Search

Background Studies in the United States have shown a genetic predisposition to hypertension in individuals of African descent. However, studies on the associations between ethnic groups and hypertension in Latin America are lacking and the limited results have been inconsistent. The objective of this study is to determine whether Afro-Colombian ethnicity increases the risk of hypertension. Methods This study is a secondary data analysis of a cross sectional study from five provinces in Northern Colombia. Randomly selected individuals (N = 2613; age-range 18–74 years) enrolled in a health care insurance company underwent physical examinations and completed questionnaires regarding ethnicity, lifestyle, and other risk factors. Hypertension in these patients was determined. Unadjusted and adjusted logistic regression analysis were calculated to determine the association between ethnicity and hypertension. Results No association between Afro-Colombian ethnicity and hypertension was found (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.66–1.09). As expected, people with a body mass index (BMI) of 30 or higher were at a greater risk of having hypertension (OR, 3.12; 95% CI, 2.35–4.16) compared with those with a normal BMI. Conclusions Findings from this study suggest no independent association between Afro-Colombian ethnicity and hypertension. Further research should focus on genotyping or socioeconomic factors such as income level.

Introduction and objectives Up to 5% patients with acute chest pain present an acute coronary syndrome (ACS). This study aimed to compare peak exercise echocardiography (ExE) and multidetector computed tomography (MCT) in patients referred to a chest pain unit. Methods 203 patients with ≥1 cardiovascular risk factors, no ischemic ECG changes and negative biomarkers were randomized to ExE (n=103) or MCT (n=100). The endpoints were hard events (cardiovascular death and non-fatal myocardial infarction), combined events (hard events and revascularizations), and combined events plus readmissions during follow-up. Cost of either strategy was also investigated. Results Mean age was 64±11 years and 131 patients were male. Hypertension was seen in 71%, hypercholesterolemia in 74%, diabetes mellitus in 28%, and smoking in 21%. Most of the patients had a low TIMI risk score (68% TIMI I and 32% TIMI II). Mean follow-up was 4,7±2,7 years. Invasive angiography due to positive/nonconclusive results was performed in 34 of the patients, 103 submitted to SE and in 27 of the 100 submitted to MCT (33% vs. 27%, p=0.15). A final diagnosis of acute coronary syndrome was achieved in 53 patients (30 [88%] in the ExE group and 23 [85%] in the MCT group, p=0.12). There were no significant differences between groups in hard events (5 [5%] patients in the ExE group and 7 [7%] in the MCT group, p=0,42), combined events (35 patients [34%] in the ExE group and 29 [29%] in the MCT group), and combined events plus readmissions (43 [42%] patients in the ExE group and 41 [41%] in the MCT). The median stay in hospital was 7 (5–10) days in the ExE group and 8 (5–10,25) in the MCT group (p=NS). For patients with negative results by either technique the mean stay was less than 8 hours. There were no differences in the global cost, although it was lower for patients with negative ExE (557 € vs. 706 €, p Conclusions Both MCT and ExE are equally effective for the stratification of patients with low to moderate probability of ACS admitted to a chest pain unit. The cost was similar with both strategies, although significant lower in ExE when negative studies were compared.

Introdução: O sarampo é uma doença viral transmitida por via aérea através de gotículas dispersas no ambiente por indivíduos infectados, motivo pelo qual tem maior incidência na fase infanto-juvenil. A sua imunização iniciou-se no Brasil em 1960 e em 1973 a vacina entrou no Programa Nacional de Vacinação. Os casos de sarampo irradiaram para diversas regiões do Brasil desde 2018/2019 e 2020 incluindo para o município de Valença (RJ). Objetivo: O presente estudo teve como objetivo geral avaliar se a cobertura vacinal afeta diretamente os números de notificação por sarampo. Materiais e métodos: Trata-se de um estudo retrospectivo, descritivo, com análise quantitativa, onde a coleta foi realizada por meio de dados secundários, obtidos via sistemas de base de dados nacionais e boletins epidemiológicos de março de 2019 até março de 2020. O presente estudo foi submetido ao Comitê de Ética e Pesquisa do Curso de Medicina do Centro Universitário de Valença, sendo aprovado pelo Parecer de número 3.976.368 Resultados: De janeiro a março do ano de 2020, em Valença (RJ), foram confirmados 25 casos e nenhum óbito. Uma quantidade significativa dos casos concentra-se na faixa etária de 18 a 28 anos e nas regiões centrais do município de Valença (RJ). A taxa de vacinação foi consideravelmente alta comparada a alguns anos anteriores ao retorno dos surtos no país em 2018. Conclusão: Conclui-se que houve um “surto” controlado pela assistência à saúde e uma boa cobertura vacinal no município. É importante manter, especialmente, a vacinação, que é distribuída gratuitamente pelo SUS.

