Elimination protocols in atopic dermatitis

Both dacryocystography and dacryoscintigraphy are well established in the evaluation of stenoses of the lacrimal drainage system. They provide limited information about the ductal anatomy itself and about periductal structures. MR imaging was evaluated for its capability to directly visualize the lacrimal drainage system in detail and simultaneously provide functional characterization of dacryostenosis. SUBJECTS AND METHODS: Twenty-seven lacrimal drainage systems of 23 patients suffering from epiphora were examined in an MR unit before and after conjunctival and intravenous application of Gd-DTPA using a surface coil. RESULTS: Dacryostenosis was found in 23 of 27 lacrimal systems. Stenoses were localized to the canalicular (n = 3), saccular (n = 8), and ductal (n = 12) level, and were classified as stenosis or occlusion. CONCLUSION: MR imaging with conjunctival contrast application allows within one examination both detailed morphological and functional assessment of the lacrimal drainage system with depiction of surrounding structures. Limitations arise mainly from demands on technical and patient-related preconditions.     

Scintigraphy of the lacrimal ducts

Scintigraphy of the lacrimal pathways is an examination method which informs us on the function of the efferent lacrimal system. The authors made bilateral scintigraphic examinations in 32 patients with obstruction or stenosis of the lacrimal pathways, 22 times they made concurrent contrast examinations of the lacrimal pathways. In seven suprasaccal and 5 saccal obstructions and stenoses they did not find penetration of activity from the conjunctival sac into the lacrimal pathways. In 16 subsaccal obstructions, 12 times penetration of activity into the lacrimal sac was found. In five patients with a partly preserved patency of the lacrimal pathways three times activity was detected in the lacrimal sac and in one instance slow penetration of activity into the nasal cavity. In complete obstructions and severe stenoses scintigraphy does not provide, as compared with conclusions of other examinations (fluorescein tests, irrigation, probing, contrast dacryocystography) new information on the type of obstruction. The method is useful in particular in conditions with a preserved patency of the lacrimal pathways, in examinations of very mild stenoses, intermittent lacrimation and doubtful cases. Scintigraphy of the lacrimal pathways is a supplementary method which must be evaluated in the context with other methods, in particular methods which provide information on the anatomy of the lacrimal system (dacryography).     

Topical contrast-enhanced CT and MR dacryocystography: imaging the lacrimal drainage apparatus of healthy volunteers

OBJECTIVE: The purpose of this study was to evaluate the feasibility of administering topical contrast material during helical CT dacryocystography and topical saline solution during MR dacryocystography to reveal the lacrimal drainage apparatus. SUBJECTS AND METHODS: Fourteen healthy volunteers underwent helical CT dacryocystography, MR dacryocystography, or both. Eight of the 14 subjects underwent both techniques; three subjects underwent MR dacryocystography, and three subjects underwent CT dacryocystography. Images were evaluated by two radiologists for degree of visualization of components of the lacrimal drainage apparatus. Each volunteer was questioned about the relative discomfort of contrast material and saline solution administration. RESULTS: The lacrimal drainage system was seen on both CT dacryocystography and MR dacryocystography. CT dacryocystography allowed two-dimensional and three-dimensional reconstructions on which adjacent bone anatomy could be seen. The MR dacryocystography two-dimensional reconstructions and maximum intensity projections also showed the drainage apparatus. However, smaller drainage structures were more consistently seen on CT dacryocystography than on MR dacryocystography. Saline solution was more comfortable than contrast material. CONCLUSION: CT dacryocystography and MR dacryocystography reproducibly and non-invasively revealed the lacrimal drainage apparatus and allowed a better physiologic examination than cannulation dacryocystography. MR dacryocystography can be performed without administration of ionizing radiation or contrast material, but this technique cannot show adjacent bone anatomy and less consistently showed the smaller drainage structures than CT dacryocystography.     

