Detection of recurrent cholesteatoma by computerized tomography after 'closed cavity' mastoid surgery.

Pre-operative Computerized Tomography was performed prior to second look operations in 10 cases to check for cholesteatoma after combined approach tympanoplasty. Three independent opinions were obtained on the CT scans and compared with the operative findings. This small series failed to demonstrate reliable pre-operative radiological detection of cholesteatoma. There was disappointing inter-observer agreement in interpretation of the CT scans.

A licence for breast cancer screening?

It is unrealistic to expect that the best results which have been reported from some research programmes will be equalled after the introduction of a nationwide breast screening service in Britain. Stringent methods of quality control will be needed or potential benefits will not be realised. Despite the disadvantages an effective method of accreditation may be the only way to contain the cost to both healthy women and the National Health Service.

Obstetric ultrasonography: wider role for radiographers?

Most obstetric ultrasound scanning is carried out by radiographers, who have professional constraints that forbid them to disclose the result of any investigation to any patient or to hold themselves as professionally qualified to diagnose. A nationwide survey was carried out to explore the paramedical aspects of obstetric ultrasound services and determine how radiographers reconcile their professional constraints with the needs and expectations of patients. It was concluded that over 70% of obstetric scanning in the United Kingdom is carried out by radiographers who tell patients some results and report both numerical and interpretational data to referring clinicians. This survey suggests that constraints on radiographers who perform obstetric ultrasonography are excessively restrictive and conflict with everyday clinical demands. The medical supervision of some obstetric ultrasound units should be improved, and partners of patients should not be encouraged to expect access to obstetric scans unless radiographers have close medical support.

The outcome of antenatally diagnosed urological abnormalities.

Twenty-eight patients undergoing routine antenatal screening by ultrasound were found to have a fetus with a major urological abnormality. In addition, two babies suspected of having an enlarged bladder were found post-natally to be normal. Seven of the 28 pregnancies were terminated before 26 weeks' gestation as a result of the ultrasound findings and all these fetuses had lethal renal abnormalities. Of the remaining 21 babies, four died of renal failure following delivery. Fifteen of the 17 babies who are alive and well had an ultrasound scan before 24 weeks' gestation. Only one of these scans revealed the abnormality. In the remaining patients the abnormality was first detected after 28 weeks. No patient had surgery in utero. Our data suggest that renal abnormalities detected prior to 24 weeks' gestation are associated with severe renal impairment. It appears that the role of antenatal drainage procedures may be of limited value.

The urographic appearances following ureteric re-implantation by the Cohen method.

The Cohen method of ureteric re-implantation for vesico-ureteric reflux is described. Following this procedure, the lower ureters have a smooth upward curve in the bladder wall and extend across the mid-line. The characteristic urographic appearances are illustrated.

Intravenous cholangiography in childhood.

Intravenous cholangiography (IVC) was performed on 102 children aged between one and 13 years. Eighty of the patients who were non-icteric were divided into four groups and received contrast medium containing either 53, 75, 106 or 150 mg iodine/kg body weight by intravenous injection over ten minutes. Complete demonstration of the common bile duct (CBD) was achieved in 85% of patients and in a similar proportion of all age groups. There was some delay in opacification of the CBD in young children but this was not of practical significance. The two higher dosage regimen gave significantly better results than the two lower dosages (p less than 0.001) and this improvement was evident in the young and older age groups. Nausea and vomiting occurred as side effects in 6%. In eight patients in whom there was inadequate demonstration by the standard IVC, an infusion technique over 3--8 hours was carried out. This improved the demonstration in three children with diagnostic results in two.

Primary disorders of bone with 'spinal block'.

Two hundred and thirty-two cases of compression of the spinal cord or cauda equina included 11 cases where compression was entirely due to a primary bony disorder and 20 further cases where developmental spinal stenosis was the main cause of compression. The former group consisted of two cases of Paget's disease and one each of polyostotic fibrous dysplasia, chondrosarcoma, achondroplasia, spondylo-epiphyseal dysplasia, Klippel--Feil syndrome, haemangioma of bone, primary bone reticulosarcoma, osteoporotic fracture and vertebral osteomyelitis. Three patients, with fibrous dysplasia, chondrosarcoma and Paget's disease with recurrent compression respectively, are described and the relevant literature is reviewed. The large number of primary disorders of bone which can cause cord compression are tabulated. Cord compression is a rare complication in most of these disorders but collectively they caused 13% of the cases of spinal block in this series.

The width of the common bile duct in childhood.

The maximum diameter of the common bile duct was measured on 85 normal intravenous cholangiograms carried out on children between the ages of 1--14 years. There was a close correlation between bile duct width and the patient's age, but a poor correlation with weight. The range of bile duct widths in each age group is tabulated as a guide to diagnosing biliary dilatation in childhood.

Renal tubular sludging of meglumine iodipamide (Biligrafin).

Linear densities which were thought to represent meglumine iodipamide were seen in the renal papillary tubules of three patients for respectively four, six and nine days following intravenous cholangiography (IVC). All three patients were children with hepato-biliary disease. Two patients had biliary roundworm infestation, and one patient had hepatic dysfunction and intestinal ascariasis with possible biliary involvement. Haematuria and renal enlargement were seen in one patient, but the cholangiogram was not conclusively implicated as a cause. This renal tubular "sludging" of biliary contrast medium is recorded because of its potential nephrotoxic significance. The possible causes are discussed.

Ascaris perforation of the common bile duct demonstrated by intravenous cholangiography.

Roundworm infection rarely causes common bile duct perforation. This complication was demonstrated by intravenous cholangiography in a sixteen month old girl.

Tuberculous erosion of the sphenoid bone.

Sphenoidal erosions due to tuberculosis are reported in four young coloured children. The lytic destruction is emphasized for refence texts indicate that tuberculosis produces a sclerotic reaction when extending to the skull base. Tuberculous osteitis of the skull occurs particularly in coloured children and adolescents. It should be considered when destructive skull lesions are seen in these patients.

Intracranial extravasation of contrast medium during carotid angiography.

The results of 5184 carotid angiograms were reviewed and five cases of intracranial extravasation of contrast medium were found. In two cases an aneurysm ruptured during angiography and extravasation into the subarachnoid space was seen. In one case medium leaked from an angiomatous malformation into the subdural space. The fourth case was a patient who had suffered closed head trauma. Here extravasation was seen deep within the brain. The fifth case illustrates two forms which extravasation from meningeal arteries may take. The incidence and prognostic significance of this finding in different conditions are discussed.

Intracerebral pneumatocele: an unusual complication following intraventricular drainage in case of benign intracranial hypertension.

The development of an intracerebral pneumatocele following ventricular catheterization for benign intracranial hypertension is described. The importance of skull radiography in the diagnosis of this previously unreported complication ist emphasized. This case demonstrates that air can accumulate without the need to implicate increased pharyngeal pressure, and despite raised intracranial pressure.