1073 cationic radionuclides might be applicable in this context. The mechanism of localisation of radiogallium in malignant tumours, as yet unknown,4 may involve some abnormal propertv shared by dystrophic muscle. This work was supported by a grant from the Edmonton of the Imperial Order Daughters of the Empire.
Departments of Pædiatrics, Radiology, Medicine and Surgery, University of Alberta, and Dr W. W. Cross Cancer Institute, Edmonton, Alberta, Canada
Chapter
P. BOWEN B. C. LENTLE F. I. JACKSON
J. S. PERCY W. M. RIGAL
decubitus at an angle of 60 degrees for a minute. Computerised coronal planes showed satisfactory filling of the basal cisterns and subarachnoid spaces of the subfrontal region. Leakage of contrast medium could be clearly seen at the level of the fracture (see figure). The patient was operated on 3 days later; the fracture was obturated by aponeurotic tissue and temporal muscle. A follow-up examination 2 months later showed that the rhinorrhoea had disappeared. We believe that computerised metrizamide cisternography is valuable in locating the site ofc.s.F. fistula. A similar diagnostic technique has lately been proposed by Drayer et al.11 Departments of Neuroradiology, Neurology, and Neurosurgery
C. MANELFE B. GUIRAUD M. TREMOULET
C.H.U. Purpan, 31 052
DIAGNOSIS OF C.S.F. RHINORRHŒA BY COMPUTERISED CISTERNOGRAPHY USING METRIZAMIDE
SIR,-Cerebrospinal-fluid (c.s.F.) rhinorrhoea can be a difficult problem for the clinician and radiologist. It can lead to severe infections such as recurrent bacterial meningitis, and the diagnosis is not always confirmed by radiology (hypocycloidal tomography, cisternography) and isotope scans. Metrizamide is a water-soluble triiodinated, non-ionic conmedium, used in myelography and ventriculography.5 Animal studies have proved that it is well tolerated when applied to cisternography,6 and some workers have proposed its use in computerised tomography in the investigation of c.s.F. circulation’ and tumours of the base of the skull and posterior fossa. 8-10 We report a case of c.s.F. rhinorrhoea in which computerised metrizamide cisternography pointed to the exact site of fluid escape. Left-sided rhinorrhoea had started 9 years after a frontal injury in a 59-year-old male. Tomography suggested a leftsided frontoethmoidal fracture. After injection of 5 ml metrizamide (at a concentration of 190 mg iodine/ml) by lumbar puncture the patient was positioned head downward in ventral trast
Toulouse, France
ULTRASOUND FOR GENETIC COUNSELLING IN POLYCYSTIC KIDNEY DISEASE
SiR,—We have been counselling the parents of a male infant who had bilateral polycystic kidney disease type m’ at necropsy. His appearance was that of the Potter syndrome, including low-set ears, epicanthal folds, short neck, wide-spaced nipples, short phalanges of the hands, bilateral dislocated hips, and bilateral club feet. He had severe respiratory distress and died six hours after birth. Chromosome analysis revealed a normal male karyotype. The family history was negative for miscarriages, stillbirths, congenital anomalies, or kidney disorders. It was suggested that the mother (age sixteen) and the father (age nineteen) should have their kidneys evaluated. We hesitated to suggest intravenous pyelography, an invasive technique, so we recommended nephrosonography, as suggested for the evaluation of clinically normal relatives of infants with renal agenesis.2 Nephrosonograms of one kidney from each 11. Drayer,
B. P.,
Wilkins,
R.
H., Boehnke, M., Horton, J. A. Rosenbaum,
A E
1
Am. J Roentgenol. 1977, 129, 149. Potter, E L., Craig, J. M. Pathology of the Chicago, 1975
Fetus and the
Infant, p. 452.
2 Zonana,
J, Rimoin, D. L, Hollister, D W., Lachman, R. S., Sarti, D A., Kaback, M M Pediat Res 1976, 10, 420.
Hayes, R. L. J. nucl. Med. 1977, 18, 640. 5. Acta radiol 1973, suppl. no. 335 6. Grepe, A., Widen, L. ibid. p. 102. 7. Greitz, T., Hindmarsh, T. ibid. 1974, 15, 497. 8 Grepe, A., Greitz, T., Noren, G. ibid. suppl. no. 346, p. 91. 9. Drayer, B P., Rosenbaum, A E. Lancet, 1976, 736. 10. Roberson, G. H., Taveras, J. M., Tadmor, R., Kleefield, J., Ellis, put assist Tomogr. 1977, 1, 241. 4.
