Prostaglandin E1 for alleviating symptoms of ergot intoxication: a case report

A woman was admitted after ergotamine tartrate overuse for migraine headaches and her symptoms of arterial vasospasm were treated with PGE1, the first reported use of the vasodilator for ergot intoxication. The advantages of producing local vasodilatation without systemic effect, as well as inhibiting the formation of arterial microthrombi, suggest PGE1 as the agent of choice for relief of symptoms due to peripheral vasoconstriction caused by ergot. Treatment with PGE1 may allow sufficient collateral to preserve limb function and integrity, while awaiting remission of anatomic changes after withdrawal of ergot.

Current experience with digital subtraction angiography in the community medical center

At the community medical center, we have introduced and successfully applied digital subtraction angiography (DSA) to disease processes seen in 1,144 patients. Although there is a trade-off between increased contrast resolution and decreased spatial resolution with the DSA approach, nonetheless in many vascular beds it provides rapid, safe, and accurate disease diagnosis.

Prostaglandin E1 in hand angiography

Prostaglandin E1 (PGE1) is a rapid, potent vasodilator which, when infused into the arterial system in low doses by bolus injection, has no significant systemic effects and has a relatively long duration of action. Sixty-three hand angiograms were done on 55 patients, comparing PGE1 to tolazoline and to angiograms done with no vasodilation. There was no significant difference between PGE1 and tolazoline in digital artery opacification; however, venous opacification was very significantly better with PGE1. PGE1 should be a drug of choice in hand angiography.

[Diffuse superficial nephroblastomatosis. Chemotherapy. 1 case]

A case of superficial diffuse nephroblastomatosis involving both kidneys in a 14-months old child is reported. Urographic and arteriographic results as well as the still little-known ultrasonographic images made it possible to determine pre-operatively the nature of the tumour and to exclude the initial diagnosis of Wilm's tumour. A relatively non-aggressive chemotherapy resulted in complete involution of the subcapsular tumoral envelope. The close embryogenic and oncogenic relationship between nephroblastoma and nephroblastomatosis is recalled.

[Renin-angiotensin-aldosterone system in obese children]

Plasma renin (PRA) and aldosterone activities were measured in 29 obese children and in 48 controls of the same age. Blood samples were taken at 8 AM after a night's sleep and after 3 days of a diet with normal sodium intake. The PRA in the obese children was lowered: m = 1.00 ng/ml/h (controls = 1.86 ng/ml/h; p = 0.01). The drop in plasma aldosterone activity was not significant: m = 134.1 pg/ml (controls: m = 167.5 pg/ml). Plasma aldosterone activity was positively correlated with PRA in controls (p less than 0.01): this correlation was not found in obese children. In obese children no dissociation could be found, in the resting state, between plasma aldosterone activity and PRA, contrary to obese adults under stimulation. In fact, 1) the aldosterone/PRA ratio did not differ significantly between obese children and controls, 2) the average value of plasma aldosterone activity that one could predict in the obese children from their average PRA level and the linear regression calculated from the controls exactly corresponded to the measured value. The elevated blood pressure found in the obese children could explain the drop in the PRA which would thus remain adapted to the blood pressure level.

Digital subtraction angiography for localization of parathyroid lesions

Transvenous digital subtraction angiography was used before surgery to evaluate seven patients with chemical evidence of hyperparathyroidism. Digital subtraction angiography identified parathyroid adenomas in six of the seven patients. This technique is a sensitive, although not specific, method to identify small vascular tumors.

Type I Glanzmann's thrombasthenia segregates independently of Ss and Duffy systems and the A, B, C, factor B, C2 and C4 loci of the HLA complex

Two patients with type I Glanzmann's thrombasthenia and 20 kindred of these patients belonging to 2 families of the Manouches gipsy tribe have been studied. Quantitative measurements of platelet membrane glycoproteins GP IIb and GP IIIa have made it possible to classify the patients into normal, thrombasthenic or carriers of the thrombasthenic abnormality. We have examined several red cell alloantigens and antigens of the major histocompatibility complex. These studies have shown that: 1) type I Glanzmann's thrombasthenia (GP IIb and IIIa abnormality) segregates independently of Ss and Fy systems and the A, B, C, Bf, C2 and C4 loci of the HLA complex; 2) a rare hemolytically inactive C4 variant segregates in these families but is not associated with the GP IIb and IIIa abnormality.

Computed tomography - guided removal of an osteoid osteoma: a case report

An osteoid osteoma nidus was removed under computed tomography (CT) scan guidance. This procedure may have advantages over en bloc resection for treatment of osteoid osteoma since it ensures the removal of the nidus without producing a large bony defect such as results from en bloc resection.

Phlebotomy with iron therapy to correct the microcytic polycythemia of chronic hypoxia

Patients with chronic hypoxia develop a physiologically appropriate "secondary" polycythemia that improves oxygen carrying capacity. Supplemental iron is often required to maintain this. In severe cases when hematocrit levels approach 70%, iron is withheld in order to avoid dangerously high hematocrit levels and the risks of vascular sludging due to "hyperviscosity." Some patients even require reduction of viscosity by exchange of their polycythemic blood for plasma when symptoms develop. Iron deficiency with microcytic polycythemia can then develop. Management of such patients is unclear. Continued blood withdrawal will worsen the iron deficiency; iron supplementation will increase the hematocrit level and the risks of hyperviscosity. The combination of frequent phlebotomy with oral iron therapy should improve iron stores while safely maintaining a stable hematocrit level in patients with microcytic polycythemia. This combination should also have multiple beneficial effects on tissue oxygen delivery and utilization. This approach has been discussed and used for a patient with microcytic polycythemia due to Eisenmenger syndrome. While on therapy the patient's clinical symptoms decreased, and his serum iron level, hematologic indices, and treadmill tolerance tests all improved.

