No abstract

The purpose of the study was to evaluate and compare opacification of the renal collecting system and ureters detected by computed tomographic urography (CTU) performed 20 min and 1 h after the ingestion of 1,000 ml of water. CTU was performed on 89 patients (55 men, 34 women; age 28-77 years) and 168 collecting systems and ureters were evaluated. A 16-detector-row scanner (Sensation 16, Siemens) was used; a two-phase protocol with a split bolus of contrast agent (total 120 ml) was applied. A combined nephrographic-excretory phase was obtained 100 s after the second injection. Three-dimensional reconstructions of the excretory phase were created and used to evaluate the degree of opacification of the collecting system and ureters. In 44 patients, water was administered 20 min before examination, and in 45 patients, 1 h before examination. CTU performed 1 h after water ingestion demonstrated complete opacification of calices in 87.5%, of renal pelvis in 97.5%, of upper ureter in 91.8% and of lower ureter in 87.5% of patients. CTU performed 20 min after water ingestion demonstrated complete opacification of calices in 79.5%, of renal pelvis in 85%, of upper ureter in 62.5% and of lower ureter in 54.5% of patients. Complete opacification of the proximal and distal ureter in the group with a 1-h delay was statistically higher (P<0.01). CTU performed on the distended bladder, 1 h after the oral ingestion of water, enables excellent opacification of collecting system, including distal ureters.

Coronary artery aneurysm (CAA) is defined as dilatation of the coronary artery that is more than 1.5 times the diameter of normal adjacent segments. A coronary artery with a diameter more than 2 cm is termed as 'giant aneurysm' and only a few cases have been described in the literature. In adults, CAA is predominantly atherosclerotic in origin; however, other causes include Kawasaki disease, autoimmune disease, trauma, infection, dissection, congenital malformation and angioplasty. Clinical presentation, prognosis and management of a giant CAA are not well defined due to limited experience. We present the case of a patient with giant aneurysm of the proximal segment of the right coronary artery.

Wormian bones are small ossicles appearing within the cranial sutures in more than 40% of skulls, most commonly at the lambdoid suture and pterion. During the skeletal analysis of an unidentified male war victim, we observed multiple wormian bones and a patent metopic suture. Additionally, the right elbow was deformed, probably as a consequence of an old trauma. The skull was analyzed by cranial measurements and computerized tomography, revealing the presence of cranial deformities including hyperbrachicrania, localized reduction in hemispheral widths, increased cranial capacity, and sclerosis of the viscerocranium. Besides unique anatomical features and their anthropological value, such skeletal abnormalities also have a forensic value as the evidence to support the final identification of the victim.

Hepatobiliary and pancreatic: Biliary rupture of an hydatid cystHydatid cysts form when the larvae of Echinococcus granulosis encyst within the liver or other organs. Cysts often grow at a rate of approximately 1 cm per year but it is common for cysts to lose viability in patients over 60 years of age. The majority of human infections are asymptomatic. However, cysts that are 10 cm or more in diameter can cause discomfort or pain in the upper abdomen. The most common acute presentation is that of rupture of the cyst into the biliary system. This usually results in cholangitis with jaundice. Other acute presentations involve liver abscesses, pancreatitis and rupture of hepatic cysts into the peritoneal or pleural cavities. In the patient described below, the hepatic cyst ruptured into the left hepatic duct and resulted in cholangitis.A 54-year-old man was admitted to hospital with upper abdominal pain, jaundice and fever (39.6°C). Abdominal pain had been present for approximately 4 weeks and had been associated with anorexia and weight loss. On physical examination, he had an enlarged liver with upper abdominal tenderness. Blood tests revealed an elevated white cell count (19.4 ¥ 10 9 /l) with a high erythrocyte sedimentation rate (113 mm/h) and an elevated C-reactive protein (75 mg/l). The serum bilirubin was elevated at 323 mmol/l and this was associated with a high alkaline phosphatise (1143 U/L) and a minor elevation of aspartate aminotransferase (126 U/L) and alanine aminotransferase (109 U/L). An upper abdominal ultrasound study showed a cystic lesion in the left lobe of the liver with a dilated left hepatic duct. A contrastenhanced computed tomography scan (Figure 1) showed a cystic structure in the left lobe of the liver, patchy calcification of the cyst wall, air in the right hepatic duct and mild dilatation of the bile duct (14 mm). No abnormalities were seen in the gallbladder. With magnetic resonance cholangiopancreatography (Figure 2), the irregular cystic structure communicated with the left hepatic duct. In addition, the bile duct was mildly dilated and the cystic structures and the bile duct were filled with spiral filling-defects. The patient was treated with antibiotics and subsequently had a surgical procedure that included a left hepatectomy, cholecystectomy, choledochotomy and T-tube drainage. On microscopic examination, there was hydatid sand with a protoscolex of E. granulosis. In the post-operative period, he was treated with albendazole. Endoscopic sphincterotomy was not performed in the above patient but can facilitate resolution of cholangitis.