Computed tomography findings of internal hernia after gastric bypass that may precede small bowel obstruction.

Purpose: This study evaluates computed tomography signs of internal hernia in gastric bypass patients, including several previously unreported signs suggestive of internal hernia.

Methods: Eighteen patients with surgically proven internal hernia were included in the study cohort. The signs analyzed included the mesenteric swirl, hurricane eye, mushroom sign, and dilated small bowel loops, as well as previously non-investigated signs such as bowel wall edema, engorged mesenteric vessels, engorged mesenteric lymph nodes, and hazy mesenteric fat.

Nongynecological endometriosis presenting as an acute abdomen.

Endometriosis is a highly prevalent disease that affects up to 10 % of menstruating women. Patients commonly present with pelvic pain or infertility, although the range of clinical symptoms varies widely. Affected women may be asymptomatic or experience mild, moderate, or severe pain that fluctuates with hormonal cycles.

Internal hernia complications of gastric bypass surgery in the acute setting: spectrum of imaging findings.

Bariatric surgery is increasingly becoming an option for the treatment of morbid obesity. Patients who have undergone gastric bypass surgery have varied post-surgical complications which present acutely in the emergency medical setting, particularly internal hernias. It may be difficult to identify an internal hernia in the absence of intestinal obstruction.

Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: milk versus VoLumen.

Objective: The purpose of our study was to prospectively compare the cost, effectiveness, and patient tolerance of milk and VoLumen, a 0.1% barium suspension, in patients undergoing abdominal and pelvic CT with oral and i.v.

Biweekly low-dose sequential gemcitabine, 5-fluorouracil, leucovorin, and cisplatin (GFP): a highly active novel therapy for metastatic adenocarcinoma of the exocrine pancreas.

Phase II studies have suggested an improved response rate and acceptable toxicity profile associated with gemcitabine combinations compared to gemcitabine alone for treatment of metastatic adenocarcinoma of the pancreas. The GFP regimen (gemcitabine, 5-fluorouracil, leucovorin, and cisplatin) is based on laboratory evidence of disease-specific chemotherapy interaction. This retrospective analysis examined the outcome of 49 consecutive patients with histologically confirmed metastatic pancreatic adenocarcinoma treated between July 1998 and September 2000.

Intestinal obstruction role of CT.

CT has significantly advanced the evaluation of small and large bowel obstruction, especially in the acute situation where high-grade or possibly strangulating obstruction is being encountered. Any physician involved in evaluating patients with bowel distention and abdominal pain where obstruction becomes a distinct diagnostic possibility should be aware of the attributes and limitations of this modality to provide the best patient care. New technological advances will hopefully limit radiation exposure and provide even more definitive information in the diagnosis of bowel obstruction.

Irinotecan combined with gemcitabine, 5-fluorouracil, leucovorin, and cisplatin (G-FLIP) is an effective and noncrossresistant treatment for chemotherapy refractory metastatic pancreatic cancer.

Background: Single agents have only modest activity as treatment for metastatic pancreatic cancer with response rates of less than 10% and median survivals of less than 6 months. Evaluations of single-agent gemcitabine and rubitecan as second-line treatment for relapsed pancreatic cancer have reported good patient tolerability and median survivals of 3.85 months and 4.

An unusual case of diverticulitis complicating pregnancy at 33 weeks' gestation.

A 38-year-old para 2 presented with the gradual onset of nausea vomiting and increasing left lower quadrant pain, at 33 weeks' gestation. She was known to have uterine leiomyomas, with ultrasonography depicting an 8-cm intramural fundal leiomyoma. In addition a left lateral nondiscrete 10 x 8-cm mass was depicted at the point of maximum tenderness.

Which treatments help? The patient's perspective.

In an effort to determine which specific aspects of treatment might account for patient satisfaction, the authors developed the Components of Treatment Questionnaire. This measure, which was administered to 500 adult inpatients along with the Client Satisfaction Questionnaire (CSQ-8; Larsen, Attkisson, Hargreaves, and Nguyen, 1979), asked patients to assess the helpfulness of their treatment. Convinced that patient input is pertinent to program design, the authors later surveyed 46 patients on treatments that they perceived as helpful and would like to receive.

The How Are You? scale: a quality-of-life outcomes measure for routine practice.

The How Are You? scale, a quality-of-life outcomes self-report measure to be completed by patients, was developed to address the concerns of the mental health consumer movement. Specific concerns included using less technical language in assessing mental health problems and developing a collaborative dialogue between clinician and patient. The How Are You? scale is a user-friendly instrument that allows patients to be actively involved in their assessment and treatment process.

Experience with breast biopsies using the Advanced Breast Biopsy Instrumentation system.

