Neurotoxicity and pharmacokinetics of ventriculolumbar perfusion of methyl 6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-alpha-D-gluco-pyranoside (MCNU) in dogs

Summary Ventriculolumbar perfusion of methyl 6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-alpha-D-glucopyranoside (MCNU), a water soluble nitrosourea with log P-0.71, may be efficacious in the treatment of subarachnoid dissemination of malignant glioma. We used 2 dogs to study the neurotoxicity and pharmacokinetics of MCNU. MCNU (1 mg), dissolved in 10 ml of artificial CSF, was administered via the right lateral ventricle during a period of 18 to 42 min and the CSF was drained by lumbar puncture. The perfusion was repeated once a week for 10 consecutive weeks. No neurological and systemic symptoms were noted after perfusion. Histological examination of the brain and spinal cord showed local denudation of the ependyma and local subependymal spongy degeneration and gliosis in the lateral ventricle into which MCNU was administered in one dog and local denudation of the ependyma in the other. When administration was over a period of 21 to 38 min, the MCNU concentration in the lumbar CSF peaked at 11.11 to 50.67 g/ml, in 28 to 78 min. The area under the drug concentration-time curve (AUC) was 1152 g×min/ml on average, significantly larger than that of ACNU. The elimination phase followed linear kinetics and the half-time was 41.1 min on average, significantly longer than that of ACNU. These findings suggest that ventriculolumbar perfusion of MCNU may be effective in the treatment of subarachnoid dissemination of malignant glioma notwithstanding some local histological changes.     

Improving the efficacy and stability of coronary reperfusion following thrombolysis: Exploring the thrombin hypothesis

A major assumption in the treatment of patients with acute myocardial infarction (MI) implies that the speed of coronary arterial reperfusion correlates directly with the overall extent of myocardial salvage, and that the extent of myocardial salvage, in turn, determines the absolute reduction in patient mortality. While a growing experience has made it clear that myocardial salvage-independent (time-independent) mechanisms of benefit also exist, few would argue with the hypothesis that the greatest benefit derived from coronary thrombolysis occurs with early (time-dependent) treatment. Thus, improvements in the efficacy of reperfusion and the stability of reperfusion are likely to have considerable impact on patient outcome.     

Die Magnetresonanztomographie in der Dentalradiologie (Dental-MRT)

Zusammenfassung Ziel dieses Beitrags ist die Vorstellung der Untersuchungsm?glichkeiten des Ober- und Unterkiefers mittels Magnetresonanztomographie (Dental-MRT) und ihre Anwendung bei der Diagnose zahnmedizinischer Erkrankungen. Sieben gesunde Probanden, 5 Patienten mit Pulpitis, 9 Patienten mit dentogenen Zysten, 5 Patienten nach Zahntransplantationen und 12 Patienten mit atrophem Unterkiefer wurden untersucht. Axiale T1- und T2-gewichtete Gradientenecho- und Spinecho-Sequenzen in 2D und 3D-Technik wurden durchgeführt. Nach der Untersuchung wurden zus?tzliche Panoramaschnitte und orhoradiale Rekonstruktionen des Ober- und Unterkiefers, unter Verwendung einer gebr?uchlichen Dental-Software, angefertigt. Der gesamte Ober- oder Unterkiefer, Z?hne, Pulpa und der Inhalt des Mandibularkanals k?nnen gut dargestellt werden. Patienten mit einer Entzündung der Zahnwurzel k?nnen ein deutliches Knochenmarks?dem in der Periapikalregion zeigen. Bei Patienten mit odontogenen Zysten ist die Beziehungen zu den umgebenden Kieferstrukturen gut darstellbar. Nach Kontrastmittelgabe zeigt sich ein Enhancement in der Zahnpulpa. Die Dental-MRT ist ein nützliches Verfahren zur anatomischen Darstellung des Kieferbereichs und zahnmedizinischer Erkrankungen.      

CT of blunt trauma of the pancreas in adults

In order to describe the CT findings in pancreatic injury and to evaluate the sensitivity of this technique, we performed a retrospective study. During a 5-year period (1993–1997), eight patients (five males and three females; age range 10–47 years) were investigated with CT. Endoscopicretrograde cholangiopancreatography (ERCP) was obtained in two patients, pre- and intra-operatively, respectively. Among the standard laboratory tests obtained at admission, the value of serum amylase was reviewed. The imaging findings, especially those obtained with CT, were correlated with the surgical findings, when available (in seven of eight patients). At admission, diagnosis of pancreatic injury was missed at CT in three of eight patients (37.5 %); thus, the sensitivity of CT for pancreatic injury was 62.5 %. ERCP showed rupture of the pancreatic duct in the two cases in which it was performed. Serum amylase was elevated at admission in four of eight patients, resulting in a sensitivity of 50 %. After surgery, an enterocutaneous fistula developed in one case, and was managed conservatively. One patient died from brain injury. Proper implementation of the CT technique and accurate film reading is mandatory to establish the diagnosis of pancreatic contusion. No correlation between CT features and type of outcome of surgical management could be established. On retrospective review of the CT examinations, it appeared that two of the three false-negative results could have been avoided. Therefore, proper CT technique and accurate film reading are mandatory in establishing the diagnosis of pancreatic injury. Received: 10 June 1998; Revision received: 26 October 1998; Accepted: 30 October 1998     

