Ultrasonography compared with intravenous urography in the investigation of adults with haematuria.

OBJECTIVE--To compare ultrasonography with intravenous urography in the investigation of adults with haematuria. DESIGN--Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each was aware of the details of the request form but not of the findings of the other investigation. SETTING--Radiology department of a teaching hospital. PATIENTS--155 Consecutive adult patients (aged 18-93) referred from general practitioners and hospital outpatient clinics with a history of haematuria. FOLLOW UP--When results of both examinations proved normal no clinical or radiological follow up was sought. All abnormal findings of either investigation were correlated with results of subsequent imaging studies or operative findings. RESULTS--81 Patients (52%) had normal findings on urography and ultrasonography. Overall, the findings of ultrasonography concurred with those of urography in 144 cases (93%). Among the discrepant findings of the two investigations ultrasonography missed two ureteric calculi; one was in a non-dilated ureter, and in the other case ultrasonography detected the secondary ureteric dilatation. Ultrasound examination alone detected four bladder tumours not visible on urography with sizes ranging from 5 to 21 mm, representing one fifth of the 20 cystoscopically proved bladder tumours detected in the series. Ultrasonography detected all the 22 neoplastic lesions discovered in the study (20 bladder, two renal). Ultrasonography clarified the nature of renal masses evident in three urograms (simple cysts). CONCLUSIONS--Ultrasonography is a safe and accurate method of investigating the urinary tract in adults with haematuria. When combined with a single plain abdominal radiograph it proved to be superior to urography as the primary imaging study in this series. Ultrasonography should certainly be preferred to urography if cystoscopy is not planned. No urothelial tumours of the upper urinary tract were found in the series, reflecting their rarity. For those patients in whom ultrasonography and plain radiography have shown no abnormality and in whom cystoscopic appearances are normal urography would be advisable to exclude urothelial tumours of the upper urinary tract.     

嗜麦芽寡养单胞菌胞外产物对斑点叉尾损伤的病理学研究

采用硫酸铵盐析从嗜麦芽假单胞菌培养物中提取其胞外产物,通过腹腔注射方式,进行了嗜麦芽假单胞菌(P.maltophilia)胞外产物对斑点叉尾(Ictalurus punctatus)损伤的系统病理学研究。结果表明,嗜麦芽假单胞菌胞外产物具有较强的毒力,对斑点叉尾(42.5±4.4)g的半致死剂量(LD50)为3.21mg蛋白/kg体重。病鱼出现神经症状,腹部和下颌充血、出血,腹部膨大,腹腔内充满大量淡黄色或带血的腹水,胃肠道黏膜充血、出血,肠套叠,肝、脾、肾肿大等临床病变。组织学病变主要表现为全身多组织、器官水肿,出血、变性、坏死以及炎症反应,特别是脑、骨骼肌、肝、脾、肾和胃肠道的损伤较为严重。超微结构观察发现病鱼肝、脾、肾和骨骼肌等器官的细胞的超微结构均有较为严重的破坏,线粒体肿胀,嵴断裂或溶解消失,呈空囊状,内质网扩张,细胞核变形,染色质溶解或固缩;研究中还发现嗜麦芽假单胞菌胞外产物可致淋巴细胞凋亡,脾和肾间质内淋巴细胞均表现为细胞核染色质浓缩边移,或核固缩成一个或数个团块凝聚在核膜周边,形成凋亡小体。       

Characterization of an iridovirus detected from cultured turbot Scophthalmus maximus in Korea

Juvenile turbot Scophthalmus maximus that became sick during an outbreak of disease at mariculture facilities at Go-Chang, Korea, in 2003, were examined to identify the cause of the disease. The fish had pale body color, an enlarged abdomen, protruding eyes, an enlarged spleen and kidney, and pale gills and/or liver. Histopathogical examination revealed basophilic enlarged cells in the kidney, spleen, gills, heart, stomach, intestine, liver, pancreas and skin. Hexagonal viral particles with a diameter of 136 to 159 nm were observed in the enlarged cells. A specific 1299 bp fragment of the major capsid protein (MCP) gene of the turbot iridovirus (TBIV) was amplified by PCR. Sequence homology was greater than 93.76% between the MCP gene in TBIV and the same gene in 5 viruses in the tentatively proposed genus Tropivirus (family Iridoviridae): red sea bream iridovirus, sea bass iridovirus, grouper sleepy disease iridovirus, African lampeye iridovirus and dwarf gourami iridovirus. These results suggest that the virus detected from turbot is similar to the proposed genus Tropivirus.     

