Structural white matter abnormalities in patients with idiopathic dystonia

We investigated whether structural white matter abnormalities, in the form of disruption of axonal coherence and integrity as measured with diffusion tensor imaging (DTI), constitute an underlying pathological mechanism of idiopathic dystonia (ID), independent of genotype status. We studied seven subjects with ID: all had cervical dystonia as their main symptom (one patient also had spasmodic dysphonia and two patients had concurrent generalized dystonia, both DYT1‐negative). We compared DTI MR images of patients with 10 controls, evaluating differences in mean diffusivity (MD) and fractional anisotropy (FA). ID was associated with increased FA values in the thalamus and adjacent white matter, and in the white matter underlying the middle frontal gyrus. ID was also associated with increase in MD in adjacent white matter to the pallidum and putamen bilaterally, left caudate, and in subcortical hemispheric regions, including the postcentral gyrus. Abnormal FA and MD in patients with ID indicate that abnormal axonal coherence and integrity contribute to the pathophysiology of dystonia. These findings suggest that ID is not only a functional disorder, but also associated with structural brain changes. Impaired connectivity and disrupted flow of information may contribute to the impairment of motor planning and regulation in dystonia. © 2006 Movement Disorder Society     

Evaluation of a new magnetic resonance imaging method for quantitating adipose tissue areas

We have developed a new magnetic resonance imaging (MRI) protocol to quantitate intraabdominal and subcutaneous fat and have validated it by comparing measurements of fat areas by MRI with those obtained by computed tomography (CT) in 11 asymptomatic volunteers who all had a single CT and MRI image taken at the level of the umbilicus. The new MRI protocol was based on a water-fat separation method by which the slice selection routines excite water and fat protons in different positions along the slice select direction. This method performed more reliably than earlier methods based on phase differences between water and fat signals. Fat areas measured by MRI exceeded those measured by CT by 8-22 percent, and fat areas and ratios obtained by MRI correlated well with CT (r = 0.98 for areas and, for ratios, r = 0.81). The ratio of intraabdominal/subcutaneous fat measured by MRI in seven males was significantly greater than that in four females. We also compared the new method with a previously published inversion recovery (IR) method in seven additional volunteers. Agreement between the two methods was excellent, and the major differences were technical: the IR protocol produced images that may require custom image processing programs when obtained on some scanners. Comparability of the two methods provides further reassurance of the validity of both. MRI presents an attractive opportunity for directly measuring intraabdominal fat in order to correlate this with metabolic parameters and to visualize changes during weight loss.     

Strut fixation of an extensive flail chest

The indications for and preferred approaches to operative stabilization of posttraumatic chest wall instability are uncertain. We suggest this simple, rapid, and effective approach to surgical stabilization by Luque rod strutting of the flail segment when operation is required.     

Definitive radiation therapy for selected cancers of the rectum

During the last 15 years, over 400 patients with adenocarcinoma of the rectum have undergone a course of endocavitary irradiation for cure or palliation of Dukes' A and B disease. This treatment method makes use of an unconventional fractionation scheme, by which the tumour receives 10,000-12,000 cGy in approximately four fractions over a period of about 60 days. The treatments are separated by an interval of 2 or 3 weeks. This method of definitive irradiation allows suitable patients to avoid abdominoperineal resection and its drawbacks. Hospitalization is avoided and the patients maintain a normal daily life. Approximately 15-20 per cent of all rectal cancer patients may be expected to fulfil the criteria for selection, which are sufficiently strict that the local control (95 per cent) and 5-year survival rates (94 per cent) can exceed those of surgery for comparable disease.     

Spectral reconstruction of high energy photon beams for kernel based dose calculations

A kernel-based dose computation method with finite-size pencil beams (FSPBs) requires knowledge of the photon spectrum. Published methods of indirect spectral measurements using transmission measurements through beam attenuators use mathematical fits with a large number of parameters and constraints. In this study, we examine a simple strategy for fitting transmission data that models important physical characteristics of photon beams produced in clinical linear accelerators. The shape of an unattenuated bremsstrahlung spectrum is known, varying linearly from a maximum at zero energy to a value of zero at a maximum energy. This unattenuated spectrum is altered primarily by absorption of low energy photons by the flattening filter, causing the true spectrum to roll off to zero at low photon energies. A fitting equation models this behavior and has these advantages over previous methods: (1) the equation describes the shape of a bremsstrahlung spectrum based on physical expectations; and (2) only three fit parameters are required with a single constraint. Results for 4 MV and 6 MV accelerators for central axis and off-axis beams show good agreement with the maximum, average and modal energies for known spectra. Previously published models, representations of beam fluence (energy fluence, dN/dE), experimental methods, and the fitting process are discussed.     

