Extensive lower limb paresis developed in three patients with terminal cancer following internal iliac (hypogastric) artery embolization. This procedure was carried out for control of hemorrhage in two of the patients and for reduction of the bulk of metastatic tumor in another. The embolic materials used resulted in extensive obliteration of small and large vessels of the posterior and anterior divisions of the internal iliac artery. The paresis is attributed to the resulting ischemia of the sciatic and femoral nerves; previous radiotherapy may also have been a contributing factor. To reduce the incidence of paralysis, identification of the bleeding vessels and selective embolization are recommended. If this cannot be achieved, and the catheter lies in the main stem, it is recommended that the emboli should not be smaller than Gelfoam pledgets (1 X 1 X 10 mm) to preserve the peripheral circulation and lessen the risk of complication.
Summary
In 10 cases of myasthenia gravis correlative studies were made by means of autoimmune serological tests, electromyography, thymic X‐ray examination (pneumomediastinography) and assessment of thymic morphology in relation to the effects of thymectomy (nine cases) and thymic irradiation (one case).
The 10 patients were placed in three groups, namely (a) three young females with a non‐involuted thymus showing “thymitis” and negative results to serological tests who derived benefit from thymectomy, (b) four older females with thymic atrophy and positive results to serological tests who for the most part gained no benefit from thymectomy, and (c) three males with thymomas and positive results to serological tests who obtained benefit from thymectomy in two instances.
The presence of the characteristic autoantibody—the myoid antibody which reacted with thymic myoid cells and skeletal muscle—was helpful in diagnosis but did not appear to be related to neuromuscular block, neither was it of value in predicting the response to thymectomy. Electromyography with the decamethonium test showed, with one exception, the characteristic myasthenic responses irrespective of the patient's age, the presence or absence of myoid antibody, or the nature of the microscopic lesion in the thymus. The radiographic outline of the thymus as determined by pneumomediastinography correlated well with the size and shape of the resected thymus. The typical histological appearance in the thymus of abundant cortex and prominent medullary germinal centres and lymphocytosis was termed “thymitis” ; it was characteristic of the thymus of patients in group (a) and the residual thymus of patients with thymoma in group (c).
Our clinical observations could be correlated with experimental studies, indicating that myasthenia gravis is associated with a destructive “autoimmune thymitis”. It is suggested that “thymitis” is associated with the release from the medulla of an uncharacterized humoral agent which causes neuro‐muscular block.
SUMMARY
Percutaneous transfemoral catheterization with selective carotid and vertebral angiography was employed in the investigation of 100 consecutive patients with subarachnoid haemorrhage. The method, which is described in detail, has many advantages and is considered the technique of choice in patients under 60 years of age. The carotid and vertebral systems are studied at the one examination with minimal discomfort to the patient. Haematomata in the neck are avoided and cross‐compression tests are performed with ease. In addition, renal arteriography, often significant because of the frequency of hypertension, may be performed at the same time. Of the 63 patients who were less than 50 years of age, it was possible to selectively catheterize both carotid arteries and obtain satisfactory vertebral angiograms in all but five cases. Over 50 years, because of arterial degeneration, the frequency with which it was necessary to supplement the method with other techniques increased.
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