Fractures on the chest radiograph in detection of alcoholic liver disease.

The presence of fractures seen on routine chest radiography was assessed in patients with liver disease to see whether it might provide a useful marker of alcoholism. Chest radiographs taken at the time of liver biopsy were examined in 149 patients--72 with alcoholic liver disease (32 (44%) cirrhotic) and 77 with various forms of non-alcoholic liver disease (15 (19 . 5%) cirrhotic)--and in 149 controls. Fractures (85 rib, two clavicular) were much more common in patients with alcoholic liver disease (20 subjects; 28%) than in patients with non-alcoholic liver disease (1; 1 . 3%) or controls 10; 6 . 7%). In alcoholic liver disease rib fractures were significantly more likely to be bilateral or multiple (more than two) or both (p less than 0 . 01). Of patients with alcoholic liver disease, those with fractures were significantly older than those without, but there was no difference in sex, social class, the proportion with cirrhosis, or the proportion known to be alcoholic at the time of the radiograph. In liver disease fractures on the chest radiograph diagnosed alcoholism with 95% specificity and 28% sensitivity. These often overlooked or ignored findings in the chest radiograph may have a wider role in the detection of alcoholism.     

Evaluation of normal findings using a detailed and focused technique for transcutaneous abdominal ultrasonography in the horse

Background

Ultrasonography is an important diagnostic tool in the investigation of abdominal disease in the horse. Several factors may affect the ability to image different structures within the abdomen. The aim of the study was to describe the repeatability of identification of abdominal structures in normal horses using a detailed ultrasonographic examination technique and using a focused, limited preparation technique.

Methods

A detailed abdominal ultrasound examination was performed in five normal horses, repeated on five occasions (total of 25 examinations). The abdomen was divided into ten different imaging sites, and structures identified in each site were recorded. Five imaging sites were then selected for a single focused ultrasound examination in 20 normal horses. Limited patient preparation was performed. Structures were recorded as ‘identified’ if ultrasonographic features could be distinguished. The location of organs and their frequency of identification were recorded. Data from both phases were analysed to determine repeatability of identification of structures in each examination (irrespective of imaging site), and for each imaging site.

Results

Caecum, colon, spleen, liver and right kidney were repeatably identified using the detailed technique, and had defined locations. Large colon and right kidney were identified in 100% of examinations with both techniques. Liver, spleen, caecum, duodenum and other small intestine were identified more frequently with the detailed examination. Small intestine was most frequently identified in the ventral abdomen, its identification varied markedly within and between horses, and required repeated examinations in some horses. Left kidney could not be identified in every horse using either technique. Sacculated colon was identified in all ventral sites, and was infrequently identified in dorsal sites.

Conclusions

Caecum, sacculated large intestine, spleen, liver and right kidney were consistently identified with both techniques. There were some normal variations which should be considered when interpreting ultrasonographic findings in clinical cases: left kidney was not always identified, sacculated colon was occasionally identified in dorsal flank sites. Multiple imaging sites and repeated examinations may be required to identify small intestine. A focused examination identified most key structures, but has some limitations compared to a detailed examination.

     

Clinical versus ultrasound examination in the evaluation of hepatosplenic schistosomiasis mansoni in endemic areas

The best way to appraise the size of abdominal organs remains undefined. Herein we compare the size of liver and spleen in hepatosplenic schistosomiasis using clinical and ultrasound (US) examination, and the size of the organs measured by US with their visualization below the costal margin ("palpable by US"). For this study, 411 individuals from an endemic area for schistosomiasis mansoni in Brazil have been selected. We found that palpable spleens and left liver lobes are larger than non palpable ones. Also, 23% of normal spleens measured by US were palpable on clinical examination, and 22% of spleens increased in size on US were non palpable. A total of 21% of normal spleens were "palpable by US". We also found 54% of normal sized right liver lobes palpable on clinical examination, whilst 54% of the increased livers, measured by US, were non palpable. About 76% of normal right liver lobes were "palpable by US". We conclude that the association of clinical, ultrasound and magnetic resonance imaging (MRI) examinations, in the near future, should give the investigators the necessary tools to perform a more accurate clinical diagnosis of hepatosplenic schistosomiasis mansoni.     

