Endoscopic ultrasound (EUS), developed in the 1980s, was initially predominantly used for guidance of fine needle aspiration; the last 25 years, however, have witnessed a major expansion of EUS to various applications, both diagnostic and therapeutic. EUS has become much more than a tool to differentiate different tissue densities; tissue can now be characterized in great detail using modalities such as elastography; the extent of tissue vascularity can now be learned with increasing precision. Using these various techniques, targets for biopsy can be precisely pinpointed. Upon reaching the target, tissue can then be examined microscopically in real-time, ensuring optimal targeting and diagnosis. This article provides a comprehensive review of the various current roles of EUS, including drainage of lesions, visualization and characterization of lesions, injection, surgery, and vascular intervention. With EUS technology continuing to develop exponentially, the article emphasizes the future directions of each modality.

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Pancreatic calcifications, exocrine insufficiency, and endocrine insufficiency are hallmarks of chronic pancreatitis, and their prevalence increases with the duration of disease. We present a case of chronic pancreatitis in which a dramatic and spontaneous decrease in the burden of both parenchymal and intraductal calcifications was noted during longitudinal follow-up. We discuss the possible reasons for spontaneously vanishing calcifications, an entity rarely described in the literature.

A case of acute renal failure after cerebral arteriography with iodinated contrast material in a patient with diabetes and azotemic nephropathy is described. A review of the literature concerning acute renal failure after radiographic contrast material is included. The main risk factors reported in the literature appear to be the presence of diabetic nephropathy and the administration of fairly large doses of iodinated contrast material. Azotemic patients should be kept well hydrated and receive doses of less than 50 cc/m2 of body surface area when studied with such materials. Careful monitoring of urinary output and serum creatinine and ready access to dialytic therapy will aid in the detection and subsequent treatment of this problem.