Giant idiopathic ulcer of esophagus in the context of acquired immunodeficiency syndrome (AIDS).

The giant ulcer of esophagus is a rare entity in the context of human immunodeficiency syndrome. In front of this type of ulceration the radiologist must to distinguish between two types of ulcers HIV, cytomegalovirus (CMV). The differential diagnosis is necessary for orientation of the therapy and is the result of association between radiological, endoscopic and pathological findings.

Malone appendicostomy: an unexpected complication.

The Malone appendicostomy is a novel option for surgical management of faecal incontinence and chronic constipation, by permitting the administration of antegrade colonic enemas for colonic evacuation. We report the case of a 54-year-old female who had undergone abdomino perineal resection for low rectal cancer followed by total perineal reconstruction with perineal colostomy, dynamic double graciloplasty and Malone appendicostomy. After 7-year follow-up, functional results and quality of life scores were satisfactory.

Physiologic variables for videofluoromanometric assessment of dysphagia: an exploratory study.

Study Aim: To assess the physiological variables among Upper Esophageal Sphincter Nadir (UESN), Hypopharyngeal Peak Pressure (HPP) and Pharyngo-Esophageal Pressure Gradient (PEPG) for Videofluoromanometry (VFM).

Patients & Method: Exploratory non-randomised prospective study comparing UESN, HPP and PEPG of three cohorts of individuals presumably presenting very distinctive "manometric signatures" based on McConnel's Piston Model of swallowing: 11 non-dysphagic volunteers called the Control Group (CG), 10 dysphagic patients presenting a Myotonic Dystrophy (MD), at various stages of evolution, and 10 patients presenting a CricoPharyngeal Barr (CPB), with no post-swallow pharyngeal residue at a previous Modified Barium Swallow (MBS). VFM tests are performed using solid-state three unidirectional transducers produced by Gaeltec Inc.

Optimal diagnosis of anastomotic colorectal leak by combination of conventional colonic enema and CT.

Post-operative complications of colorectal surgery occur not uncommonly. They have to be detected as early as possible, in order to reduce their morbidity and mortality rates. The most frequent early complications are abscesses, mechanical obstruction, and anastomotic leak.

Intrathoracic periesophageal fundoplication for short esophagus: a 20-year experience.

Background: Intrathoracic periesophageal fundoplication carries a high risk of treacherous technical complications such as spontaneous gastric perforation.

Methods: An intrathoracic fundoplication was performed on 84 patients suffering from gastroesophageal reflux disease with the junction between upper gastric folds and the unwrinkled esophageal mucosa remaining above the diaphragm while the esophageal body was quite straight on barium swallow study. Particular attention was paid to the following steps: further enlargement of the hiatal sling to avoid any strangulation of the stomach, very careful manipulation of gastric tissues with the fingers rather than with forceps, and meticulous anchoring of the wrap to the hiatus with numerous sutures while mimicking diaphragmatic movements that arise on cough.

Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography.

This study aimed to assess the feasibility of cardiac global function evaluation during a whole-chest multi-slice CT (MSCT) acquisition in patients referred for suspicion of pulmonary embolism (PE), and to compare the results with planar equilibrium radionuclide ventriculography (ERNA). Ten consecutive haemodynamically stable patients (six female, four male; mean age 69.7 years; heart rate 65-99 bpm) with suspicion of PE underwent an MSCT and ERNA within a 6 h period.

Whole stomach with antro-pyloric nerve preservation as an esophageal substitute: an original technique.

The paper describes an original technique of gastric tailoring in which the two-thirds of the lesser curvature proximal to the crow's foot are denuded flush with the gastric wall, leaving both nerves of Latarjet and the hepatic branches of the left vagus nerve intact. Maintenance of the vagal supply to the antro-pyloric segment in two patients resulted in the presence of peristaltic contractions sweeping over the antrum on simple observation of the antral wall at the end of the procedure and on both upper G-I series and intragastric manometry tracings 6 weeks postoperatively. Gastric exposure to bile on 24-h gastric bile monitoring was normal 6 weeks after the operation.

Pulmonary embolism findings on chest radiographs and multislice spiral CT.

Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. However, in many instances, a chest radiograph is usually performed as a first-line examination. Many parenchymal, vascular, and other ancillary findings may be observed on both imaging modalities with a highly detailed depiction of abnormalities on multislice CT.

[Drainage-lavage and closure of a late esophageal perforation with esophagopleural fistula and encysted pleural effusion after endoscopic injection sclerotherapy for varices].

We report a case of late perforation of the thoracic esophagus with an esophagopleural fistula after endoscopic sclerotherapy for esophageal varices in a Child-Pugh B9 cirrhotic patient. The existence of a thoracic empyema without diffuse mediastinitis allowed management of the fistula by percutaneous drainage-lavage and antibiotic therapy with subsequent closure of the esophageal wall defect and recovery from sepsis. This observation indicates that minimally invasive management of an esophageal perforation complicated by an esophago-pleural fistula is possible in highly selected patients.

Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi-detector row spiral CT and planar ventilation-perfusion scintigraphy.

Purpose: To compare multi-detector row computed tomography (CT) and ventilation-perfusion (V-P) scintigraphy in the diagnosis of acute pulmonary embolism (PE) in outpatients who were cared for in the emergency department.

