Evaluation and treatment of constipation and fecal impaction in adults

Constipation is a common complaint that physicians encounter. Understanding the patient's definition of constipation and focusing the history and physical examination provide clues to the underlying cause. Initially, an empiric treatment trial is recommended. For patients with warning symptoms or those in whom treatment fails, a limited diagnostic work-up is suggested. Tests of physiologic function are reserved for patients whose condition is refractory to therapy. Fecal impaction can be considered extreme constipation. The pathophysiologic features of fecal impaction are discussed, and recommendations are provided for treatment and prevention.     

Diagnostic imaging of neurotuberculosis

Neurotuberculosis is represented by different and possibly concomitant forms, of which the most frequent are tuberculous meningitis and parenchymal tuberculosis followed by cerebral miliary tuberculosis and the extremely rare tuberculous abscesses. Tuberculous meningitis is characterized by the presence of inflammatory meningeal exudate involving meningeal surfaces and CSF spaces with involvement of relative vascular and nervous structures. Most frequent complications are parenchymal infarction, hydrocephalus and mycotic aneurysms. Inflammatory meningeal exudate shows intense contrast enhancement. Parenchymal tuberculosis may directly involve the cerebral and/or medullary parenchyma as areas of cerebritis/myelitis with solid nodular lesions (tuberculomas) with a central area of caseating necrosis. Tuberculomas are characterized by intense nodular or ring enhancement.     

Diagnostic imaging techniques in psychiatry

Morphological and functional abnormalities have been found in several psychiatric diseases, including schizophrenia, schizophreniform disorder, manic-depressive disorder, obsessive compulsive disorder, posttraumatic stress disorder, and panic disorder. Most research concerned schizophrenia. Altered volumes of the ventricles, cortical gray matter, basal nuclei, thalamus and limbic structures have been reported. Altered activity was found in several cortical and subcortical brain structures, in particular the frontal cortex, during cognitive and pharmacological challenge. Disease progress, genetic and environmental factors appear to influence the brain abnormalities. The specificity of the findings is still limited. The use of imaging techniques in the psychiatric clinic is still restricted. Notwithstanding these limitations, focus in psychiatry research has been switched from the question if brain abnormalities exist to where they are, of what they consist and where they originated.     

Diagnostic imaging of cystic lesions in the child's orbit

The child's orbit may be involved with a variety of cysts and cyst-like lesions. Such lesions may represent development anomalies of the globe and orbit, acquired lesions of the orbit, or cystic expansions from contiguous structures. CT and MR imaging are important diagnostic tools that aid the ophthalmologist in establishing the correct diagnosis and defining the extent of these cystic lesions.     

Diagnostic ultrasound in the evaluation of scrotal masses

Evaluation of 27 patients with scrotal masses was done with gray scale ultrasound. Given the clinical diagnosis ultrasound proved reliable in almost all cases.     

Diagnostic imaging in deep vein thrombosis of the limbs

The clinically suspected deep vein thrombosis (DVT) should always be confirmed by instrumental procedures. In fact, about 70% of patients with clinically suspected DVT are shown to be negative on instrumental investigations. Phlebography is still the gold standard in the diagnosis of peripheral DVT. Main phlebographic findings are: persistent filling defect; abrupt interruption of contrast in a vein; lack of opacification in all or some deep veins; flow diversion with opacification of collateral branches. At present, peripheral phlebography is performed when the other noninvasive exams (Color Doppler US and Duplex Doppler) are doubtful, technically limited or when thrombosis of innominate veins or superior vena cava, is suspected. Real-time US enables direct visualization of the limb proximal veins. The venous wall, the venous valves, the thrombus and its development, the anatomic variants, the perivenous structures which may impact on the normal physiology of venous return, are depicted. However, the distal veins of the leg and arm and deep veins (the iliac veins, the superficial femoral vein in the adductor canal) are not accurately visualized. The US findings in DVT include: the presence of echoes within the vascular lumen; the veins in axial scans are not compressible. Pulsed Doppler and duplex Doppler combine the morphologic and functional study. Injury caused by DVT at the valvular level (postphlebitic syndrome) is visualized. Primary deep vein thrombosis caused by valvular disorders (valvular aplasia) is identified. Inadequate superficial and perforating veins to be treated with surgery are mapped. Color Doppler US depicts directly superficial and deep limb veins combining the morphologic with the functional assessment represented by the visualization of the map of flow velocity and direction. Recently, a new diagnostic procedure, the color Doppler Energy (CDE) or Power Doppler has been introduced. Together with mean flow velocity and spectral variance, the signal energy or power is also analyzed. The CDE is independent of the US incidence angle, it does not shows the flow direction, detects particularly slow flows, early canalization of thrombi and non occlusive thrombosis. Color Doppler diagnosis of thrombosis is prompt because an area with absence of color is visualized. Collateral vessels and flow direction within them, is well depicted. Beside the site and extension of thrombosis, color Doppler US is able to directly visualize the distal end of the thrombus, which when floating is at high risk for embolism. CT allows an adequate study of the iliocaval axis and is useful if phlebography or color Doppler US are not diagnostic. Iliocaval thrombosis represents a not infrequent finding during abdominal CT. The thrombus appears as a hypodense mass encircled by the hyperdense rim of contrast medium.     

