Disruption of the ATM gene in breast cancer

Mutations in the ATM gene, which maps to 11q22-23, cause the multisystem recessive syndrome ataxia-telangiectasia (AT). Breast cancer has been reported in AT patients and carriers. Sporadic breast cancer is associated with loss of heterozygosity at or in the region of ATM and chromosomal abnormalities involving 11q23. We have investigated the chromosomes, nuclei and released chromatin fibers from nine primary breast carcinoma and eight cell lines by fluorescence in situ hybridization with four fluorochrome-labeled cosmids spanning the ATM gene. The ATM gene was disrupted in one primary breast carcinoma and in the cell lines MDA-MB-231 and MCF-7. The role of these aberrations in breast carcinomas, which may lead to gene dosage or dominant negative effects on gene function, requires further investigation.

Hemodynamic assessment of local anesthetic administration by laser Doppler flowmetry

OBJECTIVE

The hemodynamic effects of local anesthetic administration with and without a vasoconstrictor were compared by using laser Doppler flowmetry.

STUDY DESIGN

Seventeen people participated in a single study session in which they were given 2 intraoral injections. The injections, which were administered in random order, consisted of 1.8 mL lidocaine (2%) with epinephrine (1:100,000) and mepivacaine (3%). Hemodynamic parameters consisting of blood pressure, heart rate, and laser Doppler flowmetry were reordered at regular intervals.

RESULTS

The laser Doppler flowmeter detected changes in the peripheral perfusion of the finger that were not detected by changes in blood pressure and heart rate. The greatest change was associated with anxiety and occurred just before the injection. The inclusion of epinephrine in the local anesthetic resulted in a persistence of these changes.

CONCLUSION

This investigation has confirmed the sensitivity of laser Doppler flowmetry as an investigational tool for assessing hemodynamic changes associated with anxiety and the administration of local anesthesia.

The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation

Computed tomography was used to image the distal radioulnar joint (DRUJ) for instability. Four methods were used to quantify subluxation of the DRUJ: the Mino criteria, the epicenter method, the congruency method, and a new method called the radioulnar ratio (RUR). Validity of the various methods was evaluated in clinical and laboratory situations. Rheumatoid patients with symptomatic DRUJ pathology had significantly more abnormal RUR values (100% vs 73% [epicenter method] and 88% [Mino criteria]). The RUR detected instability sooner in a progressive laboratory-induced instability model. The intraobserver and interobserver reliability of the RUR was high, with intraclass correlation coefficients of 0.89 and 0.87, respectively. The RUR demonstrated superior performance in the diagnosis of DRUJ subluxation.

Preliminary report on a method of human papillomavirus DNA extraction from verruca plantaris for polymerase chain reaction studies

This preliminary report on the Chelex-based extraction method of HPV DNA from verruca plantaris is the first step in a series of studies on verruca plantaris undertaken, jointly, by the Departments of Podiatric Medicine and Microbiology at Des Moines University-Osteopathic Medical Center, Des Moines, Iowa. Current projects include the development of new primers for PCR studies of HPV, exploration of different viral DNA extraction methods, and surveys concerning treatment, success of therapies, and the epidemiology of verruca plantaris.

Treatment of caliceal diverticular stones: transdiverticular percutaneous nephrolithotomy with creation of a neoinfundibulum

PURPOSE

To evaluate transdiverticular percutaneous nephrolithotomy (TDPN) with creation of a neoinfundibulum in the treatment of caliceal diverticular stones.

PATIENTS AND METHODS

Between 1990 and 1998, 18 patients with symptomatic calculi in caliceal diverticula underwent TDPN. Transdiverticular puncture into the renal collecting system with creation of a neoinfundibulum was used, eliminating the need for prolonged probing with a wire for the neck of the diverticulum. Eight diverticula were upper polar, six were interpolar, and four were in the lower pole. Stones were endoscopically treated with use of Lithoclast (Electromedical Systems, Lausanne, Switzerland), graspers, ultrasound, or a combination of these methods.

