Immediate postgadolinium spoiled gradient-echo MRI for evaluating the abdominal aorta in the setting of abdominal MR examination

To assess the reproducibility and image quality of immediate postgadolinium chelate spoiled gradient-echo MRI in demonstrating disease of the abdominal aorta. All patients (27 patients: 21 men, 6 women) with substantial disease of the abdominal aorta, who underwent abdominal MR examinations at 1.5 T between 1991 and 1995, were entered in the study. Patients were referred for evaluation of suspected aortic disease (14 patients) or other abdominal diseases (13 patients). Three experienced investigators manually measured luminal and external aortic wall diameters and rated image quality, definition of inner and outer walls, extent of disease, and presence of other abdominal abnormalities, in an independent fashion. A cardiovascular surgeon then rated all studies to determine whether clinical management could be based on the MR findings alone. There was 98 to 99% agreement in measurements of luminal and external wall diameter between the three investigators. Overall image quality was rated as good in 77.8 to 88.9% of patients. A total of 31 additional nonaortic abdominal abnormalities were detected by all observers. The cardiovascular surgeon rated 25 of 27 studies as adequate to determine clinical management based on MR findings alone. Immediate postgadolinium spoiled gradient-echo MRI is a reproducible technique for the demonstration of abdominal aortic disease and possesses good image quality. Advantages of this technique include simultaneous evaluation of other nonvascular diseases of the abdomen, short examination time, and easy implementation as part of routine abdominal MRI scanning protocol.     

Caroli''s disease: a central dot means a lot

We present here a patient of congenital non-obstructive focal dilatation of intrahepatic biliary radicles (Caroli's disease). The peculiar configuration of dilated intrahepatic biliary channels with central portal vein radicles was picked up sonologically as the 'central dot' sign. Awareness of this sign allows an accurate diagnosis without resorting to more invasive and expensive investigations.     

Spinal cord injuries--epidemiology in Portugal''s central region

Remarkable changes are taking place in the new South Africa. Planned changes in the health care arena present the new, relatively small discipline* of family practice with great opportunity for development and growth. With established generalist roots and recent formal recognition in South Africa, family practice should be well suited for a lead role in the government's efforts to extend health care access to those denied it under apartheid. Whether family practice moves into that role will depend on whether as a discipline it can project a vision of how it can meet the country's health care needs. Close examination of family practice in South Africa shows how the field reflects many of the societal problems of the past and the challenges of the future. With a clear vision of its role in the new South Africa, family practice could overcome these challenges, as well as answer a broader question about the place of family practice outside of the first world setting.     

Ras activation in astrocytomas and neurofibromas

Oncogenic mutations resulting in activated Ras Guanosine Triphosphate (GTP) are prevalent in 30% of all human cancers, but not primary nervous system tumors. Several growth factors/receptors are implicated in the pathogenesis of malignant astrocytomas including epidermal growth factor (EGFR) and platelet derived growth factor (PDGF-R) receptors, plus the highly potent and specific angiogenic vascular endothelial growth factor (VEGF). A significant proportion of these tumors also express a truncated EGFR, which is constitutively activated. Our work demonstrates that the mitogenic signals from both the normal PDGF-R and EGFR and the truncated EGFR activate Ras. Inhibition of Ras by genetic or pharmacological strategies leads to decreased astrocytoma tumorgenic growth in vitro and decreased expression of VEGF. This suggests that these agents may be potentially important as novel anti-proliferative and anti-angiogenic therapies for human malignant astrocytomas. In contrast to astrocytomas, where increased levels of activated Ras GTP results from transmitted signals from activated growth factor receptors, the loss of neurofibromin is postulated to lead to functional up-regulation of the Ras pathway in neurofibromatosis-1(NF-1). We have demonstrated that NF-1 neurofibromas and neurogenic sarcomas, compared to non-NF-1 Schwannomas, have markedly elevated levels of activated Ras GTP. Increased Ras GTP was associated with increased tumor vascularity in the NF-1 neurogenic sarcomas, perhaps related to increased VEGF secretion. The role of Ras inhibitors as potential therapy in this tumor is also under study.     