Multiple hepatic angiolipomas: a case report and review of literature

Follow-up of two hepatic angiolipomas in a patient without evidence of tuberous sclerosis is reported. Initially, the lesions presented as homogenously enhancing masses, which were nearly isodense to normal liver tissue on plain CT scans. Focal nodular hyperplasia was assumed. One year later, fat was detected in the growing tumors and percutaneous core biopsy revealed hepatic angiolipomas. Natural history of these rare lesions is unknown, and this is to the best of our knowledge the first observation of fatty metamorphosis in such a benign, mesenchymal hepatic neoplasm. Received: 8 October 1997; Revision received: 19 March 1998; Accepted: 11 May 1998     

非瓣膜性心房纤颤与老年脑梗死

目的　探讨非瓣膜性心房纤颤（ＮＶＡＦ）对老年缺血性脑卒中临床表现、预后的影响。方法　将５８ 例合并ＮＶＡＦ的老年急性缺血性脑卒中患者（ＡＦ组）与３０２ 例不合并ＡＦ患者（ＮＡＦ组）进行临床分析。结果　发现ＮＶＡＦ组有以下特点：（１）病情重,进展快,死亡率较高;（２）神经系统损害较严重;（３）腔隙性脑梗死发生率低;（４）颈内动脉闭塞常见;（５）预后差。结论　ＮＶＡＦ是引起老年缺血性脑卒中的危险因素,而且是影响其预后的重要因素。     

原发性脑室出血的CT征象与治疗（附28例报告）

目的探讨原发性脑室出血的临床表现、脑CT征象及其与治疗的关系;方法回顾性分析28例经CT证实原发性脑室出血病人的临床表现及CT征象;结果多有头痛、呕吐等脑膜刺激征表现,无脑局灶受损体征,脑CT均示原发脑室出血;结论原发性脑室出血的诊断依靠脑CT,Ⅰ型脑室出血宜行侧脑室外引流术,预后较差,Ⅱ、Ⅵ型可行腰穿脑脊液置换术．预后较好。     

Factors influencing the development of periventricular lucencies in patients with raised intracranial pressure

Summary Sixty patients with raised intracranial pressure and lowered attenuation areas around the lateral ventricles (periventricular lucency, PVL) on CT scanning were reviewed, and compared with a control group of 90 similar patients who did not have PVL. It was confirmed that PVL tends to occur in patients with acute or subacute obstructive hydrocephalus due to a tumour, and is more common in the presence of papilloedema and/or a decreased level of consciousness. Patients with very dilated lateral ventricles did not in general have PVL, but it was frequently seen in association with diastasis of the sutures. Twelve patients with PVL had no other clinical or radiological indication of raised intracranial pressure. Comparison with the control cases did not reveal any reason as to why some patients should develop PVL while others did not.     

CT对腹部创伤的诊断价值

目的 探讨CT对腹部创伤的诊断价值。方法 应用CT扫描对38例腹部外伤病人进行检查。结果 CT扫描诊断肾外伤12例，肝外伤5例，肠系膜血肿1例，肠穿孔2例，脾外伤18例，其中有7例为复合伤。CT扫描能清楚地显示脏器损伤及腹膜出血的程度、范围。结论 CT能快速、准确地检出腹腔脏器损伤的程度，为临床选择治疗方法提供重要依据。     

茎突CT薄层冠状扫描在诊断茎突过长综合征中的价值

目的 探讨“一点一线垂直法”茎突CT薄层冠状扫描在诊断茎突过长中的价值。方法测量72例双侧茎突的长度、方位、形态、厚度、尖端与咽侧壁距离,总结茎突过长病人的临床症状与诊断。 结果 ①41例67侧长度超过3.0cm,符合茎突过长的诊断;②12例12侧茎突虽未超过3.0cm(均在2.5～2.9cm),且茎突方位角>20°、末端与咽侧壁的距离<20mm,并有临床症状的应考虑茎突过长综合征;③按茎突的形态进行分型:锥型(分直锥、弧锥),束状型,分节型,发育不良型。其中分节型与临床症状有密切关系。结论 ①茎突CT薄层冠状扫描能清晰显示茎突的长度、形态、厚度、末端与咽侧壁距离,是诊断茎突过长的一种可靠方法;②“一点一线垂直法”茎突CT薄层冠状扫描无需进行图像重建,可操作性强、简捷易行、便于推广。