RESULTS

Sixteen kidneys (89%) were rendered stone-free at discharge. Two kidneys (11%) were left with stone fragments of 5 mm or smaller. Hospital stay ranged from 3 to 15 days (average, 7 days). Procedure time ranged from 45 to 169 minutes (average, 87 minutes). One patient developed a left renal-pleural fistula, which closed 1 week after chest tube drainage. No other complications were encountered for an overall complication rate of 6%.

CONCLUSION

TDPN is a safe and effective method for treating caliceal diverticular stones, with a complication rate comparable to other methods.

Scalene muscles and the brachial plexus: anatomical variations and their clinical significance

Anatomical variations may be clinically significant, but many are inadequately described or quantified. Variations in neck anatomy are important to surgeons performing surgical procedures in this region. Thirty-two female and 19 male adult cadavers were studied. The commonly described anatomical relationship of the brachial plexus (BP) lying between the anterior scalene (AS) and middle scalene (MS) muscles was found in only 60% of instances. Scalenus minimus was present in 46% of instances (bilateral in 14 cadavers). The most common variation was the penetration of the AS by the C5 and/or C6 ventral rami. The C5 and C6 roots may fuse before piercing AS (15% cases, bilateral in 4 cadavers), or the C5 root alone pierce the belly of AS (13% cases, bilateral in 3 cadavers). The roots also may pierce AS independently (6% cases, bilateral in 1 cadaver). In 3%, the C5 root was found to be completely anterior to AS.

CT assessment of cerebral perfusion: experimental validation and initial clinical experience

PURPOSE

To validate a dynamic single-section computed tomographic (CT) method to measure cerebral blood volume (CBV) and cerebral blood flow (CBF) by using a noncarotid artery as the input and to demonstrate the feasibility of this method in a pilot series of patients.

MATERIALS AND METHODS

Twelve dynamic contrast material-enhanced CT studies were performed in beagles. CBV, CBF, and mean transit time (MTT) values were calculated by using an internal carotid artery (ICA) and a noncarotid artery as the input artery to the brain. Patient studies with use of the radial artery as the input were performed (a) repetitively in two patients after subarachnoid hemorrhage, (b) in a patient with a symptomatic ICA occlusion before and after the intravenous injection of 1 g of acetazolamide, and (c) in a patient with a malignant brain tumor.

RESULTS

Linear regression analyses revealed highly significant correlations (P < .001) between CBV (r, 0.98; slope, 0.96), CBF (r, 0.89; slope, 0.87), and MTT (r, 0.80; slope, 0.76) values calculated with the ICA and the noncarotid inputs. The CT-derived patient data correlated well with ancillary clinical and neuroradiologic findings.

CONCLUSION

Dynamic single-section CT scanning to measure CBV and CBF on the basis of a noncarotid input is a highly accessible and cost-effective blood flow measurement technique.

Acute acoustic trauma--its features and management

The features and mechanism of Acute Acoustic Trauma (AAT) together with available treatments are discussed and the current guidelines in use by the Bundeswehr are also presented.

Treatment of xanthelasma palpebrarum with bichloracetic acid

BACKGROUND

Although many treatment modalities have been described for xanthelasma palpebrarum, no single technique has emerged as dominant.

OBJECTIVES

Our purpose was to review the various therapeutic modalities for xanthelasma and to assess the efficacy of topical bichloracetic acid.

METHODS

Thirteen patients with 25 xanthelasma were treated with topical 100% bichloracetic acid. Efficacy was assessed over a follow-up period of 7 months to 10.5 years (average, 64 months).

RESULTS

Eighty-five percent of patients experienced initial complete clearing, and 72% of their lesions have not required retreatment over an average period of 68 months. Recurrences responded well to repeat treatment. Eighty-three percent of recurrent or poorly responsive lesions were associated with high cholesterol. The most resistant patient had four-lid involvement. Excellent cosmetic results and high patient satisfaction were seen.