Peak torque values of the knee extensor and flexor muscles of females

Two hundred and forty-one females between the ages of 18 and 28 years were subjects for this study. Subjects were tested for knee extension and knee flexion on a Cybex(R) II isokinetic dynamometer at 60 degrees /sec using a modified seating arrangement which placed the back rest at 20 from the vertical. To familiarize subjects with the Cybex II, two practice trials of complete extension and flexion were allowed. The actual test included four consecutive trials of voluntary maximum isokinetic contractions of the knee extensors and flexors. The mean torque value of the knee extensors was 96.47 ft-lb and 51.77 ft-lb for the knee flexors. The corresponding ratio was 1.86: 1.00. The trials demonstrating the maximum peak torque values for the knee extensors and flexors were chosen to determine the time to peak torque. The mean time to peak torque for the knee extensors (2.76 sec) was only slightly longer (0.02 sec) than the mean time to peak torque for the knee flexors (2.78 sec). Based on the outcome of the investigation and the size of the sample, it is suggested that young and untrained women who have no history of health-related conditions of the knee demonstrate an approximate ratio of knee extensor strength to knee flexor strength of 2: 1 at 60 /sec. J Orthop Sports Phys Ther 1985;7(2):65-68.     

The superior laryngeal nerve loop and its surgical implications

Summary Based upon findings from 60 cadavers (120 sides), the incidence of superior laryngeal nerve loop, connecting the cervical sympathetic chain and the superior laryngeal nerve and its branches, the external and internal laryngeal nerve, was 98.3% (118 out of 120 sides). In most cases the loop connected the sympathetic chain and the external laryngeal nerve. The external laryngeal nerve was looped, and not linear as traditionally thought. The loop could be divided into three categories, V-shaped, U-shaped and mixed, and subdivided into 5 types and 17 subtypes according to morphological variation. The loop without exception innervated not only the cricothyroid muscle, but also the thyroid gland. The loop is one of the origins of the thyroid nerve. It seems that for thyroid surgery the loop, when lower in position, should be carefully separated from the superior thyroid vessels before the latter are ligated, in order to preserve a normal nerve supply to the muscle as well as to the part of the gland that remains after surgery.

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L'anse du nerf larynge supérieur, étude anatomique et applications chirurgicales

Résumé La fréquence d'une anse du nerf laryngé supérieur réalisant une anastomose entre la chaine sympathique cervicale et le nerf laryngé supérieur et/ou ses branches (rameau laryngé externe et ingerne), est de 98,3 % (118/120). Ce résultat s'appuie sur l'étude de 60 cadavres. Dans la plupart des cas, l'anastomose se fait entre la chaine sympathique cervicale et le rameau laryngé externe. Ce rameau laryngé externe a un trajet curviligne et non linéaire conformément aux données classiques. Il existe trois catégories d'anses : en "V", en "U" et mixte ; on peut également les subdiviser en 5 types et 17 sous-types en fonction des variations morphologiques. Cette anse innerve constamment non seulement le muscle cricothyroïdien mais aussi la glande thyroïde dont elle fournit une partie de l'innervation. Lors de la chirurgie thyroïdienne, si l'anse est en position basse, les nerfs doivent être soigneusement disséqués et séparés des vaisseaux thyroïdiens supérieurs avant ligature de ces derniers de façon à conserver l'innervation normale du muscle et de la partie restante de la glande.

     

Pseudolayering of Gd-DTPA in the urinary bladder

When excreted gadolinium diethylenetriaminepentaacetic acid (DTPA) collects in the bladder of a supine patient during magnetic resonance (MR) imaging, a puzzling pattern of signal intensities is noted. A gradual change in urine signal intensity with progressive addition of Gd-DTPA does not occur; instead, three sharply defined "layers" are seen both on T1- and T2-weighted images within the urine-Gd-DTPA mixture. The physical basis for this triple-layering phenomenon was investigated. A bladder phantom was constructed to reproduce the phenomenon. T1 and T2 relaxivities of urine doped with varying concentrations of Gd-DTPA were measured in vitro; measured signal intensities corresponded closely to predicted intensities. Early urine concentrations of excreted Gd-DTPA may be relatively high (10-40 mmol/L), resulting in extremely short T1 and T2 values (less than 30 msec). These extremely short relaxation times cause an artifactual pseudolayering of signal within the urine-Gd-DTPA mixture.