Sylvatic focus of American Trypanosomiasis in the State of Morelos, Mexico

Wild vectors and reservoir hosts of Trypanosoma cruzi were surveyed from February 1993 to June 1994 in Ticumán (18 degrees 46'N, 99 degrees 07'W), Mexico (Deciduous Tropical Forest). Direct faeces examination showed that 87% of Triatoma pallidipennis hosted the parasite; T. cruzi forms were present in cultures inoculated with faeces of fifty 67% triatomine bugs and thirty CD-1 strain mice (10 d old) inoculated (peritoneum) with faeces of positive insects T. cruzi amastigotes were found in heart 67%, kidneys 47%, liver 80%, lungs 50%, oesophagus 60%, skin 23%, spleen 73% and stomach 60%. T. cruzi was isolated by direct blood examination from seven 21% chiropterans and five 38% rodents and T. cruzi forms were present in cultures inoculated with blood of twenty-three 68% chiropterans and seven 54% rodents and T. cruzi amastigotes were seen in the kidneys of one 3% chiropterans and four 31% rodents and only in one Pteronotus parnellii mexicanus, organisms were seen in skin 2%. There was no association between organs and T. cruzi infection (p > 0.05).     

Widespread epithelioid angiosarcoma with ventricular wall involvement in a dog

This paper reports on a canine angiosarcoma, presenting as an "undifferentiated metastasizing tumor". A 14-year-old female Cocker Spaniel was referred to the University of Extremadura Veterinary Clinic for clinical examination after suffering rapid deterioration, with chronic cough, anorexia and cachexia. One week after clinical examination, the dog died of right congestive heart failure and ventricular arrhythmia. Blood counts revealed lymphopenia and platelet depletion. The biochemistry profile was within normal limits, except for a drop in blood urea nitrogen. Cytological evaluation of liver and spleen biopsies revealed clustered anaplastic cells that lacked convincing tissue differentiation. Major findings at necropsy were enlarged spleen and multiple, beige to dark-red nodules ranging from 0.5 to 3 cm in diameter in the heart, lung, liver and spleen. At histological examination, multiple nests of anaplastic epithelioid cells were found in sections from all affected organs. Immunohistochemistry revealed widespread expression of CD31 and Factor VIII-related antigen. The neoplastic cells were negative for CD 18. The diagnosis of epithelioid angiosarcoma, localized in the myocardium, lung, liver and spleen was made. The primary site of the neoplasm could not be determined.     

Ultrasonography compared with intravenous urography in investigation of urinary tract infection in adults.

OBJECTIVE--To compare ultrasonography with intravenous urography for investigating adults with proved urinary tract infection. DESIGN--Prospective study of patients presenting consecutively for radiological investigation of urinary tract infection between October 1988 and December 1989. Both investigations were performed concurrently and performed independently on routine lists by different duty radiologists, each of whom knew the details on the request form but not the findings of the other investigation. SETTING--Radiology department of a teaching hospital. PATIENTS--158 Consecutive adults (89 women, 69 men; mean age 49.7 (range 18-83)) referred from general practitioners and hospital outpatient clinics with a history of proved urinary tract infection. INTERVENTIONS--Urography and ultrasonography performed concurrently. When both examinations gave normal findings no clinical or radiological follow up was sought. All abnormal findings detected with either investigation were confirmed by subsequent imaging studies or by operative procedures. MAIN OUTCOME MEASURE--Accuracy of detection of abnormalities of urinary system by ultrasonography compared with urography. RESULTS--113 Patients (72%) had normal urographic and ultrasonic findings. Overall, ultrasonography concurred with the findings of urography in 149 (94%) patients, and when a single abdominal radiograph was included in the procedure, in 152 (96%). Ultrasonography missed only one important diagnosis, that of mild papillary necrosis in normal sized kidneys in a diabetic patient. It detected one early bladder tumour not visible on urography and was able to clarify the nature of renal masses (simple cysts) evident on three urograms. CONCLUSION--Ultrasonography provides a safe and accurate method of imaging the urinary tract in adults with infection. Combined with a plain abdominal radiograph, it should replace urography as the initial imaging investigation in these patients. Major savings would result from adopting this policy, and the risks to patients from ionising radiation and intravenous contrast media would be appreciably reduced.     

