[Radiological classification of pituitary adenomas]. / Radiologisk klassifikation af hypofyseadenomer.

Magnetic resonance imaging (MRI) is the modality of choice in the diagnosis of pituitary pathology. A chronological outline and discussion of the radiological classifications of pituitary adenomas applied so far are presented, with a review in depth of the up-to-date classifications based on MRI. SIPAP is an MR classification used in Scandinavia. It is basically a six-figure number describing the extrasellar extension of the adenoma. Together with tumour size, it is a useful and simple method for registration of pituitary adenomas.

[Anterior screw fixation of fractures of the dens axis]. / Anterior skruefiksation af dens axis-fraktur.

INTRODUCTION: The aim of the present study was to evaluate the results of anterior screw fixation in the treatment of odontoid fracture. MATERIALS AND METHODS: The clinical and radiographic records of the first 14 patients treated with anterior screw fixation for odontoid fracture were reviewed retrospectively. RESULTS: Satisfying stabilisation of the fracture was achieved in 10 patients (71%). In four patients, two of whom had severe osteoporosis, additional posterior C1/C2 fusion, owing to failure of screw treatment was needed. Two patients developed small occipital bedsores caused by preoperative treatment, but no further complications were observed. CONCLUSION: Although only a few patients were entered in the study, the results justify the use of anterior screw fixation as the treatment of odontoid fracture in selected patients.

[Reversible liver steatosis in patients treated with 5-fluorouracil and interferon-alpha]. / Reversibel leversteatose hos patienter behandlet med 5-fluoruracil og interferon-alpha.

Twenty-three patients with metastatic colorectal carcinoma were randomized as part of two multicenter Phase III trials to receive either 5-fluorouracil (5-FU)/interferon alpha-2A (INF-alpha) or 5-FU +/- leucovorin. The patients were evaluated regularly for response by CT of the abdomen when treatment began and then every six to eight weeks. incidentally, we found that four of 13 patients treated with 5-FU/INF-alpha and none of ten patients treated with 5-FU +/- leucovorin developed hepatic steatosis during treatment. The diagnoses were based on a decreased CT value of the liver parenchyma by the repeated CT, and histologically verified by liver biopsies. There was no relationship to cumulative 5-FU or INF-alpha dose. Based on posttreatment CT, the liver parenchyma changes were reversible after therapy was stopped. Recognition of this condition in patients receiving 5FU/INF-alpha is important to prevent a patient from being labeled as having progressive hepatic metastases.

SIPAP--a new MR classification for pituitary adenomas. Suprasellar, infrasellar, parasellar, anterior and posterior.

PURPOSE: To present a new MR classification for pituitary adenomas, a grading system named SIPAP. MATERIAL AND METHODS: SIPAP is an acronym for the 5 juxtasellar directions of tumour extension to or penetration into adjacent structures of the sella region, using a 6-figure number for each adenoma. This retrospective study was based on 87 mid-field MR examination of 56 patients with biochemically or surgically confirmed pituitary adenomas. Sagittal T1-weighted SE and coronal T1-weighted 3D FFE sequences before and after i.v. contrast administration were performed. RESULTS: The SIPAP classification was well adapted to the material. All tumours except one postoperative remnant could be classified in the grading system. The classification was useful before and after treatment, for follow-up over a longer period, and for comparing adenomas with different hormonal activity with reference to patient age and sex. CONCLUSION: The SIPAP classification together with tumour size is an optimal method for the registration of pituitary adenomas.

[Fracture-dislocation of Chopart's junction]. / Frakturdislokation i Choparts ledlinie.

Fracture dislocation of the midtarsal joint or Chopart's junction is a rare condition where an early recognition and treatment is needed to avoid instability and significant longterm foot problems. The radiological aspects are discussed based on two cases.

[Hemorrhage in cerebral cavernous hemangioma as a cause of hemiballismus]. / Blødning i cerebralt kavernøst haemangiom som årsag til hemiballisme.

A 19 year old righthanded woman, without previous neurological symptoms, was examined in April 1993, because of involuntary movements affecting especially the right hand, but also her right leg and the right side of her face. Magnetic Resonance Imagning (MRI), showed a process located in the area of the left subthalamic nucleus, which was recognized as a cavernous haemangioma. A left carotic arteriography in August was normal. The patient had a complete regression of her symptoms, wherefore there was no indication for neurosurgical intervention. The patient is still being followed without treatment.

