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This study suggests that computed tomography screening is ineffective for SCLC. Efforts to reduce mortality of SCLC should instead focus on prevention through tobacco reduction programs, as well as the development of improved treatment options.

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Pulmonary oedema is a well recognized complication of various neurological disorders but has seldom been reported in multiple sclerosis. CASE HISTORYA previously healthy woman of 46 became acutely dyspnoeic, without chest pain or palpitations. Two days earlier she had noted mild ankle swelling. On admission, heart rate was 110/min, respiratory rate 25 /min and blood pressure 100/60 mmHg. A 12-lead electrocardiogram (ECG) showed ST depression in the lateral chest leads but no Q-waves or other evidence of acute myocardial infarction. A chest X-ray revealed generalized pulmonary oedema with bilateral small pleural effusions (Figure 1). There was no evidence of infection and a ventilationperfusion scan was normal. An echocardiogram showed an akinetic intraventricular septum and anterior left ventricle wall with ejection fraction (EF) 39%. There was a small posterior pericardial effusion. It was noted that the basal and anterior wall impairment did not conform with standard coronary anatomy. Believed to be in cardiogenic shock, she was transferred to Harefield Hospital in case mechanical circulatory support became necessary.With intravenous inotropes and diuretics her condition improved; an angiotensin converting-enzyme inhibitor was introduced and the inotropic support was gradually tapered off. A coronary angiogram demonstrated normal coronary vasculature. Clinically, she made an excellent recovery, and myocardial recovery was likewise rapid: six days after the initial echocardiogram the EF had risen to 55% and on discharge 3 weeks later it was 69%.While in hospital, the patient complained of a constant tingling in both hands and intermittent slurring of speech. She had no numbness or weakness and there was no reported visual or sphincter disturbance. On further inquiry she revealed that, in the week before admission, she had had an episode of visual disturbance: when driving, everything had appeared to be 'moving up and down'. The effect was binocular and not affected by the direction of gaze. After two days this had subsided spontaneously. She also recalled neurological symptoms 10 years previously. She had woken one morning with weakness in the left arm and leg and poor coordination which caused her to fall over twice. At that time her leg and arm, but not her face, were numb and her speech was slurred as now. The symptoms resolved over a few days. Visual evoked potentials (VEPs) and a CT brain study were normal. 2 years before the current admission she had had paroxysms of head pain radiating to her left arm and associated with slurred speech but no limb weakness. More recently she had complained of similar pains in the right side of the head for several months. There was no history of Lhermitte's phenomenon.On neurological examination there were no objective abnormalities. Routine blood and biochemistry results were normal. The VEPs were still within normal limits but the cerebrospinal fluid (CSF) showed oligoclonal bands which were not matched in serum. An MRI brain study showed diffuse periventricular white ...

Background: From July 1989 to February 1996, 130 patients underwent sterotactic radiosurgery. We report the results of the first 50 patients eligible for a minimum of three years of follow-up. Methods: Twenty women and 30 men, (mean age: 37.5 years) were treated by dynamic rotation on a 6 MV linear accelerator. Prior treatment was embolization in seventeen, surgery in three and embolization and surgery in six. All had DSA and enhanced CT scanning, while some had MRI. Forty-seven treatments used a single isodose. Restricting eloquent normal tissue to 15 Gy, margin doses (at 50 -90% isodose) were 12 Gy (one patient); 15 Gy (sixteen patients); 20 Gy (31 patients); 25 Gy (two patients). Maximum diameters were: < 1.5 cm (12 patients); < 2.0 cm (nine patients); < 2.5 cm (twelve patients); < 3.0 cm (thirteen patients; 3.0 cm (four patients). Results: Forty-five patients were evaluable at three years, with thirty-nine having angiography. Twenty-five had angiographically confirmed obliterations; two had parenchymal AVMs obliterated but with residual dural components; four had MRI evidence of obliteration (refused angiography). One patient acutely had a seizure; one patient (with hemorrhages, resection, and embolizations preceding two applications of radiosurgery, separated by 3.5 years) had worsening of memory. Conclusions: Our uncorrected (five patients unevaluable at three years) and corrected angiographically confirmed obliteration rates are 54% and 60% respectively. Our follow-up (98% accounting of cohort; 78% angiographic rate) and explicit derivation of denominators help delineate the efficacy of radiosurgery at these doses. RESUME: La radiochirurgie dans le traitement des malformations arterio-veineuses: I'experience de I'Universite de Toronto. Introduction: De juillet 1989 a fevrier 1996, 130 patients ont subi une radiochirurgie stereotaxique. Nous rapportons les resultats des premiers 50 patients chez qui nous avons effectue un suivi minimum de trois ans. Methodes: Vingt femmes et 30 hommes, (age moyen: 37.5 ans) ont ete traites par rotation dynamique sur un accelerateur lineaire de 6 MV. Une embolisation avait ete effectuee anterieurement chez dix-huit, une chirurgie chez trois et une embolisation ainsi qu'une chirurgie chez six. Tous avaient eu une DSA et un CT scan avec rehaussement, alors que quelques uns avaient eu une RMN. Une isodose unique a ete utilisee pour quarante-sept traitements. En limitant la dose au tissu normal a 15 Gy, les doses aux limites de la lesion (a 50 -90% de l'isodose) etaient de 12 Gy (un patient); 15 Gy (16 patients); 20 Gy (31 patients); 25 Gy (2 patients). Les diametes maximums etaient < 1.5 cm (12 patients); < 2.0 cm (8 patients); < 2.5 cm (13 patients); < 3.0 cm (13 patients); 3.0 cm (4 patients). Resultats: Quarante-cinq patients ont ete evalues apres 3 ans de suivi, dont 39 ont eu une angiographie. Vingt-cinq avaient une obliteration confirmee par l'angiographie; 2 avaient une MAV parenchymateuse obliteree mais avec une composante durale residuelle; 4 avaient des sig...