Superficial temporal to proximal superior cerebellar artery anastomosis for basilar artery stenosis

A newly modified revascularization procedure for vertebrobasilar insufficiency due to midbasilar stenosis is reported. The approach involves anastomosing the superficial temporal artery to a proximal segment of the superior cerebellar artery. The rationale for the procedure and the surgical technique are discussed.

Diagnosis of internal jugular vein thrombosis by computed tomography

Internal jugular vein thrombosis was diagnosed by computed tomography in three cases. In all cases, selective catheterization of the internal jugular vein was avoided. Rapid intravenous infusion of contrast material was made to obtain prolonged blood iodine levels, allowing sufficient time to scan the neck adequately.

Results of gastric neutralization with hourly antacids and cimetidine in 320 intubated patients with respiratory failure

In a retrospective analysis massive upper gastrointestinal (GI) hemorrhage, defined as blood loss requiring more than two units of blood transfusion over a 24-hour period, occurred in 40 (9.5 percent) of 420 intubated, mechanically ventilated patients with respiratory failure, irrespective of the etiology of the respiratory failure. In a prospective study hourly antacid gastric neutralization, maintaining the gastric pH over 5, the incidence of massive gastric bleeding was reduced to 3 (1.4 percent) of 210 patients. In 110 additional patients, cimetidine, a histamine H2 receptor blocker, was used to prevent gastric acid secretion; 3 (2.7 percent) of 110 patients had massive upper GI bleeding; all three had solitary chronic pyloric ulcers. We conclude that gastric neutralization, either with hourly antacids or with cimetidine, is effective in reducing the incidence of massive gastric hemorrhage in intubated, mechanically ventilated patients during respiratory failure. We recommend the use of either in all intubated patients with respiratory failure. In addition, in 17 patients who had gastric bleeding at the time of transfer to the respiratory intensive care unit, gastric neutralization with hourly antacids in 14 patients and with cimetidine in three patients stopped the bleeding in all 17 patients within 24 to 48 hours.

Computed tomography of hepatic fracture: a case report

A case of hepatic fracture is presented in which computed tomography (CT) played a major role in the diagnosis. The fracture, which was suggested on scintigraphy, was easily demonstrated on CT as a low-density hematoma. The advantages and potential use of CT in this clinical setting are discussed.

A theoretical model for predicting parameter changes in soft contact lenses due to bending

Equations are presented for the theoretical determination of back vertex poser changes in soft contact lenses due to bending. The main assumption is that the volume of the lens remains unchanged. A description of changes in other lens parameters, namely, central thickness, overall diameter, and anterior radii, is presented for both spherical and toric lenses. In general, power changes predicted by the proposed model are less than those suggested by previous workers in this field. Changes however occur in other parameters which have previously been regarded as remaining constant such as the central thickness of the lens. These changes are of small degree but have significant bearing on back vertex power.

Eucalyptus oil poisoning

Accidental ingestion of eucalyptus oil by a 3-year-old boy caused profound central nervous system depression within 30 minutes, but he recovered rapidly after gastric lavage. The extreme toxicity of eucalyptus oil is emphasised.

Multiple sclerosis and serial computerized tomography. Delayed contrast enhancement of acute and early lesions

By demonstrating periventricular contrast-enhanced lesions cranial computerized tomography (CT) supported the diagnosis of multiple sclerosis in a patient with recurrent transient hemiparesis. These abnormalities were present only on delayed films taken one hour after contrast injection and probably represented acute and early demyelinating plaques. Areas of contrast enhancement evolved to isodensity with and without corticosteroid treatment. Brain scan findings mirrored cranial CT abnormalities, and both could be correlated with the clinical status and the course of the disease.

