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To compare the effectiveness of different embolizing agents in reducing or redistributing bronchial arterial blood flow, we measured systemic blood flow to the right lung and trachea in anesthetized sheep by use of the radioactive microsphere method before and 1 h after occlusion of the bronchoesophageal artery (BEA) as follows: injection of 4 ml ethanol (ETOH) into BEA (group 1, n = 5), injection of approximately 0.5 g polyvinyl alcohol particles (PVA) into BEA (group 2, n = 5), or ligation of BEA (group 3, n = 5). After occlusion, angiography showed complete obstruction of the bronchial vessels. There were no changes in tracheal blood flow in any of the groups. Injection of ETOH produced a 75 +/- 14% (SD) reduction in flow to the middle lobe (P less than 0.02) and a 75 +/- 13% reduction to the caudal lobe (P less than 0.01), whereas injection of PVA produced a smaller reduction in flow to these two lobes (41 +/- 66 and 51 +/- 54%, respectively). After BEA ligation there was a 52 +/- 29% reduction in flow to the middle lobe and a 53 +/- 38% reduction to the caudal lobe (P less than 0.05). This study has significant implications both clinically and experimentally; it illustrates the importance of airway collateral circulation, in that apparently complete radiological obstruction of the BEA does not necessarily mean complete obstruction of systemic blood flow. We also conclude that, in experimental studies in which the role of the bronchial circulation in airway pathophysiology is examined, ETOH is the agent of choice.

With common carotid artery occlusion there is usually no flow in the distal vessels. However, flow to the ipsilateral internal common carotid artery may be maintained by collateral vessels. Nine of 1100 patients referred for carotid duplex sonography were found to have occluded common carotid arteries. Five of these patients had collateral circulation with reconstitution of flow via the external carotid artery. The color Doppler sonograms of three representative patients are presented. There was antegrade flow in the internal carotid artery with retrograde flow in the external carotid artery.

This article describes the CT scans of two patients who, following carotid endarterectomy, developed headache and seizures suggestive of hyperperfusion syndrome. Their CT scans demonstrated ipsilateral mass effect and white matter hypodensity. One patient progressed to hemorrhage and died. Although infarction is described as the commonest neurologic event to occur after carotid endarterectomy, autopsy or cerebral blood flow studies in these patients suggests that the changes were due to hyperperfusion rather that infarction.

The author performed a randomized prospective study of the effects of needle size and of age, sex, myelogram type and operators on the incidence of headache following myelography. In 113 patients randomized to 22 G and 25 G needle groups, data were obtained by questionnaire on the frequency of headache up to five days following the procedure. The influence of needle size was statistically insignificant (63%, 48%, p0.05). Age (p = 0.0002), sex (p = 0.01), myelogram type (p = 0.002) and myelographer (p = 0.03) significantly affected the frequency of headache. The size of the dural perforation appears to be less important than factors relating to age, sex, myelogram type and individual myelographers in the development of headache after myelography.

High resolution, real-time ultrasound scans were obtained through the anterior fontanelle to examine the intracranial anatomy of 100 neonates. Of 43 patients with abnormalities, 26 had intracranial hemorrhage (subependymal, intraventricular, or cerebral). Of the 51 patients also studied by CT, the sensitivity of ultrasound in detecting hemorrhage was 96% and the specificity 94%. This ultrasound technique was also very useful for detecting complications such as porencephalic and subependymal cysts, ventricular septations, and hydrocephalus. In normal premature neonates (25 to 35 weeks gestation) the lateral ventricles appear as slit-like structures on the coronal scan. The midline-lateral dimension of normal lateral ventricles was 8.6 mm (range 7-11 mm) and the depth of 1.9 mm (range 1-3 mm). Follow-up scans in patients with intraventricular hemorrhage show that in mild hydrocephalus, the lateral ventricle becomes rounded rather than slit-like. This change occurs before the midline-lateral dimension of the ventricle increases.

Sixty-eight patients with intraventricular hemorrhage (IVH) diagnosed by computed tomography (CT) were reviewed retrospectively to determine the etiology and prognosis, relationship to delayed hydrocephalus, and effect on neurological outcome. The most common causes were a ruptured aneurysm, trauma, and hypertensive hemorrhage. Ruptured aneurysms of the anterior communicating artery can often be predicted from the nonenhanced CT scan. The total mortality rate was 50%; however, 21% of patients returned to normal or had only mild disability. Patients in whom no cause was identified had a better prognosis. Delayed hydrocephalus was related to the effects of subarachnoid hemorrhage rather than obstruction of the ventricular system by blood. IVH per se is seldom a major factor in the neurological outcome.

Acute orbital pseudotumors are inflammatory lesions of unknown etiology that may affect part or, less often, all of the tissue within the orbit. A retrospective computed tomographic (CT) study of 16 patients demonstrated that these lesions occur in one of five specific anatomic patterns: anterior, posterior, diffuse, lacrimal, or myositic. The most common location was lacrimal followed by anterior pseudotumors. Posterior, most common location was lacrimal followed by anterior pseudotumors. Posterior, diffuse, and myositic pseudotumors were equally frequent. Localization on the basis of clinical features correlated with the CT localization. Illustrative cases of each of the five types are included. The role of CT in evaluating the therapeutic response is discussed.

Exclusion of leukaemic meningitis by quantitation of T and B lymphocytes in cerebrospinal fluid. P. B. Harrison and A. W. Cripps, Aust. N.Z. J. Med., 1982, 12, pp. 286–287. Involvement of the central nervous system (CNS) in chronic lymphatic leukaemia (CLL) is rare.1 However, when a patient with CLL presented with meningeal symptoms and a high CSF lymphocyte count in the absence of identifiable infection, meningeal leukaemia was considered the most likely diagnosis. Subsequent quantitation of T and B lymphocytes in the blood and CSF was found to be a most valuable aid in excluding the diagnosis, and later a cryptococcal infection was proven. This case is reported to draw attention to the value of T and B lymphocyte quantitation where difficulty is experienced in interpretation of cells in CSF in patients with leukaemia or lymphoma.