CT appearances of haematomas in the corpus callosum in patients with subarachnoid haemorrhage

Corpus callosum heamatoma is a rare feature in subarachnoid haemorrhage (SAH), which may result from aneurysms of the anterior communicating artery (ACoA) or pericallosal artery (PCA). In 348 patients with aneurysmal SAH, bleeding from ACoA aneurysms in 88 cases produced no abnormality on CT in 7. Blood in the cistern of the lamina terminalis was the most frequent abnormality (76/88); haematomas of the septum pellucidum, confined to patients with ACoA aneurysms, were seen in 26 (30%). Rupture of PCA aneurysms in 12 patients gave rise to blood in the pericallosal cistern, anterior interhemispheric fissure and cistern of the lamina terminalis in 11. There was no blood in the septum pellucidum or the ventricular system in any case, but haematomas in the corpus callosum occurred in 8 (67%). In all of these, blood extended into the anterodorsal aspect of the callosum and spread posteriorly along its dorsal border. An identical, supracallosal pattern was seen in 2 patients (2.5%) with ACoA aneurysms, in whom haemorrhage was more extensive, with a large frontal lobe haematoma extending up from the cistern of the lamina terminalis in 1 and a haematoma of the septum pellucidum, with intraventricular extension in the other. In 8 patients (9%) with ACoA aneurysms a corpus callosum haematoma appeared to result from passage of blood up through the cistern of the lamina terminalis into the septum pellucidum and thence into the ventral aspect of the anterior corpus callosum; blood was present within the cistern, the septum and the ventricles.     

Effects of short-term exposure to high-dose inhaled corticosteroids on novel markers of bone metabolism

Objectives: Novel assays have been developed for markers of type 1 collagen turnover. The aim of this study was to evaluate the effect of short-term exposure to inhaled corticosteroids on both the novel and conventional markers of bone metabolism. Methods: Nine healthy subjects received 2 weeks treatment with inhaled budesonide 800 μg per day in week 1, and 1600 μg per day in week 2, or fluticasone 750 μg per day in week 1 and 1500 μg per day in week 2, with a 1-week washout in between. Measurement of carboxy-terminal propeptide of type 1 collagen (PICP), carboxy-terminal telopeptide of type 1 collagen (ICTP), plasma alkaline phosphatase bone isoenzyme, and 24-h urinary calcium excretion were made at baseline and at the end of each 2-week treatment period. Results: ICTP was significantly reduced following treatment with budesonide but not fluticasone compared with baseline: baseline 4.2 μg⋅1⁻¹ budesonide 3.0 μg⋅1⁻¹, fluticasone 3.6 μg⋅1⁻¹. There were no significant changes in PICP compared with baseline after treatment with budesonide or fluticasone. The ratio of PICP:ICTP increased significantly after treatment with both budesonide and fluticasone compared with baseline: baseline 27.4, budesonide 43.7, t 42.6. There were no significant differences between the two treatments for any of the measured parameters. Conclusions: Thus, when using sensitive markers of collagen turnover, short-term inhaled corticosteroid therapy was found paradoxically to reduced bone resorption. Received: 26 June 1995/Accepted in revised form: 14 November 1995     

Successful use of a transjugular intrahepatic portosystemic stent shunt to control severe refractory oesophageal variceal haemorrhage in a poor risk patient.

This report describes a 44 year old man with a severe gastrointestinal haemorrhage from oesophageal varices. Bleeding could not be controlled with conservative therapy and sclerotherapy. He was successfully treated with a radiologically guided transjugular intrahepatic stent shunt at a time when his condition was too poor to attempt an open surgical procedure.     

Through the looking glass: reflections on the authorship and content of current Australian nursing journals

Over the past three years, Australian nurses have witnessed a proliferation of locally published refereed nursing journals. This paper considers the refereed content published in four selected Australian nursing journals over a recent twelve month period. Material appearing in the Australian Journal of Advanced Nursing (AJAN), Contemporary Nurse, Nursing Inquiry and Collegian was categorized according to subject matter and authorship by gender and discipline. Findings indicate that articles pertaining to clinical practice, the practice of research, and professional nursing issues are well represented in the literature. These findings mark a change from earlier analyses of Australian nursing journals, which suggested that the epistemologies of other disciplines were over-represented in Australian nursing journals, and thus exerted a powerful influence over the development of nursing theory and scholarship. The increase in the number of refereed Australian nursing journals is indicative of the dynamic state of Australian nursing, in terms of confidence, scholarship and clinical practice development.     

