Deliberate epidural air injection in dogs: a radiographic study.

To investigate whether and to what extent air bubbles are present in the epidural space after injections of air, the authors designed an experiment using a chronic dog model. The epidural space was entered at the sixth or seventh lumbar interspace in six mongrel dogs (weight, 20 to 27 kg). Loss-of-resistance (LOR) to saline was tested to identify the epidural space. Three milliliters of air were injected via a Tuohy needle, followed by 5 ml of contrast material (Isovue 300, Squibb Diagnostics). Anterior-posterior (AP) and lateral radiographs were taken on day 1. On days 2, 4, and 8, the procedure was repeated, omitting the air injection. Radiographs were read by a neuroradiologist. Air bubbles were radiographically demonstrated in all six dogs on day 1, and in three of six dogs on day 2. No air was seen on later films. The air bubbles seen were small and few in number but often located near intervertebral spaces. The authors' findings suggest that injection of large volumes of epidural air should be avoided, particularly when N2O is used as part of the anesthetic or when performing diagnostic peridurography since N2O may expand the volume of existing bubbles and interfere with filling of the epidural space by local anesthetics or contrast material.

Computed tomographic diagnosis of ruptured giant posterior cerebral artery aneurysms.

Ruptured giant posterior cerebral artery (PCA) aneurysms are encountered rarely. Although computed tomographic (CT) scan features of giant intracranial aneurysms have been described. CT scan features of acutely ruptured giant saccular PCA aneurysms have not been reported. A case of an acutely ruptured giant saccular PCA aneurysm with diagnostic CT scan features and autopsy confirmation is presented. Two additional cases of apoplexy with identical clinical courses and CT scan appearances, both attributed to giant saccular PCA aneurysms, are described. Diagnostic CT scan features included evidence of intraparenchymal temporal lobe and intraventricular hemorrhage, the presence of a filling defect in the temporal lobe hematoma that enhanced after intravenous contrast administration, and evidence of proximal PCA entrance into the contrast-enhanced filling defect in the intracerebral hematoma. The incidence of PCA aneurysms and the anatomy of the PCA as it relates to these giant aneurysms, their clinical presentation, and diagnostic features of the CT scan are discussed.

Patients with small-cell lung cancer treated with combination chemotherapy with or without irradiation. Data on potential cures, chronic toxicities, and late relapses after a five- to eleven-year follow-up.

We assessed the outcome in 252 patients with small-cell lung cancer 5 to 11 years after treatment with combination chemotherapy, with or without chest and cranial irradiation, in National Cancer Institute therapeutic trials from 1973 through 1978. Twenty-eight patients (11%) survived free of cancer for 30 months or more. Fourteen patients remain alive without evidence of cancer beyond 5 years (range, 6.4 to 11.3 years), and 7 patients have returned to a lifestyle similar to that before diagnosis. The other 14 patients who were cancer-free at 30 months have developed cancer or died; 6 patients had a relapse, 4 developed or died from non-small-cell lung cancer, and 4 died of unrelated causes. A few patients with small-cell lung cancer (5.6%) may be cured. Thirty-month, cancer-free survival is insufficient to show a cure. Although late toxicities are troublesome, they do not outweigh the benefits of prolonged survival and potential for cure with modern aggressive therapy in small-cell lung cancer.

Intrathecal phenol and glycerin in metrizamide for treatment of intractable spasms in paraplegia. Case report.

Intractable lower extremity spasms after spinal cord injury is a significant source of morbidity. A case of refractory spasticity in paraplegia was successfully converted to flaccid paraplegia by intrathecal injection of phenol and glycerin in metrizamide. This chemical rhizolysis is simple and effective, and the presence of metrizamide allows both fluoroscopic guidance for accurate intrathecal phenol placement and good miscibility with cerebrospinal fluid. A brief comparative review of alternative therapeutic modalities is presented.

Thoracic chordoma in a patient with paraparesis and ivory vertebral body.

Chordoma arising in the thoracic region is uncommon. Its presentation roentgenographically as an ivory vertebra has not been previously reported. Such a case is described, and a brief review of the incidence and location of spinal chordomas is given.

Gas in the spinal canal in association with the lumbosacral vacuum phenomenon: CT findings.

Twenty-two of 79 patients examined for lumbar spinal stenosis with CT showed the vacuum phenomenon. Three of these cases also had free gas in the spinal canal. The CT findings of vacuum phenomena and free gas in the spinal canal are discussed.