Low molecular weight heparin as adjuvant therapy in active ulcerative colitis.

BACKGROUND: Heparin given intravenously has shown beneficial effects in the treatment of refractory ulcerative colitis in open trials. Low molecular weight heparin (LMWH) offers advantages in the method of administration but have not been evaluated in inflammatory bowel disease conditions. AIM: To assess the tolerability and safety of subcutaneous self-administered LMWH in outpatients with refractory ulcerative colitis and to evaluate any potential adjuvant therapeutic effect. PATIENTS AND METHODS: Twelve patients with mild to moderately active ulcerative colitis were included in the trial. The patients had either responded poorly to treatment with conventional therapy, including oral and/or rectal glucocorticosteroids, or had experienced a rapid relapse during or shortly after GCS therapy. Dalteparin sodium 5000 units s.c. injection was administered twice daily for 12 weeks. Patients were monitored for possible adverse events and changes in clinical symptoms, and endoscopic and histological scores were analysed. Leucocyte scanning was performed at inclusion and at the end of the study. RESULTS: Tolerability and compliance were excellent and no serious adverse events occurred. Eleven patients improved symptomatically and six (50%) attained complete remission after 12 weeks of treatment. Endoscopic, scintigraphic and histological scores were found to be significantly improved. CONCLUSION: Self-administered LMWH given s.c. may be a safe adjuvant therapy for patients with active, glucocorticosteroids-refractory ulcerative colitis. A controlled trial should be undertaken to confirm the positive effects found in this study.

Cholesterol granuloma of the petrous apex.

Cholesterol granuloma of the petrous apex is a newly recognized clinical entity distinct from cholesteatoma. Cholesterol granuloma usually produces symptoms of trigeminal, facial, and abducens nerve palsy and may not affect the auditory nerve. The characteristic computerized cranial tomographic (CCT) finding is a nonenhancing, smooth-walled, expansile lesion that is isodense with brain tissue in a patient with bilaterally well pneumatized mastoids and petrous apices. Treatment is limited to drainage of the cyst and insertion of a stent for permanent aeration of the petrous apex. Of ten cases of cholesterol granuloma of the petrous apex recently diagnosed at the Otologic Medical Group, the correct preoperative diagnosis was made in nine patients on the basis of CCT findings. Six of the nine patients had serviceable hearing preoperatively; serviceable hearing was maintained postoperatively in five patients.

Effects of information supply on satisfaction with information and quality of life in cancer patients receiving curative radiation therapy.

In order to test the efficacy of various information inputs, 210 consecutive cancer patients were randomized to one of three information conditions before the start of curative radiation treatment: (1) standard information plus group and repeated individual information (n=70), (2) standard information plus brochure (n=70), and (3) standard information only (n=70). Patients completed questions regarding satisfaction with information, anxiety, depression, subjective distress and quality of life at inclusion, and 1h before the start of the radiation therapy treatment (approximately 4 weeks later). Patients receiving standard information plus group and repeated individual information were significantly more satisfied with the information than were patients in the remaining two groups. There were no differences with respect to any of the other outcome measures. This study has shown that the nurses group and individual information was of significant importance in preparing the patients for the procedure of receiving radiation therapy.

Computed tomography of the nasopharynx: normal and variants of normal.

In 52 normal nasopharyngeal computed tomographic (CT) scans the various tissue planes deep to the mucosa were always seen and appeared symmetric. The superficial structures were more often asymmetric; however, by using physiologic maneuvers, coronal scanning, and this very reliable deep plane anatomy, a highly accurate interpretation is possible. A knowledge of these simple scanning techniques and of the range of normal anatomy will help radiologists avoid the equivocal and false-positive interpretations that plague other radiographic studies of this area. Because of its deep plane information, CT best complements the clinical evaluation of the nasopharynx, and should be the radiographic examination of choice.

CT approach to benign nasopharyngeal masses.

The physical characteristics of the fascial planes of the nasopharynx provide a basis for categorizing growth patterns of the more common benign nasopharyngeal masses. Lymphoid hyperplasias are confined to the surface by the very dense pharyngobasilar fascia that lies beneath the submucosa. It takes a very aggressive process to cross this fascial plane. More laterally throughout the paranasopharyngeal space the loose areolar nature of the buccopharyngeal fascia permits benign tumors in this space to assume a spherical configuration. The carotid sheath is also a loose areolar arrangement that permits free movement of the carotid artery in the neck. Juvenile angiofibromas permeate natural foramina, displace bony septa, and extend widely but do not invade the carotid sheath. Neurogenic tumors and paragangliomas are intimately associated with contents of the carotid sheath; therefore, they obliterate the low density regions surrounding the carotid vessels.

