High dose ketoconazole in the treatment of cerebral aspergilloma

A 32-year-old Chinese woman with bilateral occipital aspergilloma was treated successfully with high dose ketoconazole (1200 mg/day) for six months in conjunction with amphotericin B and 5-fluorocytosine. No unacceptable side effects occurred. The use of high dose ketoconazole could be considered in CNS aspergillosis unresponsive to conventional anti-fungal therapy.

Diagnosis and evaluation of esophageal atresia by direct sagittal CT

Direct sagittal CT is possible in newborns because of their small body-size. With this noninvasive investigation, we were able to establish a correct diagnosis in two neonates with esophageal atresia. Moreover, the demonstration of the air-filled proximal pouch and distal tracheoesophageal fistula along their whole lengths allowed exclusion of the possibility of a proximal pouch fistula and gave knowledge of the exact distance of the two segments of the esophagus needed to be bridged to allow anastomosis, thus providing additional valuable information for the surgeon preoperatively.

Recurrent pyogenic cholangitis: ultrasound evaluation compared with endoscopic retrograde cholangiopancreatography

Fifty cases of recurrent pyogenic cholangitis among Chinese in Hong Kong were studied by ultrasound and compared with endoscopic retrograde cholangiopancreatography. The sensitivity of ultrasound detection of both dilated intrahepatic biliary ducts and intrahepatic calculi is 67% as compared with endoscopic retrograde cholangiopancreatography. A negative study, therefore, does not rule out the presence of such pathological features. A dilated common duct is present in virtually every case of recurrent pyogenic cholangitis and ultrasound is very accurate in its detection. Furthermore, ultrasound is able to provide additional information which can be missed with endoscopic retrograde cholangiopancreatography. Prominent periportal echogenicity, concomitant abscesses and tumours are examples in this series. Such findings bear significance on the management of patients with recurrent pyogenic cholangitis.

Optic canal syndrome due to posterior ethmoid sinus mucocele. Case report

A case of mucocele of the posterior ethmoid sinus presenting as unilateral blindness without pain, proptosis, or diplopia is reported. Computerized tomography (CT) demonstrated the precise anatomical relationship of the mucocele to the optic nerve inside the optic canal. It is proposed to use the term "optic canal syndrome" for patients with such clinical and CT presentation. Combined transcranial excision and transnasal drainage resulted in dramatic recovery of vision.

The posterior "nutcracker": hematuria secondary to retroaortic left renal vein

Retroaortic left renal vein is an uncommon variant in the renal venous system. Recently a patient with such anomaly presented to us with hematuria.

Fifty cases of primary hyperaldosteronism in Hong Kong Chinese with a high frequency of periodic paralysis. Evaluation of techniques for tumour localisation

Fifty consecutive Chinese patients with primary hyperaldosteronism were studied. All were considered to have an adrenal cortical adenoma, this being proven by surgery in 46 cases. In contrast to other reports, periodic paralysis was a presenting feature in 42 per cent of patients. Other notable symptoms were palpitations (30 per cent) and syncope (12 per cent). Vascular complications were present in 20 per cent of cases. Mean serum potassium level at presentation was 2.1 +/- 0.1 (mean +/- SEM) and sodium 145.0 +/- 0.1 mmol/l. Serum potassium was significantly lower and plasma aldosterone higher in patients with periodic paralysis. Adrenal venography in order to localise the tumour was unreliable and was misleading in two cases. Adrenal venous sampling for steroid analysis was much more helpful, despite the difficulty of obtaining right adrenal venous blood. The side of the adenoma could be predicted in 97 per cent of cases from measurements of left adrenal venous and vena caval aldosterone levels. The use of high resolution CT gave 100 per cent accuracy in all 18 patients who underwent surgery, the smallest detected tumour being 0.8 cm in diameter. Surgery corrected hypokalaemia in all cases, and 37 of the 46 patients required no further antihypertensive treatment.

Tuberculous meningitis associated with meningeal tuberculoma

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Cerebral haemorrhage in a urban Chinese population

A prospective study of Chinese patients aged 20-70 years reveals that at least 30.5% of all strokes are due to cerebral haemorrhage. Compared to previous studies in Caucasians, there is both a proportional and absolute increase in cerebral haemorrhage amongst all strokes, alert strokes, or those who presented with just a lacunar syndrome. The cause for this increase is unclear but genetic, dietary, and other environmental factors may be involved.

Prominent periportal echogenicity: its sonographic evaluation and its significance

Prominent periportal echogenicity was detected during sonographic examination of patients suffering from recurrent pyogenic cholangitis, hepatocellular carcinoma and acute cholecystitis. To document the finding, 140 normal individuals were studied to establish a norm for the evaluation of the periportal echogenicity. The significance of this sonographic finding and its possible aetiology are discussed.

Posttraumatic acute arterial subdural hematoma manifested during anesthesia

Traumatic acute arterial subdural hematomas are rare and are associated with a high mortality rate. The authors report a case in which the initial computed tomographic (CT) scan examination failed to reveal a hematoma. Within the subsequent 4 hours, while recovering from anesthesia given so that hemostasis of bleeding soft tissue injuries could be obtained, the patient suddenly developed bilaterally dilated pupils, both nonreactive to light. A repeat CT scan then revealed large subdural and intracerebral hematomas. The case is discussed and the pertinent literature is reviewed.

Multicentric sclerosing osteosarcoma--a rare cause of cranial nerve palsy

The clinical, radiological and pathological findings are presented of a Chinese girl with sclerosing osteosarcomatosis. The findings strongly support multicentricity in a subclass of multiple osteosarcoma in the young. The unusual features in clinical presentation are emphasized.

Familial occurrence of mitral valve prolapse: is this related to the straight back syndrome?

Familial prevalence of mitral valve prolapse in a Chinese population was determined in 22 propositi of whom 10 had straight back (group A), three had abnormally high metacarpal index (group B), and nine had neither (group C). Of 71 (32 male and 39 female subjects) first degree relatives screened, mitral valve prolapse was found in 19 (seven male and 12 female subjects) (26.8%). The familial prevalence among groups A, B, and C was 20%, 30%, and 38.5%, respectively. Our study indicates that the familial occurrence of mitral valve prolapse does not depend on its association with the straight back syndrome.

Retroperitoneal fibrosis after anterior spinal fusion

Three patients with lumbar anterior spinal fusion (two with Dwyer instrumentation) developed retroperitoneal fibrosis in relation to the operative site. This complication is possibly a reaction to the retroperitoneal insult. Haematoma, low-grade infection and metallic implant are other likely contributory factors. Its occurrence is affected by the laterality of surgical approach and extent of dissection. Radiologists should be aware of such a complication when investigating post-fusion patients. Early diagnosis and treatment prevent further renal damage.

Skeletal abnormalities in mitral-valve prolapse

One hundred and fifteen Chinese patients with mitral-valve prolapse were evaluated for skeletal abnormalities, to determine their prevalence and interrelation. Measurements of thoracic dimensions from radiographs differed significantly from the normal population. The commonest thoracic abnormality was the straight back, being present in 37.5% of the male and 26.9% of the female patients. Accurate quantitation of thoracic kyphosis was difficult. Either the ratio between antero-posterior and transverse thoracic diameters or a vertebral index characterised the straight back. Other abnormalities included scoliosis, sternal and rib deformities. The mean of metacarpal indices for the patients was also significantly higher than the normal mean. An abnormal metacarpal index was present in 20.9%. There was dissociation between peripheral and thoracic skeletal abnormalities. The diagnostic, aetiological and prognostic implications of associated skeletal abnormalities were discussed.