Ceiling-mounted radiographic equipment for trauma management in the emergency room.

Use of ceiling-mounted radiographic equipment in an emergency room for management of the multiply injured patient is described. The protocol of the Advanced Trauma and Life Support manual is followed and three plain radiographs (lateral cervical spine, anteroposterior views of the chest and pelvis) are obtained by the radiographers, who are members of the trauma team. Abnormalities were diagnosed on 7 per cent of the cervical radiographs, 31 per cent of the chest and 28 per cent of the pelvis in 108 patients during the first year of use. With full integration of the radiographers into the trauma team these three initial films are obtained within 10 min. Subsequent films can be taken of skeletal injuries found clinically or incidentally on the first three plain radiographs. It is recommended that all emergency rooms should have a ceiling-mounted radiographic unit with an automatic daylight processor to provide the best service for patients with major trauma.

The diagnosis and treatment of peri-aortic fibrosis ('inflammatory' aneurysms).

A proportion of abdominal aortic aneurysms are found at laparotomy to have thick white walls and extensive peri-aneurysmal adhesions. Graft replacement in these patients is often difficult and associated with an increase in morbidity and mortality. In this study 103 patients with a clinical diagnosis of aortic aneurysm were scanned with computerized tomography to determine whether this condition could be diagnosed preoperatively. Of these, 15 showed diagnostic radiological criteria of peri-aortic fibrosis. Laparotomy revealed no false negatives and only one false positive. Clinical, serological and pathological findings have been compared to those with 'normal' aneurysms. In view of the similarities between this condition and retroperitoneal fibrosis, 5 patients were treated with Prednisone 5 mg twice daily for up to 18 months and a CAT scan technique developed to monitor the degree of thickening quantitatively. Abdominal pain disappeared rapidly, and sequential scanning showed a decrease in peri-aortic fibrosis. Measurements showed the fibrosis only to disappear, with no increase in the diameter of the aortic lumen. In some cases, the lumen was only minimally dilated, although clinical examination suggested an aneurysm. Consequently we suggest that the term peri-aortic fibrosis is a better description of this condition whose aetiology is still obscure, and in which aneurysm formation, when present, may simply be consequent upon the fibrotic reaction in the wall.

Metastasis of carcinoma to meningioma and glioma.

A case of frontal meningioma harbouring a metastasis from a previously treated breast carcinoma, and a case of metastatic carcinoma into a frontal glioma are reported.

Arteriomegaly of persistent sciatic arteries.

Angiographic findings are described in a patient with enlarged persistent sciatic arteries and a ruptured sciatic artery aneurysm. The left persistent sciatic artery was patent and dilated to a width of 10 cm throughout its length. It had ruptured in the lower thigh. The common iliac, internal iliac, and both sciatic arteries were dilated and tortuous, with generally smooth outlines. Some patchy calcification in the arterial wall was noted. Arterial flow was extremely slow in the dilated arteries, requiring very delayed films to show the right sciatic artery as far as its bifurcation at the knee.

The effect of blood flow upon the activity of gallamine triethiodide.

The onset, depth and recovery from paralysis produced by gallamine triethiodide were studied using the tibialis anterior muscle/sciatic nerve preparation in mongrel dogs, during changes in blood flow to this muscle. A roller pump was used to effect the blood flow changes via an aorto-femoral shunt. The onset and depth of paralysis were related directly to muscle blood flow. There was no correlation between the rate of recovery from paralysis and the blood flow to the muscle.