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Prosthetic graft infections are an uncommon complication of aortic bypass. These infections may have serious sequelae such as limb loss and can be lethal. They are hard to eradicate and, under certain circumstances, difficult to diagnose. Usually, computed tomography (CT) is the most efficacious imaging method for diagnosis of graft infections due to its quick availability. The sensitivity of magnetic resonance imaging in detection of perigraft infection has not been thoroughly investigated but is probably similar to that of CT. After the early postoperative period, persistent or expanding perigraft soft tissue, fluid, and gas are the CT findings of graft infection. Aortoenteric fistula should be considered a subset of aortic graft infection; however, perigraft air is more likely to be seen with an aortoenteric fistula. Other conditions associated with graft infection include pseudoaneurysm, hydronephrosis, and osteomyelitis. Adjunctive studies such as sinography, ultrasonography, gallium scanning, and labeled white blood cell scanning can be quite useful in diagnosis, determination of the extent of disease, and selection of the treatment modality. White blood cell scanning is an important complementary test to CT in ambiguous cases, such as in the early postoperative period, and may be more sensitive in detection of early graft infection.

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Intraluminal duodenal diverticulum is a rare congenital anomaly consisting of a saclike projection within the duodenum. Small diverticula may be asymptomatic; however, when these enlarge, patients may develop recurrent episodes of pain, obstruction, or pancreatitis. Normally, the diagnosis is made by barium luminal examination. We report a case where the findings were seen on computed tomography and confirmed by upper gastrointestinal series.

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A complex mass confined to the gallbladder found on CT is unusual, but nor rare, with causes including benign inflammatory disease, early primary carcinoma and metastases. Non-Hodgkin's lymphoma is rare and Hodgkin's disease, prior to the current case, unheard of involving just the gallbladder. Thus, this should be considered part of the differential diagnosis of a complex gallbladder mass.

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Somatostatinomas are rare neuroendocrine tumors that can result in a variety of symptoms depending on the secretion of other peptides in association with or in response to somatostatin. The rarity and variable clinical presentation of these tumors present problems in diagnosis and management. This report details the treatment of a 66-yr-old male who had a somatostatinoma with an atypical location and presentation. His clinical course was one of recurrent disease treated surgically and the interval development of cholelithiasis. He has survived 5 yr with his tumor, illustrating that monitoring peptide levels and an aggressive surgical approach are warranted for this condition. Prophylactic cholecystectomy should be considered at the time of exploration.

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Growth of neomucosa has been investigated as a means to increase intestinal surface area in the short-bowel syndrome. Functional neomucosa grows over patched intestinal defects, but the effect of the patching procedure on absorption is unknown. The purpose of this study was to determine morphologic and nutritional responses to intestinal patching after resection. Fifteen dogs (13 to 19 kg) underwent either 75% resection of the small intestine (control group, n = 5), simultaneous resection and patching of the intestinal remnant with colon serosa (simultaneous group, n = 5), or resection with patching 12 weeks later (delayed group, n = 5). Caloric intake was standard in the three groups. Animals were killed 40 weeks after resection or patching. At that time, defects were 95% covered with neomucosa in both patched groups. Intestinal remnant length increased significantly in controls (139 +/- 20% initial length) compared to the simultaneous group (99 +/- 6%, p less than 0.05) but not to the delayed group (119 +/- 11%). Villous height of intestinal mucosa was greater in the control and delayed groups than in the simultaneous group (714 +/- 36 and 624 +/- 111 versus 535 +/- 54 micron, p less than 0.05). Fasting gastrin levels were significantly greater in patched animals than after resection alone (p less than 0.05). Intestinal transit by barium meal was significantly longer in patched animals (18 +/- 7 minutes versus 11 +/- 6, p less than 0.05). Body weight and serum albumin level were significantly lower in patched animals at death. Fecal weight, moisture, and fat excretion were significantly increased in the simultaneous group. Although intestinal patching results in the growth of neomucosa and prolonged transit time, it has a deleterious effect on absorption and nutritional status. In part, this may be related to inhibition of intestinal adaptation and gastric hypersecretion in patched animals.

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Three patients with neoplasms on the anterior wall or dome of the urinary bladder underwent intravenous urography (IVU). In each case, the lesion was detected only on the prone-position radiograph. Contrast medium layers in the dependent part of the bladder. If all filming is performed with the patient in supine position, lesions on the anterior wall may be undetected. We advocate routine inclusion of one prone-position film during IVU.

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The ability of aerobic and facultatively anaerobic endocervical flora to inhibit the growth of Neisseria gonorrhoeae in vitro was assayed. Factors influencing the occurrence of inhibitory components of the flora in vivo were evaluated. Endocervical swabs were obtained from 229 women at a local venereal disease clinic. Endocervical flora and N. gonorrhoeae were isolated and identified, and the ability of the flora to inhibit the growth of N. gonorrhoeae was determined by an agar overlay assay. Results revealed the most active inhibitors to be streptococci, staphylococci, and lactobacilli, in that order. Among only those women harboring inhibitory endocervical flora, inhibitory lactobacilli were recovered from fewer women infected with N. gonorrhoeae than uninfected women (P less than 0.05). Among women having contact with an infected partner, those who subsequently developed gonorrhea were less likely to have inhibitory lactobacilli than those who did not become infected (P less than 0.05). No other significant differences in the composition of the inhibitory flora were noted between infected and uninfected women. During the 2 weeks following menses, recovery of inhibitory lactobacilli on culture was highest, whereas recovery of N. gonorrhoeae was lowest. These observations suggest that the presence of certain lactobacilli may reduce risk of acquisition of N. gonorrhoeae following exposure to infected partners and that the potential protective effect may be greatest during the 2 weeks after menses.

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