Endovascular approach to treatment of indirect carotico-cavernous fistulae.

The purpose of the study was to assess the cure rate in patients with indirect carotico-cavernous fistula (CCF) treated by transvenous embolisation via the inferior petrosal sinus (IPS) pathway or the superior ophthalmic vein (SOV). Twelve fistulae in 11 patients were treated by transvenous embolisation, eight patients via the IPS and four fistulae in three patients via the SOV. Angiographic cure was defined as complete obliteration of the fistula and clinical cure as total resolution of signs and symptoms. Complete cure was achieved in eight patients with nine fistulae embolised transvenously. Five fistulae were approached via the IPS and four via the SOV. Our preferred method for treatment of indirect CCF is the transvenous route. The IPS approach is technically easier and has fewer potential risks than the SOV approach. However, if the IPS is not patent the SOV can provide good alternative access to the cavernous sinus.

Adult presentation of agenesis of the hemidiaphragm.

A 66-year-old woman presented with a 3-day history of classical features of large bowel obstruction. At emergency laparotomy, the transverse colon and splenic flexure were located in the left hemithorax. The entire left hemidiaphragm was absent, and there were no diaphragmatic remnants visible. This is the oldest reported case of an absent hemidiaphragm. Previous cases of "agenesis" of the hemidiaphragm in adults either reported diaphragmatic remnants intraoperatively or failed to rule them out radiologically when managed conservatively. We would suggest that this is the first reported case of an adult presenting with true agenesis of the hemidiaphragm.

Evaluation of the role of magnetic resonance myelography in lumbar spine imaging.

The purpose of our study was to evaluate the accuracy of MR myelography in depicting disc herniation in the lumbar spine when compared with conventional MRI in patients presenting with clinical evidence of disc herniation. One hundred patients referred for conventional MR imaging of the lumbar spine also had coronal MR (TR 9000 ms, TE 272 ms eff, NEX 3, echo train length 32) myelography performed. Three experienced observers compared magnetic resonance myelography (MRM) with conventional lumbar spine MR using the following variables: visibility of thecal sac and nerve roots, and the presence, location and severity of disc herniation. Disc protrusions were seen at 110 disc space levels on conventional MR images as opposed to 93 on MRM. However, only 72 % of lesions seen on conventional MR were diagnosed by MRM. Similarly, only 63.8 % of nerve root compression abnormalities seen at conventional MR were visualized when compared with conventional MRM. The sensitivity, specificity and accuracy of MRM when compared with conventional MR was 72, 93 and 85 %, respectively. The MRM technique yields images that resemble conventional myelography and may be used to help confirm abnormalities seen on conventional MR in selected cases; however, the large number of false-positive and false-negative examinations indicates that caution should be used in interpreting MRM images.

Immunohistochemical evaluation of merosin deficiency in congenital muscular dystrophies.

OBJECTIVES: To determine the prevalence of merosin deficiency in cases of unclassified congenital muscular dystrophy and to determine the temporal stability of merosin epitopes in fixed and stored archival material. MATERIALS AND METHODS: Using an antibody to human merosin we retrospectively studied 12 cases of undiagnosed muscular dystrophy from our files to determine the prevalence of merosin deficiency. Where fresh muscle was not available, unstained stored cryostat sections or destained archival stored sections were incubated with the merosin antibody. RESULTS: Two of the 12 cases of undiagnosed muscular dystrophy were merosin-deficient. No difference in intensity of merosin staining was found between freshly cut cryostat sections and unstained stored cryostat sections. There was no difference in the intensity of merosin staining in sections archived for up to 10 years. CONCLUSIONS: We conclude that 16% of unclassified muscular dystrophies in our study are due to merosin deficiency and that merosin antigenicity remains intact in archival stored muscle tissue, facilitating retrospective evaluation of patients in whom frozen muscle is not available. To our knowledge, this latter observation has not been reported previously.

Embolisation of recently ruptured intracranial aneurysms.

Patients with subarachnoid haemorrhage due to the rupture of aneurysms unsuitable for craniotomy and clipping have been treated by coil embolisation within three weeks. Sixty nine of 75 consecutive patients were successfully treated. Procedure related complications occurred in 10 patients, resulting in permanent neurological deficits in three and one death (4.8%). The Glasgow outcome scores at six weeks were 53 grade 1, seven grade 2, four grade 3, and five grade 5. These results are comparable with surgical series despite a high proportion of aneurysms in the posterior cerebral circulation.

[Ultrasound diagnosis of the abdomen]. / Ultraschall des Abdomens.

Ultrasonography is the method of first choice for the rational work-up of abdominal pathologies. The results and limitations of this method for diagnosis of diseases of the gallbladder, bile ducts, liver, pancreas, spleen, kidney and urinary tract, adrenal glands, vessels and lymph nodes, female pelvis and gastrointestinal tract are presented in a short overview. Particular reference is made to a critical approach, emphasizing relevant further investigations.

Renal angiography in potential living related renal donors in Iraq.

Between July 1983 and March 1986, 160 potential living related renal donors underwent renal angiography. One hundred and twenty-eight have (Group 1) and 32 have not (Group 2) become renal donors. The addition of selective renal angiography did not alter the pre-operative arterial prediction made on flush aortography in 102 of 109 renal donors who had both investigations. At surgery, nine of the 13 unexpected arterial findings were in patients who had both forms of angiography. Complications of angiography in 16 patients (11%) included failed groin puncture (two), groin haematoma (eight), haematocoele (one) and loin pain (five). Three patients had renal artery damage detected at surgery, one of which resulted in graft loss. The arterial anatomy demonstrated was similar in 22 of the 23 patients in Group 2 who had flush and selective angiography. One patient (3%) developed a small groin haematoma. Forty-six patients (29%) had multiple renal arteries demonstrated angiographically. This paper highlights the incidence of renal artery damage following selective renal angiography and suggests that flush aortography provides adequate pre-operative information.

Computed tomography of the kidneys in a patient with methoxyflurane abuse.

Methoxyflurane, a general anesthetic, is a known nephrotoxin. A case is presented that demonstrated diffuse, bilateral renal cortical calcification on CT secondary to repeated methoxyflurane inhalation.