Radionuclide-imaging shuntography for the evaluation of shunt patency

Radionuclide-imaging shuntography using technetium 99m pertechnetate was performed 78 times in 43 pediatric patients to evaluate the patency of their cerebrospinal fluid shunts. The flow patterns of the isotope that best correlated with adequate shunt function were complete supine patency and immediate erect patency. Delayed erect patency and pump patency indicated inadequate shunt function. Deceptive patency, defined as a shuntogram that demonstrates patency by any mechanism but that fails to reflect the true functional state of the shunt system, was observed in 40% of all patent shuntograms. Causes of deceptive patency included intermittent shunt obstruction, partial shunt obstruction, and failure to provide complete anatomic information. Other factors important for the accurate interpretation of radionuclide-imaging shuntography included extravasation of isotope, peritoneal spread of the radioactivity, ventricular images, and failure to diagnose disconnection of the shunt.     

Nongonococcal urethritis

Nongonococcal urethritis is a venereal disease whose incidence is almost double that of gonorrhea. Despite this, the diagnosis, origin, treatment, and complications of nongonococcal urethritis remain unclear. Although some cases are undoubtedly caused by infection with Chlamydia trachomatis, the origin of many cases is uncertain. Treatment is recommended to shorten symptoms and prevent complications. This review presents the current status of this confusing disease.     

Corneal Endothelial Transplantation

Patients with visually significant corneal edema, secondary to endothelial dysfunction, before the development of scarring or vascularization, need only have the corneal endothelium replaced to restore corneal clarity. This fact, plus the lack of consistently available donor material, prompted us to evaluate tissue cultured corneal endothelium (TCCE) as a donor source. We have shown that TCCE, when transplanted, can regain normal morphology and physiologic function. To accomplish practical use of autologous stroma, a transparent gelatin membrane which can serve as substrate for endothelial growth in tissue culture, has been developed. This cellular membrane has been transplanted successfully in rabbits with good functional results. It is hoped that ultimately this technique can be developed for routine use in man.     

Results of conservative surgery for middle ear cholesteatoma

A retrospective study was carried out to analyze treatment results for cholesteatoma at the University of Iowa Hospitals and Clinics. All patients undergoing primary surgical treatment from January 1, 1969 to December 31, 1973 were followed through October 1976. Treatment failures were based on the occurrence of postoperative cholesteatoma. The probability of being disease free for periods up to five years after original surgery was then estimated for each type of operation. Postoperative cholesteatoma occurred after atticotomy in 17%, intact canal wall mastoidectomy in 35%, and modified radical mastoidectomy in 9%. The postoperative cholesteatoma rate in the group having intact canal wall mastoidectomy was more than twice as high for those patients under age nine. The likelihood of being disease free five years after intact canal wall surgery was estimated to be 36% using the life table method. Disease recurrence was significantly higher after intact canal wall surgery compared to other surgical methods. The effectiveness of this method should be evaluated in a randomized, prospective manner to minimize patient selection and treatment bias.