We report on a case of an congenital orbital tumor of impressive size, occurring in a newborn. The patient underwent orbital exenteration with a histopathologic diagnosis of cystic teratoma. The clinicopathological aspects of such a rare disease are commented.

Resumen La miositis osificante es una entidad clinica poco frecuente caracterizada por la neoformacion de tejido oseo a nivel intramuscular, pudiendose presentar localizadamente, o con menor frecuencia, de modo generalizado. Dentro de su reducida incidencia, en la forma circunscrita se pude constatar un antecedente traumatico aislado o repetitivo, que da lugar a la aparicion de la lesion. Se manifiesta clinicamente por la aparicion de dolor de caracteristicas inflamatorias y limitacion funcional. Su tratamiento engloba medidas fisicas y farmacologicas diversas, que de ser insuficientes, hacen necesaria la intervencion quirurgica para la resolucion del proceso. Presentamos un caso clinico de miositis osificante localizada en extremidad superior producida por la aplicacion de una tecnica de hemostasia quirurgica mediante manguito de presion en una paciente diagnosticada de artritis reumatoide seropositiva, especialmente interesante por su infrecuente etiologia y localizacion. Describimos el tratamiento rehabilitador pautado y su evolucion posterior. Revisamos los principales aspectos sobre el tema expuesto en la literatura.

Budd-Chiari syndrome is a rare disease characterized by hepatic outflow obstruction due to different causes. Hepatic nodules in patients with Budd-Chiari syndrome are rare and can be due to hepatocellular carcinoma and benign regenerative nodules. Imaging descriptions of regenerative nodules in cirrhotic livers are numerous, but the imaging findings of benign regenerative nodules associated with Budd-Chiari syndrome have only recently been reported. We present the computed tomographic and magnetic resonance features of benign regenerative hepatic nodules with copper accumulation in a patient with chronic Budd-Chiari syndrome.

Colonic amyloidosis is frequent, although rarely radiographically evident. The radiological findings are varied and unspecific. We report a case of perforated giant colonic diverticulum (GCD) diagnosed by helical CT in which amyloid deposition was pathologically demonstrated. The patient was a renal transplant recipient who previously had undergone hemodialysis for 10 years. A possible role of amyloidosis in the pathogenesis of this case is discussed. Giant colonic diverticulum must be included in the spectrum of gastrointestinal manifestations of amyloidosis.

The aim of this study is to present the computed tomography (CT) and magnetic resonance (MR) findings in three cases of fibrosing mediastinitis, probably secondary to tuberculosis. Two patients had diffuse involvement of the mediastinum and one patient presented with a posterior mediastinal mass. On CT, the patients with diffuse involvement showed infiltrating soft-tissue masses with multiple foci of dense calcifications. One of these lesions enhanced mildly with contrast and one did not enhance. On MR examination, diffuse masses were of heterogeneous, intermediate and low signal on T1-weighted images (n = 2) and were of homogeneous low signal (n = 1) or heterogeneous (n = 1) signal intensity on T2-weighted images. After administration of Gd-DTPA, these mediastinal masses showed heterogeneous enhancement. The posterior mediastinal mass showed homogeneous pronounced enhancement on CT and was homogeneous with intermediate T1 signal intensity and hypointense T2 signal intensity. The CT findings of an infiltrative or well-defined mediastinal mass with scattered calcifications should suggest the diagnosis of fibrosing mediastinitis in the appropriate clinical setting. Although the appearance of calcification on MR are not specific, this technique provides further information than CT especially in those cases in which the lesions appear noncalcified, because MR imaging revealed areas of low signal intensity characteristic of fibrous tissue.