Familial pterygium syndrome

Two sisters affected with the same disorder are described. They had webbing of the neck, the antecubital fossae and the popliteal regions, together with flexion deformities of the limb joints and anomalies of the vertebrae. Eight other cases are known. The condition is inherited in an autosomal recessive mode.

[Articular contracture with dwarfism and normal intelligence: a new autosomal dominant familial syndrome]

A father and his daughter has the same features: short stature, the distal phalanges, the wrists, the elbows, the feet and the knees were flexed. All other joints had abnormal range of motion. Kypho-scoliosis was present in the father only. Father's family was normal. Upon X-rays examination no abnormalities could be seen. This syndrome is inherited as autosomal dominant.

Demographic factors in the disability determination process: a logistic approach

Identifying the demographic factors that affect the likelihood of being allowed disability insurance benefits under the social security program is important in assessing the operation of that program and has been the focus of continuing research. Previous studies in this area, which have been limited to cross-tabular analyses of aggregated data and the examination of a few variables at a time, have uncovered apparently sizable differences in the probability of allowance by age, sex, race, and other demographic characteristics. This article uses a much more rigorous statistical technique--a logit maximum likelihood procedure--to examine the same question. That technique permits exploration of the relationship between a particular characteristic and the probability of allowance while controlling for the effect of other characteristics considered in the analysis. The findings show that cardiovascular primary diagnoses had a higher probability of allowance than did almost all other primary diagnoses. Mobility restrictions, older age at the onset of disability, and residence in States with temporary disability programs also were associated with a higher probability of allowance. Applicants who were black or from the South were found to have a lower probability of allowance. In general, those results applied to both men and women.

[Sensibility to insulin in obese children (author's transl)]

The glucose and immuno-reactive insulin blood levels of 46 obese children and nineteen controls were measured during the intra-venous glucose tolerance test. The glucose tolerance of the obese children was normal, whereas their blood insulin curves demonstrated hyperinsulinmeia. The sensibility to exogenous insulin in 29 of these children was within normal limits during the hypoglycemic tolerance test induced by injection of intravenous insulin. The factors explaining endogenous insulin resistance have not yet been elucidated.

Roberts's syndrome and clonidine

A child is described with features of Robert's syndrome. The mother took clonidine during pregnancy. The question of a relationship between the child's abnormalities and clonidine is raised.

A new catheter system for permanent percutaneous nephrostomy

A new catheter system is described for permanent percutaneous nephrostomy. The system allows the rapid, single stage placement of a large diameter drainage catheter. The technique avoids several problems associated with previous methods of percutaneous nephrostomy.

Radionuclide scintiphotography in defining postoperative pulmonary vasoconstriction. Succesful results after tolazoline administration in a four-month-old infant with congenital heart disease

99mTechnetium macroaggregated albumin has successfully been used to define severe postoperative pulmonary vasoconstriction in a four-month-old boy with D-transposition of the great vessels who had undergone a Blalock-Hanlon surgical atrial septectomy. Radionuclide imaging documented clinically suspected pulmonary vasoconstriction and led to the successful use of tolazoline (Priscoline) to reverse the vasoconstriction with improved pulmonary blood flow patterns.

[Hereditary chronic pancreatitis: an autosomal dominant disease (author's transl)]

We have studied a family in which three people, two child and an adult had hereditary pancreatitis. Hereditary pancreatitis is not a common disease. Abdominal pain is usually the first clinical sign in children. The knowledge of the existence of such a disease and familiarity with the family history of the child allow the pediatrician to make the diagnosis as soon as the first crisis appears. Surgery is thus avoided. Our studies show definitively that this disease is hereditary and is autosomal dominant with a strong decrease of the penetrance.

The use of a CT scan computer for non-CT applications: teaching file program

The utility of CT scanners may be further increased by using the computer contained in such scanners for non-CT purposes-the creation of a teaching file in this case. No knowledge of computer programming is assumed on the part of the operator. Directions are given in accessing the computer as well as in programming.

[Williams and Beuren's syndrome with hypertension and associated renal abnormalities (author's transl)]

The authors presented a case of the Williams and Beuren's syndrome, special by the existence of aorta coarctation, high blood pressure, nephrotic syndrome and renal dysplasia. The Williams-Beuren's syndrome is characterised by the association of facial anomalies, mental retardation and supra-valvular aortic stenosis. The case presented in this study demonstrates: -- the symptomatic diversity of the Williams and Beuren's syndrome; -- and the relationship of this syndrome and severe idiopathic hypercalcemia of the infant. The etiopathogenesis is also discussed.

Benign giant adrenal cyst and parathyroid adenoma: a case report

An unusual case of a benign adrenal cyst and a parathyroid adenoma occurring in a 59-year-old man with hypercalcemia is reported. Excretory urography, ultrasound, renal aortography, computerized axial tomography and selective thyroid venous sampling were used to establish a diagnosis. Left adrenalectomy was done because of a suspicion of malignancy, which was followed by excision of a retrolaryngeal parathyroid adenoma.

Use of the Simmons "Sidewinder" femoral-cerebral catheter for abdominal angiography

The authors describe a single catheter system which allows rapid, routine abdominal angiography. Selective and subselective studies are easily performed, and the catheter can be used without modification for Pitressin infusion and embolization.

Presplenectomy transcatheter occlusion of the splenic artery

Transcatheter splenic artery occlusion can be performed rapidly and safely prior to splenectomy. This procedure reduces splenic bulk and decreases intraoperative bleeding. Patients not operated on after transcatheter splenic artery occlusion have had high mortality, and therefore the procedure should probably not be considered unless splenectomy is contemplated. An illustrative case is reported.