ABSTRACT We present a case of fat necrosis in the thigh of a ten year old girl, resulting in unusual multiple, ovoid filling defects seen in the residual cavity following drainage of a subcutaneous haematoma. No similar cases have been found on review of the literature. The appearance is described to aid diagnosis at the time of initial cavity drainage, avoiding the need for further investigation.
Epidural catheters were implanted in rats under halothane/nitrous oxide anaesthesia. Contrast medium (Iopamidol) was injected via the catheter under fluoroscopic control 24-48 h after implantation. In 15 of 20 rats contrast could be seen leaking out of the epidural space, usually after only 25 microliters was administered. Leakage was associated with diminished antinociceptive response to morphine administered via the catheter. Both leakage and decreased response to morphine could be largely prevented by applying a drop of Supa-Glue over the site of entry of the catheter to the epidural space at the time of catheter implantation. Investigators using epidurally cannulated rats should document that leakage does not occur or discard results from rats showing evidence of leakage.
The computed tomographic (CT) appearances of dural sinus thrombosis are variable, but include visualization of thrombus within the sinus on post-contrast images (the 'empty triangle' or 'empty delta' sign). This review of 104 consecutive examinations was undertaken to assess the incidence of the empty delta sign in a paediatric group undergoing CT examinations. The number of examinations in which a sagittal sinus filling defect was seen in three or more images, was unexpectedly high. An overall incidence of 18% was noted. Defects due to bone artifact and defects seen on only one or two slices were excluded. The age distribution of abnormal scans was markedly skewed towards young infants. Nine of 27 examinations (33%) in infants less than 1 month of age, were positive for filling defects, compared with six of 21 (29%) aged between 1 and 12 months, and four of 56 (7%) aged over 1 year. This review suggests that the finding of a filling defect or empty delta sign in the sagittal sinus is not pathognomonic for sinus thrombosis that results in clinically apparent manifestations. Second, a filling defect apparent on CT may resolve spontaneously. The incidence of non-occlusive sinus thrombosis may be significantly higher than previously recognized, particularly in young infants where predisposing conditions including dehydration, infection or prematurity coexist. Previous studies have indicated that the sensitivity of the empty delta sign is approximately 30%. This study implies that either the empty sign has limited specificity in the paediatric population, or that unrecognized non-occlusive sinus thrombosis is much more frequent than previously described.
The upper limit of the normal extrahepatic duct diameter when measured by sonography in our institution is less than half that when measured by endoscopic retrograde cholangiopancreatography (ERCP). The objective of this study was to locate possible sources of this discrepancy by comparing measurements obtained on the same patient by sonography, before and after ERCP. Thirty consecutive patients referred for ERCP were entered into a prospective trial; bile duct measurements were obtained independently by both techniques in 19 patients. Correcting for radiographic magnification, the ERCP measurement was more than twice that obtained by ultrasonography. Among the possible reasons for diverse results that we considered, radiographic magnification, ultrasonic underestimation, and distending effects of retrograde cholangiography (ERCP) were not found to be prominent causes for the marked discrepancy that we observed. The most likely explanation is that the duct in individual patients was being measured at a different level by the two techniques. A retrospective comparison of the studies obtained by each method suggests that the sonographic measurement is most often of the right hepatic duct. If this is the case, the two measurements show no statistically significant difference (P greater than 0.05). A prospective trial is needed to test this hypothesis.
A reinvestigation of the relationship between the decline of tuberculosis and improvement in social conditions in England and Wales during Victorian times.A retrospective study using data published in the annual reports of the Registrar General from 1853 to 1910. MEASURES ASSESSED: The diseases studied, in addition to tuberculosis were dysentery and cholera, including their total and infant mortality. Social conditions were evaluated from earnings and population density per house.Tuberculosis mortality declined at an annual average rate of 1.71% (95% confidence interval [Cl] 0.77-2.63), whereas total mortality, infant mortality and mortality from cholera and dysentery and house population density showed no statistically significant decline over the same period. Real earnings increased by 1.05% (95% CI 0.29-1.81).Improving social conditions do not provide the total explanation for the decline in tuberculosis during Victorian times. Other factors, principally natural selection, probably played a role. Part of the current increase in tuberculosis may be caused by effective drug therapy eliminating natural selection.
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