Diagnostic imaging of diaphragmatic trauma

OBJECTIVES: The objective of this study was to estimate incidence rates for breast cancer, the most commonly occurring cancer in women, in the growing Hispanic population of Connecticut. METHODS: The population-based Connecticut Tumor Registry (CTR) routinely obtains only limited information on Hispanic origin and maiden name. In this study, surnames of CTR breast cancer patients diagnosed in 1989-1991 were matched with a list of Spanish surnames. To assess misclassification, both surnames and maiden names (from death certificates) of female Connecticut residents who had died in 1989-1991 from any cause of death at 20 years of age and older were matched with the Spanish-surname list. RESULTS: Age-specific incidence rates (1989-1991) for 'Hispanic' women (with Spanish surname) were lower than those for 'non-Hispanic' white women (with non-Spanish surname) for age 35-39 years and older. Errors in these estimated rates were probably small because among decedents the number with a Spanish surname differed by only 9% from the number with a Spanish maiden name; false positives were almost balanced by false negatives. CONCLUSION: Matching of surnames in the cancer registry with a Spanish surname list provided reasonably accurate estimates of cancer incidence rates in Hispanic women, although individual women were misclassified as 'Hispanic' or 'non-Hispanic'.     

Diagnostic imaging in otorhinolaryngology--assessment of current status

BACKGROUND: The first conventional x-rays of the paranasal sinuses were received in 1897, just two years after the detection of x-rays. During the following decades several modifications and extensions of conventional radiologic techniques were developed, but routine imaging procedures of the head and neck were mainly restricted to pictures of the paranasal sinuses and the temporal bone. In the fifties, tomography was developed, which gave us a more detailed insight of the anatomy and pathology of the paranasal sinuses and temporal bone. During the last two decades the development of new techniques, i.e. computed tomography (CT) and magnetic resonance imaging (MRI), has significantly increased the importance of modern imaging for the diagnostic evaluation of head and neck diseases. These diagnostic tools enable us to visualize anatomical structures and pathological entities with an accuracy never been expected beforehand. The pace of the improvement of these diagnostic tools, however, requires that both radiologist and otorhinolaryngologist keep up with the adequate indications of CT and MRI in the different areas of the head and neck. A close relationship and cooperation between radiologist and ENT surgeon is therefore indispensible for a fruitful and cost-effective use of modern imaging. Otherwise the patient is exposed to modern medical technology without an equivalent benefit. The purpose of the present paper is mainly to give an update and state of the art of modern imaging techniques in otorhinolaryngology, head and neck surgery. Different areas i.e. paranasal sinuses, temporal bone, salivary glands, oral cavity and oropharynx as well as the neck are discussed in terms of adequate indications for modern imaging in the diagnostic evaluation of different lesions.     

