Sinusitis and intracranial sepsis: the CT imaging and clinical presentation.

The CT imaging and clinical presentation in 14 children with coexistent intracranial sepsis and sinusitis were reviewed. A routine CT head scan (10-mm thick semi-axial slices through the cranium done before and after intravenous contrast medium administration) was found to be an inadequate initial investigation as the intracranial collection was missed in four patients and the abnormal sinuses not shown in six. In half the children the diagnosis of sinusitis was unsuspected at the time of admission. The dominant clinical features were fever, intense headache and facial swelling in early adolescent males. In this clinical setting we recommend: (1) the routine scan is extended through the frontal and ethmoidal sinuses and photographed at a window level and width showing both bone detail and air/soft tissue interfaces; (2) direct coronal projections are performed through the anterior cranial fossa if no collection is seen on the routine study; (3) an early repeat scan within 48 h if the initial study shows no intracranial pathology but the fronto-ethmoidal sinuses are abnormal and there is a high clinical suspicion of intracranial sepsis; and (4) in the presence of intracranial sepsis the vault is viewed at bone window settings to exclude cranial osteomyelitis.

Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate.

The operative rate in intussusception has been significantly reduced by (1) expansion of the indications for attempted enema reduction of intussusception to include all children except those with peritonitis or septicaemia and (2) use of the gas (oxygen) enema rather than barium. This prospective study looked at the value of performing a delayed repeat gas enema in children in whom only partial reduction was achieved during the first enema, and who remained clinically stable. Twenty-one patients (of 156 with proven intussusception) had a repeat delayed gas enema, 30 minutes or more after the first attempt at reduction. This was successful in over 50%, reducing the number of patients requiring surgery at our institution by 24% and saving approximately five children a year from surgery.

Doppler carotid artery studies in asymmetric glaucoma.

Doppler carotid artery studies were performed in 12 glaucoma patients with marked asymmetry in bilateral visual field loss. The resistance index and the pulsatility index of the internal carotid artery velocity waveforms were significantly greater on the same side as the eye with the greater visual field loss. The increased resistance to blood flow in the internal carotid artery on the side with advanced field loss might predispose the eye on this side to the effects of raised intraocular pressure by causing a reduction in the perfusion pressure at the optic nerve head. The role of ocular perfusion pressure in the pathogenesis of glaucoma is discussed. More extensive studies are necessary.