Importance of metrizamide CT for evaluation of the thoracic spine

Post-metrizamide myelographic CT of the area of interest is indicated in cases in which myelography is normal, and also in cases in which myelographic findings alone cannot explain the patient's symptoms. Obtaining early and 4-6 hour delayed CT is of great importance for the detection of syringomyelia and cystic lesions of the cord. In cases of congenital anomalies, additional information can be obtained by this method. This paper presents our experiences at Loyola University Hospital.

Cerebellar venous angiomas. A continuing controversy

We have studied three patients with angiographically documented cerebellar venous angioma (CVA). One patient had a subacute cerebellar hematoma and underwent posterior fossa craniotomy for evacuation of the hematoma and excision of the malformation. A hemorrhagic venous infarction of the brain stem and cerebellum occurred, and the patient died three weeks postoperatively. A second patient with an unruptured CVA had a history of headaches, tinnitus, and vertigo. Conservative treatment was elected, and the patient's condition remains unchanged after 11 months of follow-up. The third patient, recently diagnosed as having an unruptured CVA had episodic vertigo and disequilibrium. Conservative treatment was chosen, and he is asymptomatic after six months of follow-up. Based on a review of 24 other cases of CVA plus our experience we could not conclude any definite trend regarding natural history or treatment. However, conservative treatment seems the logical choice in patients with unruptured CVA.

Cerebellar infarction--clinical and cranial computerized tomography correlations

We analyzed the clinical and cranial computerized tomographic (CT) features of 10 patients with cerebellar infarction. Among patients with recent cerebellar infarction, the initial CT often failed to demonstrate any recognizable abnormality. Because early neurological deterioration may arise despite normal CT studies, a high level of clinical awareness is critical for appropriate intervention.

Oculomotor nuclear complex infarction. Clinical and radiological correlation

We describe a patient with an isolated mesencephalic dorsal tegmental infarct affecting the oculomotor nuclear complex and medial longitudinal fasciculus, documented by high-resolution computed tomography, after undergoing percutaneous transluminal coronary artery angioplasty. Clinically, the patient exhibited bilateral ptosis, bilateral internuclear ophthalmoplegia, transient convergence retractory nystagmus, and minimal somnolence. We believe the combined clinical and radiological findings favor the presence of a caudal, dorsal, and paramedian embolic infarct in the territory of the paramedian branches of the mesencephalic artery as the most likely mechanism for these exceptional findings and correlate them with Warwick's scheme of the oculomotor subnuclei.

Radiology of anterior cerebral artery infarction

Twenty patients with anterior cerebral artery infarction are reviewed. Usual and unusual clinical presentation and radiographic findings (angiography and computed tomography) are correlated.

The maintenance ofBdellovibrio at low prey density

A mathematical model for the interaction ofBdellovibrio and its prey predicted that a relatively high prey density (7×10(5) cells ml(-1)) would be required for the establishment of an equilibrium in a mixed population [8]. The present report shows thatBdellovibrio can be maintained in a continuous culture when the prey cell density is much lower (2-5×10(4) cells ml(-1)), and closer to that of naturally occurring bacterial populations in sea waters.

Mucocutaneous lymph node syndrome

A 3-year-old child presented with a short clinical history of fever and diffuse cervical lymphadenopathy, and the diagnosis of mucocutaneous lymph node syndrome was reached. We include a discussion of the case history and a brief review of this disorder.

Recurrence of the clinical signs of lattice corneal dystrophy (type I) in corneal transplants

Lattice corneal dystrophy (type I) is characterized by branching stromal lattice figures, white subepithelial opacities, and anterior stromal haze. Corneal transplantation is often required to restore the vision of patients with lattice corneal dystrophy. Our retrospective study of 61 penetrating keratoplasties in 39 patients with lattice corneal dystrophy found clinical signs of lattice corneal dystrophy in 29 transplants (48%) after periods ranging from three to 26 years. Subepithelial opacities or anterior stromal haze or both were the most common signs of recurrence. Lattice figures appeared in only one graft. Regrafting was necessary to restore vision in eight cases (15%) in which primary corneal transplantation had been performed for this condition.

Intraoperative and outpatient echoencephalography through a burr hole

Ultrasound images of the brain were obtained intraoperatively and on an outpatient basis through a burr hole. The patient's tumor was well visualized, prior to biopsy, after biopsy, and during radiation therapy treatment. The ultrasound images correlated closely to the CT scan findings.

Foster-Kennedy syndrome due to optochiasmatic arachnoiditis

A case of optochiasmatic arachnoiditis mimicking Foster-Kennedy syndrome is reported. The difficulties in establishing diagnosis are considered, and the literature of optochiasmatic arachnoiditis presenting in this unusual manner is reviewed.

