Serial CT scans in Haemophilus influenzae meningitis of childhood

Eleven children admitted to hospital with H. influenzae meningitis had computerized tomographic head scans during the acute stage of the illness. 10 of the 11 had at least one other scan between two weeks and 30 months later. This study evaluated the changes seen in the scans in relation to the evolution of the illness, especially with reference to subdural effusions and communicating hydrocephalus. The early scans were found to have no significance in predicting clinical outcome. However, a temporary developmental lag occurred in those children with subdural effusions, transient communicating hydrocephalus, and without permanent neurological deficit.

Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

Is selective therapy of recurrent nephrolithiasis possible?

We evaluated, in 128 patients with recurrent nephrolithiasis, the efficacy of special treatment programs for some of the common causes of nephrolithiasis, chosen on the basis of their ability to correct underlying physicochemical and physiologic derangements. Therapy included sodium cellulose phosphate for 18 patients with absorptive hypercalciuria, thiazide diuretics for 27 patients with absorptive hypercalciuria and for 10 with renal hypercalciuria, orthophosphate for eight patients with hypophosphatemic absorptive hypercalciuria, allopurinol for 21 patients with hyperuricosuric calcium oxalate nephrolithiasis, thiazide and allopurinol for 26 patients with absorptive hypercalciuria with hyperuricosuria, and high fluid intake and/or low calcium diet for 22 patients with normocalciuric nephrolithiasis. Patients in all seven groups had a significant reduction in stone formation during 1.70 to 3.37 years of treatment, as compared with the pretreatment period of three years. Remission was found in 70 to 91 percent of patients and reduced stone formation rate was encountered in 88 to 100 percent. Each treatment program produced a significant decline in stone formation rate from 1.90 to 2.28 stones per year to 0.09 to 0.55 stones per year. The actual number of stones formed during treatment was significantly lower than the number predicted from the pretreatment frequency of stone formation (less than 26 percent). The results provide evidence supporting a selective approach to therapy of nephrolithiasis.

Postischemic hypervascularity of infancy: a stage in the evolution of ischemic brain damage with characteristic CT scan

One to 2 weeks after severe brain ischemia, four infants developed an unusual vascular lesion with a characteristic appearance on computed tomography that has not been reported previously. Restricted areas (most frequently the basal ganglia and thalamus) displayed increased attenuation, which enhanced further upon infusion of contrast medium. Autopsy of one infant revealed that the CT abnormality corresponded to an extremely dense neovascular network which had almost completely replaced the parenchyma in that region. We postulate that this pathological change is a stage in the organization of ischemic brain damage reflecting the infant's vascular plasticity. Thus, hypoxia induces marked capillary proliferation in regions of normally high metabolism and capillary density. The CT pattern may prove useful in predicting the location and extent of sequelae to perinatal asphyxia.

Cerebellar degeneration with Hodgkin's disease: computed tomographic correlation and literature review

A 62-year-old man with progressive cerebellar degeneration, corticospinal tract dysfunction, and mild dementia was found to have Hodgkin's disease. Serial computed tomographic studies revealed progressive cerebellar atrophy. The clinical features and neuroradiologic studies in nine previous cases are reviewed. A thorough search for lymphadenopathy should be made in patients with unexplained cerebellar degeneration.

Malignant nasopharyngeal tumors: a neurological and neuroradiological view

Four cases of nasopharyngeal tumors are presented. The neurological complications of these lesions are discussed. The importance of the neuroradiological examination in different stages of these processes, particularly computed tomography, is emphasized.

Computed tomography of sphenoid wing meningiomas: tumor location related to distal edema

A review of the computed tomography and clinical characteristics of a series of sphenoid wing meningiomas revealed a high incidence of edema involving the ipsilateral cerebral hemisphere. This edema frequently accounted for the clinical presentation indicating the non-localizing insidious nature of these tumors. The etiology of the edema appears to be related in parts to the location of tumor in the middle cranial fossa and its proximity to the major venous pathways of this area.

Interaction of locus-of-control orientation and the performance of learning disabled adolescents

This research investigated the interaction of locus-of-control orientation with two conditions of learning on the performance of learning disabled adolescents. Locus of control is a generalized construct wherein the individual has the power to perceive outcome as being independent of one's own behavior and the result of chance, or to believe that outcomes are related to one's own behavior and efforts. A sample of 50 learning disabled adolescents were divided into two divergent samples on the locus-of-control variable using the Intellectual Achievement Responsibility Questionnaire. The subjects from the two groups were administered pretest and posttest lists of 15 spelling words under two conditions of learning (highly structured rein forcement and lowly structured rein forcement). A repeated-measures analysis of covariance was used with intelligence test scores and pretest scores partialed out. Results showed that the adolescents with internal locus of control performed significantly better in the low-structure reinforcement condition, while the adolescents with external locus of control performed significantly better in the high-structure reinforcement condition.

