Sonography of intracranial air in a newborn with meningomyelocele

A newborn with an open meningomyelocele and intracranial air is described. Transfontanellar sonography allows initial detection of the unusual and previously undocumented finding of intracranial air associated with spinal dysraphism.

Doppler sonography: a noninvasive method for evaluation of hepatic venocclusive disease

Hepatic venocclusive disease is a serious complication associated with chemotherapy and radiation used in bone marrow transplantation patients. In the past, liver biopsy has been the only reliable means of diagnosing venocclusive disease. Biopsy in such patients may be dangerous or impossible because of severe coagulopathies. The purpose of our study was to evaluate duplex Doppler sonography in diagnosing hepatic venocclusive disease. We measured the blood velocity and flow in the portal vein, hepatic vein, and inferior vena cava of six patients who were histologically proved to have developed hepatic venocclusive disease after bone marrow transplantation. There were three men and three women with a mean age of 32 years (range, 21-44 years). Examination with Doppler sonography suggested the diagnosis a mean of 41 days (range, 11-62 days) after transplantation. In three patients, the diagnosis was suggested by reversed or "to and fro" flow in the portal vein. In the other three patients, the diagnosis was suggested by a decreased flow in the portal vein. One of these patients with decreased flow had subclinical hepatic venocclusive disease. In this patient, it was not the absolute level of flow but the decrease from a baseline established before ablative therapy that suggested the diagnosis. The amplitude of pulsatility in the hepatic veins appeared to decrease with the onset of venocclusive disease. In the hepatic veins and inferior vena cava, flow toward the heart was maintained. Our findings suggest that duplex Doppler sonography may be useful in detection of hepatic venocclusive disease. We speculate that, with wider experience, Doppler sonographic detection of decreased or reversed flow in the portal vein, in the proper clinical setting, may provide a noninvasive means of reliably diagnosing hepatic venocclusive disease in patients too ill to undergo liver biopsy.

Pneumococcal colitis: report of a case with radiologic and endoscopic findings

Gastrointestinal symptoms and signs have been reported in association with pneumococcal infection for many years. Only rarely has Streptococcus pneumoniae been reported as a bowel pathogen. We report the clinical, radiographic, colonoscopic, and pathologic features of a case of pneumococcal colitis in an otherwise healthy 3.5-year-old female.

Response of the mesenteric circulation to serotonin in normal and atherosclerotic monkeys: implications for the pathogenesis of non-occlusive intestinal ischaemia

We tested the hypothesis that atherosclerosis potentiates vasoconstrictor responses in the mesenteric circulation to stimulation of serotonergic and alpha-adrenergic receptors. In normal monkeys, infusion of serotonin had little effect on blood flow to the stomach, duodenum, and colon. In contrast, in atherosclerotic monkeys, serotonin produced a modest decrease in blood flow to the stomach and duodenum, and virtually abolished blood flow to the colon. Vasoconstrictor responses to phenylephrine in the stomach and duodenum were not altered by atherosclerosis, but responses were potentiated in the colon of atherosclerotic monkeys. In summary, atherosclerosis greatly potentiates vasoconstrictor responses to serotonin in the mesenteric circulation, particularly in vessels to the colon. We speculate that release of serotonin during adherence and aggregation of platelets at atherosclerotic lesions, coupled with augmented vasoconstrictor responses to serotonin, may play a role in the pathogenesis of non-occlusive mesenteric ischaemia.

Fragmentation of biliary tract stones by lithotripsy using local anesthesia

Extracorporeal shock wave lithotripsy has become an important mode of therapy for renal lithiasis in patients who cannot withstand surgery. Recently, this method has been successful in fragmenting biliary stones in selected healthy patients. We report the successful fragmentation of biliary stones after the administration of local anesthesia in two patients who were poor surgical risks.

Capacitance of the rabbit portal vein and inferior vena cava

1. We used vessel strips and whole vessels in vitro to determine the length-tension and pressure-volume relationships of two veins with similar diameter and wall thickness, the portal vein and inferior vena cava of rabbits. 2. Length-tension studies indicate that longitudinal and circular strips of the portal vein have significantly smaller elastic moduli than similar strips of the inferior vena cava (P less than 0.05). 3. Pressure-volume relationships of intact vessels indicate that pressures greater than 5 mmHg do not produce significant increases in volume of the inferior vena cava, whereas volume of the portal vein increases significantly over a range of pressures from 2 to 15 mmHg. 4. Activation of smooth muscle with noradrenaline reduces the volume of the vena cava at distending pressures less than or equal to 5 mmHg. In contrast, noradrenaline reduces the volume of the portal vein at pressures up to 10 mmHg. During inactivation in calcium-free solution and activation with noradrenaline, the portal vein is more compliant than the inferior vena cava (P less than 0.05). 5. Morphometric studies demonstrate more collagen in the inferior vena cava than in the portal vein. Differences in capacitance of the vessels may be related, in part, to greater collagen content in the inferior vena cava.

