Intracerebral pneumatocele: CT findings

Two cases of intracerebral pneumatocele following trauma are presented. One to two months after initial treatment both patients had deteriorating neurologic status. The diagnosis was made by radiography. When a pneumatocele is suspected clinically, computed tomography can play a vital role in determining the precise location of the gas collection, its relationship to the fracture site, and the amount of mass effect on the brain.     

Striated intramural gallbladder lucencies on US studies: predictors of acute cholecystitis

Ultrasound scans of 51 consecutive patients with gallbladder wall thickening were reviewed, and specific sonographic features were correlated with surgical and clinical follow-up. Two patterns of thickening were identified as specific indicators of the presence or absence of acute cholecystitis. "Striated" wall thickening, consisting of several alternating, irregular, discontinuous, lucent and echogenic bands, was seen in eight of 13 patients (62%) with acute cholecystitis. This pattern was not encountered in any of the patients who did not have acute cholecystitis. Conversely, "three-layer" thickening, consisting of a single circumferential lucent zone between two relatively uniform echogenic layers, was seen in only one of 13 patients (8%) with acute cholecystitis but in 11 of 38 patients (29%) with other diagnoses. Other abnormalities, including the presence of intramural echogenic foci and wall irregularities, were more frequently seen in patients with acute cholecystitis but were not as helpful. Use of these features may suggest or help exclude a diagnosis of acute cholecystitis in those patients in whom the cause of gallbladder wall thickening is otherwise not apparent.     

Radiotherapy for melanotic freckles

Five patients who received radiotherapy (RT) for 7 melanotic freckles (MF, also known as Hutchinson's freckles, lentigo maligna) were reviewed 8 to 37 months after their treatment by RT. Local control and a favourable cosmetic result occurred in all patients. Treatment toxicity was minimal. Few reports about the use of RT for MF exist. Many other treatments including observation alone have been associated with high rates of recurrence, and in some cases conversion to invasive melanoma has occurred. RT appears to be a safe and effective treatment for this condition, providing that doses equivalent to 44 Gy in 11 fractions or more are given.     

Prognostic significance of thyroid gland involvement in laryngeal carcinoma

We reviewed 173 laryngeal specimens that included thyroid tissue received from patients undergoing laryngectomy between 1966 and 1980 for evidence of thyroid gland invasion. Twenty-three (14%) of the larynges demonstrated thyroid involvement. In 15 specimens, involvement of the thyroid gland was by direct extension, and in eight the thyroid was involved metastatically. The survival in this group of patients was poor, with 18 patients dying of their disease within three years. Subglottic extension of 10 mm or greater was noted in 21 of 23 patients, and local recurrence was noted in 15 of 18 patients dying of their disease. The importance of removing one or both lobes of the thyroid gland in advanced laryngeal cancer is restated, and a surgically aggressive approach to the paratracheal nodes is recommended in patients with extensive subglottic involvement.     

Training course in local anaesthesia of the airway and fibreoptic intubation using course delegates as subjects

Background. We describe a practical method of training anaesthetistsin the technique of awake fibreoptic intubation. This is performedon a training course using the delegates as subjects. Methods. The first 15 subjects underwent cardiovascular monitoringduring airway fibreoptic endoscopy performed by other coursemembers. They were subsequently interrogated by use of a questionnaire. Results. Evidence from questionnaires suggests this method ofinstruction is acceptable in this self-selected group of individuals.Gagging was the commonest unpleasant side-effect of airway endoscopy,although only one delegate rated this as uncomfortable. Fifty-fourper cent of subjects found the procedure slightly painful; 46%reported no pain at all. Overall, the procedure was rated asacceptable by 85% of subjects and enjoyable by 15% of subjects.No delegate found endoscopy or intubation distressing. Cardiovascularmonitoring revealed pulse rate and arterial pressure changesof less than 25% of baseline values. Paraesthesia developedin one individual and nasal bleeding in two cases, neither ofwhich was clinically significant and did not interfere withendoscopy. Conclusions. The use of course delegates as subjects for trainingwas acceptable to anaesthetists and is associated with a lowlevel of discomfort and morbidity. Br J Anaesth 2002; 89: 586–93