CONCLUSIONS

Topical bichloracetic acid is a viable alternative to other modalities in the management of xanthelasma. Advantages include simplicity, cost-effectiveness, speed, safety, and efficacy.

Bronchogenic cyst: an unusual cause of lump in the neck

Bronchogenic cysts are rare congenital benign lesions that are usually detected in the paediatric patient with symptoms of infection or compression on vital structures. They are rarely diagnosed in the adult population. We present a case of bronchogenic cyst presenting as a lump in the neck in an adult patient. Radiological imaging helped to diagnose this lesion accurately before any form of intervention. Complete surgical excision is the treatment of choice.

Diagnostic pitfalls in sports related laryngeal injury

The serious nature of laryngeal trauma sustained during sporting activity can be easily overlooked. Concomitant injury should not distract from the diagnosis of potential airway problems. The effects of head and neck trauma on the airway may be delayed. The assessment and management of a patient with suspected laryngeal injury should be carried out by experienced medical practitioners.

Complications of radiologically placed central venous ports and Hickman catheters in patients with AIDS

OBJECTIVE

To determine any differences in the complications following radiologic placement of 2 devices--Hickman catheters and central venous ports--to permit long-term central venous access in patients with AIDS.

PATIENTS AND METHODS

Thirty-eight patients with AIDS received 52 long-term central venous access catheters. Seventeen received 23 Hickman catheters and 27 received 29 central venous ports (hence, 6 patients received both). Complications rates were determined retrospectively from clinical records and radiologic studies.

RESULTS

The only acute complications were pneumothoraces--3 in the patients receiving Hickman catheters and 2 in the patients receiving central venous ports. Infections developed in 12 of the patients receiving Hickman catheters a median of 53 and a mean of 96 days after placement. Infection developed in 8 of the patients receiving central venous ports a median of 125 days and a mean of 184 days after placement. This difference was statistically significant (p < 0.001). The most common organism in these infections was Staphylococcus aureus. The only other nonacute complication was 1 nonocclusive thrombosis of the superior vena cava, which occurred in a patient with a Hickman catheter 240 days after placement and resolved once the catheter was removed.

CONCLUSION

Central venous ports are preferred over Hickman catheters for long-term central venous access in patients with AIDS.

Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques

The intra- and interobserver variability of 3 techniques for measuring the humpback deformity of 37 scaphoids using longitudinal computed tomography was assessed. The 3 measuring techniques were the lateral intrascaphoid angle, the dorsal cortical angle, and the height-to-length ratio. The intraobserver reliability of the intrascaphoid angle was poor; the dorsal cortical angle was moderate to excellent, and the height-to-length ratio was excellent. The interobserver reliability of the intrascaphoid angle was poor to moderate, the dorsal cortical angle was moderate to excellent, and the height-to-length ratio was moderate to excellent. For all 3 observers, the intra- and interobserver reliability was the best for the height-to-length ratio and worst for the intrascaphoid angle. The height-to-length ratio is the most reproducible method of assessing the humpback deformity. Clinical correlation is required to establish whether the height-to-length ratio will be of value in predicting the outcome of fractures of the scaphoid.

Informed consent: patients' and junior doctors' perceptions of the consent procedure

The important task of obtaining informed consent is often left to the most junior member of the surgical team, whose understanding of the surgical procedures involved may be limited. Little is known about patients' and junior doctors' satisfaction with the consent procedure, which was studied with the use of questionnaires. The vast majority of patients (95%) were satisfied with the explanation given to them prior to obtaining consent although 45% thought that the doctor who signed the consent form would be performing the surgery. Thirty-seven per cent of the junior doctors questioned admitted to obtaining consent for procedures of which they had little understanding. The majority of both junior doctors and patients felt that the surgeon performing surgery should sign the consent form. Junior doctors cannot be expected to obtain informed consent for procedures they do not fully understand and patients's; expectations must be taken into consideration if the seemingly inexorable rise in medico-legal litigation is to be halted.

Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures

Arthroscopy was used to assess the soft tissue injuries associated with distal radial fractures in 118 acute intra- and extra-articular fractures. The triangular fibrocartilage complex (TFCC) was torn in 46 of 118 patients--in 35% of intra-articular fractures and in 53% of extra-articular fractures. No correlation between ulnar styloid fractures and TFCC injuries could be found. Scapholunate (SL) ligament injuries with instability were present in 21.5% of intra-articular fractures and in 6.7% of extra-articular fractures. Lunotriquetral (LT) ligament injuries with instability were present in 6.7% of intra-articular fractures. and in 13.3% of extra-articular fractures. Combined SL and LT injuries were present in 5.6% of intra-articular fracture. Preoperative radiographs correlated with TFCC injury. Patients with TFCC tears had greater shortening and dorsal angulation on the preoperative radiographs. Preoperative radiographs had no predictive value for interosseous ligament injury. Ligamentous injuries are commonly associated with both intra-articular and extra-articular distal radial fractures.

Percutaneous inferior vena caval approach for long-term central venous access

PURPOSE

The authors report their experience with the translumbar inferior vena cava (IVC) approach for central venous access during a 6-year period at three teaching hospital sites.

PATIENTS AND METHODS

Twenty-nine percutaneous IVC central venous access catheters were inserted in 22 patients during a 6-year period in the radiology departments of three teaching hospital sites. All patients had undergone unsuccessful attempts at conventional central venous access. Information was gathered by retrospective radiologic and hospital chart review.

RESULTS

All attempted placements were successful. Catheters were in place for a total of 3,510 catheter days. The average length of catheter placement was 121 days (range, 14-536 days). Life-table analysis predicted catheter function rates of 55% and 29% at 6 and 12 months, respectively. Three procedure-related complications occurred. A lower pole branch of the right renal artery was inadvertently entered with a 22-gauge needle during attempted IVC puncture in one patient without clinical sequelae. A second patient developed a small groin hematoma at the femoral venous puncture site, which resolved spontaneously. A third patient developed a moderate retroperitoneal hematoma, which resolved without specific intervention. The sepsis rate was 2.8 infections per 1,000 catheter days with an average time to infection of 127 days (range, 10-536 days).

CONCLUSION

In the authors' experience of 29 translumbar central venous catheter insertions, all attempts were successful. Percutaneous central venous access via the IVC is a safe and effective option for patients in whom more conventional access is not possible.

Abnormalities of the hook of the hamate in patients with carpal tunnel syndrome

The hook of the hamate is an important landmark in endoscopic carpal tunnel release. We studied the incidence of abnormalities of the hook of the hamate in patients with carpal tunnel syndrome. One hundred thirty-one consecutive patients presenting with carpal tunnel syndrome underwent carpal tunnel radiography. Abnormalities of the hook of the hamate were present in 6 of 131 patients (4.6%). The hook of the hamate was aplastic in 3 of 131 patients (2.3%). A bipartite hook of the hamate was present in 1 patient (0.8%). A nonunion of an old fracture of the hook of the hamate was found in two patients (1.6%). The previously reported incidence of an aplastic hook of the hamate in the general population is 1 of 1,452 (0.06%). The odds ratio revealed a 34-fold increase in the risk of hamate abnormalities in the carpal tunnel population (p < 0.001). Hook of the hamate abnormalities may be more common than previously reported.

Laryngeal tuberculosis: an unsuspected danger

It is always important to treat conditions which may be cancerous with respect and, where there is suspicion, to take biopsies for histological examination. A hoarse voice may, in addition, be a sign of tuberculosis of the larynx, and the clinical appearance can be similar to a carcinoma. Preoperative chest x-ray (not always performed) and an awareness by the histologist of such a possibility are important now that this condition is increasing in frequency in parallel with conditions where immunological status is compromised.

High tracheostomy and other errors--revisited

Timely cricothyrotomy may be life-saving, but it is not without its complications. Together with tracheostomy performed too high, there are high incidences of stenosis and voice changes afterwards-often neglected because the patient has so many other problems. Jackson warned of these problems over 70 years ago-his message is still relevant.

