Bilateral hypertrophic olivary degeneration following surgical resection of a posterior fossa epidermoid cyst.

Hypertrophic olivary degeneration is a result of a primary lesion damaging the dento-rubro-olivary pathway. It is a transynaptic form of degeneration and is unique, causing hypertrophy rather than atrophy of the inferior olivary nucleus. We report a case of bilateral hypertrophic olivary degeneration following surgical excision of a posterior fossa epidermoid cyst and review the relevant literature.

Brachial diplegia as a result of cervical cord injury.

OBJECTIVE: To report a case of brachial diplegia with normal lower limb power, after a cervical cord injury. DESIGN: Case report of a 63-year-old man who sustained a neck trauma following a fall. SETTING: Department of Neurology, University Hospitals of Leicester, Royal Infirmary, Leicester, UK. CASE REPORT: The mechanism of the injury was probably one of hyperflexion resulting in central cervical cord contusion. Initial neurological examination revealed brachial diplegia, with posterior column sensory involvement of the lower limbs which had normal power. The patient was also in urinary retention but had no respiratory involvement. Magnetic resonance imaging (MRI) of the spinal cord showed a hyperintense signal in the central mid-cervical cord. CONCLUSION: Pure brachial diplegia represents a rare clinical presentation of cervical cord pathology, including trauma, of which clinicians should be aware.

CT staging of renal carcinoma: a prospective comparison of three dynamic computed tomography techniques.

Three dynamic computed tomographic methods used for staging of renal carcinoma in 70 patients are described and compared. Twenty-eight patients were examined using incremental dynamic scanning across the kidneys whilst infusing contrast via an arm vein (technique 1). Eighteen patients were staged using a single location dynamic scan sequence at the level of the renal hilum followed by an incremental sequence during an infusion of contrast into the femoral vein (technique 2). Twenty-four patients were examined using a single location sequence at the level of the renal veins and a rapid bolus incremental dynamic technique (technique 3). Technique 1 correctly staged 20 patients (72%) with 4 patients (14%) understaged and 4 (14%) overstaged, technique 2 correctly staged 11 (61%) patients with 3 (17%) overstaged and 4 (22%) understaged and technique 3 staged 17 (71%) correctly with 3 (13%) understaged and 4 (17%) overstaged. The techniques using single location scanning were more accurate in demonstrating tumour involvement of the renal vein and inferior vena cava but were less accurate in assessing extracapsular spread. Technique 3 was the most accurate in the diagnosis of lymph-node involvement. As accurate pre-operative knowledge of vascular involvement by tumour is more important to the surgeon than the presence of extracapsular spread, the combined single location and incremental scan technique is advocated.

Staging of renal cell carcinoma by dynamic computed tomography: a prospective comparison of two techniques.

Two dynamic computed tomographic methods used for staging renal carcinoma in 46 patients are described and compared. Twenty-eight patients were examined using an infusion technique during incremental dynamic scanning across the kidneys with contrast administered via an arm vein. Eighteen patients were staged using a technique comprising a single location dynamic scan sequence at the level of the renal hilum followed by an incremental sequence during an infusion of contrast into the femoral vein. When compared with overall pathological staging, the arm vein infusion technique correctly staged 20 patients (72%) with four patients (14%) understaged and four (14%) overstaged. The femoral vein infusion and single location dynamic scanning technique correctly staged 11 (61%) patients with three (17%) overstaged and four (22%) understaged. The femoral vein infusion with single location scanning was more accurate in demonstrating tumour involvement of the renal vein (83.3% correct vs. 78.6%), inferior vena cava (94.4% correct vs. 89.3%) and lymph nodes (88.9% correct vs. 78.6%) but was less accurate in assessing extracapsular spread (77.8% correct vs. 96.4%). The additional information obtained from the single location dynamic sequence is sufficiently valuable for this part of the second technique to be used in any scanning protocol for staging renal carcinoma.

A prospective study of the value of conventional CT, dynamic CT, ultrasonography and arteriography for staging renal carcinoma.

The value of dynamic CT scanning for staging renal carcinoma was studied prospectively in 28 patients and the results compared with those of ultrasonography, arteriography and conventional CT. Arteriography correctly staged 48% of tumours; ultrasonography and conventional CT correctly staged 50% and dynamic CT correctly staged 72%. Dynamic CT staged renal carcinoma more accurately than ultrasonography, conventional CT or arteriography and it is suggested that arteriography should be restricted to specific indications such as the mapping of arterial anatomy and therapeutic renal artery embolisation.

Oral mebeverine in barium enema preparation.

A double blind controlled trial to determine the effect of mebeverine (Colofac) pre-medication on the incidence of spasm, pain and discomfort during examination of the colon by double contrast barium enema was carried out. There was a significant reduction in spasm on fluoroscopy and reported pain and discomfort in the mebeverine group. The number of segments of spasm on the radiographs was not significantly reduced.