Comparative advantages of small- and large-dose metrizamide myelography.

A series of myelographies performed with a smaller than customary dose (3.75 g) of metrizamide was compared with a series using the larger customary dose. While little decrease in the incidence of headache and vomiting resulted from the decreased dose, there was a heartening drop in the incidence of psychoneurologic side effects. Little difference in diagnostic quality between the two series resulted when the contrast agent was injected close to the site of main interest, but total spinal canal myelography performed with the low dose is often inadequate.

Breast metastases from extramammary malignancies.

Metastatic foci to the breast from a wide variety of primary malignancies appear on mammograms as circumscribed spheroid shadows with only slightly irregular margins, and without evidence of microcalcifications, spiculations, or other signs of desmoplastic response that characterize many primary scirrhous carcinomas. In the cases studied, there was close correlation between the size of the metastatic lesion at palpation and mammography, a feature also characteristic of the well-circumscribed carcinomas. This is not the case with most scirrhous breast carcinomas, whose associated desmoplastic reaction results in an apparent larger size by palpation than observed on mammography.

High-resolution CT of the jugular foramen: anatomy and vascular variants and anomalies.

In high-resolution computed tomographic (HRCT) images of dry skulls and patients, the anatomy of the jugular foramen and its neighboring structures was demonstrated to excellent advantage. Among those structures visualized were the cortical margins of the jugular compartments, which are important in evaluating tumor involvement, the anatomic relationship between the jugular fossa and the hypotympanum, and the adjacent basal foramina. The inferior tympanic canaliculus, which transmits the inferior tympanic artery and nerve and houses one fifth of the glomus formation, thereby playing a role in arterial anomalies as well as glomus tumors, was occasionally recognizable. In addition, subtle bone findings associated with vascular anomalies in and around the jugular foramen, critically important in the differential diagnosis of glomus tumors, were visualized. Examples of these findings are presented.

An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease.

OBJECTIVE: There is a perception of increasing and widespread use of alternative medicine for inflammatory bowel disease (IBD). We assessed the usage of alternative therapies among patients with IBD, whether there were similar or contrasting variables that were predictive of such use, and contrasted the use in four different centers in North America and Europe. METHODS: Patients in four IBD centers completed a self-administered questionnaire regarding alternative medicine. The centers were in Cork, Los Angeles, Stockholm, and Winnipeg. Patient demographics, the use of 18 types of alternative medicine, and attitudes towards alternative and conventional medicine were compared. A multiple logistic regression analysis was used. RESULTS: Fifty-one percent of 289 patients used some form of alternative medicine. The percentages of use by site were Cork = 31%, Los Angeles = 68%, Stockholm = 32%, and Winnipeg = 57%. The six most commonly used therapies in descending order were: exercise (28%), prayer (18%), counseling (13%), massage (11%), chiropractic (11%), and relaxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. The highest odds ratios (confidence intervals [CIs]) for using any form of alternative medicine were associated with: being single 3.1 (1.7-5.7), Los Angeles patient 4.4 (2.3-8.3), Winnipeg patient 2.7 (1.3-5.9), and an increase of alternative medicine use of 2.7% for every M.D. visit (CI, 2-11%/visit). The patient age, gender, disease diagnosis, or duration of disease were not predictive of any type of alternative medicine use. Regarding attitudes, respondents from Cork were most favorable toward alternative medicine use and least favorable toward conventional medicine. Based on attitudes, subjects were more likely to use alternative medicine if they were not satisfied with conventional therapy, viewed hospitals as dangerous places, thought that alternative medicine practitioners should have a role in hospitals, and felt their medical situation was hopeless. CONCLUSIONS: Fifty-one percent of respondents used some form of alternative medicine. The use was greater among the North American patients than the European ones. Respondents were more likely to use alternative medicine if they were single, in a higher income bracket, and an urban dweller.

Cholesterol granuloma of the petrous apex: CT diagnosis.