Leber's hereditary optic neuropathy associated with a disorder indistinguishable from multiple sclerosis in a male harbouring the mitochondrial DNA 11778 mutation.

This report describes a multiple sclerosis (MS)-like disorder in a male patient with Leber's hereditary optic neuropathy (LHON) harbouring the mitochondrial DNA 11778 base pair mutation. Given the population frequencies of MS and LHON, coincidental occurrence is unlikely. Hypothetically the mitochondrial mutation underlying LHON may contribute to presumably immunologically mediated involvement of other myelinated axons in the central nervous system in susceptible individuals, producing a disorder indistinguishable from MS. We recommend that investigation for oligoclonal bands in CSF, evoked potentials and MR brain scan in these patients be supplemented with mitochondrial DNA analysis.

Reversible hepatic steatosis in patients treated with interferon alfa-2a and 5-fluorouracil.

BACKGROUND: Thirty previously untreated patients with metastatic colorectal carcinoma were randomized as part of two multicenter Phase III trials. Twenty-two patients were randomized to receive either 5-fluorouracil (5-FU)/interferon alfa-2A (IFN-alpha) or 5-FU/leucovorin (11 patients in each arm). Eight patients were randomized to receive 5-FU/IFN-alpha or 5-FU alone (4 patients in each arm). METHODS: Twenty-three patients (13 patients treated with 5-FU/IFN-alpha and 10 patients treated with 5-FU/leucovorin or 5-FU alone) were evaluated regularly for response by computed tomography (CT) scans of the abdomen when treatment began and then every 6-8 weeks. RESULTS: Incidentally, four patients developed hepatic steatosis during treatment with IFN-alpha and 5-FU. The diagnosis was based on a decreased CT value of the liver parenchyma by repeated CT scans of the abdomen during treatment, and this diagnosis was verified histologically by liver biopsy. There was no relationship to cumulative IFN-alpha or 5-FU dose. Based on posttreatment CT scans, the liver parenchyma changes were reversible after therapy was stopped, and there were no significant clinical sequelae. No patients treated with 5-FU/leucovorin or 5-FU alone experienced a decreased CT value of the liver parenchyma. CONCLUSION: Hepatic steatosis was been observed in approximately 30% of patients treated with IFN-alpha and 5-FU. The hepatic changes were fully reversible after the treatment was stopped. Recognition of this condition is important to prevent a patient from being labeled as having progressive hepatic metastases.

[A complication of oleothorax--after 38 years]. / Komplikation til oleothorax--38 år efter.

We present a case-history of a 50 year-old woman who 38 years earlier had been operated for pulmonary tuberculosis by plugging of the pleural cavity with oil (oleothorax). She developed a tumour under the scapula, which it turned out was due to migration of the oil plug to the subscapular area, an unusual complication to oleothorax. Other complications are described.

[Focal fatty liver. A dilemma of differential diagnosis in ultrasonography and CT]. / Fokal fedtlever. Et differentialdiagnostisk dilemma ved ultralydundersøgelse og CT.

Based on four cases and relevant background literature we partly want to draw attention to the occurrence of focal fatty liver (FFL) and its manifold appearances in connection with ultrasonography (US) and computed tomography (CT), and partly to point out possible pitfalls in US-diagnosis of the liver in cases of extensive fatty liver, where the residual foci of normal liver may incorrectly be interpreted as abnormal lesions. US and CT examination of FFL may cause differential diagnostic problems with risk of misinterpretation and erroneous diagnosis, especially if the phenomenon is unknown. In cases of doubt in US examination, where the uncharacteristic findings together with patient information indicate further examinations, additional CT is first of all recommended. If this still brings no clarity to the diagnosis, the clinical condition in every case will prescribe whether to undertake additional CT after a few weeks or immediately carry out US/CT guided liver biopsy. Current as well as formerly presented research shows that FFL is mainly located in the right hepatic lobe, and possible reasons for that are discussed.

[Chordoma. An unusual cause of cauda equina syndrome]. / Kordom. En usoedvanlig årsag til cauda equina syndrom.

Acute cauda equina syndrome caused by a chordoma in the third lumbar vertebra is presented as a case report. This combination has not previously been described.