Surgical evaluation and management of refractory constipation in older children

Chronic constipation is a common childhood problem that accounts for 3% to 5% of pediatric visits and 10% to 25% of referrals to pediatric gastroenterologists. The etiology of constipation can be elusive, and extensive investigation often fails to identify a specific cause. The authors conducted a 5-year retrospective review of the patients referred for deep transanal rectal biopsy to determine the usefulness of this procedure in the evaluation and subsequent surgical management of refractory constipation. Specimens obtained by transanal rectal biopsy established a diagnosis for 30 of the 70 patients, and 17 of these 30 had subsequent procedures in the treatment of their constipation. The authors conclude that transanal rectal biopsy identifies a significant number of patients with previously unidentified neuroenteric disorders who may benefit from additional surgery in the treatment of constipation refractory to medical management.     

Diagnostic imaging 100 years ago

The aim of the present study was the evaluation of the role of adjuvant radiation therapy in the prevention of recurrence after excision. Between July 1, 1985, and April 1, 1993, 64 patients (43 men, 21 women) were referred for radiation therapy after excision of a nasal pterygium. All patients were followed for 1-9 years (median 5.5 years). Radiation therapy was done with a strontium 90 eye applicator at a total dose of 30 Gy fractionated into six fractions of 5 Gy each. In all, 49 patients were treated after their first excision and 15 patients had undergone multiple prior excisions. In 8 of 64 irradiated patients, recurrent pterygium was detected (12.5%); 4 recurrences developed after first excision and adjuvant radiation therapy (8.16%) and the other 4, following multiple former reexcisions and radiotherapy (26.7%). Pterygium did not recur in any of the primarily treated patients who were irradiated within 3 days of surgery. In contrast, 3 of 7 accordingly treated patients (42.9%) who started radiation therapy at between 7 and 10 days after surgery developed recurrent pterygium. Adjuvant radiation therapy after excision of pterygium lowers the overall rate of recurrence to 12.5%. In an adjuvant situation after first excision, radiation therapy should be initiated within 3 days of surgery, the result being freedom from recurrence.     

Diagnostic imaging modalities in parotid gland enlargement

Twenty patients with various parotid gland enlargement were selected from outpatient dental clinic. The classical sign of the parotid enlargement is swelling which may by localized as inflammatory, cystic, neoplastic or associated with systemic diseases as diabetes mellitus, sjogren's syndrome and may occur after ingestion of certain drugs or metals. These heterogeneous pathological swellings have great morphological variation that need various diagnostic imaging modalities to be visualized. The favoured modality has been evolved from plain radiography, to sialography, scintigraphy, ultrasonography and to computed tomography. The application and limitation of each modality were presented.     

Ewing sarcoma. Diagnostic imaging

Ewing's sarcoma is a highly malignant neoplasm of the bone whose origin is still uncertain. A strong relationship exists between Ewing's sarcoma and tumors of neural origin (Ewing family of tumors). Ewing's sarcoma must be distinguished from other round-cell tumors like lymphoma and neuroblastoma and also must be differentiated from osteogenic sarcomas. On plain radiographs, Ewing's sarcoma appears as a lytic or mixed lytic-sclerotic, rarely as predominantly sclerotic lesion with margins Lodwick grade III. It is located primarily in the diaphyseal and metadiaphyseal regions of the long bones of the lower extremities. A large soft tissue tumor is usually present. Magnetic resonance imaging is the imaging modality of choice to evaluate the extent of the primary lesion, to monitor the response to neoadjuvant chemotherapy and to follow up non-resected Ewing's sarcomas. Bone scintigraphy is necessary to detect skeletal metastasis, and 201thallium scanning has been shown to be sensitive in the monitoring of treatment response. Today, computed tomography is not longer used to image the tumor site; however, spiral CT of the lungs plays a central role as a staging and follow-up tool.     

Diagnostic imaging strategies in small animal nephrology

The diagnostic imaging methods most readily available to the private practitioner are survey radiography, radiographic contrast procedures, and ultrasonography. Nuclear medicine imaging techniques are available at referral centers. The advantages and disadvantages of these methods as well as the favored strategies of the authors in their utilization for the diagnosis of renal disorders in the cat and dog are discussed.     

Ultrasonographic evaluation of urinary tract in children with chronic functional constipation

Urinary tract anomalies were prospectively investigated with ultrasound in 31 children with chronic functional constipation. These children were compared with 29 healthy controls without constipation both before and after treatment. Bladder residue and upper renal tract dilatation after micturition were significantly more common in the group with constipation than in the improved after-treatment and control groups.