Intraluminal growing tumors of the bile duct are uncommon causes of jaundice. The sonographic appearance of 2 hilar cholangiocarcinomas or Klatskin tumors and a benign extrahepatic biliary cystadenoma is described. Compared to contrast studies of the bile ducts, sonography better defined the intraductal character of the neoplasms. However, the ultrasound appearance did not allow differentiation between the adenocarcinomas and the benign cystadenoma.

A case of pulmonary and esophageal tuberculosis in an 82-year-old female is presented. Esophageal tuberculosis is very rarely seen in Europe and the United States, but the disease is still endemic in India. The major differential diagnosis is esophageal malignancy. Findings that can suggest the diagnosis are tracheo-esophageal fistula formation, enlarged, centrally necrotizing lymph nodes, and a micronodular lung pattern.

A 39-year-old woman with inflammatory bowel disease was admitted to the hospital because of cramping abdominal pain and diarrhea. Ultrasound of the abdomen revealed thickening of the wall of the descending colon. At endoscopy mucosa-covered nodules with substenosis were seen. A double-contrast examination showed narrowing in the transition zone between the descending colon and sigmoid with mucosal nodularities and barium spots in between. Examination of the resection specimen revealed colitis cystica profunda. After surgical treatment the history of the patient was uneventful.

A 32-year-old man presented with severe abdominal pain located in the mesogastrium and right hemi-abdomen. A barium transit study showed a tubular structure of 6 cm arising from a bowel loop in the distal ileum, with an intraluminal polypoid mass near the bottom. Diagnosis of a benign lesion within a Meckel's diverticulum was made. Anatomopathology confirmed a Meckel's diverticulum and demonstrated that the polypoid mass was caused by an unusual great ectopic island of gastric mucosa.

Chronic pancreatitis is defined as a continuous inflammatory process usually characterized by a relentless and progressive loss of pancreatic parenchymal tissue (Kloppel and Maillet 1992). After a subclinical phase of variable duration, recurrent attacks of abdominal pain are noted, and exocrine or endocrine insufficiency (or both) appears (Lankisch et al. 1993). In most cases, both exocrine and endocrine functions are lost, although the loss of endocrine function appears later in the disease (Steer et al. 1995).

The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.

Rationale and Objectives. The purpose of this study was to evaluate a variety of methods to induce chronic pancreatitis and its radiologic expression by experimentally inducing this condition in cats.Materials and Methods. Chronic inflammatory and fibrosing pancreatitis was produced in cats by intraductal injection of 1.5 mL of 94% ethanol in one group or by a combination of intraductal and intraparenchymal injection of ethanol together with partial obstruction of the main pancreatic duct to 70% of its original lumen by Fixation of a small catheter in the papilla. For comparison, other cats underwent total obstruction of the main pancreatic duct. All groups, as well as untreated control cats (n = 3), underwent repeat laparotomy to obtain biopsy specimens.Results. Cats with total obstruction showed progressing fibrosis with dilatation of ductules occasionally infiltrated with granulocytes. From 26 weeks on, acini and islets of Lnagerhans became atrophic. Radiographs showed progressive but diffuse dilatation of ducts, ductules, nd side branches. Cats from the other two groups had interlobular inflammation and fibrosis with flattened and irregular ductular epithelium. Later, ductular proliferation occurred, interstitial inflammation subsided, and fibrosis increased. Radiographs showed very irregular ducts and ductules with stenosis and dilatation. From 26 weeks on, no substantial differences were observed between the cats who received only intraductal injection of ethanol and the cats who underwent the combination of procedures.Conclusion. The histopathologic and radiographic alterations that evolved from damage to the ductal epithelium in the cat resembled the features of chronic pancreatitis in humans and differed from those caused by total obstruction of the main pancreatic duct in cats.

To compare intravenous cholangiography (i.v.c.) and magnetic resonance imaging (MRI) as preoperative imaging techniques in patients scheduled for laparoscopic cholecystectomy. Twenty patients underwent i.v.c. and MRI, 40 axial 'localizer' images were first obtained with a half-Fourier single-shot turbo spin echo (HASTE) sequence. Next, an extremely high T2-weighted rapid acquisition relaxation enhancement (RARE) acquisition (TE = 1100 msec) was used for MR cholangiography. All images obtained with i.v.c. and MRI were independently analyzed by two observers. The relative visibility of the (normal or abnormal) gallbladder (GB), cystic duct (CD), and bile ducts (BD) on both types of images was scored as follows: 1 = MRI better than i.v.c.; 2 = no difference; 3 = i.v.c. better than MRI. We observed 3 anatomic variants: 1 of the cystic duct and 2 of the intrahepatic bile ducts; 15 patients had gallstones; one had cholecystitis. Magnetic resonance images were considered more informative than i.v.c.-images for visualization of GB in 11 patients (55%), for CD in 9 patients (45%), and in 8 patients (40%) for visualization of the CBD. Intravenous cholangiography outperformed MRI in the evaluation of the CBD and CD in one patient (5%). The combined use of half-Fourier single-shot RARE and high T2-weighted RARE MR imaging is a valuable alternative to i.v.c. in the preoperative evaluation of gallbladder and biliary tract.

Although lipomas are the second most frequent benign tumors of the gastrointestinal (GI) tract, development of multiple lipomas in both stomach and duodenum is extremely rare. We present a patient with gastroduodenal lipomatosis who was examined with barium studies, CT, and MRI.