E2F binding is required but not sufficient for repression of B-myb transcription in quiescent fibroblasts

We have previously shown in mouse NIH3T3 fibroblasts that transcription of the B-myb gene, which encodes a transcription factor required for S phase entry, is repressed through a promoter E2F site in G0/early G1. Transcription repression at this stage of the cell cycle was correlated with binding of a specific p107/E2F complex to this site. We report here, however, that transfection of cells with the known components of this complex, p107, E2F-4 and DP-1, did not repress the B-myb promoter in cycling NIH3T3 cells, although p107 inhibited transcription transactivation by E2F-4/DP-1. To establish definitively the contribution of E2F to repression, the effects of further mutations within and surrounding the E2F site were examined. It was evident that E2F binding and repression were closely correlated, lending greater weight to the contention that E2F itself is implicated in this activity. These studies also identified a closely linked site, designated the downstream repression site (DRS), which was not required for E2F binding or transactivation but which was necessary for repression. These findings indicated that E2F-dependent repression and activation are independently regulated phenomena and suggest that repression involves additional interactions determined by the promoter context.

Characterization of Newcastle disease virus vaccines by biological properties and sequence analysis of the hemagglutinin-neuraminidase protein gene

Six commercially available monovalent Newcastle disease virus (NDV) live-vaccines were examined for their biological and genomic stability in comparison to their stated parent virus. Thermostability of the hemagglutinin at 56 degrees C for 5 min was consistently observed among the majority of the vaccine viruses. One exception was a recently developed NDV vaccine isolated from turkeys that had a thermostability of 15 min. Neuraminidase activity, as measured by elution rate of agglutinated red blood cells, varied among vaccine viruses and correlated with that of the parent isolate. Virulence as measured by intracerebral pathogenicity index ranged from 0 to 0.39 among NDV vaccine-type viruses, well within the range of avirulent lentogens. Sequence of the fusion protein cleavage site from all the NDV vaccine isolates examined was consistent with that for lentogens. The entire hemagglutinin-neuraminidase gene sequence was 98% similar among all the NDV vaccine viruses examined and phylogenetic classification of commercial vaccine types correlated with their respective parent virus. Consequently, the commercially produced NDV vaccines reported here appear relatively stable when mass produced in avian embryonated eggs.

Virus characterization and sequence of the fusion protein gene cleavage site of recent Newcastle disease virus field isolates from the southeastern United States and Puerto Rico

Nine Newcastle disease virus (NDV) isolates obtained from Puerto Rico, Georgia, Alabama, Mississippi, and Texas were analyzed for in vivo pathogenicity, biological properties (hemagglutination of mammalian erythrocytes), and for sequence variation at the amino acid and sense RNA level of the fusion protein cleavage site. Intracerebral pathogenicity index values ranged from 0 to 0.3 and the intravenous pathogenicity index obtained for all isolates was 0. Four isolates hemagglutinated bovine erythrocytes, whereas no hemagglutination was observed using equine erythrocytes. By direct sequencing of reverse transcription polymerase chain reaction products, all the isolates had a predicted fusion cleavage sequence comparable to lentogenic NDV strains. Based on nucleotide sequence, the viruses could be grouped phylogenetically with the B1 vaccine-type virus. However, nucleotide sequences were not 100% similar to the B1 or La Sota NDV strains, indicating that minor genetic heterogeneity occurs among lentogenic field isolates of NDV.

Cricothyrotomy: the anatomical basis

Cricothyrotomy is an important surgical technique. We studied the anatomy of the cricothyroid membrane in 13 adult fresh cadavers preserved at 45 degrees F and examined at 70 degrees F. The working dimensions of the cricothyroid membrane were measured for emergency cricothyrotomy and placement of an airway tube. The vertical measurement ranged from 8-19 mm (mean 13.69 +/- SE 0.96 mm) and the maximal width between the cricothyroid muscles ranged between 9 and 19 mm (mean 12.38 +/- SE 0.91 mm). The distance from the upper limit of the cricothyroid membrane to the vocal cord was 9.78 +/- SE 0.52 mm. Eight subjects (62%) had an artery delineated transversely across the cricothyroid membrane. Two subjects (15%) had sclerosis of the cricothyroid joint. To promote the safe use of cricothyrotomy, the anatomy of the cricothyroid membrane is defined and clinically relevant data are presented.

