Cisternal puncture, although less frequently used since the advent of computed tomography and magnetic resonance imaging, is an important tool in the neurodiagnostic armamentarium. An anatomic study of cisternal puncture was conducted on fresh cadavers by direct visualization and fluoroscopic guidance of cisternal puncture. Anatomic and radiographic analyses demonstrated a dramatic dynamic anatomy of the cisternal space during cisternal puncture and indicated that "tenting" of the dura mater over the needle occurs reliably during cisternal puncture. Lateral fluoroscopy may decrease the risk of cisternal puncture by allowing visualization of needle depth in the cisternal space.
Background: Bronchiolitis obliterans organizing pneumonia is a rare disease that mimics infectious pneumonia. Most patients respond well to corticosteroid therapy.Methods: We report a single case and findings from an English language literature search of MEDLINE using key words "bronchiolitis obliterans organizing pneumonia."Results and Conclusions: Bronchiolitis obliterans organizing pneumonia should be considered when a patient with pneumonia does not respond to antibiotics and has multiple patchy infiltrates and characteristic bronchoalveolar lavage patterns. A tissue sample is required for definitive diagnosis. Infection by a multiresistant organism can occur with multiple antibiotic therapy and concomitant use of corticosteroids, particularly when no initial infecting organism is identified. (J Am Board Fam Pract 1998;11:41-5.) Bronchiolitis obliterans organizing pneumonia is a rare clinical entity that family physicians should consider when a patient does not respond to usual treatment of infectious pneumonia. Clinical symp-
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