Renal failure in the respiratory intensive care unit

The development of renal failure during respiratory failure is of grave prognostic significance. In 686 patients with respiratory failure, 74 developed renal failure; these had a mortality of 80%. The leading predisposing factors are: 1) gastrointestinal bleeding with hypovolemic shock; 2) sepsis with shock; 3) drug induced nephrotoxicity; and 4) hypotension. With antacid gastric neutralization, judicious use of nephrotoxic antibiotics, the incidence of renal failure can be reduced. Once renal failure occurs, early dialysis may increase the chances of recovery in these critically ill patients.

Case report. The iron rim sign

A chronic cystic cerebral hematoma occurred in the frontal lobe and mimicked both clinically and radiographically a frontal sinus mucocele. A rim seen on multidirectional tomography and unenhanced computed tomography was presumed to be composed to calcium. However, electron microscopic analysis revealed the rim to be composed almost entirely of iron from hemosiderin breakdown products. This is the first such report of an "iron rim" that we could find in the literature.

The monitoring role of plasma CEA alone and in association with other tumor markers in colorectal and mammary carcinoma

During the past decade, evidence has accumulated to show that most, if not all, human tumors produce a variety of different factors which, if they pass into the blood and/or urine, may serve as tumor index substances (tumor markers).7 Tumor markers may either be: 1) tumor-derived--i.e., produced by the tumor itself, or 2) tumor-associated--i.e., produced by other tissues in response to the presence of the tumor and its local or distant effects on that tissue. Examples of this latter category include the changes in urinary hydroxyproline output in patients with bone metastases or the altered levels of serum acute phase proteins in neoplasia in general.7 Tumor-derived markers may be produced by either the tumor cell population itself, e.g., CEA, alpha-fetoprotein (AFP), and other oncofetal antigens, inappropriate hormones such as ACTH etc., or by their supporting framework (stroma), e.g., the osteolysins of human breast cancer.3

Machakos project studies. Agents affecting health of mother and child in a rural area of Kenya. V. Pertussis sentypes in Kenyan children 1974--1975

Cultures of Bordetella pertussis were isolated by pernasal swabs from Kenyan children in whom whooping-cough was suspected. Serotyping of 94 of these isolates was undertaken by four laboratories in Europe, and there was very close agreement in their typing results. Each laboratory found that the incidence of type 1, 3 was the lowest of the three types, and that there were approximately equal numbers of types 1, 2, 3 and 1, 2. No new serotype was found. This distribution of serotypes was found in all age-groups; and it is in marked contrast with that currently seen in vaccinated communities, where type 1, 3 predominates. The implications of these findings for vaccination against whooping-cough in East Africa are discussed.

Diagnostic usefulness of plasma carcinoembryonic antigen levels in acute and chronic liver disease

Raised plasma carcinoembryonic antigen (CEA) levels were found in over 90% of 71 patients with chronic liver disease and 50% of 16 patients with acute liver damage. Levels increasing chronicity and clinical severity of disease. In individual patients, the plasma CEA level fluctuated with the clinical condition. Persistently normal levels were never found in patients with chronic liver disease in poor clinical condition. A very high level suggests a bad prognosis. If CEA is considered together with SGPT, a discriminant function can be calculated, separating patients with acute liver damage and those with an acute exacerbation of chronic active hepatitis, with a high degree of certainty. In acute damage, peak CEA levels occur later than the time of maximum liver necrosis, suggesting that the rise is not owing to release of CEA from damaged cells. There is no significant difference in CEA level between patients with and without spontaneous or surgical portosystemic shunts, suggesting that high levels are not attributable to bypass of the liver. The timing of the rise in CEA in acute liver damage suggests that raised levels may be associated with regeneration. The tendency for higher levels to occur in those patients with greater disturbances of liver function suggests altered metabolism or excretion of CEA.

Computed tomography of systemic lupus erythematosus

Computed tomographic (CT) findings in 14 patients with systemic lupus erythematosus are correlated with clinical symptomatology. Microinfarction (manifested by perisuical atrophy) large infarcts, and hematomas are the major abnormalities demonstrated by CT. The neuropathology of these changes is discussed.