Localization of the central sulcus and adjacent sulci in human: a study by MRI

Variations in localization of the central sulcus and the sulci around the central sulcus namely the superior frontal sulcus, precentral sulcus, postcentral sulcus, marginal ramus of cingulate sulcus were studied in vertex sections retrospectively by magnetic resonance imaging (MRI) method in 3580 cases. Out of total number of cases, 1000 who did not show any macroscopic intracranial pathology were carefully selected for research. Additionally, 0-1 age group was excluded from the study because the sulci develop in first year of postnatal life, excluding the possibility of considering these as anatomical variations. Thus, the total number of cases is decreased to 990. 16 variations related to localization of the superior frontal sulcus, precentral sulcus, central sulcus, postcentral sulcus and the marginal ramus of the cingulate sulcus were identified. The asymmetries of the sulci, the most variable sulci and the distribution of the variations according to sex were statistically analysed.     

Sialadenosis: a presenting sign in bulimia

BACKGROUND: Sialadenosis refers to noninflammatory, often recurrent, enlargement of the salivary glands, most frequently the parotids, which is almost always associated with an underlying systemic disorder. These include diabetes, alcoholism, malnutrition, anorexia nervosa, and bulimia. It is thought that the various causes of sialadenosis all result in a common pathogenetic effect in that they produce a peripheral autonomic neuropathy which is responsible for disordered metabolism and secretion, resulting in acinar enlargement. METHODS: This paper reports a case of sialadenosis as a presenting sign in bulimia and studies the histologic and electron microscopic features of this disease. RESULTS: Light microscopy showed acini which appeared to be larger than normal and which were composed of plump pyramidal cells containing prominent zymogen granules. There was less interstitial fat, and the ducts were widely dispersed. Electron microscopy showed the acinar cells to be packed with membrane-limited, dark secretory granules some of which showed moulding of their outlines. Cellular organelles and nuclei were inconspicuous. CONCLUSIONS: Management of sialadenosis depends upon identification of the underlying cause, which must then be corrected. In bulimia, the swellings may be refractory to standard treatment modalities, and parotidectomy may be considered as a last resort to improve the unacceptable aesthetics.     

Spinal imaging and intervention: 1998

Imaging of the lumbar spine is the most common application of magnetic resonance (MR) imaging in many radiologic practices. MR imaging has replaced computed tomography (CT) and CT myelography as the primary mode of spinal imaging and has relegated myelography to a secondary role in the evaluation of lumbar spinal disorders. At the same time, however, it has become evident that the correlation between gross anatomic findings as depicted on MR images and the clinical signs and symptoms detected by the clinician may be lacking. Defining the precise anatomic source of patients' complaints on the basis of imaging studies must be approached judiciously because a significant proportion of the population has disc disease as depicted on imaging studies, yet many have no clinical findings.     

Spinal retroflexion in craniorhachischisis: its classification and limitations

Spinal retroflexion has been studied in five stillborn human fetuses having craniorhachischisis. The findings show that retroflexion in this variant of anencephaly can be classified into severe, moderate and mild forms. The three grades can be differentiated from one another by the direction of the face, shape of the mentothoracic junction, extension of hairline on back, radiographic abnormalities of the spine, and the diaphragmatic defects. It is discussed that, though the anencephalies with severe or moderate degree of cervical retroflexion resemble iniencephaly in their features of spinal retroflexion, those having mild retroflexion are contrasted and should not be categorised with iniencephaly. It is suggested that for precision the term "spinal retroflexion" should be used after duly prefixing it by an appropriate word (severe, moderate or mild) indicating the degree of retroflexion observed.     

The rim sign in epidural hematoma: case report

A case of epidural hematoma of 7 days' duration showed a rim sign in the dynamic and static brain images. The significance and value of a rim sign are discussed.     

