Osteoid osteoma. Computed tomography guided percutaneous excision.

The authors' experience with computed tomography guided excision of osteoid osteoma in an outpatient setting using an Einhorn biopsy set and a power drill in 21 patients is described. In the last 5 years, 21 patients aged 7 to 51 years who had radiographic findings and symptoms of osteoid osteoma were included in the study. The nidus of the tumor was excised successfully in all cases using a coaxial technique with a power drill. Excision of the nidus was confirmed by postexcision computed tomography scans, histologic evaluation, and absence of symptoms on clinical and radiographic followup. Only one minor complication and no recurrences occurred with a mean followup of 17 months (range, 9-43 months). Percutaneous computed tomography guided excision is an effective, safe, and cost effective method of treatment of osteoid osteoma.

Hyperbaric oxygen for treatment of closed head injury.

Traumatic and vascular brain injuries consist of acute episodes followed by development of chronic components of varying magnitude and duration whose potentials for recovery differ. We discuss a case of closed head injury in which interventional hyperbaric oxygen (HBO) with single photon emission computed tomography were used as aids in determining the presence of recoverable neurons, to follow therapeutic progress, and to determine the end point of therapy. This case also shows the successful use of intensive HBO as a therapeutic modality.

Gray scale ultrasonography and rose bengal scintigraphy in the evaluation of the patient with jaundice.

In our experience, the ultrasonic examination should be the procedure of choice in the initial investigation of the patient with jaundice. It is independent from liver function and a noninvasive test which can be performed rapidly; in addition, the cause of extrahepatic obstruction can often be determined preoperatively. In our study, in many patients, the rose bengal scintigram has been indeterminate and has not been helpful in predicting whether obstructive or nonobstructive jaundice exists. Rose bengal scintigraphy appears to be of most help only in those patients in whom an adequate sonographic examination cannot be performed. Newer imaging agents currently being developed may prove to be more satisfactory in the future.

Grey scale ultrasonography: evaluating the jaundiced patient.

Over a period of one year, 75 patients with jaundice were evaluated by grey scale ultrasonography. Intravenous cholangiography was attempted in 26 instances (bilirubin value greater than 4.3 mg/100 ml) and was diagnostic in only four. Ultrasound, on the other hand, was diagnostic for surgical jaundice in 62 of the 75 cases (82%). In 52 of the 62 patients a cause for the extrahepatic obstruction was demonstrated: 40 had cholelithiasis and choledocholithiasis, and 12 had tumors (11 pancreatic tumors, one lymphoma). In the remaining ten instances, obstruction was sonographically demonstrated but the cause was not. Of these, four patients were subsequently proven to have distal common duct stones, five had carcinoma of the pancreas and one had cholangiocarcinoma. This evidence indicates that ultrasound should be the noninvasive procedure of choice in the clinical assessment of obstructive jaundice.