Conservative surgical management of placental implantation site hemorrhage.

BACKGROUND: Our purpose is to show that a simple, conservative, fertility-preserving surgical technique can be used to control postpartum hemorrhage from a hypotonic placental implantation site. CASE: Postpartum hemorrhage from a hypotonic placental implantation site at cesarean delivery was treated with surgical excision of the hypotonic segment, resulting in immediate cessation of the bleeding when other measures had failed. The patient's postoperative course was uneventful. The uterus and adjacent vascular structures were evaluated with magnetic resonance imaging studies at 4 weeks postpartum and were free of abnormality. CONCLUSION: Simple excision of a hypotonic bleeding site may be desirable and practical when fertility preservation is desired.

Malignant lesions presenting as symptoms of craniomandibular dysfunction.

Three cases of carcinoma, seen in a head/neck pain management practice during the past 2 years and presenting as craniomandibular dysfunction symptoms, are reported. Clinicians should always consider a differential diagnosis because of the variety of potential causes of the symptoms presented by the patient. These symptoms act as clues to help to differentiate between a routine or "evil" process. The need for imaging and remaining, when the clinical symptoms do not correlate with the clinical examination through established guidelines for craniomandibular dysfunction or head/neck pain, is of paramount importance.

Consumer satisfaction and perceived quality of outpatient health services.

The authors examined factors related to consumer satisfaction and willingness to recommend the provider among 1,366 patients receiving examinations at a free-standing medical imaging facility. The nontechnical (nonmedical) characteristics of the service encounter were drawn from three conceptual domains--staff behavior, atmospherics, and information--and two subjective judgments regarding the medical service itself: examination comfort and perceived worth. The authors hypothesized that all of these factors are related to increased consumer satisfaction and willingness to recommend the provider. Data collection was based on a service script, and factor analysis was used to organize elements from each domain into a map of consumer perceptions. Multivariate logistic regression indicated that items from each domain were significantly related to patient satisfaction and willingness to recommend the provider.

Corticosteroid hormonal influence on cranial computerized tomography: observations in the Rhesus monkey.

Six adult male Rhesus monkeys (T), treated with 0.5 mg/kg dexamethasone for 106 days, and 6 weight-watched controls (U), were studied postmortem with pathologic examination and cranial computerized tomography (CT). Cortical atrophy, as defined by perisulcal atrophy and ventricular dilatation, was found in 50% of each group, but marked changes were noted only among T. Adrenal, brain, and body weights were all lower among T (p less than 0.05). No significant histopathologic abnormalities were found. Our data suggest that CT changes of cortical atrophy may be caused by corticosteroid hormones alone, but are inconsistent and probably dependent upon individual susceptibility to the effects of corticosteroids.

The value of computed tomography in delineating suprasellar extension of pituitary adenomas.

Pituitary tumors commonly produce suprasellar extension. We have found that in assessing lateral suprasellar extent, the pneumoencephalogram and arteriogram are least accurate. CT scanning significantly increases the accuracy, and it is recommended that all patients with pituitary tumors have an initial CT scan.

Varied CT appearance of aneurysms of the vein of Galen in infancy.

An aneurysm of the vein of Galen can have a varied CT appearance in infancy. The classical picture is a spherical posterior third ventricular mass with the density of circulating blood contiguous with a dilated straight sinus and with uniform contrast enhancement. With varying degrees of thrombosis of the aneurysm which may occur in late infancy, the mass can change in density and the dilated straight sinus disappear. With total thrombosis, a precontrast hyperdense rim develops with a low density. The rim enhances but the low density center does not change with contrast infusion. Our experience in three patients with this spectrum of CT findings will be demonstrated and correlated with clinical findings and angiography.

Evaluation of cerebral infarction by computed tomography with special emphasis on microinfarction.

Computed tomography has proved to be the most effective mode of evaluating cerebral infarction in 143 documented cases. This was especially true when multiple focal infarcts were present. The incidence of contrast enhancement in acute infarcts was 88%. Concomitant acute and old infarcts were observed in 20% of cases. In the acute stage of stroke, radionuclide studies are preferable to contrast angiography since the latter may aggravate the pre-existing focal ischemia. Follow-up CT and radionuclide scans were extremely useful in confirming the diagnosis and demonstrating various postinfarction sequelae.

The value of radionuclide myelography in the evaluation of spinal arachnoiditis.

On the basis of myelographic findings, spinal adhesive arachnoiditis was classified into three types: type I (peripheral or marginal), type II (central), and type III (advanced). Depending on its location and extent, it may be divided into group A (lumbar), group B (thoracic), and group C (cervical). In view of the fact that intrathecal injection both of oily and of water-soluble contrast media tends to produce spinal arachnoiditis, we have been using radionuclides for pre- and postoperative myelography to evaluate arachnoiditis. Radionuclide myelography with 131I-HSA or 111In-DTPA is a safe modality which provides useful information regarding spinal arachnoiditis.

Left atrial myxoma: computed tomography as a diagnostic modality.

The workup of left atrial myxomas has variably ranged from a physical examination, laboratory tests, and echocardiography to the invasive modalities of angiography and cardiac surgery. We propose that computed tomography (CT) be considered a sensitive, noninvasive adjuvant in the diagnosis of these tumors. This report describes successful utilization of CT imaging in one such case of proven left atrial myxoma.

Computerized tomography in evaluation of atlantoaxial subluxation in rheumatoid arthritis.

Nineteen patients with rheumatoid C1-C2 subluxation of greater than or equal to 5mm were studied by computerized tomography (CT). CT demonstration of spinal cord compression as defined by loss of posterior subarachnoid space was present in 11/19 (CT+) and absent in 8/19 (CT-). Fourteen patients were examined by a blinded neurologist. Cord compression by CT correlated better with clinical neurologic status than did routine radiographic studies. Absent superficial abdominal reflexes and history of bladder dysfunction correlated highly with cord compression by CT. Two CT+ patients developed neurologic deterioration requiring spinal fusion. Our data suggest that CT is a useful, noninvasive adjunct in management of patients with rheumatoid C1-C2 subluxation.