Coxiella burnetii infection in C.B-17 scid-bg mice xenotransplanted with fetal bovine tissue

Two from a group of approximately 50 C.B-17 scid-bg mice were examined because of lethargy, dehydration, and rough coat. Three months prior to development of clinical signs of disease, mice of this study had been surgically implanted with fetal bovine liver, thymus, and lymph node. At necropsy, marked splenomegaly and mild hepatomegaly were observed in both animals. Large areas of necrosis and inflammation, with associated intracytoplasmic granular basophilic inclusions, were observed in histologic sections of multiple organs. Aerobic and anaerobic culturing of the liver yielded negative results. Six months after the initial case, four more reconstituted scid-bg mice from a different fetal donor had identical clinical, gross, and histologic signs of disease. To determine whether the basophilic inclusions represented an infective agent, 4-month-old immune-naive C.B-17 scid-bg mice were inoculated intraperitoneally with a liver and spleen homogenate from an affected mouse. Two weeks after inoculation, mice developed clinical signs of disease and lesions identical to those seen in the signal mice. On ultrastructural examination of the liver, pleomorphic bacteria were found in large cytoplasmic vacuoles of hepatocytes. Bacterial DNA was amplified from the liver, using primers that amplify a segment of the 16S rRNA gene from many bacterial species. Sequencing of the polymerase chain reaction (PCR) product revealed gene sequence identical to that of Coxiella burnetii, the agent of Q-fever. These results highlight the need to consider infective agents of the donor species when working with xenografted animals.     

The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned?

The value of erect and supine abdominal radiographs and erect chest radiographs was analysed prospectively in 102 consecutive patients admitted to hospital with acute abdominal symptoms. The radiographs were reported on initially by junior surgeons of the admitting team, special note being made of the value of the erect abdominal radiograph over the combination of the supine abdominal radiograph and erect chest radiograph. On the basis of information obtained from the erect abdominal radiograph alone no changes in patient management were recorded. A consultant radiologist reported on the same radiographs at a later date. In five cases the erect abdominal radiograph was thought to have contributed useful or additional information, although in four of these cases abnormal features were visible in the supine film. In three of the five cases important but subtle information was missed by junior surgeons. In five of the 102 patients information obtained from the erect abdominal radiograph was potentially misleading. The small yield of positive information, potentially misleading features, and lack of effect on surgical management suggest that the routine use of the erect abdominal radiograph in the acute abdomen should be abandoned.     

Experimental infection of pups with Ancylostoma caninum larvae from an abnormal host, the chicken

The migration and distribution of Ancylostoma caninum larvae in the tissues of chickens, infected orally with 1,000 larvae, were studied. Larval yield at necropsy from different organs after digestion with artificial gastric juice revealed a 62.9% recovery four hours after inoculation, followed by a sharp decline to 5.4% at 72 hours. Larvae were found in the heart within four hours, the lungs within eight hours and the liver within 12 to 18 hours but no larvae were recovered from the spleen, kidney or brain. Migration in the muscles of head, neck, thorax and abdomen was detected at 12 hours and was maximal at 36 hours. The establishment of patent infection in the definitive host was studied by feeding infected chicks to hookworm-free pups (one chick/pup) 48 hours, 7 days and 14 days after infection. The mean worm burden at necropsy was highest (15) in the pups fed with chicks 48 hours after infection and was three and nil in the other groups respectively.     

Carcinoembryonic antigen content in fine needle aspirates of the lung. A diagnostic adjunct to cytology.

