Hemodynamics of the varicocele. Part II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography

Left renal vein compression occurring mainly with the patient in the upright position, and being less severe or absent in the supine position, was considered to be the main cause of varicoceles. We show that left renal vein compression is, indeed, more severe with the patient in the upright than in the supine position and that it produces a left renocaval pressure gradient that is responsible for the retrograde blood flow in the left testicular vein. This pressure gradient, which was determined in the supine and semierect positions in 34 patients, increased from a mean of 3.8 mm. Hg in the supine position to a mean of 7.8 mm. Hg in the semierect position. On the basis of the assumption that the renocaval pressure gradient measured with the patient in the semierect position determines the presence and velocity of a retrograde flow in the left testicular vein, as shown by the dynamic portion of the varicocele scintigram (see part I), these variables were analyzed and the correlation coefficient proved to be good. Therefore, we conclude that the varicocele occurs when the left testicular vein lacks valves or there is a renogonadal bypass, and the severity of the left renal vein compression in the (semi) upright position determines the velocity of the retrograde flow in the left testicular vein and the size of the varicocele.     

Thyroid carcinoma. Correlation between clinical and pathological findings.

Our survey of 146 cases of thyroid carcinoma showed the following points: (a) in 20% of the cases the gland was diffusely enlarged without nodules; (b) in 35% of 34 cases, thyroid carcinoma was located in areas other than the "cold" zones; (c) multiple foci of carcinoma were found in 67% of cases with total or subtotal thyroidectomy and in 33% of cases with partial thyroidectomy; (d) anaplastic carcinomas (13% of cases) occurred in patients of all ages, 29% of them in patients younger than 30 years.     

Waardenburg syndrome in South Africa. Part I. An evaluation of the clinical findings in 11 families

The clinical findings in 11 families with 52 members affected with the Waardenburg syndrome (WS) are presented and compared with the findings from other studies. The families are assigned to WS type I (7 families containing 31 affected individuals), or type II (4 families with 21 affected members), depending on the presence or absence of dystopia canthorum, and the differences between the two types are discussed. The hypothesis that the features of WS are explicable on the basis of a neural crest defect is supported. Attention is drawn to the finding of spina bifida in 2 unrelated WS type I patients, and of delayed milestones or poor school performance necessitating special schooling in 9 different unrelated patients. Deafness has previously been considered to be the most disabling characteristic of the condition, but if there is an increased incidence of spina bifida or mental retardation associated with WS, the approach to genetic counselling might need to be altered.     

Comparison of clinical, laboratory, radiographic, and scintigraphic findings in erosive and nonerosive hand osteoarthritis. Results of a two-year study

OBJECTIVES: The primary objective was to compare the clinical, radiologic, laboratory, and scintigraphic features in 28 patients with erosive hand osteoarthritis and in 24 with non-erosive hand osteoarthritis. Other objectives were to evaluate clinical, radiographic, and scintigraphic progression in the two groups over a two-year period and to estimate the value of bone scintigraphy for predicting clinical and radiographic progression. METHOD: Prospective two-year study of 52 patients with hand osteoarthritis, of whom 28 had at least three subchondral erosions and 24 patients had no erosions. RESULTS: The group with erosive disease had higher serum immunoglobulin G levels (14.53 +/- 3.79 mg/L vs. 12.03 +/- 4.01 mg/L; P < 0.05) and a higher radiographic index (91.81 +/- 3.67 vs. 25.88 +/- 12.81; P < 0.001), whereas the group with non-erosive disease had a higher rate of paresthesia (66.7% vs. 39.3%; P < 0.05) and higher values for the erythrocyte sedimentation rate (25.21 +/- 20.86 vs. 13.21 +/- 12.85; P < 0.05) and serum C-reactive protein level (8.82 +/- 6.08 vs. 3.25 +/- 6.92; P < 0.01). None of the other study parameters showed any significant differences, and both age and sex distribution were also similar in the two groups. At completion of the two-year follow-up, no changes versus baseline were found in any of the study parameters in the overall study population or in either of the two groups. The baseline scintigraphic index was significantly correlated with the radiographic index at baseline (r = 0.497; P < 0.01) and at study completion (r = 0.550; P < 0.001). Joints with a positive baseline scintigram were significantly more likely to show radiographic progression (21.09%, vs 6.68% in negative joints; P < 0.001) and joint tenderness exacerbation (21.22% vs. 13.73%; P < 0.001). CONCLUSION: These data suggest that bone scintigraphy may be useful for predicting clinical and radiographic progression of hand osteoarthritis with or without erosions.     