The dot pattern expectancy task: Reliability and replication of deficits in schizophrenia.

The dot pattern expectancy (DPX) task was created to efficiently assess context-processing deficits in patients with schizophrenia. Three studies investigated the characteristics of the DPX relevant for clinical applications. To answer questions regarding the psychometric properties of the task, performance on this task was studied in 2 healthy samples. Acceptable reliability and internal consistency and retest reliability were found for most measures of context processing, but not for a difficulty control condition. These characteristics were also found in a suggested brief version (DPXbrf), which may be more practical for clinical purposes. In a 3rd study, schizophrenia patients showed a specific deficit in context processing, replicating previous findings. Findings of these studies indicated some promise for use of this task in measuring context processing and also identified characteristics of this task that need to be strengthened to increase reliability, feasibility, and single-subject interpretability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spinal cord injury management in Salisbury: the history of the Duke of Cornwall Spinal Treatment Centre

One point remains paramount in our minds and that is, in order to achieve the goals we have set, we need vigorously to ensure that Spinal Units continue to be seen as the only facilities competent to provide for the diverse needs of spinal cord injured patients. We at the Duke of Cornwall Spinal Treatment Centre are fortunate in having a first class, expanding facility and have the tireless cooperation of both our staff and those of the other departments in Salisbury. We recognize also that we can play a leading role in the treatment of patients, not only from the Southwest, but, where and when appropriate, from further afield.     

Spinal cord stimulation in multiple sclerosis: clinical results

Clinical results of spinal cord stimulation by means of epidural electrodes are reported in 19 patients with multiple sclerosis. On temporary stimulation with percutaneous electrodes, significant improvement in mobility occurred in 27.7% of 18 patients and the same number showed improved sensory function. Only one of 13 patients with severe upper limb ataxia improved. The major response, both in terms of the percentage of patients responding and the extent of the responses seen was in bladder function: 75% of 16 patients with bladder symptoms improved and seven of the 11 patients with severe bladder disturbance (Kurtzke grade 3 or more) improved. Four of these seven patients had before and after cystometry and 3 showed reduced detrusor hyperreflexia. Altogether, 10 patients had a worthwhile clinical response in one or more aspects of the disease and of these, nine have so far gone on to permanent stimulation. Medium-term results (up to two years) show that, with one exception, improvement in bladder function has been maintained as long as stimulation has been continued and at least 50% of improvement in mobility has been maintained. A favourable response depends not upon the fact of stimulation but upon the type of stimulation received. This, along with other evidence, indicates that the response is not caused either by a placebo effect or by the natural fluctuation of the disease.     

The CT halo sign: a new finding in intestinal lymphangiectasia

A "halo sign" has been described in patients with Crohn disease, ulcerative colitis, radiation enteritis, ischemic colitis, and pseudomembranous colitis. This sign is characterized by an inner ring of low CT attenuation surrounded by a higher attenuation outer ring. We present a patient with primary intestinal lymphangiectasia in whom CT demonstrated a halo sign correlated with mucosal biopsy.     

Motion integration with dot patterns: effects of motion noise and structural information

To better understand how local motion detectors merge their responses so as to permit the global determination of objects' movements in the visual field, direction discrimination of performance was measured using a flexible class of moving dots--two sets of dots translating sinusoidally 90 deg out of phase along orthogonal axes. When dots' velocities are combined, a global motion along a circular trajectory emerges, clockwise or counter-clockwise depending on the sign of the phase lag. However, the results of the present experiments indicate that dot patterns are segregated into distinct, but interacting, streams when each dot motion can be accurately determined. In contrast, perceptual coherence of the global motion occurs when each local motion signal is "blurred" by a "motion noise". Direction discrimination performance then increases regularly with both noise amplitude and noise frequency, i.e., noise speed. Performance also increases when relative motion between dots is added. Testing different dot configurations indicates that performance is better for spatial arrangements that display structural properties (a square shape), as compared to overlapping random distributions. Interestingly, when the delay between stimulus onset and motion onset increases up to 300 msec, performance improves when dot patterns convey come form of structural organization but not when the dots are distributed at random. Relations of these results to existing models of motion integration are considered.     