Carcinoembryonic Antigen (CEA) was measured in 59 consecutive fine needle aspirates (FNAs) of the lung from 58 patients to determine if the CEA content would enhance the sensitivity of the cytologic diagnosis. Twenty-eight males and 30 females with tumors 1-40 cm in diameter were studied. Final diagnoses were correlated with the clinical history, radiologic studies, tissue (when available) and follow-up. Image-guided FNAs were performed by radiologists using a 22-gauge Chiba needle and 20-mL syringe with one to four passes per specimen. Cytologic examination included rapid assessment in the radiology suite and a final diagnosis in 24 hours. CEA was measured by enzyme immunoassay using monoclonal antibody. Nine benign aspirates and 50 malignant aspirates were diagnosed. The sensitivity of cytology was 86% and specificity, 100%. Using 5 ng/mL as the cutoff, the sensitivity of CEA for malignant aspirates was 50% and specificity, 90%. The combined sensitivity of CEA and cytology was 95%. The mean CEA in malignant aspirates was 131 ng/mL and in benign aspirates, 2.41. The highest mean CEA was seen in adenocarcinoma, 402.6 ng/mL. Lower CEA content was seen in epidermoid carcinoma (58.6 ng/mL), large cell carcinoma (8.09), oat cell carcinoma, metastatic carcinoma of the kidney and breast, thymoma and lymphoma (each less than 1 ng/mL). Elevated CEA alone was diagnostic in two aspirates of bronchioloalveolar carcinoma; carcinoma with an unknown primary source, three; and large cell carcinoma, one. The adjunctive use of CEA in FNAs of the lung enhances the sensitivity of the cytologic diagnosis.     

Toxic Megacolon in Ulcerative Colitis

Toxic dilatation of the colon is now a well-recognized complication of ulcerative colitis. Our experience with four cases is presented. The clinical picture was characterized by severe ulcerative colitis with increasing abdominal distension, high swinging temperatures, obvious toxicity, and a moderate to high leukocytosis with a pronounced shift to younger forms. Accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy and, most important of all, awareness of the condition facilitate diagnosis in most cases. The main indications for surgical intervention are progressive abdominal distension and impending or actual perforation. Ileostomy and subtotal or total colectomy are the surgical procedures of choice. We feel that steroids play little part in the early management, but are of value in the early postoperative period. The three patients in our series treated surgically survived. One treated by medical means alone died of peritonitis.     

The Incidence of Palpable Liver and Spleen in the Postpartum Period

Abdominal examination was performed in 75 healthy women after normal delivery. The liver was palpable in 23 patients, the spleen in nine. The author believes that these organs were palpable because of ptosis rather than enlargement. Knowledge of this fact should keep the physician from attributing undue importance to the presence of a palpable liver and spleen in the postpartum period.     

Leukocyte kinetics in the human lung: role of exercise and catecholamines

In six normal supine subjects epinephrine infusion produced a greater leukocytosis with smaller changes in heart rate and blood pressure than did norepinephrine or isoproterenol. Upright exercise in those subjects produced a greater leukocytosis than supine exercise at the same work load. To determine the lung's participation in these events, indium-labeled neutrophils (PMN) were given to four of the subjects. We found that 20-25% were retained in the first pass through the lung when compared with technetium-labeled erythrocytes. The number of labeled PMN in the lung gradually decreased and the number in the spleen and the liver increased. Exercise and catecholamine infusion caused an acceleration in the release of labeled cells from the lung, an increase in both labeled and unlabeled cells in the peripheral blood, and an increase in the number of labeled cells in the liver and spleen. This suggests that increased perfusion of low-flow areas in the lung may contribute to the increased leukocytosis seen in association with both exercise and catecholamine infusion.     

Indirect haemagglutination (IHA) test in the serodiagnosis of amoebiasis

Among 72 patients clinically suspected of Entamoeba histolytica (E. histolytica) infections, 39 positive cases (54%) were detected serologically by the indirect hemagglutination (IHA) test. Parasitologically, microscopic examination of three consecutive stool specimens from all these patients indicated positivity for E. histolytica cysts and or trophozoites in 10 of the patients with IHA antibody titers greater than or equal to 1:128, which is of clinical significance. Another 2 patients were parasitologically positive but showed low IHA antibody titres (1:32-1:64); follow up indicated response to treatment with metronidazole. The highest serological positivity (100%) were detected in patients with liver abscess, all were clinically proven cases of extra-intestinal amoebiasis. IHA antibody levels of clinical significance were seen in all four patients with chronic dysentery with parasitological evidence of E. histolytica in their stools. In a group of patients with abdominal pain nine positives were detected serologically, four of which were positively diagnosed concurrently by parasitology; the remaining five patient's sera showed high IHA antibody titres with absence of cysts or trophozoites in stools, indicative possibly of persistence of antibodies from past infection. The serologic determination of E. histolytica IHA antibodies in a control group consisting of normal healthy school children and adults of both sexes without any clinical evidence of amoebiasis showed the absence of any positive titres of clinical significance; low titres (1:32-1:64) were detected in 5.2% of 232 sera tested. Parasitological examination of three consecutive stool specimens from all individuals in the control group showed the presence of cysts of E. histolytica in just two among 232 tested (0.9%).     