Objective: A retrospective review of our experience with advanced breast biopsy instrumentation (ABBI) was undertaken to evaluate its efficacy for excisional breast biopsy of lesions detected on mammography. To our knowledge, experience with ABBI has not been previously reported in the radiology literature.

Materials And Methods: Biopsies using the ABBI system and an adapted dedicated table were performed in 53 patients who had 54 mammographically evident lesions.

Use of magnetic resonance urography.

Objectives: Magnetic resonance urography (MRU) is a new technique that uses heavily weighted T2 coronal images with fat suppression pulse. Urine appears white on MRU, resembling an intravenous urogram (IVU). Contrast agents are not necessary.

Prospective evaluation of colonic obstruction with computed tomography.

Background: To determine whether computed tomography (CT) can satisfactorily diagnose and evaluate patients with suspected colonic obstruction.

Methods: Seventy-five patients with suspected colonic obstruction were evaluated prospectively by CT and compared with the gold standards of surgery and/or endoscopy in 65 patients, clinical course in nine, and contrast enema (CE) in one. A limited comparison between CT and CE (26) patients was also made in those patients who had both studies.

Visceral fat and race-dependent health risks in obese nondiabetic premenopausal women.

Our previous finding that a waist-to-hip ratio (WHR) >0.85 was not associated with similar health risks in black, compared with white, obese premenopausal non-diabetic women of similar fatness is attributed to either 1) a different relationship between WHR and visceral adiposity or 2) differences in the relationship between visceral adiposity and the metabolic abnormalities of obesity. We measured visceral (VAT) and subcutaneous adipose tissue (SCAT) areas at midwaist in 25 black and 25 white obese nondiabetic pre-menopausal women with similar BMI, percentage body fat, and wide range of WHR (0.

Abdominal CT findings when the superior vena cava, brachiocephalic vein, or subclavian vein is obstructed.

Objective: We evaluated findings on contrast-enhanced abdominal CT scans that suggest obstruction of the superior vena cava, brachiocephalic vein, or subclavian vein.

Subjects And Methods: We conducted a retrospective review of 22 patients with superior vena caval, brachiocephalic vein, or subclavian vein obstruction and analyzed the upper abdominal images on a chest CT scan or an abdominal CT scan. We assessed collateral vessels in the upper abdomen to answer the following question: Did enhancement approach undiluted IV contrast or were there other findings? In the second part of our study, we conducted a prospective review of abdominal CT scans of 200 patients without known mediastinal disease or known upper extremity venous occlusion to determine the frequency of abnormal enhancement of these vessels in a healthy population.

Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT.

Objective: The purpose of this study was to determine whether CT can be used to diagnose ischemia of the small intestine in patients with small-bowel obstruction due to adhesions or hernia.

Subjects And Methods: During a 12-month period, 60 patients underwent surgery for complete or high-grade small-bowel obstruction due to adhesions or hernia, and 29 (48%) had evidence of associated intestinal ischemia. All of these patients had been preoperatively diagnosed by CT as having high-grade small-bowel obstruction.

Role of CT in evaluating patients with small-bowel obstruction.

The accurate and rapid diagnosis of acute small-bowel obstruction has troubled surgeons and radiologists for more than a century. With the advent of CT, solving the problem is now a possibility. CT can accurately diagnose obstruction, determine the likely cause and location, and even suggest whether there is associated bowel ischemia or strangulation.

Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings.

Objective: The expeditious diagnosis of complete and partial mechanical small-bowel obstruction, as opposed to paralytic ileus, during the immediate postoperative period may be difficult on the basis of clinical and plain film radiographic findings. For this reason, we prospectively evaluated the use of CT in this setting and compared it with the clinical and plain film evaluations as well as with various contrast examinations.

Subjects And Methods: Thirty-six postoperative patients with signs and symptoms of paralytic ileus or mechanical small-bowel obstruction were examined clinically and had plain abdominal radiographs.

MR urography: technique and application.

Purpose: To evaluate a magnetic resonance (MR) technique for depicting the kidneys and urinary tract.

Materials And Methods: Fourteen patients with urinary tract obstruction and 20 without obstructions were examined with a modified, heavily T2-weighted fast spin-echo pulse sequence (MR urography). In addition, six healthy volunteers underwent modified MR urography with intravenous administration of furosemide and ureteral compression prior to imaging.

Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance).

Purpose: To assess the efficacy of chest radiography in the detection of active pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).

Materials And Methods: Initial interpretations of chest radiographs of 133 adult patients with AIDS and positive sputum or bronchoalveolar lavage cultures for Mycobacterium tuberculosis were reviewed. Radiographic findings were correlated with CD4 T-cell counts, sputum stains for acid-fast bacilli (AFB), and antituberculous drug sensitivity.