Eighty-eight kidneys obtained at necropsy from normotensive subjects aged over 50 years were examined histologically and by post-mortem pyelography and angiography. Moderate or severe scarring was present in 50%. Its distribution and the absence of calyceal deformity make pyelonephritic scarrig unlikely. Its extent was related to the severity of change in the renal vessels, but not to age. On pyelograms, scarring was difficult to distinguish from fetal lobation. Kidneys with the most severe histological changes in the vessels tended to show the most marked angiographic distortion, though in general the two techniques examine different parts of the renal vascular bed. Total renal area and "cortical" area, measured from the angiograms, were not significantly correlated with age, thouth both tended to be smaller in older subjects. These dimensions, particularly cortical area, were significantly correlated with vascular changes, being smallest when vessels were most markedly affected. Results suggest that the loss of renal tissue which occurs in the elderly, particularly selective loss of cortex, is more closely related to events in the renal vasculature than to age itself.
This investigation demonstrates that in terms of static occlusion combined orthodontic-orthognathic surgery is effective in correcting severe malocclusion.
A 21-year-old man presented to the accident and emergency department at St Peter's Hospital, London, in September 2008. Following consumption of alcohol, the patient had been assaulted and had experienced facial trauma. Later, the patient had a witnessed generalised tonic-clonic seizure and the next day noted weakness of the right leg. A CT scan of the brain revealed a solitary lesion in the left presylvian region close to the vertex, involving the leg area of the primary motor cortex. A subsequent MRI scan showed the lesion to be a cavernous haemangioma. The patient had no history of epilepsy. This raised the question as to whether the assault caused the lesion to haemorrhage, resulting in the seizure and spastic monoparesis, or did the formerly asymptomatic cavernoma bleed spontaneously with the assault being coincidental?
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