Adenoid cystic carcinoma of the parotid metastasizing to liver: case report

Background  

Adenoid cystic carcinoma is a rare malignant parotid tumor. Metastasis can occur even a decade or more after initial treatment of the primary.     

Percutaneous dilation of ureteral strictures in renal transplant patients

Percutaneous dilation of benign ureteral strictures was performed as an alternative to surgical therapy in 14 patients with renal transplants. Dilations were performed with balloon catheters in 13 patients and with a tapered angiographic catheter in one patient. Eleven strictures were successfully dilated (79%). There were three recurrences (21%). Follow-up in nine of the 11 successful cases ranged from 12 to 61 months (mean, 29 months; median, 24 months). There were no complications directly related to balloon dilation. The high success rate in this series may be related to the early diagnosis of strictures in these closely followed patients.     

Trauma of the extremities: prospective comparison of digital and conventional angiography

Digital subtraction angiography (DSA) and conventional film angiography (CFA) were compared prospectively in 50 patients with trauma of the extremities. Each patient underwent both procedures with comparable imaging parameters and injections. Three angiographers reviewed the angiograms for the presence of seven angiographic signs of arterial injury. The two modalities showed pseudoaneurysms, arteriovenous fistulas, vessel displacement, occlusion, and focal narrowing equally well. CFA was superior to DSA in delineating intimal dissection; DSA was better for demonstrating extravasation. Clinical follow-up demonstrated that both procedures had a sensitivity of 100%; the specificity was 94% for DSA and 97% for CFA. Neither procedure produced a false-negative result.     

An unusual consequence of stereotactic colloid cyst aspiration: Case report

The removal of a colloid cyst of the third ventricle by stereotactic cyst aspiration is frequently performed as an alternative to a transcortical-transventricular or transcallosal operative route. A consequence of a CT-guided stereotactic aspiration, where residual colloid cyst material has been dislodged into the lateral ventricle and likened to an intraventricular mouse, is described.     

A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour

AIM: Our objective was to evaluate the effect of training in a patient- centred intervention for GPs and practice nurses on outcomes for patients with Type II diabetes. METHODS: We carried out a randomized controlled trial within general practices as the basis for randomization and a before-and-after design for measures of patient outcome. A parallel process study examined the use of the method by professionals. The study was carried out in 29 general practices in South Glamorgan who had participated for at least 2 years in a local scheme of audit and CME in relation to Type II diabetes care. The subjects were 252 Type II diabetic patients recruited by 15 experimental and 14 control practices. The main outcome measures were changes in glycosylated haemoglobin, patient satisfaction with care and treatment, functional health status and professional ability to apply the intervention. RESULTS: Professionals adopted the innovative method with enthusiasm, but after 2 years only 19% continued to apply the method systematically. The trial was, therefore, unable to demonstrate significant biochemical or functional improvements. This highlights the need to understand the factors associated with professional uptake and subsequent ability to sustain changes in behaviour. CONCLUSIONS: The efficacy of this behavioural intervention remains unproved, despite its acceptability to professional staff. Detailed and prolonged development and testing of behavioural interventions is an essential first step before embarking on randomized controlled trials which involve complex behavioural changes in professionals or patients.