The assessment of light intensity preference in psychiatric patients: a questionnaire

PROBLEM: Psoas abscesses are really rare so that the diagnostic onset is commonly very late. The differential diagnosis to other retroperitoneal processes is therefore important. METHOD: In a period of observation of 6 years 21 patient were treated with psoas abscesses. The evaluation of 16 records was done retrospectively under consideration of etiology, history, clinical examination, lab results and x-ray/CT/MRI etc. RESULTS: With the knowledge of the anatomy of the ilio-psoas muscle the clinical examination gives us important information about the diagnosis of psoas abscess. The history and the clinical examination precede the further diagnostics and are condition for high rates of sensitivity and specificity. Lab results indicate an absedation without being specific. The exclusive position of radiological diagnostics is undisputed. Ultrasound, x-ray and leucocyte marked bonescan are proven to be helpful in cases of unknown location of the abscesses. Method of choice seems to be the contrast enhanced CT-scan. The differential diagnosis includes gastrointestinal or renal disorders as well as pathology of bone or joints. In our cases differential diagnosis was complicated since the diagnostic onset was delayed and the initial therapy was not adequate. The diagnosis "abscess of the psoas" does not imply a general regime for therapy therefore an individual treatment in consideration of percutaneous and operative drainage has to be recommended. In selected cases a combination therapy is advised. CONCLUSION: In every case of retroperitoneal symptoms the differential diagnosis of an abscess of the psoas has to be regarded. The diagnosis is subtil and requires clinical and laboratory examinations as well as contrast enhanced computerscan. The therapy follows operative measures. The technique has to be individually decided.     

Dacryocystitis associated with nasolacrimal duct cyst

An infant presented with persistent epiphora after successful probing of the lacrimal system. Examination of the nose showed a cystic structure occluding lower portion of the lacrimal drainage system. In cases of recurrent obstruction, nasal examination and endoscopic marsupialization may help guide the clinician towards the most appropriate treatment.     

Correlation of MRI and histopathological findings in inflammatory skin diseases

PURPOSE: Can spatial and contrast resolution be achieved with currently available MR devices for the successful assessment of inflammatory diseases of the skin? METHOD: High resolution MRI was performed in 20 patients with non-malignant diseases of the dermis and subcutis. The skin biopsies subsequent to the MR examinations were indicated for clinical reasons. The MR examinations were done in the location of later performed skin biopsies using a 1.0 Tesla system (Gyroscan T10 NT, Philips, Best, the Netherlands) and a surface coil of 7.5 cm inner diameter. Conventional spin-echo (SE-Sequenz)- and gradient-echo (GRE)-sequences were optimised to obtain maximum spatial resolution with a sufficient signal-to-noise ratio within a tolerable examination time. MR visualisation of histopathology was assessed by four readers using a questionnaire. RESULTS: In 15 of 20 cases, high resolution MRI allowed a correct classification of the visualised dermal and subcutaneous patterns, in accordance with the histological work-up of the corresponding specimen. Due to the still only suboptimal spatial and contrast resolution the structure of the epidermis could not be assessed adequately. Determination of contrast enhancement or non-enhancement after administration of intravenous contrast agent provided information on the degree of tissue perfusion in 19 patients, which complemented the morphological assessment. CONCLUSION: High resolution MRI allows to identify non-invasively histological main patterns of inflammatory skin diseases. However, final diagnosis often depends on higher microscopic resolution and special staining.     

The prevalence and severity of cancer pain: a study of newly-diagnosed cancer patients in Taiwan

In current clinical practice the "double-stapling technique" is the standard for reanastomosis following minimally invasive sigmoid resection. In the present study, we compared the TESA technique (transient endoluminally stented anastomosis) with conventional stapled anastomosis and evaluated the effect of remnant foreign material on follow-up examination with endosonography. Laparoscopic sigmoid resection was performed in 12 pigs (mean weight 63+/-5.9 kg). Animals were randomly divided into two groups: In Group A, reanastomosis was performed following a standard technique using a 29-mm circular stapler. In Group B, the TESA technique using a resorbable radiopaque stent of polyglycolic acid was applied. The anastomosis was examined by plain x-ray on days 1, 7, and 14, and by contrast enema on day 42, respectively. Endosonography, macroscopic inspection, and histological evaluation of the anastomosis were performed on day 42. All anastomoses in group A were patent. In one animal in Group B stent displacement with subsequent leak of the anastomosis was observed. Circumferential length of the anastomosis on day 42 did not differ between the groups (Group A: 8.00+/-0.45 cm vs. Group B: 7.8+/-2.0 cm, p = 0.82). The duration of the operation was 130+/-27 minutes in Group A and 100+/-18 minutes in Group B (p = 0.06). Weight gain was equal: Group A: 24+/-9.6 kg vs. Group B: 24+/-5.0 kg, p = 0.74. Endosonography on day 42 postoperatively in the area of the anastomosis in group A was impaired due to metallic staples. TESA is a competitive method for reanastomosis following laparoscopic sigmoid resection. In contrast to the conventional technique, the anastomosis is free of foreign material 1 month after the operation, which facilitates follow-up examinations with endosonography as well as other imaging diagnostics.     