Purpose: to assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology Material and Methods: We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n=2) or diffuse (n=23) omental pathology. These results were compared to the final diagnoses as determined by laparotomy (n=15), laparoscopic biopsy (n=3), endoscopic biopsy (n=1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n=6). the final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement. the CT-guided biopsies were performed with 1.0–1.8-mm Surecut core-needles Results: in 16 patients, the final diagnosis was metastatic adenocarcinoma - with the primary tumor sites in the ovary (n=3), stomach (n=1), appendix (n=2), and unknown (n=10). in the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1. Sufficient histological (n=16) or cytological (n=8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case. in differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92%. It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders. There were no biopsy-related complications Conclusion: CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology

Resumen El sindrome de Larsen es una osteocondrodisplasia poco frecuente caracterizada por la existencia de anomalias craneo-faciales junto con multiples luxaciones articulares congenitas bilaterales, especialmente a nivel de las caderas y las rodillas, dentro del contexto de una condicion de hiperlaxitud generalizada. El cuadro incluye, de igual forma, anormalidades de la segmentacion vertebral, huesos supernumerarios, lesiones cardiovasculares y modificaciones del desarrollo del cartilago. Las alteraciones osteoesqueleticas que presentan los pacientes que padecen este sindrome dan lugar a distintos deficits que pueden requerir la valoracion y tratamiento del facultativo especialista en Rehabilitacion y Medicina Fisica. Revisamos un caso de sindrome de Larsen con una muy rara asociacion a un deficit de factores de la coagulacion, que con el antecedente de luxacion congenita bilateral de rodillas, presento un gran hematoma de partes blandas, impotencia funcional y limitacion del balance articular tras un traumatismo en una de ellas. Descartadas lesiones oseas, se pauto tratamiento conservador rehabilitador mediante ultrasonoterapia, fisioterapia y crioterapia. Exponemos la evolucion clinica del caso y hacemos una revision de los principales aspectos expuestos al respecto en la literatura.

The purpose of this study was to evaluate the contrast-enhanced CT characteristics of pathologic thoraco-abdominal lymph nodes in 38 patients infected with Mycobacterium tuberculosis (30 without AIDS and eight with AIDS). Unenhanced scans of chest, abdomen and pelvis were also done in all cases. The CT attenuation values and the enhancement characteristics of the largest node or group of lymph nodes were evaluated in a dynamic sequence over a period of 10 min. On unenhanced CT the nodes were of low attenuation (less than 30 HU) in 18 cases and of soft tissue attenuation (greater than 35 HU) in 20 cases. Four post-contrast patterns of enhancement were found: (i) peripheral rim enhancement (n = 22); (ii) inhomogeneous enhancement (n = 8); (iii) homogeneous enhancement (n = 6); and (iv) homogeneous nonenhancing nodes (n = 2). Increase of attenuation and obliteration of perinodal fat was found in 13 cases, most of them with the peripheral rim enhancement pattern. Seven cases had a combination of enhancing patterns in the same nodal group. The central enhancement was usually moderate (mean, 30 HU) but was marked (greater than 60 HU) in three patients with the homogeneous enhancement pattern. Neither the nodal attenuation values nor the patterns of enhancement are characteristic of tuberculosis, however adenopathy showing peripheral rim-enhancement with relative low attenuation centres can suggest a diagnosis of tuberculosis in the appropriate clinical setting.

Six patients with solitary pyogenic splenic abscesses treated by CT-guided percutaneous drainage (by catheter or needle), are presented. There were 3 unilocular, purely intrasplenic abscesses and 3 complex lesions with loculations and perisplenic involvement. Percutaneous drainage and intravenous antibiotics were curative in 4 patients. In the other 2, who had multiloculated abscesses, despite initially successful drainage, splenectomy was performed because of intractable left upper quadrant pain in one case and persistent fever and drainage of pus after 30 days in the other. These patients also developed large, sterile left pleural effusions.

Apresentamos um caso de tumor orbitário congênito de grande tamanho, ocorrendo em criança recém-nascida. A paciente foi submetida a exenteração da órbita e o diagnóstico anatomopatológico foi de teratoma cístico. Os aspectos clínico-patológicos desta rara doença são comentados. We report on a case of an congenital orbital tumor of impressive size, occurring in a newborn. The patient underwent orbital exenteration with a histopathologic diagnosis of cystic teratoma. The clinicopathological aspects of such a rare disease are commented.

Apresentamos um caso de tumor orbitário congênito de grande tamanho, ocorrendo em criança recém-nascida. A paciente foi submetida a exenteração da órbita e o diagnóstico anatomopatológico foi de teratoma cístico. Os aspectos clínico-patológicos desta rara doença são comentados.

