Tilt-test diagnosis of hypotensive transient ischaemic attacks

Eight elderly patients with postural hypotension who presented with transient ischaemic attacks are reported. Six patients underwent head-up tilt testing with continuous blood pressure monitoring. During tilt, postural hypotension was found in five patients and in three patients transient ischaemic attacks were reproduced. Postural hypotension is probably a rare cause of transient ischaemic attacks, but may be underrecognized.

Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed

Reversible posterior leukoencephalopathy is a syndrome of headache, seizures and visual loss, often associated with an abrupt increase in blood pressure. Prompt diagnosis and therapy with antihypertensives, anticonvulsants, removal of any offending medication and treatment of associated disorders is essential since early treatment might prevent progression to irreversible brain damage. We present six illustrative cases presenting to Christchurch Hospital and review the condition. All were hypertensive, two were receiving immunosuppressant therapy after transplantation and one chemotherapy. Only three made a full recovery. The term reversible posterior leukoencephalopathy is a misnomer as the condition is not always reversible, is not necessarily confined to the posterior regions of the brain and can affect both white and grey matter. Magnetic resonance imaging findings of increased T2 and fluid attenuated inversion recovery signal predominantly involving the posterior regions of the cerebral hemispheres should alert the clinician to the possibility of this diagnosis.

Malignant granular cell tumour of the sciatic nerve

A case of malignant granular cell tumour of the sciatic nerve is presented. Computed tomography demonstrated isodensity with muscle and minimal enhancement. Magnetic resonance demonstrated T1 isointensity with muscle with marked enhancement, and isointensity with fat on proton and T2 images. Pathological evidence is presented for its probable Schwann cell histogenesis.

The effect of simvastatin and bezafibrate on bile composition and gall-bladder emptying in female non-insulin-dependent diabetics

Female non-insulin-dependent diabetics have a high prevalence of gallstones. Treatment of hyperlipidaemia in these patients may modify the risk. Seventeen female non-insulin-dependent diabetics (age 35-65) were treated with simvastatin (n = 10) or bezafibrate (n = 7) and had the cholesterol saturation index (CSI) of bile and gall-bladder emptying measured before and after 3 months therapy. In both groups, there was a significant reduction in serum cholesterol following treatment. The mean pretreatment cholesterol saturation indices of bile did not differ between the two groups but, after 3 months therapy, there was a highly significant difference in CSI between the bezafibrate group (2.0 +/- 0.33) and the simvastatin group (1.1 +/- 0.14) P < 0.002. Whereas the increase in the CSI (42%) observed with bezafibrate therapy was significant, the decrease in the simvastatin group (14%) was only significant in those whose pretreatment cholesterol saturation indices were elevated. Despite the differences in CSI observed between the two treatment groups, no changes in gall-bladder emptying were detected.

Variation in the estimation of gallbladder volume using the sum-of-cylinders method

RATIONALE AND OBJECTIVES

Gallbladder contraction was measured by ultrasound, using the sum-of-cylinders method, as part of a study of the effects of lipid-lowering drugs. Although this method of measurement has been validated in the literature, paired measurements were obtained to provide an additional check on reproducibility.

METHODS

A total of 136 pairs of gallbladder measurements were made on 17 patients using the sum-of-cylinders method of calculating gallbladder volume. Each pair comprised a left posterior oblique and a supine measurement performed at the same ultrasound examination to assess measurement error.

RESULTS

There was a large average coefficient of variation of 21%.

CONCLUSIONS

Marked measurement variability limited the ability of the sum-of-cylinders technique to detect even modest alterations in gallbladder contractility, at least in this population subgroup.

Cuff expander eases enema tip assembly

Some barium enema kits are manufactured with two-part enema tips, enabling a cuff to be placed on the tip only if required. Difficulty can be experienced during enema tip assembly while attempting to place the cuff on the tip. A readily available gadget used in the farming sector provides a neat and cost-effective solution to this problem.

Hemorheology and fistula function in home hemodialysis patients following erythropoietin treatment: a prospective placebo-controlled study

The beneficial effect of correcting anemia in end stage renal failure using recombinant human erythropoietin (rHuEPO) is sometimes complicated by thrombosis of the arteriovenous fistula. This placebo-controlled study investigated the relationship between hemorheological changes caused by rHuEPO and alterations in fistula function and heparin requirements in home hemodialysis patients. Erythropoietin induced a rise in high shear rate blood viscosity, a determinant of blood flow in large vessels. Doppler assessment of brachial artery blood flows, tests of fistula function and heparin requirements were similar in the two patient groups. These findings indicate that rHuEPO treatment of renal anemia resulted in the expected rise in red blood cell mass and blood viscosity although these changes did not cause problems with arteriovenous access or alter fistula function in the short term.