Dacryoscintigraph evaluation of the repaired lacrimal drainage system

We have used dacryoscintigraphy to study the efficiency of the lacrimal system following the repair of a divided lower canaliculus in 4 children. This test has been reliable in evaluating lacrimal function and suggests that a canaliculus can be repaired and splinted satisfactorily. Our experience with dacryoscintigraphy confirms that it is a safe comfortable, and reliable method for studying the patency of the lacrimal drainage system.     

Functional anatomy of the human efferent tear ducts: a new theory of tear outflow mechanism

BACKGROUND: The mechanism of lacrimal drainage under physiological conditions is controversial. The aim of this study was to analyze the three-dimensional architecture of human efferent tear ducts from functional and clinical points of view. A new theory of tear outflow is discussed. METHODS: Thirty-two prepared lacrimal systems of adults were examined by histological, immunohistochemical and scanning electron microscopic techniques. RESULTS: The wall of the lacrimal sac is made up of collagen bundles, elastic and reticular fibers arranged in a helical pattern. Wide luminal vascular plexus are embedded in this helical system and connected to the cavernous tissue of the inferior turbinate in the region of Hasner's valve. Immunohistochemical analysis showed evidence of type I and type III collagen as well as chondroitin 4- and 6-sulfate. CONCLUSION: With blinking, the lacrimal part of the orbicularis muscle contracts. The fornix of the sac moves in a cranial-lateral direction. Thus the lacrimal sac distends and may be "wrung out" due to its medial attachment and helically arranged fibrillar structures. The vascular plexus may play an important role in the absorption and drainage of lacrimal fluid.     

Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta

PURPOSE: To assess the severity of adverse reactions to contrast media in outpatient computed tomographic (CT) examinations in a conventional clinical setting. MATERIALS AND METHODS: In 4,936 patients, CT was performed with four protocols: ionic contrast medium with sodium meglumine as the cation (in one protocol, contrast material was warmed to 35 degrees C before injection; in another protocol, it was administered at ambient temperature); warmed, ionic contrast medium with nonsodium pure meglumine as the cation; and warmed, nonionic iopamidol. RESULTS: Adverse reactions to ionic contrast material statistically significantly decreased (P<.05) when it was warmed before administration. Reactions to ionic contrast media without a sodium cation were statistically significantly fewer (P<.001) than reactions to those with a sodium cation. In all protocols, pediatric patients had fewer reactions than adult patients. CONCLUSION: In outpatient CT examinations, nonionic, warmed contrast medium was the best option because no severe reactions resulted from its use. Prevalence of adverse reactions was comparable to that in controlled randomized studies.     

Carcinomas of the lacrimal drainage system

Primary carcinomas of the lacrimal drainage system are rare. These malignant neoplasms typically present as noncompressible, nontender masses with low-grade dacyrocystitis and/or unilateral epiphora. Lymph node metastasis may occur late in the disease course. Complete surgical resection is the best treatment choice; extensive procedures such as orbital exenteration and maxillectomy may be necessary for complete tumor extirpation. Further adjunctive radiotherapy may improve local control. We present two cases of carcinoma of the lacrimal drainage system, including one locally controlled tumor with apparent lymph node metastasis that occurred 21 years after primary treatment. A review of the histopathology and literature concerning carcinomas of the lacrimal drainage system is presented.     

Screening for skin cancer in primary care settings

OBJECTIVE: To estimate the frequency of recorded screening for skin cancer in primary care settings. DESIGN: Retrospective observational cohort study. SETTING: Two academically affiliated Department of Veterans Affairs Medical Centers. SUBJECTS: Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics. MAIN OUTCOME MEASURE: Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period. METHODS: Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits. RESULTS: Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%), prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P < .001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination. CONCLUSION: Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.     