Die Verfasser berichten uber Ultraschall- und CT-Befunde an 7 Patienten mit periportaler und pankreatischer tuberkuloser Adenitis. Bei Ultraschall-Scans zeigten sich echoarme Adenopathien bei 6 Patienten. Der 7. Patient wies eine echoarme, unscharf definierte Masse auf. CT-Untersuchungen zeigten vergroserte Lymphknoten geringer Dichte (25-35 HU) mit unmittelbar nach Kontrastmittelgabe auftretender peripherer Randverstarkung bei 3 Patienten. - Eine infiltrierende inhomogene Masse fand sich bei einem Patienten, lobulare Tumormassen von Weichteildichte bei nach Kontrastmittelgabe verzogerten Scans bei 2 Patienten. Die Ultraschallbefunde liefern keine Unterscheidungsmerkmale bei Tuberkulose und anderen Ursachen von Adenitis. Die CT-Darstellung schwankt in ihrer Aussage; lediglich die dichtearmen Knoten mit peripherer Verstarkung bei Scans nach Kontrastmittelgabe deuten auf Tb. We present ultrasound (US) and computed tomography (CT) findings in 7 patients with periportal and peripancreatic tuberculous adenitis. In US scans, hypoechoic adenopathies were found in 6 patients while in the other one a hypoechoic, poorly marginated mass was seen. CT studies showed hypodense (25-35 HU) enlarged lymph nodes with immediate postcontrast peripheral rim enhancement in 3 patients. An infiltrating inhomogeneous mass was present in other patient and soft tissue density lobulated masses were found in delayed postcontrast scans of 2 patients. The US findings are of no help in distinguishing tuberculosis from other causes of adenitis. The CT appearance has been variable and only the hypodense nodes with peripheral enhancement in postcontrast scans are suggestive of this entity.

We report on a case of an congenital orbital tumor of impressive size, occurring in a newborn. The patient underwent orbital exenteration with a histopathologic diagnosis of cystic teratoma. The clinicopathological aspects of such a rare disease are commented.

La lipoproteinosis alveolar es una enfermedad muy infrecuente. Una revision realizada en el Index Medico Espanol de 1971 a junio de 1994 solo muestra 9 casos. El deposito intraalveolar de este material lipoproteinico produce hipoxemia severa y favorece la infeccion por germenes oportunistas. El tratamiento con lavado bronquial masivo (LBM) remueve este material intraalveolar y asi mejora el intercambio de gases y disminuye el riesgo de infecciones. Aportamos un caso de lipoproteinosis alveolar primaria tratado con LBM, que previo a este tratamiento y despues de iniciar tratamiento esteroide desarrollo una infeccion por Aspergillus fumigatus . En este paciente esta terapeutica se realizo sin complicaciones y con ella se obtuvo gran mejoria clinica y gasometria. La historia natural de esta enfermedad es poco conocida. Se han observado remisiones espontaneas y debido a que el LBM no esta exento de riesgos sigue existiendo controversia sobre la indicacion de este tratamiento. Nosotros pensamos que cuando hay hipoxemia importante debe realizarse precozmente porque tiene pocos riesgos, mejora el intercambio de gases y probablemente disminuye el riesgo de infecciones oportunistas.

Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still on medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses.

An unusual case of fibrolamellar hepatocellular carcinoma (FLHCC) presenting as multiple intrahepatic lesions of cystic appearence on the computed tomography (CT) study is decribed.

Amyloidosis is a uncommon disease which affect respiratory system with well defined patterns. We describe a case of multiple nodular pulmonary amyloidosis in a 81 year old man mimicking other entities: metastatic disease, tuberculosis and other granulomatose diseases. In our patient amyloide substance was type AA, being type AL the most frequent one in nodular pulmonary amyloidosis.

The coincidence of an urachal adenocarcinoma with another similar tumour in other location makes necessary to separate a true primary from a metastatic adenocarcinoma. We report the case of a 66-years-old-man with an urachal mucinous adenocarcinoma and two colonic adenocarcinoma excised in the same surgical act, showing both macro and microscopic studies together with immunohistochemical techniques, that were useful to differentiate the origin of both neoplasms. Among them, the antibody to keratin 7, a cytoplasmic epithelial protein, was positive in the urachal and negative in the colonic tumour.

