Transvaginal sonographic appearance of thrombosed uterine arteries after uterine artery embolization: the "white snake" sign.

Purpose: The aim of this prospective study was to describe the appearance of thrombosed uterine arteries on transvaginal sonography performed after uterine artery embolization (UAE) and to assess the prognostic value of the "white snake" sign with regard to symptomatic outcome at 12 months.

Methods: Patients who underwent UAE from January 1, 1999, to July 31, 2000, for the treatment of symptomatic leiomyomas were included in the study. Transvaginal sonography was performed before and at 3, 6, and 12 months after UAE.

Occupational allergies caused by latex.

Allergy to natural rubber latex is an important cause of occupational allergy in healthcare workers. Disposable medical gloves are the major reservoir of latex allergens, particularly powdered gloves, in healthcare delivery settings. Diagnosis of latex allergy requires a history of exacerbation of cutaneous, respiratory, ocular, or systemic signs and symptoms after exposure to natural rubber latex products; and evidence of sensitization by patch testing, skin testing, measurement of latex-specific IgE antibodies, or challenge testing.

Fundamentals of multichannel CT.

Multichannel CT has become a very valuable tool in diagnostic imaging. It provides a combination of fast and long coverage in conjunction with thin slices. The fast scanning allows for single-breathhold scanning, fewer motion artifacts, and better use of intravenous contrast media.

The history and future of implantation therapy for gastroesophageal reflux disease.

The initial development of endoscopic implantation techniques for the treatment of gastroesophageal reflux disease in the 1980s helped set the stage for current implantation techniques and studies, which now include more than 500 patients. The relative simplicity of these techniques adds to their attraction. Ultimately, multiple factors, including therapeutic efficacy durability, safety, simplicity, and cost-effectiveness, will determine clinical application of these techniques.

Classification of small bowel Crohn's subtypes based on multimodality imaging.

This article has reviewed the imaging features that correspond to and support the classification of patients into clinical subtypes of Crohn's disease. One study showed that radiologic features on barium studies closely correlated with the Crohn's Disease Activity Index, and another study indicated that CT findings changed patient management in up to 29% of cases. Knowledge of the location, severity, and presence of complications assist in providing patients with appropriate treatment options.

Current concepts in imaging of small bowel obstruction.

The diagnosis and treatment of small bowel obstruction continue to evolve. The imaging approach in the work-up of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this disease have undergone considerable changes over the past two decades. This article examines the current concepts related to the use of imaging technology in the diagnosis and management of patients with small bowel obstruction.

Multidetector-row helical CT enteroclysis.

Currently, CT-E is not recommended as the first-line examination in patients when mucosal detail is required. Double-contrast barium air enteroclysis has advantages in demonstrating small mucosal abnormalities. The authors find CT-E of value in the work-up of patients with symptoms of intermittent small bowel obstruction, particularly those with a history of prior abdominal surgery; in the further work-up of selected patients with high-grade obstruction in whom general surgeons prefer initial conservative management (immediate postoperative small bowel obstruction, patients with history of prior abdominal surgery for malignant tumor, history of radiation treatment, and possible internal extraintestinal fistulae); in looking for complications of small bowel Crohn's disease; and in the patient with unexplained anemia or gastrointestinal bleeding.

Technical refinements in enteroclysis.

As the primary method of investigating the small bowel, enteroclysis remains a technique in evolution. Technical refinements have made the examination faster to perform, better tolerated by patients, and easier to interpret. More recently, its essential principle of volume challenge has been combined with the tremendous advantage of CT cross-sectional imaging with multiplanar reformatting to give rise to the exciting new techniques of CT enteroclysis and MR enteroclysis (see separate reviews in this issue).

Treatment of early stage non-small cell lung cancer.

Photodynamic therapy (PDT), brachytherapy, electrocautery, cryotherapy, and Nd-YAG laser therapy are therapeutic options available for management of endobronchial malignancies. All of these treatment modalities have been used for both palliation of late obstructing cancers, and more recently have been used as primary treatment of early radiographically occult cancers. We reviewed the evidence for the use of these treatment options in the management of early lung cancer.

Ruptured pericallosal aneurysm causing hemorrhage along the fornix.

We present a 57 year-old man with a pericallosal aneurysm causing parenchymal hemorrhage in the preseptal region of the frontal lobe with extension into the fornix. We briefly discuss the literature pertaining to ruptured pericallosal aneurysms and their bleeding patterns.

Imaging of intrathoracic metastases of nonseminomatous germ cell tumors.