Arterial embalming method of the cadaver and its application to research

Ever since 1974, the cadaver has been embalmed by the arterial embalming method, using pre-embalming fluid with blood clot disperser and cell conditioner for the removal of blood clots and drainage of blood, at the Department of Anatomy of the Kawasaki Medical School. According to this method, the cadavers are always very well fixed so that they can be used for not only anatomical dissection but also research for the vascular system by vasography, kinematics of the joint and other histologic examinations. In this report we have described our embalming procedure concretely and its application to research.     

CT angiography of cerebral venous circulation: anatomical visualization and diagnostic pitfalls in interpretation

PURPOSE: To show the frequency of visualisation of the dural sinuses and cerebral veins with CT-angiography (CTA) with special reference to anatomical variants. METHODS: 34 CTA (1 mm slice thickness, 120 ml nonionic KM, 2 ml/s flow, 40 s prescanning delay) were performed in 30 patients to examine the cerebral venous system. In an anatomic study of cadavers (n = 10) without known disease of the cerebral veins the great sinuses were opened and examined. RESULTS: The superior sagittal, the transverse, the sigmoid and the straight sinus could be evaluated in all cases (100%). The cortical and deep cerebral veins as well as the small sinuses were visualised in 12-97% of the examinations. A sinovenous thrombosis was diagnosed in 4 of the 30 patients. Asymmetric superior sagittal sinus bifurcation (12/30), a hypoplastic sinus transversus (2/30) and a persistent sinus occipitalis (4/30) were found as anatomical variants. In 10 of the 30 patients we discovered 17 dural sinus filling defects produced by large arachnoid granulations. Similar findings could be demonstrated in the pathologico-anatomic examination series. CONCLUSION: CT angiography is suitable for detailed evaluation of the cerebral veins. Anatomic variants, arachnoid granulations, as well as fibrous bands and septa, which may lead to misinterpretation in conventional CT, can be clearly demonstrated. The sensitivity and specificity of CT in diagnosis of sinovenous thrombosis were increased thereby.     

Dacryocystitis associated with malignant lymphoma of the lacrimal sac

BACKGROUND: Tumors of the lacrimal sac are unusual, and lymphomas of the lacrimal sac are quite rare. Four patients with a history of well-differentiated, small cell lymphoma or chronic lymphocytic leukemia presented with either acute or chronic dacryocystitis and epiphora due to lymphomatous infiltration of the lacrimal sac. METHODS: All four patients underwent dacryocystorhinostomy with lacrimal sac biopsy. All tissues underwent complete histopathologic evaluation including immunohistochemical studies for cell surface markers and, in addition, were compared with previous biopsies performed for the initial diagnosis of lymphoma. FINDINGS: All biopsies demonstrated small cell well-differentiated lymphoma on histologic and immunofluorescent examination. No patient demonstrated orbital involvement on computed tomography. One patient had previously diagnosed chronic lymphocytic leukemia and one patient demonstrated diffuse lymph node involvement on postoperative systemic evaluation. All four patients underwent additional chemotherapy. No recurrence of dacryocystitis or epiphora occurred. CONCLUSION: Four patients presented with dacryocystitis secondary to lacrimal sac lymphoma. Lymphomatous lacrimal sac infiltration is an unusual cause of dacryocystitis. Biopsy of the lacrimal sac plays a diagnostically important role in dacryocystorhinostomy even in the absence of obvious tumorous involvement of the lacrimal sac mucosa.     

Transient response harmonic imaging: an ultrasound technique related to brain perfusion