The purpose of this study was to describe the computed tomography (CT) findings in pancreatic tuberculosis (PT).We retrospectively reviewed the CT features in six patients with PT, three of whom had AIDS.Pancreatic lesion masses were found in four patients, small (1 cm) low-attenuation pancreatic nodules in one, and diffuse enlargement of the pancreas in one. The pancreatic lesion masses were found in all the non-AIDS patients and in one patient with AIDS and were located in the head of the pancreas in two cases and involved the body, neck, and head of the gland in the other two. The masses showed low attenuation in two cases, soft-tissue attenuation in one, and appeared as an infiltrating inhomogeneous lesion with retropancreatic spread, encasing the celiac trunk and superior mesenteric artery in one. Low-attenuation peripancreatic and/or periportal adenopathies with peripheral rim enhancement were found in three cases, and slight bile duct dilatation was evident in four. Four patients had disseminated tuberculosis, whereas pancreatic and peripancreatic tuberculosis were the sole manifestation of tuberculosis in the other two.The present data suggest that PT usually appears as a nonspecific focal lesion mass in HIV-seronegative patients, whereas there is a variable spectrum of CT findings including focal lesion mass, multiple small low-attenuation pancreatic nodules, or diffuse enlargement of the gland in AIDS patients. Low-attenuation peripancreatic and periportal adenopathies with peripheral rim enhancement and other data of disseminated tuberculosis are ancillary findings that should support a diagnosis of PT.

Medullary thyroid carcinoma (MTC) is a rare malignancy which spreads frequently to cervical lymph nodes. We report the CT findings of MTC metastatic cervical adenopathies in two patients with previously resected MTC. The CT scans showed calcifications (one patient) and massive homogeneous postcontrast nodal enhancement. Medullary thyroid carcinoma should be included in the differential diagnosis of entities showing calcifications and intense homogeneous adenopathic enhancement on CT studies.

Alveolar lipoproteinosis is a rare disease, a review of the Spanish Medical Index for 1971 to June 1994 showing only 9 reported cases. The intra-alveolar deposit of lipoprotein-type matter produces severe hypoxemia and favors infection by opportunistic germs. Treatment with massive bronchial lavage (MBL) removes the matter from the alveolar space, improves gas exchange and decreases the risk of infection. We report a case of primary alveolar lipoproteinosis treated with MBL in which the patient developed infections by Aspergillus fumigatus before lavage and after starting steroid treatment. The procedure was performed without complications, with significant clinical and gasometric improvement. The natural evolution of this disease is poorly understood. Spontaneous remissions have been observed, and as MBL is not a risk-free procedures, its use in treatment is controversial. We believe that when severe hypoxemia is present, MBL should be used early, when the risk is slight; MBL improves gas exchange and probably reduces the risk of opportunistic infection.

Since the introduction of effective antituberculous chemotherapy, upper respiratory tract tuberculosis is infrequent; nasal involvement is a very rare form of this disease. In this localization, tuberculosis is usually unilateral and typically discloses a definite granular mass or an ulcer. We report a case manifested by an intranasal mass on computerized tomography scans that evolved as chronic rhinitis.

We describe a 41-year-old patient with adult-onset dermatomyositis who developed persistent pneumomediastinum and severe subcutaneous emphysema due to end-stage interstitial lung disease. The diagnosis of dermatomyositis was based on proximal muscle weakness, electromyographic findings of inflammatory myopathy, and positive findings on muscle biopsy. Low levels of creatine kinase elevation were found at the time of diagnosis (a form of dermatomyositis which has been associated with a poor prognosis). The patient had no signs of cutaneous vasculitis. Despite treatment with prednisone and azathioprine, she died of intercurrent gram-negative sepsis 15 months after the diagnosis of dermatomyositis.

Alagille syndrome, or arteriohepatic dysplasia, is a disorder characterized by paucity of intrahepatic bile ducts, peculiar facies and skeletal anomalies. We report a typical case of this syndrome in an 18-year-old girl, in whom abdominal CT showed bilateral renal cysts and aortic wall calcification, findings unreported in the radiological literature.