Gastrointestinal torsion in a channel catfish (Ictalurus punctatus)

A case of gastrointestinal torsion with dilatation in a farm-raised channel catfish (Ictalurus punctatus) was examined at the Thad Cochran National Warmwater Aquaculture Center (Stoneville, Mississippi, USA). The affected fish was a gravid female broodfish, which displayed pale gills and a markedly distended abdomen. Internal examination revealed that the gastrointestinal tract and ovaries were rotated around each other four times in a counterclockwise direction as viewed in right lateral recumbency. The catfish had a markedly distended gastrointestinal tract, pale liver, hypoplastic spleen, hypoplastic swim bladder, and high volume of ascitic fluid. Blood analysis indicated multiple abnormalities, including severe anemia and metabolic acidosis. The etiology of the torsion was uncertain; however, the presence of a hypoplastic swim bladder most likely allowed for increased movement of the gastrointestinal tract and ovaries. When examining cases of abdominal distention in fish, gastrointestinal torsion can be considered among the differential diagnoses.     

Hepatosplenic candidiasis, a late manifestation of Candida septicaemia in neutropenic patients with haematologic malignancies

Systemic candidiasis with Candida-induced abscesses, predominantly in the liver and the spleen, was diagnosed in 27 patients with haematologic malignancies after intensive cytostatic therapy. Specific features included septic fever unresponsive to antimicrobial therapy, hepatosplenomegaly with multiple lesions in the liver and spleen (diameter up to 2 cm) as detected by computed tomography (CT) or ultrasound, and an elevation in liver enzymes. During treatment, induced neutropenia, hepatic and splenic foci were poorly defined histologically and were not identified by imaging procedures. After granulocyte recovery these foci showed characteristic histological patterns. Ultrasound and/or CT investigations of the abdomen now revealed characteristic lesions in the liver and the spleen. Gamma-GT and alkaline phosphatase were early indicators of hepatic involvement in Candida septicaemia and were often already elevated in aplasia.     

Dietary supplementation with cysteine prodrugs selectively restores tissue glutathione levels and redox status in protein-malnourished mice(1)

Protein malnutrition (PM) is a major health problem in the world. PM compromises antioxidant defense in the body. In particular, PM decreases tissue glutathione (GSH) levels. A high protein diet was found to restore tissue GSH levels in animal studies, however it is not recommended for the early phase of PM rehabilitation. Therefore, using dietary supplementation to restore tissue GSH without giving a high protein diet may be an adjunct therapy that helps improve antioxidant status during the early rehabilitation of PM. In this study, we systematically compared the efficacy of dietary supplementation of four cysteine prodrugs: N-acetylcysteine, L-2-oxo-4-thiazolidine-carboxylate, methionine, and GSH, on tissue GSH in mice fed a protein-deficient (0.5%) diet. Results showed that dietary supplementation of cysteine prodrugs to PM mice restored GSH levels in liver, lung, heart and spleen, but not in colon. GSH and GSSG levels in brain and kidney were not affected by cysteine prodrug or PM. Supplementation also restored the redox status in liver and heart (based on GSH/GSSG), and in liver and spleen (based on GSSG/2GSH reduction potential). This suggests that the restoration of GSH levels and redox status by cysteine prodrugs are tissue-specific, and that the two indicators of redox status are not always interchangeable. However, all four prodrugs exhibited similar GSH-enhancing capacities, showing no prodrug-specificity as seen in cell culture studies. In conclusion, this study provided information that may be useful in a clinical setting where a short-term oral supplementation of cysteine prodrugs is necessary for the early rehabilitation of PM patients.