A gas filled intradural cyst associated with disc degeneration

A case of a lumbar intradural, extramedullary gas filled cyst is described. This was associated with degenerative disc disease and presented with radicular signs and symptoms. The radiological differential diagnosis of such a mass includes infection and tumours. The association of intradural gas with degenerative disc disease is previously reported. This case further illustrates the association of degenerative disc disease with an intradural gas filled cyst and provides an interesting radiological differential diagnosis for an extramedullary intradural mass.

Results of a multicenter study of the retrievable Tulip Vena Cava Filter: early clinical experience

PURPOSE

To evaluate clinically a new, retrievable vena caval filter in a multicenter study.

METHODS

The Tulip filter is a stainless steel half-basket that is suitable for antegrade or retrograde insertion via an 8.5 Fr introducer sheath. The filter can be retrieved via the jugular approach using an 11 Fr coaxial retrieval system. Forty-eight filters were implanted via the femoral approach and 38 via the jugular approach in 83 patients. Follow-up examinations (plain films, colorcoded duplex sonography) were performed up to 3 years after filter insertion (mean 136 days) in 75 patients. Twenty-seven patients were screened by colorcoded duplex sonography for insertion site thrombosis.

RESULTS

An appropriate filter position was achieved in all cases. Insertion problems occurred in 3 cases; these were not due to the filter design but to an imperfect prototype insertion mechanism that has now been modified (n = 2) or a manipulation error (n = 1). In 2 of these cases the filters were replaced percutaneously; 1 patient required venotomy for filter removal. No further complications due to filter insertion occurred. Two filters were used as temporary devices and were successfully removed after 6 and 11 days, respectively. There was 1 fatal recurrent pulmonary embolism (PE) and 2 non-fatal PE, 5 complete and 3 partial caval occlusions, and 3 caudal migrations of the filter. Insertion site venous thrombosis was not seen in the 27 patients monitored for this complication.

CONCLUSION

Precise placement of the Tulip filter is feasible by either access route and the device appears mechanically stable. Further observations are needed to confirm that safe filter removal is practical up to 10 days after its insertion.

Computed tomographic portography in preoperative imaging of hepatic neoplasms

Preoperative selection of suitable patients for liver resection is dependent on the quality of radiological imaging. Computed tomography (CT) identifies approximately 70 per cent of lesions. Computed tomographic arterial portography (CTAP) during contrast enhancement of the liver via the portal vein may be superior to conventional CT. Preoperative CTAP was evaluated in 60 patients with hepatic neoplasm (48 having colorectal metastases) who subsequently underwent laparotomy. The preoperative images were compared with intraoperative palpation, intraoperative ultrasonography and histology of the resected liver. Fifty-six patients (93 per cent) underwent partial hepatectomy. The detection rate sensitivity for CTAP was 110 of 116 lesions in the 56 patients (95 per cent) and for intraoperative ultrasonography was 114 of 116 (98 per cent). CTAP correctly identified all lesions found at histology in 50 of 56 (89 per cent) resected specimens. At laparotomy four of 60 patients (7 per cent) were inoperable; two of these had been predicted to be so by this technique. CTAP correctly identifies and locates the majority of hepatic tumours, particularly metastases, and is the procedure of choice for selection of suitable candidates for partial hepatectomy.

Case report: the effect of contrast density on computed tomographic arterial portography

Artifacts associated with computed tomographic arterial tomography (CTAP) are well documented. We report a patient undergoing CTAP in whom laminar flow artifact occurred using Iopamidol 370 mg ml-1 but not when using Iopamidol 300 mg ml-1 under identical conditions. The denser Iopamidol 370 mg ml-1 mixed inadequately with unopacified blood in the portal vein. This was not a problem with the less dense Iopamidol 300 mg ml-1 which is likely to be a more reliable contrast agent for CTAP.

Skeletal abnormalities in Refsum's disease (heredopathia atactica polyneuritiformis)

Refsum's disease is a rare inborn error of phytanic acid metabolism in which skeletal abnormalities are part of the clinical syndrome. The reported incidence of bone changes in patients with Refsum's disease varies widely and reflects the small series published to date. An analysis of the skeletal abnormalities of the largest series of patients in the world is presented.

The measurement of ankle movements--a new method

We describe a new goniometer for the measurement of dorsiflexion and plantarflexion of the ankle. It has been assessed for ease of use and reliability.

A force sensor and peak-reading recorder for measurement of cervical dilatation force

Earlier dilatation force-sensing transducers, when subjected to side loads, suffered frictional losses which affected their accuracy. This new instrument incorporates a thermal-writing chart recorder and a digital readout of the peak force during dilatation of the cervix.