Successful treatment with rFVIIa of spontaneous intracerebral hemorrhage in a patient with mechanical prosthetic heart valves.

Intracerebral hemorrhage (ICH) is associated with high mortality in patients on oral anticoagulant treatment. The normalization of hemostatic balance usually requires slow-acting or risky treatments, such as vitamin K, fresh frozen plasma or prothrombin complex concentrates, which have narrow therapeutic windows particularly in cardiopathic patients like those with mechanical heart valves. Recombinant activated factor VII (rFVIIa) seems useful in patients with normal or pathologic coagulation who have an ICH. We report of a patient on acenocumarol for mitro-aortic valve replacement, referred for headache and found at computerized tomography scanning to have a parietal hemorrhage with ventricular invasion. International normalized ratio was 3.22. The patient was treated with vitamin K and with a bolus of 80 mug/kg of rFVIIa, with correction of the international normalized ratio within 15 min. Sequential computerized tomographies showed progressive reduction of the hematoma and normalization of ventricular spaces and the patient fully recovered. No valvular dysfunctions or cardiac thrombi were found at sequential echocardiograms. Neurological examination at 3 months follow-up visit was completely normal. To our knowledge, this is the first report of the safe and successful use of rFVIIa to treat ICH in a patient on oral anticoagulants for prosthetic heart valves.

[Bone choristoma of the bilateral choroid and asymmetric microphthalmia]. / Choristome osseux de la choroïde bilatéral et microphtalmie asymétrique.

The authors report a case of associated bilateral asymmetrical microphthalmia and osseous choristoma of the choroid in a seventeen year old young woman. This association, to the author's knowledge, has not been previously reported in the literature. The bone choristoma was present in the eye's posterior poles and the clinical features were studied by electroretinography, fluorescein angiography, A-B scan ultrasonography, computerized axial tomography and nuclear magnetic resonance. The authors hypothesize that a choroid developmental tumor was produced by exposure to the rubella virus during embryonic life.

Rare multiple orbital localizations of sarcoidosis. A case report.

We report a case of bilateral orbital sarcoidosis without other systemic lesions. Steroid therapy did not improve the clinical status of the patient.

Radiculography with reduced amounts of contrast medium.

Because of the frequency and seriousness of side effects observed after radiculography, due to, among the other things, the amount of contrast medium, the authors describe a method that gives diagnostically satisfactory results using a low dose of contrast and a tangent-beam technique. Among 106 patients undergoing radiculography with a tangent-beam technique and Iopamidol, only 4 developed mild side effects, namely headache in three cases and headache with nausea in one.

[Sacroradiculo graphic and myelographic investigations with iopamidol: study of 610 examinations (author's transl)]. / Complicanze da radicolografia e mielografia con iopamidolo: bilancio su 610 esami.

610 sacrorodiculographic and myelographic examinations were carried out injecting at lumbar level Iopamidol at 200, 300 and 370 mg I/ml concentrations. Immediate and early complications have been noticed in 18,52% of cases, i.e. sensation of pain during contrast injection, headache, nausea, vomit, neck stiffness, photophobia, epilepsy. In sacrorodiculographic examinations, side effects especially occurred by using 370 mg I/ml concentrations; in lumbar and thoracic myelographies, incidence of complications did not statistically differ by uing 300 or 370 mg I/ml concentrations. Side effects have occurred most frequently in cervical myelographies carried out with 370 mg I/ml concentration. Analysis of complications as well as radiographic results suggest to use Iopamidol at 300 mg I/ml concentration in sacrorodiculographics, in lower thoracic myelographies and in studies of narrowed, stenosed or obstructed canals; Iopamidol at 370 mg I/ml concentration may be used in upper thoracic studies and cervical myelographies.

[Epilepsy following cisternography with water-soluble contrast (author's transl)]. / Epilessia da cisternografia con contrasto idrosolubile triodato.

A case of epilepsy is reported during ventriculography with hydrosoluble triiodate contrast (methylglutamine iotalamate). The cysternal interhemispheric cavities of the midline were flooded. This complication, which could have been lethal was treated with thiopental sodium salt, 6 methylprednisolone, mannitol, curare, trans-larynx intubation, ventilation with oxygen and nitrous oxide. The AA. conclude that the presence of an anaesthetist-resuscitator is essential during ventriculography with triiodate hydrosoluble contrast medium.

[Myelopathic patterns of calcification of the posterior longitudinal ligament]. / Quadri mielopatici da calcificazione del legamento longitudinale posteriore.

Three patients with calcification of the posterior longitudinal ligament with myelopathy are reported and discussed. This condition which is frequent in Japan is rarely described in the western population. Such calcification is not only a radiographic finding but is a progressing phenomenon which may extend to compressive lesions of the spinal cord. All patients with calcification of the posterior longitudinal ligament should be fully studied neurologically and followed up.

[Internal maxillary artery and collateral circulation in thrombosis of internal carotid artery (author's transl)]. / L'arteria mascellare interna ed i circoli di compenso nella trombosi della carotide interna

From 53 cases of thrombosis of the internal carotid artery in the neck, collateral circulation through external carotid branches was angiographically demonstrated in 34 subjects. Anastomosis between external and intracranial circulations was seen to take place through three ways formed by internal maxillary, superficial temporal and facial arteries. The role of internal maxillary artery is emphasised as the most important pathway in the connections between the two circles.