CNS lesions in neonatal isoimmune thrombocytopenia

We treated two siblings with classic neonatal isoimmune thrombocytopenia and porencephalic cysts in whom the CNS lesions occurred in a vascular distribution, for which there is no clear explanation. Whether the CNS vasculature is injured by the immune process at certain susceptible sites in larger vessels or whether there is a thrombotic process occurring at sites of vascular injury is speculative. This observation suggests that vascular factors are involved in the development of CNS lesions in this condition.

Long-term changes in corneal endothelium following penetrating keratoplasty. A specular microscopic study

One hundred clear corneal grafts with a minimum follow-up of 10 years and average follow-up of 17.4 years were studied with specular microscopy. Central and peripheral graft endothelial cell counts as well as central corneal thickness measurements were done and these were correlated with the following parameters: diagnostic subgroups; donor age; graft age (follow-up time); and the postoperative clinical course. The average central endothelial cell counts for the entire series was 684 cells/mm2. Peripheral cell counts were performed in 78 eyes and averaged 749 cells/mm2. Central corneal thickness was measured in 80 eyes and averaged 0.49 mm. There were no statistically significant differences in central or peripheral cell counts when analyzing donor age, graft age, or postoperative course. When cell counts were examined among the diagnostic subgroups, those in the hereditary stromal dystrophy subgroup had a significantly lower cell density when compared to those in the keratoconus subgroup.

Radiologic evaluation of tuberculous meningitis

Five cases of primary tuberculous meningitis are presented. In three cases of acute meningeal process, the classic computed tomographic (CT) scan findings of basal meningeal enhancement, hydrocephalus and arteritis on angiography were found. These radiologic findings suggested the diagnosis, and antituberculosis treatment was therefore instituted at an early stage of the disease. In the remaining two cases with late complication of tuberculous meningitis, hydrocephalus and basal vessel arteritis were present. The importance of correlation of the clinical and radiographic findings is discussed.

Groups for parents of children with Down's Syndrome and multiple handicaps: a pilot project

One of the main purposes of an Infant Stimulation Program is to assist parents in finding ways of adjusting to and developing the potential of the handicapped child. The Peel Infant Stimulation program at the Mississauga Hospital in Mississauga, Ontario, while aptly fulfilling this purpose, noted that in some instances the stress of having a handicapped child added tension to the marital relationship. In addition, some parents appeared to have difficulty recovering from the news of their child's condition. In response to these observations a consultant with expertise in groups, couples, and family therapy was hired to help form groups for parents who appeared to be having difficulties. An Occupational Therapist from the Infant Stimulation Program was trained in group leadership while co-leading the groups with the consultant. The article explores the rationale for the groups, describes the sessions, and discusses a number of issues that are pertinent to the running of the groups. The intent of the article is to encourage staff working in similar programs to investigate the use of parent groups.

Malignant lymphoma of the nervous system

The radiological findings in 22 patients with malignant lymphoma of the nervous system are reviewed in relation to the clinical and histological features. The radiological findings were grouped into four major categories: intracranial, orbital, nasopharyngeal, and spinal. A fifth category, complications, was considered separately. The common neuroradiological manifestations of nervous system lymphoma are reviewed and compared with the recent literature.

The prognosis for keratoplasty in keratoconus

The long-term results in 326 eyes grafted for phakic keratoconus by the same surgeon were reviewed. All consecutive grafts performed for this disease with a minimum of five-year follow-up were included in the study. The mean follow-up was 11.3 years, with a range of 5 to 34 years. Ninety percent of grafts remained clear, 3% were nebulous but retained 20/40 vision, and 7% failed. Donor age was available for 188 of the 326 grafts. No relationship was found between donor age and long-term graft clarity even when older (more than 70 years) donor tissue was used. The visual acuity was measured with the patient's preferred optical device worn daily. Seventy-three percent of eyes achieved 20/40 or better vision after their initial graft.

Putting secondary prevention to the test: A study of an early intervention strategy with disabled workers

The enormous costs associated with physical and pyschiatric disability have camouflaged, in some ways, the utility of prevention in the area of disability. Overwhelmed by the needs of the severely disabled, funding and service agencies have been legislatively mandated to earmark their monies disproportionately for the most severely disabled rather than channeling funds toward early intervention services. The study described in this article is designed to measure the cost and health implications of an alternative allocation of resources for the disabled, to compare a secondary and tertiary prevention service. The preventive disability service that was tested was designed out of the results of a preliminary study of disability claimants, conducted at the same site. The study population was a sample of the claimants of the Health and Security Plan of a large urban union. Persons who filed claims with the Plan during 1974 were studied in terms of their demographic, employment and disability characteristics. High, moderate and low risk groups were identified; a specified subsample was targeted for testing the preventive service.