent live attenuated influenza A (H3N2) vaccine (an inhibitor-resistant recombinant strain named "Alice") and of a bivalent vaccine composed of "Alice" and influenza B strain R75 (also inhibitor-resistant), was tested in healthy and asthmatic adults. Two intranasal doses of the monovalent "Alice" vaccine were given to 95 healthy adults in the winter of 1973-74. Ninety-three % of 68 subjects with initial serum hemagglutination (HI) titers of less than or equal to 1:40 had a significant (4-fold or greater) antibody increase in post-vaccination sera. Overall, 77% of the vaccinees had significant antibody rises. Two doses of the bivalent (A/B) vaccine were given to 53 healthy adults in the winter of 1974-75. Eighty-two % of 34 subjects with initial HI titers of less than or equal to 1:40 had 4-fold or greater antibody rises to influenza A, and overall 57% of the vaccinees responded. The B component of the bivalent vaccine was less effective; only 56% of persons with initial HI titers of less than or equal to 1:40, and 28% of all vaccinees had significant antibody rises. Both tf asthmatics who received "Alice" and one of 10 (10%) who received the bivalent vaccine had serologic responses to influenza A. None of the asthmatics responded to the B component of the bivalent vaccine. Analysis of the incidence of febrile respiratory illness during an influenza outbreak in the winter of 1974-75 revealed no differences in the attack rates of placebos and vaccines. In conclusion, both the "Alice" and bivalnet (A/B) vaccines were effective in eliciting serologic responses to influenza A in healthy persons. They were less effective in asthmatics. The lack of protection observed may have been due to the onset of influenza before the vaccine could take effect or to the failure of the vaccine itself.