Spontaneous dissecting aneurysm of the vertebral artery is an infrequent cause of vertebro basilar ischemic strokes. Previously reported cases concern essentially occlusion of the basilar artery. Only 14 cases of spontaneous dissecting aneurysm concern the extracranial vertebral artery among these eight were angiographically documented. In this study based upon 15 patients (20 dissecting aneurysms), the authors discuss etiological factors, such as hypertension or fibromuscular dysplasia: on clinical findings they insist upon the diagnostic value of preliminary symptoms, cervical pain or posterior headaches; the most frequent angiographic appearance was a long and irregular stenosis of one or two segments of the vertebral artery. The prognosis of these aneurysms most often appears favourable in this group.
The results of bronchoalveolar lavage in three patients with a presumptive diagnosis of methotrexate induced lung disease are presented. Lavage fluid was characterised by the presence of large numbers of lymphocytes, which in two patients were predominantly lymphocytes of the T8 phenotype. These findings further support the hypothesis that immune mediated mechanisms may play a part in the pathogenesis of this disorder in some patients, and indicate that bronchoalveolar lavage may be helpful in the evaluation of patients suspected of having methotrexate induced lung disease.Pulmonary damage associated with methotrexate administration is a common clinical problem in patients receiving this drug. The clinical manifestations of this disorder have been described in detail.' Nevertheless, the diagnosis remains difficult to establish since no pathognomonic features have been described, and even invasive techniques such as open lung biopsy cannot firmly establish the diagnosis.We report here three cases of methotrexate lung in which bronchoalveolar lavage was performed. Our findings support the hypothesis that cell mediated immune responses may be important in the pathogenesis of the disease and suggest that, in the appropriate clinical setting, bronchoalveolar lavage may be useful in evaluation of patients suspected of having developed this disorder.
MethodsBronchoalveolar lavage was performed by a technique based on the method of Reynolds and Newball.2 Following fibreoptic bronchoscopy four 50ml aliquots of 0 9% sodium chloride were instilled into the right middle lobe bronchus. Fluid was recovered by gentle suction after each aliquot, filtered through gauze, and placed on ice. Total cell counts were determined with a haemocytometer, and a differential cell
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