In an era of rigid budget controls and limited resources, the efficiency of coating operations is of great concern. With expenditure reduction in mind, an investigation was initiated into the costly materials and procedures necessary in the production of X-ray optics. The expense of certain specialty substrates required us to evaluate the feasibility of a substrate recycling program. Substrate reuse could reduce initial cost and save acquisition time. Past research in this area centered mainly on stripping or resurfacing optics. Although this has been proven to be successful, it is time consuming and unsatisfactory for figured optics. One solution to this problem is to simply overcoat the optic with a new multilayer coating. If it could be demonstrated that there were no adverse effects to the performance of the optic, then the efficiency gains to both time and budget would be evident. Also worth of investigation, would be to explore the minimum thicknesses that are needed for proper masking of past multilayer coatings. In this paper we seek to examine these points and to determine which parameters of the x-ray overcoatings could adversely effect the performance. By exchanging coating elements, their thickness, and their composition we will demonstrate that there is not degradation of reflectivity. Included will be research substantiated by scanning electro microscope, and Mg-K(alpha) X-ray diffraction.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Metastatic vesical tumours caused by blood- or lymph-borne neoplasias from any part of the body are extremely uncommon (less than 1% of vesical tumours), and even within this group lung tumours are the origin in a very small number of cases. Diagnosis usually happens in advanced stages due to the limited symptomatology exhibited. This paper refers two cases of vesical metastatic neoplasias from lung tumours, one an oat-cell anaplastic carcinoma and one epidermoid. Also, in the first one there was the peculiarity of haematuria being the early manifestation which lead to the diagnosis of lung neoplasia.

A pancreatic oncocytoma in a 77 year old man is described. A CT scan showed liver metastases three years earlier. The patient died from complications after surgery for a perforated duodenal ulcer, and at autopsy a primary tumor in the tail of the pancreas and several liver metastases were found. The morphologic and biologic features of this unusual tumor are discussed.

We report on an HIV positive patient with bilateral primary renal non-Hodgkin lymphoma that remitted with chemotherapy. The clinical and radiological features, which are initially not distinct from those of other tumors in the same site, and the therapeutic possibilities are discussed.

Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still on medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses.

Our goal for FY 91 was to develop the capability to deposit multilayer thin film coatings of prescribed period gradient onto planar and figured substrates. To accomplish this goal we have extended our use of deposition flux masking to create laterally graded multilayer coatings. In addition, we have constructed a planetary substrate rotation fixture for deposition of axisymmetric graded thickness multilayer structures on planar and figured optics. Materials combinations for the layered synthetic microstructures (LSM's) we have fabricated by these techniques include: tungsten/carbon, molybdenum/silicon, molybdenum disilicide/silicon and chromium carbide/carbon. Soft X-ray diffraction characterization of the LSM's has verified that we have deposited controlled thickness graded period structures.

Hemorrhage is a very rare complication of renal cyst in childhood. We report a six year-old-male with spontaneous macroscopic hematuria in which ultrasound and CT studies demonstrated a solid renal mass. Pathological examination of the resected lesion revealed a hemorrhagic cyst.

Bilateral suprarenal haemorrhage (BSH) has not been often described as a cause of chronic suprarenal insufficiency. The diagnosis before death is difficult and it was rare until the CAT scan became a routine diagnostic tool. Of 25 cases reported since 1981, 23 were diagnosed by CAT scan. We report a case of a patient that developed bilateral suprarenal haemorrhage (BSH) during heparin therapy for pulmonary embolism. The early clinical picture resembled a septic shock, and the diagnosis of Addison disease was made later. We reviewed the medical literature and we emphasized the clinical problems in which we should suspect the diagnosis of BSH, where early therapy with steroids may be critical to save the patient's life.

We have deposited, via magnetron sputter deposition, multilayer structures comprised of alternating layers of low atomic number materials such as (1) carbon and boron carbide, (2) silicon and boron carbide, (3) silicon and carbon, and (4) aluminum and boron carbide. Layer periods for these materials combinations range from 63.5 to 75 angstrom. These low atomic number multilayers exhibit significant first-order Bragg diffraction of Cu k-alpha radiation. Calculations of the reflectivity performance for multilayers of this composition have been made using a computer code based on the modified Darwin-Prinz theory. Experimental measurements and code predictions are in close agreement. Multilayers of this type may find application in devices requiring ultralow dispersion focusing x-ray optics, such as long focal length focussed beam lines, x-ray microscopes, and x-ray telescopes. Diagnostics for plasma characterization in fusion experiments that are free from L-edge absorption, high transmittance/high resolution beam splitting x-ray optics, and output couplers soft x-ray laser cavities are other possible applications for low-Z1/ low-Z2 multilayers.© (1992) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

In Western countries, haemoperitoneum following rupture of hepatocellular carcinoma (HCC) is unusual. Three patients are presented in whom massive intraperitoneal haemorrhage secondary to spontaneous rupture of HCC was diagnosed by computed tomography (CT). CT demonstrated a peripheral hepatic tumour and free intraperitoneal fluid with areas of high-attenuation, representing acute blood-clot, close to the tumour in every case. In our opinion, CT is a valuable imaging modality in the diagnosis of ruptured HCC.