Renal Contrast on CT Myelography: Diagnostic Value in Patients with Spontaneous Intracranial Hypotension.

BACKGROUND AND PURPOSE: The significance of renal contrast on CT myelography is uncertain. This project examined different patient populations undergoing CT myelography for the presence of renal contrast to determine whether this finding is of diagnostic value in spontaneous intracranial hypotension. MATERIALS AND METHODS: Four groups of patients were analyzed for renal contrast on CT myelography. The control group underwent CT myelography for reasons other than spontaneous intracranial hypotension (n = 47). Patients in study group 1 had spontaneous intracranial hypotension but CT myelography negative for dural CSF leak and CSF venous fistula (n = 83). Patients in study group 2 had spontaneous intracranial hypotension and CT myelography positive for dural CSF leak (n = 44). Patients in study group 3 had spontaneous intracranial hypotension and CT myelography suggestive of CSF venous fistula due to a hyperdense paraspinal vein (n = 17, eleven surgically confirmed). RESULTS: Renal contrast was present on the initial CT myelography in 0/47 patients in the control group, 10/83 patients in group one, 1/44 patients in group 2, and 7/17 patients in group 3. Renal contrast on initial CT myelography in patients with suspected or surgically confirmed CSF venous fistula was significantly more likely than in patients with a dural CSF leak (P = .0003). CONCLUSIONS: Renal contrast on initial CT myelography was seen only in patients with spontaneous intracranial hypotension. This was more common in confirmed/suspected CSF venous fistulas compared with dural leaks. Early renal contrast in patients with spontaneous intracranial hypotension should prompt scrutiny for a hyperdense paraspinal vein, and, if none is found, potentially advanced diagnostic studies.

Treatment of esophageal obstruction from mediastinal compressive tumor with covered, self-expanding metallic Z-stents.

BACKGROUND: Mediastinal malignancies may involve the esophagus, leading to esophageal stenosis and dysphagia. Rigid and self-expanding esophageal stents have been used for effective palliation, but their use in extrinsic, compressive lesions is controversial. METHODS: A retrospective review of self-expanding Gianturco-Rösch Z-stents that were successfully placed in 13 patients with malignant esophageal obstruction due to extrinsic lesions. RESULTS: All patients had an improvement in dysphagia of at least two dysphagia grades. The mean dysphagia grade fell from 3.15 to 0.62. Mean survival was 2.2 months. Early (within 48 hours) procedure-related complications occurred in 4 of 13 patients and consisted of minor, transient chest pain that resolved within 6 hours (3 patients) and endoscopic stent dislodgment into the stomach (1 patient). Late complications (> 48 hours) occurred in 2 patients and consisted of a partial proximal stent migration and the development of a benign stricture proximal to the stent. There was no procedural or stent related mortality. CONCLUSIONS: Esophageal obstruction and malignant dysphagia from extrinsic, compressive mediastinal malignancies can be effectively and safely palliated with self-expanding Gianturco- Rösch Z-stents.

Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy.

BACKGROUND: Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. METHODS: Self-expanding Gianturco-Rosch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. RESULTS: Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 of 37 (2.5%) without prior therapy (p = 0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p = 0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p = 0.012; odds ratio, 32.63) and also an association with female gender (p = 0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. CONCLUSION: Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.

Fatal noncutaneous visceral infection with varicella-zoster virus in a patient with lymphoma after autologous bone marrow transplantation.

After undergoing high-dose chemotherapy and autologous bone marrow transplantation, a patient developed fatal disseminated infection due to varicella-zoster virus (VZV) with no coincident skin lesions. This article describes this unusual case and briefly reviews the English-language literature on the abdominal presentation of VZV infection as well as that on VZV infection after bone marrow transplantation. In the severely immunocompromised host, visceral infection with VZV may uncommonly occur in the absence of skin lesions. The possibility of such infection should be considered when immunocompromised patients develop unusual symptoms or other evidence of visceral disease (e.g., cholecystitis).

Saturation of human chromosome 3 with unique sequence hybridization probes.

We have generated chromosome 3-specific recombinant libraries in both lambda and cosmid cloning vectors starting with somatic cell hybrids (hamster/human) containing either an intact chromosome 3 or a chromosome 3 with an interstitial deletion removing 75% of long-arm sequences. The libraries contained between 2 X 10(5) and 5 X 10(6) independent recombinants. Approximately 2% of the recombinants in these libraries contain inserts of human DNA. These were identified by hybridizing the recombinants to radioactively labeled total human DNA. Over 2500 recombinants containing human DNA were isolated from these various libraries and DNA was prepared from each of them. This represents 80,000 kb of cloned chromosome 3 sequences. One-third of the DNAs were digested with EcoRI or HindIII, and fragments free of repetitive sequences were radioactively labeled using random hexanucleotide primers and tested as unique sequence hybridization probes. Over 6500 of the fragments were tested and of these 758 were unique sequence probes with minimal or no background hybridization. Their hybridization only to chromosome 3 was verified. These probes, which were derived from 452 independent recombinants, should provide an effective saturation of human chromosome 3.