Spinal subarachnoid hematoma complicating lumbar puncture: diagnosis and management.

Two patients with altered hemostatic mechanisms developed spinal subarachnoid hemorrhage after difficult lumbar punctures. One patient had received anticoagulation therapy soon after lumbar puncture and the other had a low platelet count (63,000/mm3) at the time of lumbar puncture. In both patients a hematoma evolved, producing blockage of cerebrospinal fluid flow. Clinical manifestations consisted of severe back and radicular pain with sphincteric disturbances followed by rapidly developing severe paraparesis. Of the methods of radiographic evaluation that were used, including computed tomography (CT) without contrast enhancement, myelography, CT with intrathecally administered contrast medium, and magnetic resonance imaging, we found the best study to be myelography via lateral cervical puncture followed by CT. Unfortunately, diagnosis was delayed, and surgical evacuation of the hematomas did not substantially improve the patients' conditions. The salient clinical and radiographic features of this disorder and its pathophysiology are reviewed. Prompt recognition of these lesions is necessary so that surgical intervention may maximize chances of recovery.

Pulsatile flow index for qualitative measurements of blood flow with duplex ultrasound. An experimental study.

We determined the accuracy of Doppler blood flow measurements in an experimental investigation using a tissue-simulating phantom, pulsatile flow pumps and heparinized blood. A new index for qualitative assessment of blood flow, the pulsed flow index (PFI) is described. The PFI takes advantage of the area under the flow velocity curve between the true zero line and the diastolic baseline. Under conditions of continuous flow, the PFI ranged from 0.82 to 0.94 (mean value 0.90). The PFI was found to be relatively independent of the transducer/vessel angle (+/- 8%) and the inter/intra-operator variation was small (+/- 7.5%, or +/- 7%, respectively).

Distribution of cytoplasmic estrogen and progesterone receptors in human endometrium.

Unoccupied estrogen receptors and progesterone receptors were measured in the cytoplasm of five sections along the length of endometrium obtained from noncancerous, premenopausal hysterectomy specimens. The concentrations of the two receptors were measured with tritiated estradiol or R5020 (a synthetic progestin), the latter two having been purified by high-pressure liquid chromatography, and were found to be highest in the fundus and lowest in the cervix. Progesterone receptor levels, ranging from 50 to 3,500 fmoles of R5020 bound per milligram of protein, were generally much higher in each section of the endometrium than estrogen receptor levels, which ranged from 0 to 500 fmoles of estradiol bound per milligram of protein. Near ovulation it seemed that the distribution profiles of both receptors became very steep, with more than a tenfold difference in the receptor levels being found between the fundus and the cervix. Receptor levels measured in endometrial samples obtained by curettage or aspiration should be interpreted with caution.