Vanishing tumour of the internal auditory meatus.

OBJECTIVES: We report a very rare case of prostatic metastasis in the internal auditory meatus, which disappeared with treatment. CASE REPORT: An elderly man presented with a history of hearing loss, dizzy spells and, more recently, facial palsy. He also complained simultaneously of urological symptoms, which on investigation revealed advanced, metastatic prostate cancer. Radiological investigation, in the form of magnetic resonance imaging, revealed an internal auditory meatus mass which resembled an acoustic neuroma. The patient was treated with hormone injections.Tumours of the internal auditory meatus and cerebellopontine angle are mostly primary. Rarely, metastatic deposits have been described in this region, from squamous cell carcinoma, malignant melanoma, malignant parotid oncocytoma, renal carcinoma, and lung and thyroid primaries. CONCLUSION: To our knowledge, this is a very rare report in the world literature of prostatic metastasis to the internal auditory meatus. We discuss the common presenting features, investigations and treatment options for metastatic prostatic tumours of the internal auditory meatus and cerebellopontine angle.

The correlation of the radiologic extent of lung transplantation edema with pulmonary oxygenation.

OBJECTIVE: The study set out to evaluate the relationship between the efficiency of pulmonary oxygenation and the extent of the reimplantation response as revealed on chest radiography after bilateral lung transplantation. MATERIALS AND METHODS: Postoperative chest radiographs of 31 patients who had undergone bilateral lung transplantation were evaluated for the extent of the reimplantation response. For each patient, the contemporaneous oxygenation indexes (partial pressure of oxygen in arterial blood divided by fraction of inspired oxygen) were calculated and correlated with a radiographic score produced from the evaluation of chest radiographs. RESULTS: The method of evaluating chest radiographs for the extent of the reimplantation response was shown to be reproducible. Although mean oxygenation indexes were found to decrease with increasing radiographic scores, this trend was not statistically significant. CONCLUSION: Although the extent of the reimplantation response on the early postoperative chest radiography inversely correlated with the oxygenation efficiency of the transplanted lungs, this finding was not statistically significant.

Case report: A rapidly expanding testicular mass due to a ruptured ovarian follicle.

An ovotestis is the commonest gonad in the small number of patients who are true hermaphrodites. In the majority of ovotestes, testicular and ovarian tissue is arranged end-to-end. There has been only one previous report of the sonographic appearances of an ovotestis. We present the sonographic findings in a patient who developed a rapidly enlarging upper pole testicular mass, which was found on histology to be a ruptured ovarian follicle with spermatogenesis occurring within the adjacent testicular tissue.

How reliable are ultrasound measurements of renal length in adults?

Ultrasound assessment of patients with renal impairment commonly includes measurement of bipolar renal length. Reduction in length is considered to indicate chronic renal disease and is a factor in deciding whether to proceed to renal biopsy. To date, no published data are available on interobserver and intraobserver variation in sonographic renal length measurement in adults. Bilateral renal lengths were measured in 20 adult subjects, with no history of renal disease, by three experienced operators, on two separate occasions. Limits of agreement for replicate measurements by each ultrasonographer and for replicate measurements by each pair of ultrasonographers were determined. Values of repeatability (a measure of intraobserver variation) and reproducibility (a measure of interobserver variation) were calculated for all renal length measurements, and for right and left renal lengths separately. Results indicate that replicate renal length measurements differ by less than 1.85 cm in 95% of cases, and the magnitude of variations is similar when measurements are made by either single or different ultrasonographers, and are similar for right and left renal length measurements. This suggests that sonographic bipolar renal length measurements in normal adult kidneys are reasonably reliable. In diseased kidneys, however, in which identification of renal poles is difficult, interobserver and intraobserver variation may be much greater.

Effect of eicosapentaenoic acid on restenosis rate, clinical course and blood lipids in patients after percutaneous transluminal coronary angioplasty.

In order to study the effects of eicosapentaenoic acid (Maxepa), Maxepa placebo and aspirin/dipyridamole combination on the clinical course and restenosis rate of atherosclerotic lesions after percutaneous transluminal coronary angioplasty 79 men and 29 women were randomly divided into three treatment groups and restudied angiographically within one year of the procedure. Angina recurred less in the Maxepa group than in the other groups, although not statistically so. Restenosis rate was significantly reduced in the Maxepa group (11%) compared to the placebo group (30%) but, while less, was not significantly lower than in the aspirin/dipyridamole group (17%). Maxepa treatment appears to reduce restenosis rate of coronary artery lesions after percutaneous transluminal coronary angioplasty and may be an acceptable and equally effective alternative therapy to aspirin/dipyridamole.

Percutaneous transluminal coronary angioplasty in multilesion disease: complete versus incomplete revascularization.

