Strangulation in child abuse: CT diagnosis

The central nervous system is commonly affected in child abuse. Between April 1985 and July 1986 three infants were identified in whom the primary mode of injury had been strangulation. In each case computed tomography (CT) demonstrated a large cerebral infarction confined to vascular territories associated with small subdural hematomas. There was no history or visible evidence of significant head trauma. Autopsy of one infant confirmed the presence of a hemispheric infarct, thin subdural hematoma, and an area of subintimal hemorrhage in the carotid artery ipsilateral to the infarct. The remaining two patients survived with residual hemiparesis. CT findings of a large cerebral infarction with an associated subdural hematoma in an infant without a history of a significant trauma should suggest the possibility of child abuse and may be the primary manifestation of abuse in some patients.     

Biliary lithotripsy: early observations in 106 patients. Work in progress

One hundred six patients underwent extracorporeal shock wave lithotripsy for cholelithiasis. Of these, 28 patients underwent cholangiographically guided lithotripsy for bile duct stones to assist nonoperative stone removal by endoscopic or radiologic intervention. Fragmentation occurred in 20 of 28 cases (71%) with an average of two lithotripsy sessions. Hemobilia was observed in four patients (14%) for a 24-hour period. Seventy-eight of the 106 were outpatients with symptomatic cholecystolithiasis with one to five calculi who underwent cholecystographic or ultrasound-(US) guided shock wave lithotripsy as definitive therapy. US examination showed stone fragmentation in 86% of cases. With an average of 1.6 treatment sessions and 4,750 shocks, fragments were 4 mm or smaller in 46% of patients. Nine percent of patients had no fragments after an average of 10 weeks, but long-term follow-up is not yet available. Two patients developed acute pancreatitis attributable to fragment passage and one patient acute cholecystitis, likely due to cystic duct obstruction by a fragment.     

Tarsal navicular stress fractures: radiographic evaluation

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.     

The binding of ouabain to normal and chronic lymphocytic leukemic lymphocytes

The binding of the cardiac glycoside, ouabain, to cells had been used to quantify the number of active cation pumps. In this study, lymphocytes were incubated with 3H-ouabain and the equilibrium binding analyzed for the maximal number of specific binding sites. Lymphocytes from normal peripheral blood bound 44,200 +/- 9920 molecules/cell, compared with 29,200 +/- 8370 molecules/cell for the lymphocytes of chronic lymphocytic leukemia (CLL) subjects. This difference was significant (p less than 0.01) and did not reflect a lower number of sites on B cells than T cells, since B-cell-enriched lymphocytes from normal peripheral blood showed the same ouabain binding characteristics as the standard T-cell-rich preparation. Although monocytes bind threefold more ouabain than lymphocytes, the small monocyte contamination (3.0%) in normal lymphocyte preparations could not account for the difference between normal and CLL. The fewer ouabain binding sites on CLL lymphocytes may reflect both their smaller size (by 10%) and lower mitotic activity compared with lymphocytes from normal peripheral blood.