Angiolipoma of suprasellar region.

An angiolipoma of the suprasellar region occurred in an 8-year-old boy. Review of 5 intracranial angiolipomas, including the current case, revealed that four were in the sellar region of one man and three women. One was in the thalamus of a man. The average age of the patients was 49 years, and average size of the tumors was 2.5 cm across. The angiolipomas associated with the sellar region often created abnormalities of the eye viz exophthalmos, decreased vision, and palsy of the oculomotor nerve. Sudden onset has ensued in a massively hemorrhagic thalamic angiolipoma. The characteristic low density with negative Hounsfield unit values in CT scan and hyperdensity in MRI of the brain suggested adipose tissue component of the angiolipoma. The angiography has depicted the angiomatous component of the latter. The combined characteristic CT scan, MRI, and angiographic features should demonstrate both vascular and adipose tissue elements of the angiolipomas before pathologic examination.

Low osmolar (non-ionic) contrast media versus high osmolar (ionic) contrast media in intravenous urography and enhanced computerized tomography: a cost-effectiveness analysis.

The cost-effectiveness of three alternative policies for the use of intravenous contrast media for urography and enhanced computerized tomography (CT) are analyzed. Alternative #1 is to use high osmolar contrast media (HOCM) in all patients, the historical policy. Alternative #2 is to replace it with low osmolar contrast media (LOCM) in all patients. Alternative #3 is to use LOCM only in the high risk patients. Data on the 6,242 patients who underwent intravenous urography and enhanced CT at the Department of Radiology, Chulalongkorn Hospital in 1989 were used. Both societal and hospital viewpoints were analyzed. The incremental cost-effectiveness (ICE) between #2 and #1 was 26,739 Baht (US$1,070) per healthy day saved (HDS), while the ICE between #3 and #1 was 12,057 Baht (US$482) per HDS. For fatal cases only, ICE between #2 and #1 was 35,111 Baht (US$1,404) per HDS, while the ICE between #3 and #1 was 18,266 Baht (US$731) per HDS. The incremental cost (IC) per patient was 2,341 Baht (US$94) and 681 Baht (US$27) respectively. For the hospital viewpoint the ICE between #2 and #1 was 13,744 (US$550) and between #3 and #1 was 6,127 Baht (US$245) per HDS. The IC per patient was 1,203 Baht (US$48) and 346 Baht (US$14), respectively. From the sensitivity analysis, #3 should be used if the LOCM price is reduced more than 75% (equal to 626 Baht or less) and more than 80% of the patients are able to pay for the contrast media.

Symptomatic intraspinal genuine endodermal epithelial cyst.

An intraspinal cervicodorsal endodermal epithelial cyst occurred in a 20-year-old man who experienced sudden paraparesis at the age of 6 years and subsequently developed progressive sensory disturbances. The patient underwent repeated surgical explorations indicating that the lesion may be difficult to identify. The cyst wall consisted of the outer smooth muscle and connective tissue and the inner epithelium that produced mucin and mucopolysaccharide. The intimate association between the epithelium and smooth muscle makes the cyst wall strikingly like the wall of the digestive tract or the respiratory passage and supports the endodermal origin of the cyst which must be distinguished from the neuroepithelial cyst. The pathogenesis of the endodermal epithelial cyst is suggested to be related to congenital maldevelopment of the notochord and the primitive gut.