Radiographic management of juvenile angiofibromas

Juvenile angiofibromas are benign, vascular, locally aggressive neoplasms that are preferably treated by surgical resection, or irradiation if surgery is not possible. Adequate surgery in the past has been limited by incomplete knowledge of the anatomy of the tumor and technical difficulties related to the vascularity. To better define the tumor, 12 patients with juvenile angiofibroma have been studied by axial and coronal high resolution computed tomography (CT). The extent of the neoplasm was better demonstrated by CT than by other techniques. Based on the CT findings, we propose an anatomic classification that is helpful in determining treatment methods. Nine patients were considered operable, and eight of these underwent preoperative embolization with Silastic spheres and Gelfoam. The preoperative embolization significantly reduced operative difficulty and the necessity for blood transfusions. Based on these cases, we believe the current radiographic management of juvenile angiofibromas should consist of plain films, CT, angiography and, in surgical cases, preoperative embolization.     

Impact of ureteral stent diameter on symptoms and tolerability

BACKGROUND AND PURPOSE: Indwelling double-pigtail ureteral stents are frequently associated with debilitating symptoms. A randomized study was performed to evaluate the effect of stent diameter (4.7F v. 6F) on symptoms and tolerability. PATIENTS AND METHODS: Between February and October 2000, 46 consecutive patients undergoing ureteroscopy for stone disease were randomly assigned to receive either a 4.7F (group I) or a 6F (group II) ureteral stent following the procedure. The patients were asked to leave their stents in place for minimum of 7 days. Pain and irritative urinary symptoms in the two groups were compared according to a scale ranging from 0 (none) to 5 (severe). The two groups were also compared for stone size and location, rigid v. flexible ureteroscopy, anesthesia, stent migration, and ureteral dilation. RESULTS: There were no differences between the groups in terms of pain (P = 0.28) or irritative symptoms (P = 0.37). There was a tendency for stents in group I to migrate distally and dislodge more often than those in group II (32% v 10%). CONCLUSIONS: When stent insertion following ureteroscopy is deemed necessary, a minimum diameter of 6F is recommended.     

Metabolic effects of constant hypertonic glucose infusion in well-oxygenated fetuses.

In order to investigate the metabolic effects of a constant hypertonic glucose infusion in well-oxygenated fetuses, ten experiments were carried out in nine long-term experiments in fetal lambs. It appeared that a constant hypertonic glucose infusion did not significantly affect the fetal blood gases, pH, and plasma lactate levels when fetal glucose was kept below 150 mg. per 100 ml. It was also demonstrated that glucose infusions significantly increased the fetal lactate levels and decreased the blood pH when fetal plasma glucose was over 150 mg. per 100 ml. However, there was no decrease in fetal PO2 and pco2 until fetal glucose reached values over 300 mg. per 100 ml. These studies suggest that constant hypertonic glucose infusion does not improve fetal blood gases or pH and that fetal hyperglycemia over 300 mg. per 100 ml. produces severe metabolic acidosis.     

Carcinoma of the subglottic area.

The subglottic area is defined as an anatomic region which is cylindrical in shape whose inferior margin is the inferior border of the cricoid cartilage and which is limited superiorly by an imaginary circle 5 mm below the free margin of the true vocal cords. Of 591 patients with glottic and subglottic cancers, only five (percent) had primary subglottic tumors and 132 (22 percent) had glottic tumors with subglottic extension. Sixty-five percent of the patients with glottic primary with subglottic extension were Stage 2 and 35 percent were Stage 3. Most patients were treated surgically. Hemilaryngectomy is a very satisfactory primary modality in the treatment of Stage 2 and some Stage 3 glottic lesions with subglottic extension. Stage 2 and 3 glottic cancers which involve greater than 10 mm of the subglottis carry a significantly decreased prognosis. Patients with T3 lesions with cord fixation with subglottic extension show a decreased survival.