CT Demonstration of Complex Dorsal Spinal Dysraphism

An unusual a, qe of dorsal spinal dysraphisrn in a four yar old child is presented. Various abnormalities including diasternatomyelia, an extradural arachnoid cyst arising from one of the two dural tubes, and lipomeningomyelocele with a related rib-like bony structure were demonstrated with Iohexol CT and subsequently confirmed at surgery.     

MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY

Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.KEY WORDS: Heart injuries, Thoracic injuries, Traumatology, Wounds, gunshot, Wounds, nonpenetrating, Wounds, penetrating     

Computer-Automated Structure Evaluation (CASE) of Retinoids in Teratogenesis Bioassays

Computer-Automated Structure Evaluation (CASE) of Retinoidsin Teratogenesis Bioassays. FRIERSON, M. R., MIELACH, F. A.,AND KOCHHAR, D. M. (1990). Fundam. Appl. Toxicol. 14, 408–428.The potential usefulness of the retinoids, a large group ofsynthetic compounds chemically and structurally related to vitaminA, in the treatment of severe dermatologic diseases and in theprophylaxis and therapy against cancer is severely limited becauseof their potential teratogenicity. CASE analysis of publishedretinoid data from the hamster teratogenic-ity assay and thelimb bud "spot" culture system has targeted the hydrophobicregion of the retinoids as having the greatest effect on therange of potencies studied. In addition, log p's (as calculatedby the CASE program) below a certain value appear to unilaterallyresult in nontera-togenic retinoids in the In vivo hamster assaysystem.     

Effect of exercise and dietary modification on serum aminotransferase levels in patients with nonalcoholic steatohepatitis

Background: Nonalcoholic steatohepatitis (NASH) is commonly associated with overweight and insulin resistance. Aerobic exercise is known to reduce insulin resistance. We studied the effect of regular aerobic exercise on serum aminotransferase levels in patients with NASH. Methods: Sixty‐five (mean age 38.7 ± 9.5 years; 46 [78%] males) out of 94 patients diagnosed with NASH participated in the study. Each patient was advised regular aerobic exercise for 30 min duration per day, and trained to achieve a heart rate of 60–70% of his/her maximal heart rate for at least 5 days a week. In addition, those with a high body mass index (BMI) were advised a moderately energy‐restricted diet. Patients were followed up monthly for at least 3 months by BMI, waist‐hip ratio (WHR), waist circumference (WC), aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Results: Forty‐three (72.8%) patients had a high BMI. Central obesity (WHR ≥0.90 cm in men and ≥0.85 cm in women) was present in 58 (98.3%) patients and metabolic syndrome in 12 (20.3%) patients. In the 44 patients who complied regularly with the exercise program, serum ALT normalized in 20 (45%; P < 0.05), and mean AST and ALT values declined from 70.5 and 104.0–41.5 (P < 0.001) and 63.2 (P < 0.001), respectively. Overweight patients lost a mean 3.1 kg (range 0–13 kg) weight and showed a decline in BMI (28.7 vs 27.5; P < 0.001) and WC (99.4 cm vs 96.1 cm; P = 0.001). Serum ALT did not normalize in any of the 15 patients who failed to comply with the exercise program; their pre‐ and post‐AST (82.8 and 81.2, respectively) and ALT (98.0 and 96.1, respectively) levels, BMI (27.5 and 27.6, respectively) and WHR (0.99 cm and 0.99 cm, respectively) did not show any significant change at 3 months, and also for an extended mean follow‐up period of 5.3 months. Conclusion: Moderate intensity aerobic exercise helps in normalizing ALT levels in patients with NASH.     

Modulation of the Sinus Rate during Ventricular Fibrillation

Background: During supraventricular and ventricular tachycardia, the arterial baroreflex predominates with minimal contribution from the cardiopulmonary reflex. To our knowledge, the role of the arterial baroreflex gain (BRG) during and immediately following termination of ventricular fibrillation (VF) has not been characterized.
Objective: We hypothesized that (1) arterial BRG correlated with sinus node cycle length (SNCL) changes during VF, and that (2) the greater the arterial BRG, the greater the blood pressure (BP) recovery following successful defibrillation.
Methods: Arterial BRG was assessed in 18 patients referred for the implantation of a defibrillator incorporating an atrial lead. The average SNCL was measured during the 5 seconds prior to VF induction and the last 5 seconds during VF before defibrillation. Percent SNCL change (%ΔSNCL) was determined. Arterial BP recovery was calculated as the difference in mean BP following defibrillation compared to during VF.
Results: Arterial BRG ranged between –3 and 18 ms/mmHg. During VF, SNCL shortened in 11 patients (group A, mean %ΔSNCL =–15%), and surprisingly lengthened in seven patients (group B, mean %ΔSNCL = 5%). There was no correlation between %ΔSNCL and arterial BRG. In fact, arterial BRG in group A was lower when compared with group B (P = 0.075). Similarly, there was no correlation between arterial BRG and BP recovery.
Conclusions: We found no correlation between arterial BRG and %ΔSNCL during VF, or BP recovery following defibrillation. Our findings of SNCL lengthening in 7 of 18 patients suggest that in some patients, arterial BRG plays a minor role during VF with a greater contribution from the cardiopulmonary BRG.     

Adrenocortical carcinoma with tumor thrombus in the right hepatic vein

Adrenocortical carcinoma is an unusual neoplasm with very poor prognosis. Patients present with an abdominal mass often exceeding 5 cm or as a functional tumor. Computed tomography is effective to demonstrate the neoplasm as an inhomogeneous adrenal lesion with irregular margins, and magnetic resonance imaging is helpful to visualize invasion into large vessels as well. Reported herein is a case of large adrenocortical carcinoma with tumor thrombus extending into the right hepatic vein.