Outpatient lumbar myelography. Initial results in 79 examinations using a low-dose metrizamide technique

Seventy-nine patients underwent lumbar myelography on an outpatient basis, with a low (3.75 g) dose of metrizamide as the radiocontrast agent and a 25-gauge spinal needle used for lumbar puncture. No patient experienced significant neurotoxicity following the examination; 70.8% (56 of 79) experienced minimal (23%) or no (48%) side effects. Three patients (3.8%) were admitted to the hospital for management of common side effects (headache, nausea/vomiting, back pain). We obtained postmyelographic computed tomographic scans on 96% (76 of 79) of the patients. Our initial results suggest that outpatient lumbar myelography is safe and can be performed with a very acceptable incidence of side effects.     

Complications of percutaneous nephrostolithotomy

In 224 patients, renal stones were removed from the urinary tract using either direct extraction with a basket or forceps (59 patients), ultrasonic lithotripsy (164 patients), or infusion chemotherapy (one patient). Residual stone fragments were present more frequently in patients treated with ultrasonic lithotripsy (27%) than with direct extraction (5%). Other complications included hemorrhage (eight patients), catheter dislodgement (four patients), large amounts of urine extravasation (three patients), glycine ascites (three patients), infection (two patients), pneumothorax (one patient), and a prolonged ileus (one patient). More complications occurred among the first 50 patients than the last 50 patients, even though more difficult cases, including patients with staghorn calculi, were accepted during the latter period. Although a learning curve exists, complications can be minimized by attempting to treat more favorable cases during the initial experience.     

Prevention of transfusion-associated graft-versus-host disease: selection of an adequate dose of gamma radiation

To determine the optimal dose of gamma radiation necessary to inhibit T- lymphocyte function and prevent transfusion-acquired graft-versus-host disease (TA-GVHD), a donor plateletpheresis component was initially divided into ten 20-mL samples. One sample was not irradiated, while the other nine samples were treated with gamma radiation at doses ranging from 500 to 4500 cGy. T-lymphocyte function was subsequently measured by mixed lymphocyte cultures and mitogen stimulation assays. The results were assessed in each test by calculating the percentage of inhibition of each irradiated sample as compared to that of the unirradiated sample. The accuracy of the delivered dose of gamma radiation was measured with thermoluminescent dosimeters. It was concluded that a nominal dose of 3000 cGy (actual dose delivered, 2898 cGy) is the appropriate amount of gamma radiation needed to eliminate T- lymphocyte-mediated graft-versus-host disease.     

Functional status‐based risk–benefit analyses of high‐KDPI kidney transplant versus dialysis

Yearly, over half of deceased‐donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high‐KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased‐donor KT candidates on dialysis listed in 2005–2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time‐varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10–40, 50–70, and 80–100. With KDPI 0–99 KT, KPS 10–40 patients will survive ≥4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to ≥7.83 years after KDPI < 100 KT. The risk‐adjusted analyses suggested that patients are expected to benefit more from KDPI 81–99 KT than from remaining on dialysis.     

Ultrasound of the whole breast utilizing a dedicated automated breast scanner

Innovations in design of a dedicated breast scanner resulted in automation of the scanning process, the production of high resolution images of the whole breast and an efficient mode of image review. The results of clinical evaluation of the prototype of this breast scanner investigating normal breasts as well as benign and malignant breast lesions are presented.     

Intensity of Central Pain: Analysis of Pain Scores in 18 Patients

Abstract: The aim of this clinical study was to investigate the intensity of central pain in 18 patients. Each patient systematically recorded their own pain scores a total of 700 times (ie, 7 times/day for 100 consecutiv e days) using a standard four-point scale. In all 18 patients, the intensity of pain varied considerably (ranging in grade from no pain, mild pain, moderate pain to severe pain). During the 100 days, the average number of times (percentage of total) that each grade of pain intensity was scored was: no pain 7.4 (1.1%); mild pain 570.9 (81.6%); moderate pain 93.4 (13.3%), and severe pain 28.3 (4%). The difference between mild pain and moderate, severe, or no pain was significant. Thus, in our patient group the intensity of central pain was mostly mild, not severe. In contrast to other reports, our data suggest that to state that the intensity of central pain continues to be intolerable and severe throughout the day is an exaggeration. Among our 18 patients, an exacerbation of pain intensity was observed 507 times. Of these 507 events, 392 (77.3%) were due to specifiable factors and 115 (22.7%) were due to unknown factors. The specifiable factors could be attributed to: emotional factors 261 times (66.6%), somatic stimuli 44 times (11.2%), weather 38 times (9.7%), fatigue 29 times (7.4%), visceral activity 20 times (5.1%). Since there is no universally effective treatment for central pain, the strategy to manage central pain should primarily focus (if possible) on prevention of the exacerbating factors of central pain.     

Tuberous sclerosis: characteristics at CT and MR imaging

Computed tomography (CT) and magnetic resonance (MR) imaging findings were reviewed in 26 patients with tuberous sclerosis. All patients underwent CT; 16 patients underwent both. The CT features included subependymal nodules in 25 of 26 patients (96%) and calcifications in 23 of 26 (88%). Parenchymal hamartomas (cortical tubers) were seen in 23 of 26 patients (88%). These lesions had less attenuation than surrounding brain in 16 of 26 patients (62%) and were calcified in 14 of 26 patients (54%). Contrast enhancement of a lesion, indicating a subependymal giant cell astrocytoma, occurred in three of 26 patients (12%). The MR imaging characteristics included subependymal nodules (periventricular nodules) of intermediate signal intensity in ten of the 16 patients (63%). Parenchymal hamartomas, demonstrated in 15 of the 16 patients (94%), usually exhibited long T1 and T2 relaxation characteristics. The pattern was noted to be reversed in the two newborn patients (13%). One parent demonstrated a forme fruste at CT but had a normal MR image.