Angiographic demonstration of recanalization of the basilar artery

This report details the clinical course and angiographic findings of a patient with intermittent vertebrobasilar insufficiency. Recanalization of the basilar artery was demonstrated during anticoagulant therapy. A review of the literature failed to disclose a previous report of this occurrence.

Unusual metastases from a medulloblastoma: case report

Calvarial and extracranial metastases by hematogenous spread of primary intracranial neoplasms have been considered a rare occurrence. This report deals with the clinicopathological and radiological findings of a child with metastatic medulloblastoma. Correlation of serial postoperative computed tomography (CT) scans and the autopsy examination indicated hematogenous calvarial and intracranial spread of the primary lesion.

Interhemispheric subdural hematoma

The clinical presentation and surgical management of an interhemispheric subdural hematoma, a rare entity, is presented and the literature reviewed. Either hemiparesis, worse in the lower than the upper extremity, or lower extremity monoparesis is characteristic of this lesion. Computerized tomography (CT) is the preferred diagnostic procedure. An interhemispheric hematoma, either acute or chronic, is best treated by osteoplastic craniotomy. Specific anatomical considerations, clinical features, and the recommended surgical technique is described.

Keratoplasty for bullous keratopathy with intraocular lens

The presence of a pseudophakos does not appear to introduce any greater hazard when keratoplasty is required because of corneal edema. This, together with the histories obtained from patients requiring such keratoplasty, strongly suggests that the insult to the corneal endothelium takes place at the time of placement of the intraocular lens in the great majority of cases. Of possible further significance is the fact that five of the sixteen patients who underwent keratoplasty had had secondary procedures to stabilize or to reposition the lens following the original lens implantation. The increased trauma inherent in the intraocular lens operation has been pointed out by many authorities. The fact that twelve of the sixteen patients requiring keratoplasty had been operated by experienced, nationally known intraocular lens surgeons further emphasizes this. The immediate problem appears to be the development and refinement of surgical techniques to avoid some of the complications which have been described. The prognosis for keratoplasty in cases of bullous keratopathy with an intraocular lens has been found to be at least as good as in cases without an intraocular lens.

Acute appendicitis: efficacy of prophylactic preoperative antibiotics in the reduction of septic morbidity

The course of 200 patients who recently underwent appendectomy at UCLA for acute appendicitis has been reviewed to determine the efficacy of preoperative systemic antibiotic prophylaxis in reducing septic morbidity after surgery. Among those with nonperforated appendicitis who were given gentamycin and clindamycin preoperatively, a reduction of infection rate from 10.2 to 5.3 per cent was found when compared with patients who received no antibiotics.

Penetrating keratoplasty in herpes simplex keratitis. Recurrence in grafts

A review of 231 penetrating keratoplasties performed for corneal disease due to herpes simplex keratitis shows that clear grafts may be obtained in 75% and satisfactory visual results in about 70% during a long-term follow-up. Over a three-year follow-up period, recurrence of the herpetic disease in the graft was observed in 12%. Over a longer period of follow-up, up to 15 years, the rate of recurrence increased to 47%. About half of the corneas with recurrence achieved clear grafts with treatment. Recurrence did not appear to be less frequent in those cases which circumscribed scars as compared with those in which there was diffuse scarring. The state of activity of the disease preoperatively could not be demonstrated to influence greatly the results of the keratoplasty.

Evaluation of intracerebral hematoma by computed tomography

The CT scan appearances of acute intracerebral hematoma are usually diagnostic, and can be differentiated from hemorrhagic tumor and infarction. Some prognostic evaluations can be made, depending on the site and size of the hemorrhage. Sequential studies indicate resolution of the density of the hematoma over a period of approximately six weeks. This however does not appear to correlate with pathological resolution, but does reflect the hemoglobin concentration in the hematoma. Angiography is indicated when an underlying AVM or aneurysm is suspected, whereas contrast infusion studies are not of great value in detecting these lesions.

Lattice corneal dystrophy

The clinical and histologic aspects of 34 primary and six reoperative keratoplasties for lattice corneal dystrophy are evaluated. Surgical and postoperative complications were minimal and not considered specific for lattice corneal dystrophy. Visual results were highly favorable in a long-term evaluation. No lattice figures were seen to recur in any of the 34 primary or six reoperative grafts; however, opacities did occur in several grafts. Amyloid was definitely found in one reoperative graft specimen. A nonamyloid material was also found in the subepithelial and superficial stromal area in both the lattice dystrophy and reoperative specimens.

ABO Blood groups and corneal transplantation

A study of 150 corneal donor-recipient grafts, examined for ABO type, revealed that 25% of the grafts were from corneas from incompatible donors. Recipients with histocompatible sensitization exposures such as prior corneal transplant, one or more pregnancies, or one or more blood transfusions were no more likely to experience graft failure if the graft were from an ABO incompatible donor than from a compatible donor. Of 13 graft failures (8%), three of the failed grafts were from AB donors, a significant result. No detrimental effect of transplanting across the ABO barrier could be proven with assurance for any parameter.