Radiologic imaging is crucial in the evaluation of intrathoracic metastatic nonseminomatous germ cell tumors. Helical CT is the workhorse of radiologic staging and is sensitive in the detection of parenchymal nodules and mediastinal lymphadenopathy. CT may also demonstrate other less common sites of metastatic disease.

MR imaging in nonneoplastic muscle disorders of the lower extremity.

The exquisite tissue contrast and multiplanar capability of MRI make it the optimal imaging modality for diagnosing muscle injuries and other muscle disorders. These examinations can be performed with increasing speed because of improvements in gradient strength and software and coil design. Presently, some of the limitations of MRI of muscle relate to the lack of specificity of the findings.

Patient satisfaction measurement: current issues and implications.

Healthcare consumers are demanding excellence in care and services from care providers, and payors are following in their expectations. Demonstration of quality outcomes and consumer satisfaction with services are now a priority and the primary competitive edge in healthcare. Hospitals and healthcare systems that invest in programs to determine how patients evaluate their experiences will have valuable information to make transformational changes in care delivery and services.

Does the addition of an oral barium tracer improve the ability of the preliminary abdominal radiograph to assess efficacy of colonic cleansing? A prospective randomized controlled evaluation.

Background: We investigated whether the ability of preliminary abdominal radiography to assess the adequacy of colonic preparation is improved by the addition of an oral barium tracer to the laxative preparation and the optimal dosage of this tracer.

Methods: A single-blind, randomized controlled evaluation of four parallel groups of adult patients was performed. All patients were scheduled to a receive a double-contrast barium enema at a tertiary care hospital or an outpatient clinic.

Sphincter of Oddi (pancreatic) hypertension and recurrent pancreatitis.

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis and pancreatic-type pain. The gold standard for diagnosis is sphincter of Oddi manometry, most commonly performed at endoscopic retrograde cholangiopancreatography (ERCP). Noninvasive testing, such as secretin-stimulated transabdominal or endoscopic ultrasound assessment of pancreatic duct diameter, is less reliable and has relatively low sensitivity.

Lack of an association between granuloma annulare and type 2 diabetes mellitus.

Background: Conflicting reports have been published regarding whether a relationship exists between granuloma annulare (GA) and diabetes mellitus (DM).

Objectives: To evaluate the prevalence of DM in patients with GA using a case-control design.

Methods: The incidence of DM was determined in 126 patients with GA.

Current strategies for the diagnosis of pulmonary embolus.

Venous thromboembolic disease (VTD), comprising venous thrombosis and pulmonary embolus, is responsible for innumerable deaths every day. Wide variance in its presentation and clinical manifestations and the resultant difficulties in achieving its diagnosis have confounded attempts to define optimal diagnostic and treatment strategies. Those strategies should be predicated on the understanding of the manifestations of VTD and of the attributes and interrelationship of the various modalities available for its diagnosis.

Risk factors associated with postoperative pulmonary complications following total abdominal hysterectomy.

The purpose of this descriptive correlational study was to describe the relationships between risk factors and the development of postoperative pulmonary complications (PPCs) following total abdominal hysterectomy (TAH). As part of a large, prospective study, data were analyzed on a subset of women who had undergone TAH. Data collection included a preoperative interview and chest exam followed by a daily postoperative interview, chest exam, and review of the medical chart.

Abdominal and pelvic needle aspiration biopsies: can we perform them well when using small needles?

Background: The aim of this study was to compare abdominal fine-needle aspirations (FNAs) performed with large (>/=20-gauge) or small (
Methods: Abdominal and pelvic FNA procedures were retrospectively reviewed. Needle size, imaging guidance used, number of pathology slides created, complications, and cytologic and final diagnoses were obtained by reviewing radiologic, medical, and cytology records.

Measurement of liver volume using spiral CT and the curved line and cubic spline algorithms: reproducibility and interobserver variation.

Background: The purpose of this article was to evaluate the accuracy and reproducibility of spiral computed tomography (CT) and the curved line and cubic spline algorithms in measuring liver volume.

Methods: Spiral CT was performed in phantoms, cadaveric liver specimens, and 35 live human subjects (19 healthy volunteers and 16 patients). Images were transferred to a workstation, and volumes were measured by two observers.

Spontaneous occurrence of gangrene due to clostridium septicum in a patient with advanced endometrial carcinoma.

Background: We report the first known case of spontaneous, atraumatic Clostridium septicum gangrene occurring in a patient with recurrent endometrial adenocarcinoma.

Case: A 63-year-old white female undergoing chemotherapy for recurrent endometrial adenocarcinoma presented with right "arthritis-like" shoulder pain. She denied fever, chills, or shoulder trauma.