Cholesterol granuloma of the petrous apex is a readily recognizable and treatable entity that is more common than previously realized. Cholesterol granuloma grows slowly in the petrous apex as a mass lesion until it produces hearing loss, tinnitus, vertigo, and facial twitching. Twelve cases of cholesterol granuloma of the petrous apex are illustrated; ten of these are analyzed in detail, especially with respect to CT findings. A sharply and smoothly marginated expansile lesion in the petrous apex, isodense with brain and nonenhancing on CT, is in all probability a cholesterol granuloma. Cholesterol granuloma and cholesteatoma of the petrous apex are different lesions and treated differently. Cholesterol granuloma can be treated simply and effectively by drainage and permanent fistulization. Preoperative recognition by CT is important for planning proper treatment.

High-resolution CT in the evaluation of glomus tumors of the temporal bone.

High-resolution computed tomography (HRCT) was performed in 33 cases of glomus tumors of the temporal bone and 10 cases of other tumors in and around the jugular foramen. HRCT helped to differentiate glomus tumors from vascular anomalies and from other benign or malignant lesions, and to determine the extent of deep involvement. It provided essential information for planning the surgical approach. When a lesion is large or appears atypical, complementary angiography is helpful. Otherwise, angiography may not be necessary.

Aberrant carotid artery: radiologic diagnosis with emphasis on high-resolution computed tomography.

The authors here enumerate the high resolution CT findings they believe distinguish this lesion from other retrotympanic pulsatile masses.

CT-compatible system for stereotactic biopsy and brachytherapy of infratentorial tumors.

Teletherapy of nonresectable radiosensitive brain tumors is the mainstay of adjunctive treatment. In the past two decades brachytherapy has begun to play an ever-increasing role, particularly on the European continent. Yet this attention has been addressed almost exclusively to lesions of the supratentorial space. This article describes modifications of the Riechert-Mundinger stereotactic system which were made by one of us (P.D.) to allow an unencumbered yet precisely computerized stereotactic approach to posterior fossa lesions for biopsy and interstitial radiation with iridium 192. A case report is described to illustrate the technical details involved in such an undertaking.

Computer-aided, CT-guided biopsy and brachytherapy of brain tumors.

The authors present the principles of computer-aided, CT-guided stereotaxis as it applies to the modified Riechert-Mundinger equipment. A preliminary report on 20 prospectively biopsied and interstitially radiated patients with cerebral mass lesions is discussed. 192Ir served as the interstitial isotope exclusively. To date the results are encouraging and complement the European experience. However, a great deal of improvement is possible, particularly in the sophistication of interstitial radiation of brain tumors; all well within presently available technology.

Gas-CT cisternography for detection of small acoustic nerve tumors.

Gas-CT cisternography is a simple and accurate procedure for detection of small acoustic nerve tumors. Review of one of the largest series in a single institution found that 98% of the studies clearly showed the presence or absence of tumors. The diagnostic pitfalls of the small number of studies in which significant errors were made, or could have been made, are discussed. It is concluded that certain situations appear to call for extra caution: (a) when the filling defect does not show a convex surface, (b) when the amount of cisternal gas is marginal, and (c) when the canal is small. In such situations careful attention to details and healthy skepticism may avert potential errors.

Intratemporal vascular tumors: evaluation with CT.

Eleven patients each with a benign intratemporal vascular tumor (hemangioma or vascular malformation) were assessed with computed tomography (CT). Clinical, surgical, and histologic correlations were also available. On CT scans, most of the 11 tumors were smaller than 10 mm. Four occurred in or around the internal acoustic canal, six at the geniculate ganglion, and one at the posterior genu. The involved bone margins were often unsharp, and "honeycomb" bone or intratumoral bone spicules were sometimes present. Intratemporal vascular tumors cause profound nerve deficits despite their small size and must be resected early to salvage nerve function.

Intratemporal vascular tumors: detection with CT and MR imaging.

The diagnostic contributions of computed tomography (CT) and magnetic resonance (MR) imaging were compared in 12 patients with benign intratemporal vascular tumors (hemangioma or vascular malformation). The tumors included six in the internal acoustic canal and six in the geniculate ganglion region. Clinical and histologic correlations were made. Two of the six patients with tumors in the internal acoustic canal underwent CT, and both required gas cisternography to show the tumor. Five patients in that group underwent MR imaging, and all five studies showed the tumor. All six patients with geniculate ganglion tumors underwent CT. Results in one study were questionable, and five showed the tumor. Five patients in this group underwent MR imaging, but the MR findings were positive in only two cases. MR imaging should therefore be performed before CT in the evaluation of facial nerve dysfunction, as it demonstrated all tumors in the internal acoustic canal and some in the geniculate ganglion region. If MR findings are negative, CT should then be performed to rule out a possible geniculate ganglion lesion.