Characterization of Newcastle disease virus isolates by reverse transcription PCR coupled to direct nucleotide sequencing and development of sequence database for pathotype prediction and molecular epidemiological analysis

Degenerate oligonucleotide primers were synthesized to amplify nucleotide sequences from portions of the fusion protein and matrix protein genes of Newcastle disease virus (NDV) genomic RNA that could be used diagnostically. These primers were used in a single-tube reverse transcription PCR of NDV genomic RNA coupled to direct nucleotide sequencing of the amplified product to characterize more than 30 NDV isolates. In agreement with previous reports, differences in the fusion protein cleavage sequence that correlated genotypically with virulence among various NDV pathotypes were detected. By using sequences generated from the matrix protein gene coding for the nuclear localization signal, lentogenic viruses were again grouped phylogenetically separate from other pathotypes. These techniques were applied to compare neurotropic velogenic viruses isolated from an outbreak of Newcastle disease in cormorants and turkeys. Cormorant NDV isolates and an NDV isolate from an infected turkey flock in North Dakota had the fusion protein cleavage sequence 109SRGRRQKRFVG119. The R-for-G substitution at position 110 may be unique for the cormorant-type isolates. Although the amino acid sequences from the fusion protein cleavage site were identical, nucleotide sequence data correlate the outbreak in turkeys to a cormorant virus isolate from Minnesota and not to a cormorant virus isolate from Michigan. On the basis of sequence information, the cormorant isolates are virulent viruses related to isolates of psittacine origin, possibly genotypically distinct from other velogenic NDV isolates. These techniques can be used reliably for Newcastle disease epidemiology and for prediction of pathotypes of NDV isolates without traditional live-bird inoculations.

Cell-cycle regulation of human B-myb transcription

We demonstrate here that activity of the human B-myb promoter is regulated during the cell cycle by the E2 transcription factor (E2F). Comparison of the human B-myb promoter sequence with that of its murine counterpart revealed an evolutionally conserved sequence that contains an E2F-binding site. In transiently transfected murine NIH3T3 and human HaCaT cells, luciferase (Luc) reporter activity directed by the human B-myb promoter was found to increase significantly in late G1/S phase of the cell cycle. Mutation of the promoter E2F site resulted in significantly greater Luc activity in NIH3T3 and HaCaT cells made quiescent by serum deprivation, indicating that E2F repressed transcription of this gene during G0. Analysis of E2F DNA-binding activity in G0 HaCaT cells revealed a distinct complex that apparently contained neither the retinoblastoma gene protein, pRb, nor the related p107 protein. De-repression of transcription in S phase was accompanied by the disappearance of this G0 E2F complex and the appearance of a distinct complex containing p107. In addition, complexes containing pRb were detected at both stages of the cell cycle.

Emergency drug therapy. Drugs and routes of administration

Management of medical emergencies requires a thorough knowledge of specific medications and their routes of administration. This article briefly discusses the medications that should be included in a basic emergency cart and routes in which to administer them.

The Burn Wheel: a practical guide to fluid resuscitation

During preparation for mass casualties of burn victims in the Gulf War (1990-91), a 'Battlefield Burns Table' was devised to allow rapid calculation of fluid replacement. By standardizing weights and using only Hartmann's Solution BP, a regimen could be prescribed by the non-specialist without resort to mathematical calculations. By means of a revolving disc, this has now been refined for use in a civilian setting where expert burn advice may not be immediately available.

