A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.
Although diaphragmatic paralysis is a rare recognized complication of chest tube malposition, Chilaiditi's sign occurring as a result of this complication has never been reported in literature to the best of our knowledge. We describe one such case, which had an interesting clinical sequence of events and radiographic findings and suggest that the medial end of the chest tube should be positioned at least 2 cm from the mediastinum on the frontal chest radiograph to avoid these complications.
severe breast enlargement. She refused surgery. In March 1979 she attended the endocrine-infertility clinic.The breasts were huge, tense, nodular, warm to palpation, and tender. The patient had begun to log her breast size regularly for four months before this visit. She agreed to accept experimental treatment with danazol, continue self-measurement, and submit to repeated blood sampling.Serum oestradiol, luteinising hormone (LH), and prolactin concentrations were measured by double antibody radioimmunoassay. The intra-assay variation for oestradiol was 9 0%, for LH 4 9°', and for prolactin 7 9%. We report a case of spontaneous priapism successfully treated by embolisation of the internal pudendal artery using gel foam.
Case reportA 26-year-old unmarried man was admitted as an emergency on 24 August 1977, two days after the onset of priapism. He had had one episode of painful erection five days before, but this had subsided spontaneously after a few hours.No response was obtained with chlorpromazine 50 mg thrice daily, and the next day heparin and ancrod were started and a left corporosaphenous shunt performed under general anesthesia. No appreciable effect was noticed from these measures, and 24 hours later a right corporosaphenous shunt was carried out.No improvement was observed over the next three days. Amyl nitrate was tried with no effect, and attempted aspiration and irrigation of the corpora cavernosa under general anaesthesia failed. With the aspiration needle still in place corporocavernosography was performed. This showed free drainage by the right corporosaphenous shunt, the left one being occluded.The priapism persisted despite the effective venous drainage by the right corporosaphenous shunt. On the eighth day after admission percutaneous catheterisation of the right femoral artery was performed and a pelvic arteriogram obtained. The internal pudendal arteries were larger than normal with distinct staining of the base of the corpora cavernosa. Early venous filling was not seen in either corpus cavernosum. The right internal pudendal artery was embolised with a single shower of gelatin foam emboli.
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