Correlation between clinical, arthrographic and arthroscopic findings in meniscal lesions

There are many different references about the accuracy of physical examination and arthrographic exploration in diagnosing meniscal tears. Therefore we analysed retrospectively 334 arthroscopic examinations, which were done because of a suspected or a proven meniscal lesion. We found an accuracy of 84% true-positives and true-negatives with regard to the physical examination and an accuracy of only 71.2% with regard to the arthrographic investigation. Our results were converted into a formula (stated in [11]), declaring the predictive value of a result. These findings led us to a certain scheme in diagnosing meniscal or other knee pain, presented here.     

Correlation of radiographic and clinical findings in spinal deformities

Operative treatment for spinal deformities can be undertaken to halt progression of deformity or to treat a patient's clinical complaints. New emerging research using validated health outcomes instruments has begun to investigate which radiographic parameters of spinal deformity correlate with clinical symptoms. Adolescent idiopathic scoliosis tends to present without complaints of pain, and studies have demonstrated that health-related outcomes measures do not correlate with the degree of deformity correction. Clinical complaints in adult scoliosis show a poor correlation with curve magnitude. Studies of adult scoliosis demonstrate that positive sagittal balance is poorly tolerated and correlates with suboptimal health outcomes. Further studies are needed to clarify the clinical significance of radiographic features of spinal deformities further.     

Post-prostatectomy incontinence: Part I. The urodynamic findings in 107 Men

A retrospective review of 107 men referred for evaluation of post-prostatectomy incontinence (71 post radical retropubic prostatectomy, 26 post transurethral resection of the prostate, and 10 post open prostatectomy) was conducted. After in-depth urodynamic studies, only 40 men (37%) were found to have sphincteric insufficiency alone, 36 men (34%) had sphincteric insufficiency combined with high pressure bladder dysfunction (detrusor instability and/or decreased compliance), and 21 men (20%) had bladder dysfunction alone as the sole cause of post-prostatectomy incontinence. Ten patients (9%) had normal urodynamic studies. The role of bladder dysfunction as a causative factor in post-prostatectomy incontinence is strongly emphasized. © 1992 Wiley-Liss, Inc.     

Deep vein thrombosis after total hip replacement: a clinical and phlebographic study.

Two hundred and forty-seven phlebograms (113 bilateral and 21 unilateral) were performed in 134 patients 10--14 days after total hip replacement. Fifty-eight per cent of the patients were found to have deep vein thrombosis. The patients with DVT were significantly older than patients without DVT, but there was no difference regarding sex, type of hip prosthesis, side of operation or day of mobilization. No difference was found in the duration of operation and anaesthesia, the operative haemorrhage and the amount of bank blood transfused in patients with and without DVT. Fifty per cent of the thrombi were confined to the calf veins. Ninety-seven per cent of these thrombi were asymptomatic and were as frequent on the operated as on the non-operated side. The remaining 50 per cent of the thrombi engaged the thigh with or without simultaneous calf vein involvement. These thrombi produced symptoms in 23 per cent of the cases and were significantly more common on the operated than on the non-operated side. It is concluded that DVT after hip replacement can be of two different types: thrombosis caused by stasis and the general effects of trauma and thrombosis caused by local factors involving the thigh veins of the operated leg.     

Diagnosis of vertebral osteomyelitis: clinical, radiological and scintigraphic features

Incidence of non-tuberculous vertebral osteomyelitis has been increasing significantly over the past 15 years. Its prompt diagnosis remains difficult. Presented here are five cases of vertebral osteomyelitis studied clinically, with laboratory studies, radiographically, and with Tc-99m bone and In-111 labeled white blood cells (In-111 WBC) scintigrams. Three of the cases are described in detail. The In-111 WBC studies were not found useful in detecting the infection in four out of the five patients. Reasons for these false negative results are discussed. Clinical, etiopathogenic and radiographic characteristics of vertebral osteomyelitis are also presented.