Scrotal ultrasound scans carried out on 156 patients were reviewed in a retrospective study and the sonographic findings and indications evaluated. Ultrasound was able accurately to distinguish the normal from the pathological scrotum. Extratesticular lesions were readily differentiated from testicular lesions. Abnormal testicular echo patterns were usually associated with tumours, but orchitis, granulomas and haematomas were found to have a similar appearance. Occult testicular tumours could readily be identified. Ultrasound was also useful in excluding underlying pathology in hydroceles, in the diagnosis and follow-up of epididymitis and other epididymal lesions and in the assessment of underlying testicular damage in traumatic haematoceles. Ultrasound may also be useful in post-orchiectomy follow-up examinations to exclude tumour in the contralateral testis.
1465since ischaemia or procaine block of peripheral nerves usually abolishes it.3 4Toxic reactions to penicillamine, especially haematological, renal, and gastrointestinal disturbances, occur in patients with rheumatoid arthritis. Neurological complications are relatively uncommon. Polymyositis and myasthenia gravis have been reported, but both were excluded in our patient. The decremental EMG response found only at higher stimulation rates, in the absence of single fibre EMG abnormalities, is unlike that found in myasthenia gravis or EatonLambert syndrome.5 To recognise neuromyotonia requires careful clinical and EMG examination since it is easily mistaken for myasthenia gravis.We thank Dr C G Barnes for referring this patient.
A cholecystokinin (CCK) test was performed on 13 female patients who were thought to be having attacks of gallbladder pain and in whom at least one cholecystogram had been normal. In 10 of these patients the CCK test was performed during the course of a repeat cholecystogram in order to assess the effect of CCK on gallbladder contraction. There was no constant relationship between a positive test and gallbladder contraction as measured radiographically. Cholecystectomy was undertaken in 9 patients and of these, 4 had been CCK positive, 4 had been CCK negative and 1 had reacted equivocally. None of the CCK positive patients had stones at operation, whereas 2 of the CCK negative patients had one or two small stones. In this small series cholecystectomy relieved both the CCK negative and CCK positive patients of pain with equal frequency. It is concluded that a negative CCK test by no means excludes the presence of symptomatic gallstones in patients with X-ray negative gallbladder pain.
To the growing list of anomalous pulmonary veins the following case observed in a 7-day infant, may be added l.Post mortem examination revealed but one major abnormality. The four normal pulmonary veins converge as if to enter the left atrium. Instead they unite behind the heart to form a common pulmonary trunk 3 em. long which arches over the dorsal surface of the right bronchus and empties into a normal vena cava superior about 1 em. above its end ( fig. 1). The common pulmonary trunk receives an additional tributary from the superior lobe of the right lung.The lungs are normal in all respects. The surface vessels are rather conspicuous. The arrangement of bronchi, arteries, and veins at the root of each lung is normal save for the additional vein from the right superior lobe already referred to. The greater part of the anomalous common pulmonary trunk lies in a well-marked azygos groove of the right lung, andThe infant was born October 7th. Delivery was spontaneous and respiration also. Though the baby cried and breathed spontaneously, there was a slight dusky cyanosis present from birth. Physical examination revealed no other abnormalities than B heart rate of 180. The infant's progress was fairly good. He nursed at the breast and took complementary feedings quite well. He became slightly jaundiced October 11th. A t times when crying he would become definitely cyanosed, a t other times he would cry vigorously without very much change. On October 14th, his abdomen appeared very much distended. His cry became weak and shrill and the cyanosis severe. He died on the same day at the age of 7 days.
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This study presents the results of abdominal ultrasonic scanning in 108 patients attending a tropical referral hospital. Clinical diagnoses included hepatocellular carcinoma, metastatic liver disease, amoebic liver abscess, hydatid disease, obstructive jaundice, hepatosplenomegaly of uncertain aetiology and renal cysts and tumours. Because of its ability to distinguish solid from fluid-filled lesions, we found ultrasonic scanning the most useful initial investigation for the differentiation of hepatic masses. Ultrasonography is also ideal for the diagnosis of abdominal cysts and is extremely reliable in differentiating extrahepatic from intrahepatic obstructive jaundice. It is a non-invasive procedure, quick and easily repeatable and has great potential in tropical medical practice.
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