G. J. Com-
Sonograms of kidneys
Computerised tomography cisternogram with metrizamide. Coronal plane showing the leakage of the contrast medium at level offrontoethmoidal fracture arrow’.
of parents of infant with
polycystic kidney
disease.
tppcr klelncB
mother’s normj) let’t kidnev. l,oB er- t.1thcr’,
po)BcBsttc nght
Departments of Pædiatrics, Radiology, Medicine and Surgery, University of Alberta, and Dr W. W. Cross Cancer Institute, Edmonton, Alberta, Canada
Chapter
P. BOWEN B. C. LENTLE F. I. JACKSON
J. S. PERCY W. M. RIGAL
decubitus at an angle of 60 degrees for a minute. Computerised coronal planes showed satisfactory filling of the basal cisterns and subarachnoid spaces of the subfrontal region. Leakage of contrast medium could be clearly seen at the level of the fracture (see figure). The patient was operated on 3 days later; the fracture was obturated by aponeurotic tissue and temporal muscle. A follow-up examination 2 months later showed that the rhinorrhoea had disappeared. We believe that computerised metrizamide cisternography is valuable in locating the site ofc.s.F. fistula. A similar diagnostic technique has lately been proposed by Drayer et al.11 Departments of Neuroradiology, Neurology, and Neurosurgery
C. MANELFE B. GUIRAUD M. TREMOULET
C.H.U. Purpan, 31 052
DIAGNOSIS OF C.S.F. RHINORRHŒA BY COMPUTERISED CISTERNOGRAPHY USING METRIZAMIDE
SIR,-Cerebrospinal-fluid (c.s.F.) rhinorrhoea can be a difficult problem for the clinician and radiologist. It can lead to severe infections such as recurrent bacterial meningitis, and the diagnosis is not always confirmed by radiology (hypocycloidal tomography, cisternography) and isotope scans. Metrizamide is a water-soluble triiodinated, non-ionic conmedium, used in myelography and ventriculography.5 Animal studies have proved that it is well tolerated when applied to cisternography,6 and some workers have proposed its use in computerised tomography in the investigation of c.s.F. circulation’ and tumours of the base of the skull and posterior fossa. 8-10 We report a case of c.s.F. rhinorrhoea in which computerised metrizamide cisternography pointed to the exact site of fluid escape. Left-sided rhinorrhoea had started 9 years after a frontal injury in a 59-year-old male. Tomography suggested a leftsided frontoethmoidal fracture. After injection of 5 ml metrizamide (at a concentration of 190 mg iodine/ml) by lumbar puncture the patient was positioned head downward in ventral trast
Toulouse, France
ULTRASOUND FOR GENETIC COUNSELLING IN POLYCYSTIC KIDNEY DISEASE
SiR,—We have been counselling the parents of a male infant who had bilateral polycystic kidney disease type m’ at necropsy. His appearance was that of the Potter syndrome, including low-set ears, epicanthal folds, short neck, wide-spaced nipples, short phalanges of the hands, bilateral dislocated hips, and bilateral club feet. He had severe respiratory distress and died six hours after birth. Chromosome analysis revealed a normal male karyotype. The family history was negative for miscarriages, stillbirths, congenital anomalies, or kidney disorders. It was suggested that the mother (age sixteen) and the father (age nineteen) should have their kidneys evaluated. We hesitated to suggest intravenous pyelography, an invasive technique, so we recommended nephrosonography, as suggested for the evaluation of clinically normal relatives of infants with renal agenesis.2 Nephrosonograms of one kidney from each 11. Drayer,
B. P.,
Wilkins,
R.
H., Boehnke, M., Horton, J. A. Rosenbaum,
A E
1
Am. J Roentgenol. 1977, 129, 149. Potter, E L., Craig, J. M. Pathology of the Chicago, 1975
Fetus and the
Infant, p. 452.
2 Zonana,
J, Rimoin, D. L, Hollister, D W., Lachman, R. S., Sarti, D A., Kaback, M M Pediat Res 1976, 10, 420.
Hayes, R. L. J. nucl. Med. 1977, 18, 640. 5. Acta radiol 1973, suppl. no. 335 6. Grepe, A., Widen, L. ibid. p. 102. 7. Greitz, T., Hindmarsh, T. ibid. 1974, 15, 497. 8 Grepe, A., Greitz, T., Noren, G. ibid. suppl. no. 346, p. 91. 9. Drayer, B P., Rosenbaum, A E. Lancet, 1976, 736. 10. Roberson, G. H., Taveras, J. M., Tadmor, R., Kleefield, J., Ellis, put assist Tomogr. 1977, 1, 241. 4.
G. J. Com-
Sonograms of kidneys
Computerised tomography cisternogram with metrizamide. Coronal plane showing the leakage of the contrast medium at level offrontoethmoidal fracture arrow’.
of parents of infant with
polycystic kidney
disease.
tppcr klelncB
mother’s normj) let’t kidnev. l,oB er- t.1thcr’,
po)BcBsttc nght