Materials And Methods: Ninety-four nonconsecutive patients, in whom acute PE was suspected, underwent thin-collimation multi-detector row CT (collimation, 4 x 1 mm; pitch, 1.25; scanning time, 0.

Management of pharyngoesophageal (Zenker's) diverticulum: which technique?

Background: Incomplete symptomatic relief of pharyngoesophageal (Zenker's) diverticulum after endoscopic stapling or laser division has been reported by some authors. The clinical relevance of cricomyotomy, although supported by experimental data, remains controversial.

Methods: Operative procedures consisted of transcervical resection (n = 34, group I), transcervical resection plus cricomyotomy (n = 12, group II), transcervical cricomyotomy (n = 8, group III), transcervical cricomyotomy plus diverticulopexy (n = 47, group IV), endoscopic stapling division (n = 31, group V), and endoscopic laser division (n = 55; group VI).

[Spiral CT in pulmonary embolism].

Pulmonary embolism is a leading cause of morbidity and mortality that can occur in many clinical situations. For several years, spiral CT has represented a relatively non invasive modality for diagnosing this common disease. The present article is reviewing the CT features of acute and chronic pulmonary embolism, the technical aspects of spiral CT acquisition, the diagnostic accuracy and major limitations and pitfalls of the technique.

Tracheal laceration and tension pneumomediastinum of spontaneous favorable outcome.

The case of a 75-year-old women with probable tracheal laceration and tension pneumomediastinum after intubation is reported. A dramatic reduction of tracheal caliber was observed during fiberoptic bronchoscopy. Despite severe dyspnea, the patient healed with conservative measures.

Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy.

Background: The classic manual end-to-side technique of esophagogastrostomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture.

Methods: A terminalized semimechanical side-to-side technique of cervical esophagogastrostomy was performed in 16 patients by the application of an Endo-GIA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped posterior opening between the two lumina. The anterior aspect of the anastomosis was hand-sewn using a classic running suture.

Solitary fibrous tumor of the pleura: a report of five cases diagnosed by transthoracic cutting needle biopsy.

Five patients had a solitary fibrous tumor of the pleura; a well-known but rare entity. In all cases, biopsy by a transthoracic cutting needle (Tru-Cut; Travenol; Deerfield, IL) yielded specimens adequate for histologic analysis and gave the clue to the diagnosis. In four patients, surgical resection confirmed the diagnosis.

Laparoscopic treatment of gallbladder duplication. A plea for removal of both gallbladders.

Background: Gallbladder duplication is a rare congenital condition, which can now be detected preoperatively by imaging studies.

Methods: We report a case of duplicated gallbladder with symptomatic unilobar gallstones. Appropriate biliary workup (ultrasound, oral cholecystography, and intravenous cholangiography) allowed a correct preoperative diagnosis.

[Value of echography in the diagnosis of acute intestinal occlusion].

Objective: The aim of our study was to assess the value of sonography in the diagnosis of acute intestinal occlusion.

Material And Methods: Sonographic findings were reviewed in 50 cases of intestinal occlusion (39 small bowel and 11 colonic occlusions). The final diagnosis was based on surgical findings (n = 40) or clinical course and further imaging findings (n = 10).

[Unilateral peripheral pulmonary nodules: initial symptoms of a limited form of Wegener's disease].

The X-ray and CT follow-up features of unilateral peripheral pulmonary masses spontaneously varying in size and amount in a patient with limited Wegener disease are reported. Diagnosis was established by nasal biopsy and dosage of the neutrophils anti-cytoplasmic autoantibodies. The current literature over the condition is reviewed.

Bronchioloalveolar carcinoma: computed tomography findings.

The aim of the present study was to investigate the appearance of bronchioloalveolar lung carcinoma on computed tomography (CT) scans, and to determine the frequency of signs suggestive of this diagnosis. CT features of 42 cases with pathologically proven bronchioloalveolar carcinoma were retrospectively analysed for pattern, size, location and secondary signs suggesting the diagnosis. Bronchioloalveolar carcinoma had one of the following patterns: solitary nodule or mass (16), lobar consolidation (10), multilobar consolidations (13) and diffuse nodules (3).

Pulmonary sequestration. Visualization of an enlarged azygos system by CT.

The purpose of this study was to determine the prevalence of enlargement of the azygos system in the case of lung sequestration and its potential usefulness in the differential diagnosis of lower lobe opacities. Seven consecutive adult cases of pulmonary sequestrations were retrospectively enrolled; 4 sequestrations were proved surgically and all 7 angiographically. A group of 50 consecutive patients with a normal chest CT were used as controls.

[Recurrent lithiasis following cholecystectomy imaged with ultrasonography, tomodensitometry and cholangiography].

It is generally admitted, that after cholecystectomy, the cystic duct and the gallbladder remnant may cause symptoms, by being the site of inflammation. Recurrence of stones in a reformed gallbladder is avoided when cholecystectomy is complete. We report the case of a 43-year-old woman, presenting 19 years after cholecystectomy with a reformed gallbladder containing stones demonstrated by US, CT and cholangiography.

Radiologic findings of normal and compromised thoracic venous catheters.

We review the radiologic findings of normal positioning, malpositioning, and complications related to the more commonly used thoracic venous catheters. These include central venous catheters, long-term central venous access catheters, and pulmonary artery catheters. The radiologist plays an important role in the early recognition of the complications of these catheters.