BACKGROUND AND PURPOSE: Gray-scale harmonic imaging is the first method to visualize blood perfusion and capillary blood flow with ultrasound after intravenous contrast agent application. The purpose of the present study was to evaluate the potential of transient response second harmonic imaging (TRsHI) to assess normal echo contrast characteristics in different brain areas by transcranial ultrasound. METHODS: In 18 patients without cerebrovascular diseases, TRsHI examinations were performed bilaterally with the use of the transtemporal approach after application of 6.5 mL of a galactose-based microbubble suspension (400 mg/mL). The transmission rate was once every 4 cardiac cycles. Regional cerebral contrast was visually assessed and then quantified off-line with the use of time-intensity curves. In 4 different regions of interest (ROI) (posterior part of the thalamus [ROIa], anterior part of the thalamus [ROIb], lentiform nucleus [ROIc], and white matter [ROId]), the following parameters were evaluated: peak intensity, area under the curve (AUC), and time to peak intensity. AUC ratios for ROIc/a, d/a, c/b, and d/b were calculated. RESULTS: In all patients parenchymal contrast enhancement was visually detectable. One hundred thirty-one characteristic time-intensity curves (baseline phase, peak contrast intensity, slow washout phase) were demonstrable in 144 ROIs. In ROIc and ROId, characteristic contrast curves could be observed most frequently (68/72 examinations), whereas time-intensity curves in ROIa and ROIb could not be evaluated because of inadequate contrast enhancement in 9 of 72 examinations. Time to peak intensity varied between 20 and 52 cardiac cycles; in 1 patient it was 88 cardiac cycles. In all individuals AUCs and in 16 of 18 subjects peak intensity in ROIc and ROId showed a 2- to 10-fold increase compared with ROIa and ROIb. In no examination did AUC ratios show a >2-fold side difference irrespective of the ROI. CONCLUSIONS: The present study demonstrates for the first time that TRsHI produces accurate contrast in different brain areas and represents an ultrasonic tool related to brain perfusion. Absolute values of quantitative parameters show high variations caused by different temporal bone thicknesses and a complex relationship between echo contrast concentrations and measurements of optic intensities. Ratios between different ROIs help to compare contrast enhancement in different brain areas. Furthermore, because of the fact that attenuation of contrast enhancement in TRsHI depends strictly on the insonation depth, harmonic imaging studies of brain perfusion cannot be compared directly with other imaging techniques such as positron emission tomography.     

Pyomyositis and staphylococcal scalded skin syndrome

Pyomyositis is a rare musculoskeletal infection in non-tropical countries. We report a child who had pyomyositis complicated by staphylococcal scalded skin syndrome. This complication has not previously been described in patients with pyomyositis. Early diagnosis of pyomyositis was made by ultrasound examination, and percutaneous needle drainage under ultrasound guidance was performed. Pus aspirated and blood cultures grew Staphylococcus aureus. No open surgical drainage was required and resolution of the abscess was documented by serial ultrasound examinations.     

Use of duodenal drainage in the diagnosis of acalculous gallbladder disease

Because of overreliance on oral cholecystograms, we have re-evaluated a little used laboratory test, duodenal drainage. In a series of 56 patients with normal oral cholecystograms and upper GI series who underwent duodenal drainage and cholecystectomy, 53 (95%) were found to have positive microscopic examinations. We think duodenal drainage is a safe, simple test which should be used as an adjunct to history and physical examination and oral cholecystography. In regard to clinical follow-up, 96 per cent of patients followed were judged to have excellent-to-good results.     

Schizophrenia and its hospitalization (author''s transl)]

Radionuclide dacryography (RND) has the following indications: 1. Localisation of obstructions in the lacrimal drainage system. 2. Judgement of relative tear obstruction. 3. Pre- and post-operative control of the function of lacrimal drainage in surgical and radiotherapy of the inner canthus region. 4. Investigations of tear secretion are described and own preliminary results are discussed. 5. Resorption of suitable marker substances clinically. First results of conjunctival resorption of pertechnetate are reported. 6. The possibility of testing in vivo radioactive drug delivery systems is shown by means of own investigations. 7. The absorbed radiation dose using RND is very low as compared to radiological methods, thus justifying repeated controls and investigations even in children.     

The interpretation of the data from the ultrasonic examination of patients with acute and chronic suppurative lung and pleural diseases

Observations were made in 104 patients with acute and chronic lung abscesses and pleural empyema. The endoscopic, bacteriological and ultrasonic methods were used to make full diagnosis and to begin treatment. This article describes the part of the work devoted to the ultrasonic diagnostics. Different forms of lung abscesses were revealed and explained. The method was used to differentiate the collection of pus in the lung and pleural cavity, to reveal the structure of pathologic processes and its development, to learn the character of changes in the lungs and pleural space. The method is rather simple and gives the doctor much information about the condition of the pathologic tissue.