Peritoneal inclusion cysts have not received the attention they merit in the imaging literature. We present a series of peritoneal inclusion cysts and describe their sonographic features. Our findings lead us to encourage more conservative therapies. All seven patients in our series had pelvic pain and had undergone surgery previously. An ovary surrounded by septations and fluid was the most common finding by transvaginal sonography. Doppler examination showed low resistive flow in the septations. Conservative therapy was used in five cases with excellent results. We found that a confident diagnosis of peritoneal inclusion cysts is possible with ultrasonography. This diagnosis should encourage the use of more conservative therapy.
Brain biopsies have an uncertain role in the diagnosis of patients with dementia or neurologic decline of unknown etiology. They are often performed only after an exhaustive panel of less invasive tests and procedures have failed to provide a definitive diagnosis. The objective of this study was to evaluate the sensitivity of brain biopsies in this patient group through the retrospective analysis of 53 brain biopsies performed for neurologic disease of unknown etiology at a single tertiary care institution between December 2001 and December 2011. Patients with known nonlymphomatous neoplasms thought to be associated with the neurologic symptoms or with immunodeficiency were excluded from the study. Furthermore, the clinical presentation, imaging and laboratory tests were compared between diagnostic groups to identify factors more likely to yield a diagnosis. Sixty percent of the biopsies were diagnostic (32 out of 53), with the most common histologic diagnosis of central nervous system lymphoma in 14 of 53 patients (26% of total) followed by infarct in four subjects (7.5%). A few patients were found to have rare and unsuspected diseases such as lymphomatosis cerebri, neurosarcoidosis and neuroaxonal leukodystrophy. Complications from biopsy were uncommon and included hemorrhage and infection with abscess formation at the biopsy site. These results suggest that brain biopsies may be useful in difficult cases in which less invasive measures have been unable to yield a definitive diagnosis.
ARTERIAL HYPERTENSION requiring i.v. vasodilator therapy occurred early after coronary artery bypass surgery in approximately two out of three patients in an earlier study from this institution.' Although nitroglycerin is often viewed predominantly as a venodilator, our clinical studies of i.v. nitroglycerin in patients with acute myocardial infarction clearly indicate that, at higher infusion rates, nitroglycerin is also a potent arterial dilator. Nitroglycerin reduced both left ventricular filling pressure and mean arterial pressure, while stroke volume remained constant or increased.2' s Lowering of peripheral vascular resistance was greatest in patients who had hemodynamic evidence of severe left ventricular failure.In the present study, we used a randomized crossover protocol to determine whether i.v. nitroglycerin could be as effective as sodium nitroprusside in reducing arterial pressure in patients who were acutely hypertensive after coronary bypass. Previous studies have shown that nitroglycerin and nitroprusside can have opposite effects on the severity of regional ischemia.' 6 In these studies, nitroglycerin improved regional ischemia by increasing intercoronary collateral flow, while nitroprusside appeared to worsen ischemia by decreasing coronary perfusion pressure without improving collateral flow. Thus, if i.v. nitroglycerin is equally effective for treating acute hyper-
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