Cases of the day. General. Benign thymic cyst complicated by hemorrhage.
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Biomedical subjects
Publications and source records attributed to P Robillard.
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Adhesive capsulitis of the shoulder is an idiopathic condition characterized clinically by pain and limitation of movement. The characteristic arthrographic features are those of limited capacity of the joint, pain during injection, and retracted recesses. Progressive distension of the capsule with 1% lidocaine and 40 mg of triamcinolone acetonide (Kenalog) is a recommended form of treatment for this condition. Twenty-five patients treated by this method were reviewed retrospectively. Eleven (44%) were completely relieved of their symptoms, 6 (24%) had a 50% improvement, and 8 (32%) had no relief. Patients with idiopathic adhesive capsulitis responded more favorably to the treatment than those with a traumatic etiology. The duration of symptoms had no correlation with the results of therapy. There were no complications from the treatment.
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The safety and efficacy of iohexol, a new nonionic contrast agent, were compared with a diatrizoate (Renografin-76) in a double-blind, parallel study of peripheral arteriography by femoral puncture in 60 patients. Extra-large field serial peripheral arteriography was used and a posterior tibial nerve block was applied to all patients in the study. Similar changes in blood chemistry were observed following the injection of iohexol and diatrizoate but these changes did not require corrective measures. Significantly more patients complained of a sensation of severe heat after receiving diatrizoate (38%) than after the injection of iohexol (10%) (p = 0.001). Four patients in the diatrizoate group experienced one or more adverse reactions, including mild urticaria. Only mild nausea was reported by a single patient in the iohexol group. Overall, 100% of the studies were diagnostic but more of the radiographs taken after the injection of iohexol were rated excellent than after the injection of diatrizoate.
Digital angiography depends upon computer recording and manipulation of the radiographic image rather than the use of film. We use a small focal spot x-ray tube, a cesium iodide image intensifier and the image is recorded on a 512 X 512 matrix at 1.2 frames per second. Subtraction angiograms have been obtained in 250 patients and 86% of the results were graded as either good or excellent in head and neck examinations. There is however a small proportion of patients in whom results are unsatisfactory and in whom this fact can be attributed most often to cardiac failure. The advantages of digital intravenous and intra-arterial subtraction angiography have been evaluated and amount to improved patient safety, high system contrast and favourable cost effectiveness; these outweigh the limitations of the restricted field of view and the relatively low resolution of the image in comparison with conventional arteriography.
For the last two decades the most common method of radiographic study of the venous system of the lower limbs has been ascending phlebography, by injection of contrast material in a superficial vein on the dorsum of the foot. We report our own experience with another approach, using a large field technique on recumbent patients, with elevation of the limbs, thus taking advantage of gravity. The contrast injection is usually made in a more distal superficial vein of the foot after a tiny cut-down. Excellent results are consistently obtained in demonstrating all the deep veins, including the iliac vessels. The same principles may be applied to upper limb phlebography.
The BCG vaccination program officially set up in 1949 in the Province of Quebec has been retrospectively evaluated for the period from 1956 to 1961. Two series of age groups were studied, 0-14 and 15-29, each comprising populations of several hundred thousand. At the beginning and the end of the period, the rates of primary vaccination were, in percentages of viable births, from 40 to 47.8 and, in cumulative percentages, for the 0 to 14 year age group, from 39.98 to 53.41, and for the 0 to 29 year age group, from 29.22 to 45.98.During this period, the ratios between the yearly rates of incidence of new cases of pulmonary tuberculosis per 100,000 in vaccinated and non-vaccinated individuals ranged from 1-2.5 to 1-3.5 within the age group 0-14 years and from 1-4.5 to 1-7 within the age group 15-29 years. When only the incidence of the more severe forms of tuberculosis is considered, the ratios ranged from 1-3.7 to 1-6.0 for the younger group and from 1-5.3 to 1-7.6 for the older one.Mortality from pulmonary tuberculosis was practically non-existent in the vaccinated groups and decreased from 2.5 to 1.3 per 100,000 population in the non-vaccinated groups.
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PURPOSE: To compare the efficacy and safety of streptokinase (SK) and urokinase (UK) in the treatment of local thrombolysis. PATIENTS AND METHODS: Over a 24-month period, 40 patients with 45 lower limb arterial occlusions of less than 45 days duration underwent intraarterial fibrinolysis. Twenty occlusions were treated with recombinant UK and tissue culture-derived UK, and 25 occlusions were treated with SK. The study was retrospective, but the two groups were very homogeneous in terms of vascular surgical history, medical risk factors, and occlusion characteristics. RESULTS: Complete lysis (95% or more) was achieved in 84% of SK infusions and 89% of UK infusions. Endoluminal and surgical interventions as well as clinical outcomes of SK and UK treatment were comparable. However, infusion time was significantly longer for SK treatment: 28.5 hours versus 19.1 hours for UK treatment (P = .035). Complication rates were not statistically significantly different. Average length of stay in the intensive care unit was identical (2.2 days) for both groups, and the difference in hospital stay was not statistically significant (7.7 days for SK vs 8.7 days for UK). CONCLUSION: At the concentrations and doses used, the efficacy and safety of SK and UK were comparable, despite longer SK infusion time.