Motor vehicle related injury on the bridges between Montreal and the South Shore of the St. Lawrence River, 1978-1982

The injury experience related to motor vehicle crashes on four bridges and one tunnel in Montreal, Quebec, Canada, from 1978 to 1982, are described. Particular attention is given to the Jacques Cartier Bridge, publicly perceived as being excessively dangerous. Data from the Quebec Automobile Insurance Board and police reports confirm an excess of deaths (19/34; rate ratio = 4.5) and severe injuries (69/109; rate ratio = 6.2) on the Jacques Cartier Bridge, and the association of 74 per cent of the fatalities and 64 per cent of the severe-injury cases on this bridge with a single curve. Crashes follow a consistent pattern; vehicles fail to negotiate the curve and strike vehicles moving in the opposite direction. The demonstrated association between crashes and design factors provides a basis for identifying effective remedial and preventive measures.

Small intestinal motility in myotonic dystrophy patients

We performed jejunal manometric studies on 10 myotonic dystrophy patients who had symptoms of disordered gastrointestinal motility. Reduced peristalsis of the duodenum and proximal jejunum was noted in 1 patient who had an upper gastrointestinal series, but the small bowel was radiographically normal in 8 other patients. None of the myotonic dystrophy patients had a normal jejunal manometry. The abnormalities included low amplitude contractions during phases 2 and 3 of the migrating motor complex and after eating, as well as a higher frequency of contractions during phase 2. Retrograde propagation of phase 3 occurred in 2 patients, and interruption of contractions during phase 3 occurred in 4 patients. The incidence of tonic contractions was also higher in myotonic dystrophy patients. We conclude that (a) abnormal small intestinal motility is common in patients with myotonic dystrophy and (b) jejunal manometry is more sensitive than barium radiographic studies in detecting small intestinal motility abnormalities in this disorder.

Responsiveness of longitudinal and circular muscle layers of the portal vein

This study was performed to compare mechanical activity produced by acetylcholine and histamine in longitudinal and circular muscle layers of the portal vein. Peak tension was measured in longitudinal and circular muscle strips from portal veins of rabbits as they were superfused with acetylcholine and histamine (10(-6) to 10(-4) M). Responses to acetylcholine were three to four times greater in longitudinal muscle than in circular muscle; for example, acetylcholine (10(-5) M) produced contractions of 1.6 +/- 0.2 X 10(3) (mean +/- SE) dynes in longitudinal muscle and 0.4 +/- 0.09 X 10(3) dynes in circular muscle. In the same strips, histamine produced similar responses in the two layers: histamine (10(-5) M) produced contractions of 0.4 +/- 0.1 X 10(3) dynes in longitudinal and 0.4 +/- 0.1 X 10(3) dynes in circular muscle. Histological studies of portal vein muscle strips showed that the longitudinal muscle layer is three to four times thicker than the circular muscle layer. Thus, in response to acetylcholine, tension developed in each muscle layer is proportional to the thickness of that layer. In response to histamine, however, longitudinal muscle develops less tension than is predicted by the thickness of the muscle layer. We conclude that longitudinal and circular muscle layers of the rabbit portal vein differ in their responsiveness to histamine.

Unanswered questions about the periodic health examination

The periodic health examination in its application as a screening procedure in asymptomatic, ostensibly healthy persons is explored with a focus on the following issues: (a) the impact on health, (b) the content of a beneficial health examination, and (c) the effect of the examination on the physician-patient relation. The application discussed is distinct from use of the examination as a tool for diagnosis, prognosis, or therapeutic planning for patients with a specific illness. The discussion also shows a relatively recent change in the goal for the clinical assessment. There has been a shift in emphasis from establishing a diagnosis as the main outcome event of the periodic "checkup" to the identification of an intervention of value to the patient. Evidence from various studies that throw some light on related questions is considered. Special ethical issues surrounding the unsolicited medical assessment are identified. Finally, some ground rules for decisions about the periodic health examination are proposed.