Serial stereotactic biopsies and CT scan in gliomas: correlative study in 100 astrocytomas,oligo-astrocytomas and oligodendrocytomas

Histologic features of 100 supra-tentorial astrocytomas, oligodendrogliomas and oligo-astrocytomas obtained from serial stereotactic biopsies were compared with the corresponding CT scans. Topographic comparisons provided by visualization of the biopsy trajectories on post-biopsy CT scans were available in 24 cases. Areas of contrast enhancement and low attenuation were compared with the histologic grade of malignancy, tumor delimitation and structural type. The latter was determined as follows: Type I-solid tumor tissue without significant peripheral isolated tumor cells; Type II-solid tumor tissue associated with peripheral isolated tumor cells; Type III-isolated tumor cells only.There was a strong correlation between areas of contrast enhancement and tumor microvascularity. In addition, contrast enhancement occurred only in the solid tumor tissue component of the neoplasm. This correlation accounted for the relationship observed between CT images and the structural type of glioma. Contrast enhancement was constant in structural type I gliomas, inconstant in structural type II, and absent in structural type III. No correlation was found between malignancy and contrast enhancement. Contrast enhancement occurred in all grades of malignancy but was a constant feature of grade 4 gliomas. The volume of the tumors could not be reliably determined from CT images alone. Areas of low attenuation on contrast CT scans could correspond to either peritumoral edema or to edematous parenchyma infiltrated by isolated tumor cells.Serial stereotactic biopsies combined with calculations based on the CT scan provided a more precise definition of the tumor volume and identification of structural type. Such classification may prove useful in prospective analysis of various modes of therapy.     

Caudal-posteroanterior view in coronary arteriography

Posteroanterior (PA) and caudally angulated PA views were obtained in 20 patients undergoing routine coronary arteriography. Although the left main coronary artery (LMCA) was seen well on both views in all patients, the PA-caudal view improved depiction of the LMCA bifurcation in 15 (75%). In addition, the PA-caudal view markedly improved depiction of the circumflex artery, affording optimal depiction of this artery and its branches in 78%-89% of patients. Neither the PA nor the PA-caudal view allowed adequate depiction of the left anterior descending artery. Thus, the PA-caudal view should supplant the PA view in routine coronary arteriography.     

Long-term survival and outcome after first stroke in the Sicilian Aeolian Island Archipelago population

BACKGROUND: Only a restricted number of population studies based on long-term prognosis after a stroke have been published. We analyzed long-term survival and outcome in insular first-ever stroke population from the Aeolian Archipelago. SUBJECTS AND METHODS: From 1 July, 1999 to 30 June 2002, 62 patients with first-ever stroke were recruited to evaluate short-term incidence and outcome. Information for every patient was collected by phone interviews after 3 months, 1 year, and 4 years. RESULTS: 30 days case fatality rate was 24.2% (95% C.I. 14.22 to 36.75). Fifty-one percent (95% C.I. 35.8 to 66.3) of patients died before last survey and 39.1% died during the first year of follow-up. Annual approximate death risk amounted to about 10%. The cerebrovascular causes were the most frequent causes of death (65.2%). A high level of invalidity at 4 years was present in many survivors (40%). None of the deceased had followed physio-kinesitherapy, or applied for equipment or services. CONCLUSION: More attentive medical care for stroke patients could help improve outcome, reducing mortality for patients from the Aeolian island, who already showed a low incidence.     

Morphological changes due to Lead exposure and the influence of DMSA on the gill tissues of the freshwater fish, Catla catla

Catla catla fingerlings were reared in freshwater and exposed to 15.5 ppm concentration of lead for 60 days. The morphological changes on the gill of the C. catla fingerlings due to lead intoxication and the effect of DMSA (meso 2,3-dimercaptosuccinic acid) on the affected tissues were observed using Scanning Electron Microscope. It has been found that the lead treated gill tissues showed certain marked changes, such as cell hypertrophy, alteration in the lamellar surfaces, epithelial hyperplasia and the fusion of adjacent lamellae. The antidote DMSA treatment reduces the toxic effects and helps the recovery of gill tissue and its return to the level of the control/normal.     

Synergistic anticonvulsant effect of valproic acid and ethosuximide on pentylenetetrazole-induced epileptic phenomena in rats

The possible synergistic effect of valproic acid and ethosuximide in combination on pentylenetetrazole-induced epilepsy was investigated in rats. Valproic acid and ethosuximide administered intraperitoneally both showed dose-dependent anti-epileptic activity towards pentylenetetrazole-induced myoclonias and tonic-clonic seizures. The valproic acid-ethosuximide combination had a synergistic pharmacological effect. Against myoclonias combined valproic acid-ethosuximide produced a non-significant decrease in the effective dose of both drugs compared with treatment with either drug alone. In the case of tonic-clonic seizures the protective effect against the seizures was significantly increased by combined treatment compared with treatment with either drug alone. Neither plasma concentrations nor any other pharmacokinetic parameters were significantly changed when the same doses of valproic acid and ethosuximide were given, singly or in combination.     

Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

Background  

Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP) aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses.     

Mesoatrial shunts for Budd-Chiari syndrome and inferior vena cava thrombosis: angiographic and hemodynamic evaluations

When inferior vena caval obstruction complicates the Budd-Chiari syndrome, conventional portosystemic shunts are not possible. The mesoatrial shunt has been devised to enable portal and sinusoidal decompression in these patients. Findings in 12 patients with Budd-Chiari syndrome and inferior vena caval obstruction in whom a mesoatrial shunt was performed are reported. Preoperative inferior vena cavography with pressure measurements is essential to determine the appropriate shunt procedure. Postoperatively, shunt patency is assessed with superior mesenteric arterial portography. Where possible, transvenous catheterization of the shunt is performed to confirm patency and assess hemodynamic function.     

Expert system-controlled image display

Conventional computer-based medical expert systems deliver advice to physicians as written text. While such advice is useful, it has distinct limitations in a visually oriented discipline such as diagnostic radiology, in which decisions often depend on pattern recognition and appreciation of subtle morphologic features. The authors developed a prototype expert computer system, IMAGE/ICON, which displays groups of images sorted into a series of axes based on different ways in which they may be similar. They may share a common feature, group of features, causes, or clinical setting. IMAGE/ICON may display examples of morphologic variations of a dominant finding or a spectrum of abnormalities seen in an specific disease or group of diseases. The system also assembles a written analysis of key features of a case. Such a tool may be useful as a diagnostic aid or for continuing medical education. It is likely to have particular impact in the form of an intelligent radiologic workstation, as picture archiving and communication systems become available.     

Pellegrini-Stieda disease

Pellegrini-Stieda disease is a condition occasionally observed on routine radiographic examinations of the knee. A literature survey revealed little in the way of explanation or therapeutic management of this disorder. An overview of this condition with an emphasis on etiological theory and treatment is offered along with two classic radiographic examples.