A radiological study on intra- and extra-cranial calcifications in adults with X-linked hypophosphatemia and associations with other mineralizing enthesopathies and childhood medical treatment.

OBJECTIVES: 1) The objective of this study was to explore radiological signs of intracranial and nuchal ligament calcifications in adult patients with X-linked hypophosphatemia (XLH) compared with controls and 2) to correlate signs of cranial calcifications in XLH patients with the presence of other extra-cranial enthesopathies, with the severity of skeletal XLH impact and with medical treatment during childhood. SETTING AND SAMPLE POPULATION: Lateral and postero-anterior cephalograms from 36 adult XLH patients and 49 adult controls and X-rays from spine, pelvis, knees and ankles from 31 of the 36 XLH patients. METHODS: Radiological signs of intracranial and nuchal ligament calcifications in XLH patients were compared with controls by Fischer's exact test. In XLH patients, the presence of cranial calcifications was correlated with the presence of other enthesopathies, with the severity of skeletal XLH impact and with medical treatment by Fischer's exact or chi-squared test. RESULTS: Six (17%) XLH patients revealed major signs of intracranial calcifications. Nuchal ligament calcifications were common in XLH patients compared with controls (p = 0.018). Enthesopathy was present at 0-24 sites per XLH patient (median 2). Intracranial calcifications trended to correlate positively with vertebral enthesopathies (p = 0.059). Nuchal calcifications correlated positively with the severity of skeletal XLH impact (p = 0.040). Vertebral enthesopathies correlated negatively with medical treatment (p = 0.008). CONCLUSION: More XLH patients than controls showed nuchal ligament calcifications, and some XLH patients showed intracranial calcifications. Severely affected XLH patients often had nuchal ligament calcifications. Medically treated XLH patients had few vertebral enthesopathies.

[Reversible liver steatosis in patients treated with 5-fluorouracil and interferon-alpha]. / Reversibel leversteatose hos patienter behandlet med 5-fluoruracil og interferon-alpha.

Twenty-three patients with metastatic colorectal carcinoma were randomized as part of two multicenter Phase III trials to receive either 5-fluorouracil (5-FU)/interferon alpha-2A (INF-alpha) or 5-FU +/- leucovorin. The patients were evaluated regularly for response by CT of the abdomen when treatment began and then every six to eight weeks. incidentally, we found that four of 13 patients treated with 5-FU/INF-alpha and none of ten patients treated with 5-FU +/- leucovorin developed hepatic steatosis during treatment. The diagnoses were based on a decreased CT value of the liver parenchyma by the repeated CT, and histologically verified by liver biopsies. There was no relationship to cumulative 5-FU or INF-alpha dose. Based on posttreatment CT, the liver parenchyma changes were reversible after therapy was stopped. Recognition of this condition in patients receiving 5FU/INF-alpha is important to prevent a patient from being labeled as having progressive hepatic metastases.

[Pressure and flow-profile of different spinal needles]. / Tryk- og flowprofil for forskellige spinalkanyler.

The flow characteristics of four different types of spinal needles were investigated by measuring the infusion pressure during steady state infusion of either saline or an X-ray contrast agent. Two pencilpoint needles, a Whitacre 22Gauge and a Sprotte 24Gauge, possessed flow characteristics similar to a 22Gauge Quincke point needle. Use of pencilpoint needles for spinal anaesthesia results in a lower incidence of postdural puncture headache compared to the Quincke point needle. We therefore recommended the use of pencilpoint needles for myelography.

Reversible hepatic steatosis in patients treated with interferon alfa-2a and 5-fluorouracil.

BACKGROUND: Thirty previously untreated patients with metastatic colorectal carcinoma were randomized as part of two multicenter Phase III trials. Twenty-two patients were randomized to receive either 5-fluorouracil (5-FU)/interferon alfa-2A (IFN-alpha) or 5-FU/leucovorin (11 patients in each arm). Eight patients were randomized to receive 5-FU/IFN-alpha or 5-FU alone (4 patients in each arm). METHODS: Twenty-three patients (13 patients treated with 5-FU/IFN-alpha and 10 patients treated with 5-FU/leucovorin or 5-FU alone) were evaluated regularly for response by computed tomography (CT) scans of the abdomen when treatment began and then every 6-8 weeks. RESULTS: Incidentally, four patients developed hepatic steatosis during treatment with IFN-alpha and 5-FU. The diagnosis was based on a decreased CT value of the liver parenchyma by repeated CT scans of the abdomen during treatment, and this diagnosis was verified histologically by liver biopsy. There was no relationship to cumulative IFN-alpha or 5-FU dose. Based on posttreatment CT scans, the liver parenchyma changes were reversible after therapy was stopped, and there were no significant clinical sequelae. No patients treated with 5-FU/leucovorin or 5-FU alone experienced a decreased CT value of the liver parenchyma. CONCLUSION: Hepatic steatosis was been observed in approximately 30% of patients treated with IFN-alpha and 5-FU. The hepatic changes were fully reversible after the treatment was stopped. Recognition of this condition is important to prevent a patient from being labeled as having progressive hepatic metastases.

[Ambulatory lumbar myelography]. / Ambulant lumbal myelografi.

Out-patient lumbar myelography was carried out on 74 consecutive patients, and adverse reactions were registered by the patients themselves. Twenty-four percent experienced moderate or severe headache; 62% experienced increasing back pain of a moderate or severe degree; 40% experienced increasing leg pain of a moderate or severe degree; 15% experienced nausea/general symptoms to a moderate or severe degree. Twenty-nine percent experienced the myelography as unpleasant in a moderate or severe degree. Fourty-seven percent had some kind of adverse reaction for > or = four days. Eleven patients (16%) were admitted to hospital because of severe adverse reactions, mostly headache, and nine of them were treated with a blood patch. Twenty-five percent were referred for operation for their back disease. Generally, out-patient lumbar myelography is well tolerated, but a large proportion of the patients experience temporary adverse reactions to a moderate or severe degree, perhaps in part because of immobilisation in connection with photographing procedures.

Incidence of sinusitis in patients with nasotracheal intubation.

Sinusitis is a complication known to accompany nasotracheal intubation, but its frequency has not been well documented. Twelve patients suffering from cerebral haemorrhage or from cranial trauma and treated with mechanical ventilation were examined for radiological and bacteriological signs of sinusitis with CT-scanning, and cultures of nasal pus discharge. All patients showed radiological signs of sinusitis within 3 days after intubation. They all developed fever, six with a known focus outside the sinuses. There was an even distribution of Gram-negative and Gram-positive bacteria. It is concluded that sinusitis should be considered where fever occurs without known focus in patients with nasotracheal intubation.