We report the results of percutaneous transluminal coronary angioplasty (PTCA) in the first 200 consecutive patients to undergo this procedure for multilesion coronary disease at Dunedin Hospital. In Group I, which consisted of 86 patients (67 men and 19 women, with a mean age of 56 years), complete revascularization of 228 lesions (2.7 lesions per patient) was undertaken. Primary success was achieved in 217 lesions (95%) in 78 patients (91%). There were five major complications, including myocardial infarction in four cases (5%) and emergency coronary artery bypass grafting (CABG) for failed PTCA in one case (1%). In Group II, which comprised 114 patients (82 men and 32 women, with a mean age of 57 years), partial revascularization of 186 lesions (1.6 lesions per patient) was attempted. Primary success was achieved in 165 lesions (89%) in 96 patients (84%). There were nine major complications, including myocardial infarction in two cases (2%), emergency CABG for failed PTCA in four cases (4%), and in-hospital death in three cases (3%). During a follow-up period ranging from 3 to 38 months (mean, 11 months), 16 (20%) of the patients in Group I and 16 (18%) of those in Group II have had recurrent angina and/or restenosis. Twenty-five of these patients have undergone repeat PTCA, with primary success in 24 cases (96%), and six have undergone elective CABG. There has been only one late death (0.6%) after successful PTCA. Complications occurred more frequently in patients with unstable angina (10.0%) and postinfarction angina (19.0%) than in those with stable angina (1.4%). However, the complication rate for multilesion PTCA has become increasingly lower until it now equals that associated with single-vessel PTCA at this institution (about 4% overall).

Percutaneous transluminal coronary angioplasty: the early Dunedin experience.

Since May 1981 39 men and 11 women (mean age 55 years) have undergone percutaneous transluminal coronary angioplasty at Dunedin Hospital. Angioplasty was performed in 34 (68%) patients with stable angina, 13 (26%) with unstable angina and in three (6%) patients with acute myocardial infarction. Primary success (reduction in angiographic stenosis without associated myocardial infarction or emergency coronary bypass) was achieved in 77% of those patients with single vessel coronary disease (27 of 35 procedures) and of 62% in those patients with multiple vessel disease (16 of 26 procedures). Successful angioplasty was obtained in 81% (25/31) of those patients with anterior descending disease, 67% (4/6) of those with circumflex disease and 58% 14/24) of patients with right coronary disease. Thirty-four patients (68%) following successful angioplasty were rendered asymptomatic. Five (10%) underwent emergency coronary bypass grafting and one of these patients died. Percutaneous transluminal coronary angioplasty is a useful alternative to coronary artery bypass surgery and may be performed in a majority of patients with symptomatic single vessel coronary artery disease and in selected individuals with multiple vessel coronary disease.

Family history, cigarette smoking and other risk factors in patients with myocardial infarction.

All patients entering a coronary care unit had data collected and stored prospectively on a computer file. Family history and risk factor data have been abstracted for those with confirmed myocardial infarction. These data are compared between those aged less than 50 years and those aged between 50 and 70 years. Cigarette smoking habits are compared with age matched data from the 1976 census population study of cigarette smoking habits. The risk factors of hypercholesteolaemia, obesity, diabetes, hypertension and cigarette smoking greater than 20 per day, do not separate the two age groups although cigarette smoking is more prevalent in the patient groups compared with the census population. Age of fathers' death is not different between the two age groups but death from myocardial infarction, presence of ischaemic heart disease during life in fathers and fewer nonsmokers in the younger age group clearly separate them from older age group patients. This study serves to emphasise that in order to prevent the development of myocardial infarction special attempts sould be made to prevent cigarette smoking in those whose fathers have died of a myocardial infarction or have symptoms of ischaemic heart disease.

Left main stem coronary artery dissection.

Left main stem coronary artery dissection is a rare cause of sudden death. This occurred in a previously asymptomatic 42-year-old white woman; clinical, arteriographic, and necropsy findings are described. Extrathoracic total body perfusion with isolated catheter perfusion of the dissected coronary artery using cold cardioplegic solution may be effective preoperative treatmemt.

Ventilatory responses to exercise and to carbon dioxide in mitral stenosis before and after valvulotomy: causes of tachypnoea.

1. The ventilation and cardiac frequency during progressive exercise and the respiratory responses to breathing carbon dioxide have been measured in 33 female patients with mitral stenosis and in 31 control subjects. Compared with the control subjects, the patients' exercise ventilation and cardiac frequency were increased; the exercise tidal volume at standard minute volume, the vital capacity and the ventilatory response to carbon dioxide were reduced. The extent to which the standardized tidal volume was lower during exercise than during breathing carbon dioxide was correlated with the severity of the stenosis, as gauged by the increase in exercise cardiac frequency above the level predicted from anthropometric measurements. 2. Twenty patients were studied postoperatively. In the 12 who showed clinical improvement the exercise ventilation and cardiac frequency were reduced and the exercise tidal volume at a given minute ventilation was increased. The latter change occurred despite a reduction in vital capacity, which was probably a residual effect of thoractomy. There was no significant change in the response to breathing carbon dioxide. No material change in function was observed in the patients whose condition was not improved by the operation. 3. It is suggested that in mitral stenosis the tachypnoea which occurs during exercise, whilst mainly a mechanical consequence of the reduced vital capacity, is also partly due to pulmonary congestion stimulating intrapulmonary receptors.

Transposition of the great arteries, primum atrial septal defect, azygos continuation of the inferior vena cava, bilateral superior venae cavae and dextrocardia with centrally placed liver.

Successful surgical correction of transposition of the great arteries in a nine-year-old girl with dextrocardia, primum atrial septal defect, bilateral venae cavae, and azygos continuation of inferior vena cava is reported. The patient was cooled on cardiopulmonary bypass and the operation performed under circulatory arrest at 19 degrees C. nasopharyngeal temperature. The problems of diagnosis and management are discussed.

Biloculate false aneurysm of the right ventricle after cardiac surgery.

A case of a 12-year-old boy who had double false aneurysms of the right ventricle after incomplete closed pulmonary valvotomy six years earlier is presented. The aneurysms were successfully treated surgically, and the aetiology is discussed.