Spinal meningeal melanocytoma presenting with superficial siderosis of the central nervous system. Case report and review of the literature

1. We recently demonstrated that intrathecal administration of prostaglandin E2 (PGE2) and PGF2alpha induced allodynia through a pathway that includes the glutamate receptor and nitric oxide (NO)-generating systems from pharmacological studies. In order to clarify the involvement of NO in prostaglandin-induced allodynia, we measured NO released from rat spinal cord slices by a chemiluminescence method. 2. PGE2 stimulated NO release from both dorsal and ventral regions all along the spinal cord. PGE2 stimulated the release within 10 min and increased it in a time-dependent manner. 3. The PGE2-induced NO release was observed at 100 nM-10 microM. PGF2alpha stimulated the release at concentrations higher than 1 microM, but PGD2 (up to 10 microM) did not enhance it. 4. 17-Phenyl-omega-trinor PGE2 (EP1 > EP3) and sulprostone (EP1 < EP3) were as potent as PGE2, but PGE1 was less potent, in stimulating NO release. While M&B 28767 (EP3) did not enhance the release, butaprost (EP2) stimulated it at 1 microM. The PGE2-evoked release was blocked by ONO-NT-012, a bifunctional EP1 antagonist/EP3 agonist. 5. The PGE2-evoked release was Ca2+-dependent and blocked by MK-801 (NMDA receptor antagonist) and L-NAME (NO synthase inhibitor). The release was also inhibited by PGD2 and dibutyryl-cyclic AMP. 6. The present study demonstrated that PGE2 stimulates NO release in the rat spinal cord by activation of NMDA receptors through the EP1 receptor, and supports our previous findings that the NO-generating system is involved in the PGE2-induced allodynia.     

CT angiogram sign: incidence and significance in lobar consolidations evaluated by contrast-enhanced CT

BACKGROUND: Neuropathological data are very scarce in systemic sclerosis and fail to demonstrate primary changes in the brains of such patients. CASE DESCRIPTIONS: A 41-year-old woman with CREST syndrome developed signs of dementia after an episode of severe dehydration and died two months later of septic shock. A 63-year-old woman with CREST syndrome and a history of two unexplained transient ischemic attacks had had balance disorders since age 62. She died of severe pulmonary hypertension. In both cases, the autopsy showed extensive wall calcification of small arteries and arterioles in the brain, primarily in the basal ganglia, and also in the frontal lobes and the cerebellar area in the second case. No known cause of cerebrovascular calcification was found in either patient. CONCLUSION: The neuropathological findings in these two patients suggest that systemic sclerosis may induce primary vascular changes in the brain, of which calcification may be a marker.     

The rim sign in hepatic abscess: case report and review of the literature

We studied a previously healthy patient who presented with a 3-wk history of fever, flu-like symptoms and abdominal pain. METHODS: Blood cultures were positive for Escherichia coli. A computed tomography (CT) scan revealed a 2-cm low-density focus in the right hepatic lobe. A technetium-99m-mebrofenin scan showed a photopenic area in the right hepatic lobe surrounded by a rim of activity greater than the adjacent parenchymal activity. RESULTS: Gallbladder visualization was normal and the diagnosis of hepatic abscess was made. CT-guided percutaneous drainage of the lesion yielded six cc of pus, the culture of which grew E. coli, Prevotella and Bacteroides fragilis. Drainage and a 6-wk course of intravenous antibiotics were followed by clinical improvement and resolution of the abscess by CT. CONCLUSION: The rim sign and its possible mechanism of causation in hepatic abscess are discussed in this report, together with a review of the literature.