Hemicranial Volume Deficits in Patients with Temporal Lobe Epilepsy With and Without Hippocampal Sclerosis

Summary: Purpose: In patients with refractory temporal lobe epilepsy, studies have suggested volume deficits measured by MRI of brain structures outside the epileptogenic hippocampus. Hippocampal sclerosis (HS) is a frequent, but not obligate, finding in such patients. The present study examines the influence of the presence of HS on quantitative magnetic resonance imaging (MRI) measurements.
Methods: We analyzed 47 patients and 30 controls by quantitative MRI, including intracranial volume (ICV), hemicranial volume, hippocampal volume (HCV), and T₂relaxometry. MRI results were compared with histological findings in the resected temporal lobe.
Results: Histology documented HS in 35 patients (HS group) and other findings in 12 patients (no-HS group). In both groups, the hemicranial volume ipsilateral to the epileptogenic focus was significantly smaller than on the contralateral side (p <0.004). The HCV on both sides was smaller in the HS group compared with patients without HS (p ≥ 0.004). Unilateral hippocampal atrophy and increased T, value were found in 71% of patients with HS, and bilaterally normal HCV and T, value were found in 67% of patients without HS.
Conclusions: The smaller hemicranial volume on the focus side, irrespective of the presence or absence of HS suggests a different pathogenic mechanism for the additional hemicranial volume deficit, compared to HS itself. The contralateral HCV deficit depends on the presence of HS, indicating a pathogenic connection between damage to both hippocampi.     

A comparative study of the distribution in the male rat of platinum-labelled cis-dichlorodiammine platinum (II), cis-trans-dichlorodihydroxy-bis-(isopropylamine) platinum (I), and cis-dichloro-bis-cyclopropylamine platinum (II)

Summary Three platinum derivatives, cis-dichlorodiammine platinum (II), (DDP), cis-trans-dichlorodihydroxy-bis-(isopropylamine)platinum (IV) (CHIP) and cis-dichloro-bis-cyclopropylamine platinum (II) (CP), have been prepared with a gamma-emitting platinum label. The distribution of these complexes was studied in male rats.The results are presented as fractions of the administered radiolabel per gram of tissue and per total organ. Accumulation in the liver was highest initially following CP and lowest after DDP, but by 14 days the levels in kidney and liver were highest with CP. The concentration in the skin was relatively high after all the compounds, but was the most conspicuous after DDP at the early times. In general, patterns of distribution between the other organs were similar with DDP and CP.CHIP, however, exhibited a different pattern of distribution. Over the first 24 h the level of platinum in most tissues declined more rapidly than after either of the other two compounds but the residual label persisted for a longer period. In the kidney there appeared to be a secondary uptake of labelled material, presumably from other tissues. The level present at 14 days after CHIP was also significantly higher in a number of other organs than after the other two drugs. The increase in label in the spleen at the later times may be due to the removal of circulating damaged cells and consistent with the higher levels of residual platinum in the blood. There was also a higher level of residual platinum in the blood especially after IV administration of the labelled agent.The results show that CHIP was cleared at a faster rate from blood and kidney than the other two complexes, results which closely resembled clinical findings with these three agents, to be published elsewhere.The greater retention time of label after CHIP also suggests that longer-term toxicity may follow its repeated administration. Present address: Radiochemical Centre, Amersham International     

Use of a Microprocessor in the Control of Malignant Hypertension with Sodium Nitroprusside

Summary: Use of a microprocessor in the control of malignant hypertension with sodium nitroprusside. R. V. Jackson, J. B. Love, W. G. Parkin, M. L. Wahlqvist and N. S. Williams, Aust. N.Z. J. Med. , 1977, 7 , pp.414–417.
In a malignant hypertensive, steady control of blood pressure at a pre-determined level has been achieved with the continuous intravenous infusion of sodium nitroprusside. A microprocessor was programmed to assess the patient's blood pressure and adjust the rate of nitroprusside infusion so that a mean pressure of 106 mmHg was achieved. Brief interruption of the nitroprusside infusion allowed the effectiveness of changes in oral therapy to be evaluated. Thiocyanate concentrations were measured throughout as an index of potential nitroprusside toxicity. After six days, blood pressure control was maintained with oral therapy alone and papilledema had almost resolved.