This study examines possible quantifiable causes of postdeglutition pharyngeal retention in the elderly. Manofluorography and computer processing of video images are performed. Retention in the valleculae and in the piriform sinuses is associated with a markedly reduced pharyngeal shortening, a low tongue driving force (TDF), and a diminished amplitude of the pharyngeal contraction. There is no relationship with the hypopharyngeal suction pump (HSP). Retention limited to the valleculae is associated with a low TDF, and retention restricted to the piriform sinuses is accompanied by a reduced pharyngeal shortening.

Background & Aims: Standard corticosteroid therapy for Crohn's ileitis induces symptom relief without improvement of endoscopically visible lesions. In this study, the effect of azathioprine therapy on the inflammatory lesions in the neoterminal ileum of patients with severe postoperative Crohn's recurrence was examined. Methods: Macroscopic ileal lesions were studied endoscopically or radiologically after at least 6 months of azathioprine therapy after complete weaning of corticosteroids. All patients who underwent an ileocecal resection for Crohn's disease at our institution between January 1989 and December 1993 and who subsequently developed severe recurrent ileitis treated with azathioprine were included. Results: Of the 19 patients treated with azathioprine for recurrent ileitis, 15 could be re-evaluated by endoscopy or radiological examination. The therapy resulted in induction and maintenance of clinical remission in all 15 patients, at least 6 months after complete weaning of the corticosteroids, Complete macroscopic healing of the neoterminal ileum was observed in 6 of 15 patients, near-complete healing with only superficial erosions remaining in 5 of 15 patients, partial healing in 3 of 15 patients, and unchanged inflammatory lesions in 1 patient. Conclusions: It is concluded that azathioprine leads to mucosal healing in severe recurrent Crohn's ileitis and may be the treatment of choice in this indication.

A case is reported in which spiral CT was most the contributive imaging technique in the diagnosis of a postoperative intrathoracic gastric herniation. The coronal reformatted spiral CT images demonstrated very well the intrathoracic stomach located above a normally positioned left hemi-diaphragm. Compared with conventional CT, the multiplanar reconstruction capability provided by spiral CT allowed a much better delineation of the diaphragm in this case.

In comparison with the first half of this century the frequency of X-ray induced lesions diminished spectacularly both in patients and in radiologists in the second half; this was due to more and more rigorous radioprotection. The present measures of radioprotection may be divided into two groups according to their appliance to the patient or the operator. Prevention of irradiation of an unknown pregnancy is the responsibility of the clinician (application of the 10 days rule) but equally of the radiologist (warning poster in the radiological department, query of possible pregnancy). The sensitivity of the imaging material has been raised by adaptation of film, intensifying screens, grids and the use of image intensifier with TV-chain and photofluorography. The quantity of X-rays to the patient may be directly lowered by reducing the time and dose of fluoroscopy, the number of radiographs, by using a diaphragm, by covering some organs with lead shields and by choosing different examination modalities. Dose reduction to the patient may also be achieved by modifications of the quality of the X-ray beam (filter, KV/MA) and by proper indication of the examination. Patient's dose can be calculated by phantom simulation and by chromosomal blood study. The operator is never allowed to put his unprotected hand in the X-ray beam. The amount of scattering radiation to the operator will be lowered by several of the above mentioned measures reducing the patient's dose and by choosing the most favourable direction of the axis X-ray tube-image intensifier. Direct protection of the operator is achieved by lead-glass screens, lead flaps around the patient, lead gloves, apron and glasses and by raising the distance between the operator and the X-ray tube. Early detection of unusual radiation is possible by systematic dosimetry.

The case of a 75-year-old man with a history of hiatal hernia, who develops an acute gastric volvulus 17 days after a superior lobectomy of the left lung, is described. No similar cases were found in literature.

Stenosis of the bifurcation of the hepatic bile duct is usually caused by malignant lesion. We report on three different causes of benign stenosis of the hepatic confluence with a similar radiological pattern on direct cholangiography. The first case is considered a spontaneous neuroma, the second a periductal abscess, and the third case a postoperative stricture Bismuth type 4.

A case of esophageal metastasis from a breast carcinoma is presented. Location was, as usual, midesophageal. The interval of time between breast carcinoma and the onset of esophageal symptoms was rather long. Barium swallow examination enabled correct diagnosis, whereas several series of superficial endoscopical biopsies were negative. Diagnosis was confirmed by deep endoscopical biopsy.

An abdominal ultrasound examination performed on two patients with abdominal pain showed segmental wall thickening of the colon that proved to be due to ischemic colitis. In one case, the typical "target lesion" was recognized. These findings could be confirmed with computed tomography, whereas a single contrast enema was unable to demonstrate the ischemic disease. In the second case, a typical five-layered structure of the bowel wall could be demonstrated. It is concluded that US can be useful in the early diagnosis of colonic ischemia.

This study examined the effects of changes in body position on different swallowing parameters derived from manofluorographic examinations. Quantitative data were obtained in a group of 12 young healthy volunteers. They were all tested in the upright position; six of them were also evaluated in the supine position, and the other six in the upside down position. In the different positions all volunteers were able to swallow a liquid bolus without aspiration or stasis. However, the dynamics of the swallow became different. Lying down resulted in a pharyngeal transit time comparable with the upright position. The tongue driving force was higher and the hypopharyngeal suction power weakened. In the upside down position, the pharyngeal transit time became longer and the tongue driving force was even more powerful. There was no apparent difference in the traditional manometric parameters; the amplitude, duration, and propagation velocity of the pharyngeal contraction on swallowing did not change obviously in the different body positions.