Longitudinal computed tomography of the scaphoid: a new technique

Computed tomography is increasingly utilized for the evaluation of scaphoid fracture, nonunion, and deformity. We have developed a new technique of positioning patients while performing longitudinal computed tomography of the scaphoid. With the wrist positioned in radial deviation and neutral flexion, greater patient comfort is provided and immobilization of the wrist is not required. A reproducible image can be obtained with attention to the alignment of the scanning plane to the longitudinal axis of the scaphoid on the scout image, and verified with the "target sign". High resolution images, which clearly demonstrate the abnormalities of the scaphoid, can be produced even if the patient has a cast on the wrist or if there is hardware in situ.

Insertion of subcutaneous central venous infusion ports by interventional radiologists

OBJECTIVE

To evaluate the safety and efficacy of radiologic implantation of subcutaneous chest wall infusion ports by interventional radiologists, rather than surgeons, at a tertiary care hospital.

PATIENTS AND METHODS

Review of radiology department and hospital records for 38 patients (ranging in age from 21 to 70 years), in whom a total of 41 infusion ports had been inserted between January 1992 and January 1994.

RESULTS

All of the implantations were successful. The only acute complication was pneumothorax, which occurred in one patient; insertion of a chest tube was required. There were no cases of hematoma, air embolism or arterial puncture. The infusion ports remained in place for 12 to 492 days (for a mean of 167 catheter days per patient). Total follow-up was 6863 catheter days. The overall incidence of catheter-related infection was 1.3/1000 catheter days; removal of the port was necessary in eight cases. Occlusion of the catheter occurred in two cases, one after 21 days and the other after 308 days. Neither migration nor fracture of the catheter tip occurred. Overall, removal of the port was required because of catheter-related complications in nine cases (22%); in these cases the port was removed after a mean of 181 (range 21 to 420) days.

CONCLUSIONS

Because the success and complication rates observed here were similar to those reported for insertions performed in the operating room, the authors conclude that central venous infusion ports can be safely and efficiently implanted by interventional radiologists.

Symptomatic hypocalcemia and hypoparathyroidism in two infants of mothers with hyperparathyroidism and familial benign hypercalcemia

Neonatal hypocalcemia secondary to maternal hypercalcemia is relatively rare. We describe two infants with hypocalcemia and generalized seizures at 2 weeks and at 5 days of age, respectively. In the first case the infant was delivered of a mother who was subsequently diagnosed as having hyperparathyroidism. In the second case the infant was a member of a kindred with familial benign hypercalcemia. The evaluation of late-onset neonatal hypocalcemia should include an evaluation of maternal hyperparathyroidism and, in some cases, an evaluation for familial calcium disorders.

The value of otoscopy

Images

Reduction of bowel motion artifact during digital subtraction angiography: a comparison of hyoscine butylbromide and glucagon

The authors compared the effectiveness of hyoscine butylbromide (Buscopan) and glucagon in reducing bowel motion artifact during abdominal intra-arterial digital subtraction angiography. Sixty-six patients referred to the radiology department of a tertiary-care hospital for abdominal angiography between October 1989 and July 1992 consented to participate in the study. Diabetic patients receiving insulin and those with glaucoma were not considered for the study. The patients were assigned at random to receive either Buscopan (39 patients) or glucagon (27) intravenously before angiography. Images obtained at three stages during the procedure were reviewed independently by three experienced vascular radiologists who were blinded as to treatment group; images for nine patients in the Buscopan group and seven in the glucagon group were excluded because of breathing artifact or body movement. For each image the radiologists scored bowel motion in each section of a six-section grid. The bowel motion scores during early, middle and late arterial phases and the total scores for the two groups did not differ significantly (t-test). On the basis of these findings, the authors continue to use Buscopan because it is less expensive than glucagon.

Primary amyloidosis of the larynx

The history, examination and operative findings of primary amyloidosis of the larynx are very suggestive of carcinoma, indicating the need for careful histological examination. Staining with Congo red shows a characteristic birefringence. Systemic amyloidosis may be present.

Dysphagia caused by a foreign body in the thyroid

A case is described where neck pain of unknown origin associated with dysphagia was found to be caused by a foreign body in the thyroid gland.