Ictal Single-Photon Emission Computed Tomography Imaging in Extra Temporal Lobe Epilepsy Using Statistical Parametric Mapping

PURPOSE: To examine the application of statistical parametric mapping (SPM) to analyze ictal single-photon emission computed tomography (SPECT) scans in surgical candidates with extratemporal lobe epilepsy. METHODS: The authors selected patients who underwent successful ictal SPECT acquisition in the process of surgical treatment of intractable partial epilepsy. Thirteen patients were identified who met inclusion criteria for confident seizure localization from either intracranial electroencephalogram recordings or epilepsy surgery outcome. In these cases, ictal scans were registered to an in-house-developed normal SPECT atlas composed of 14 spatially normalized brains of normal subjects. SPM96 was used to test on a voxel-by-voxel basis for statistically significant increases in blood flow associated with each patient's ictal scan. The results were then mapped back onto the patient's magnetic resonance image (MRI) for final interpretation. Statistical parametric mapping (SPM) analysis of ictal SPECT scans was compared to both conventional visual interpretation and the analysis of subtraction ictal SPECT co-registered to MRI (SISCOM). RESULTS: Ten of 13 patient scans showed localizing focal ictal increases in regional cerebral blood flow, all of which were concordant with ultimate epilepsy localization. Of the 3 cases not localized with SPM, 1 was localized by conventional visual interpretation and another, not localized by visual interpretation, was correctly localized with SISCOM. Two cases not localized by SISCOM were localized by both visual and SPM analysis. CONCLUSIONS: This work provides supportive evidence for proof of principle that SPM can be used to provide objective, accurate analysis of ictal SPECT scans in patients with extratemporal lobe epilepsy.     

Identifying incident cases of parkinsonism among veterans using a tertiary medical center.

To better understand the impact of incident Parkinson's disease (PD) on the Veteran's Health Administration (VHA) and to develop methods applicable to future epidemiological research, we performed a medical record review study at a tertiary referral VHA medical center. Searching the local data base, we identified 782 veterans with diagnostic codes for PD or secondary parkinsonism (SP) between 1998 and 2000. Based on structured medical record review, a movement disorders specialist confirmed diagnoses for incident parkinsonism cases. Among the 782, 191 incident parkinsonism cases were identified (100 PD, 75 SP, and 16 Parkinson's Plus). Incident PD cases were older at diagnosis (74.5 vs. 70.4 yr; P < 0.05) and more likely to be white (81% vs. 62; P < 0.07) than incident SP cases. Diagnostic codes were insufficient to distinguish between incident PD and SP (positive predictive value, 57% and 39%, respectively), and VHA sources failed to identify 21% of confirmed deaths among the incident PD cohort by November 2004. Although the large number of incident cases identified suggests PD is an important cause of disability among elderly VHA users, observed limitations of VHA sources for identifying incident PD cases and determining their vital status should be considered when designing future studies.     

Alteration of bronchomotor tone after deep inhalation. Mechanisms and pediatric data]

There is significant alteration of airway calibre after deep inhalation (DI). An increase of airway calibre has been evidenced in children in case of mild asthmatic obstruction and after a positive response to methacholine or exercise challenge. Such an increase is blunted in the presence of a moderate to severe asthmatic airway obstruction and no bronchodilatory effect of DI has been found in infants. Bronchial hyperreactivity and airway inflammation strongly influence post-DI alterations of bronchomotor tone. Airways and lung parenchyma are interdependent but both exhibit imperfect elasticity. Hysterisis characterizes imperfect elasticity of pressure-volume relationship. The mechanical theory of relative hysteresis between airway and lung parenchyma is the main mechanism implicated in the induced changes of airway calibre. DI may influence results of lung function testing in children. The technique may be of interest to increase sensibility of routine lung function testing in children.     

Longitudinal predictors of continued tobacco use among patients diagnosed with cancer

Even though continued smoking by cancer patients adversely affects survival and quality of life, about one third of patients who smoked prior to their diagnosis continue to smoke after their diagnosis. The implementation of smoking cessation treatments for cancer patients has been slowed by the lack of data on correlates of tobacco use in this population. Thus, this longitudinal study assessed demographic, medical, addiction, and psychological predictors of tobacco use among 74 head, neck, and lung cancer patients. Multivariable binary logistic regression analyses, with outcome categorized as smoker or nonsmoker, indicated that the likelihoodthat patients would be a smoker was associated with lower levels of perceived risk and a higher level of quitting cons. Multivariable nominal logistic regression, with outcome classified as continuous smoker, continuous quitter, relapser, or follow-up quitter, indicated that: (a) patients categorized as continuous smokers reported significantly lower quitting self-efficacy than follow-up quitters and continuous quitters, (b) relapsers reported a significantly lower level of quitting self-efficacy than either follow-up quitters or continuous quitters, and (c) continuous smokers exhibited a significantly lower level of risk perceptions than continuous abstainers. These findings can be useful for the development and evaluation of treatments to promote smoking cessation among cancer patients. Support for this study was provided by National Institutes of Health Grants CA57708, CA06927, CA88610, CA95678, and CA76644.     

The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament.

Magnetic resonance (MR) imaging has shown that tears of the anterior cruciate ligament (ACL) are frequently accompanied by meniscal and osseous injuries. Abnormalities of the cartilage overlying the lateral femoral condylopatellar sulcus (notch) also have been noted during arthrotomy of ACL-deficient knees. In this study, the appearance of this sulcus on MR images and the depth of the sulcus on conventional radiographs are compared in patients with normal and torn ACLs to determine whether a deep sulcus is a useful indirect sign of a torn ACL. In 62 patients with clinically and/or arthroscopically confirmed normal ACLs, the mean depth of the lateral femoral sulcus was 0.45 mm (range, 0.0-1.2 mm) compared with 0.89 mm (range, 0.0-5.0 mm) in 41 patients with clinically and/or arthroscopically confirmed ACL tears (significant at the 5% level). No patient with a normal ACL had a sulcus greater than 1.2 mm in depth. A sulcus deeper than 1.5 mm is equivalent to 3 standard deviations above the mean and was a reliable indirect sign of a torn ACL.     

Computed tomography in gunshot wounds to the neck: Can we predict vascular injury?

The purpose of this study was to evaluate the ability of helical computed tomography (CT) to detect arterial injuries in gunshot wounds to the neck. In a blinded retrospective review, 54 helical CT scans of the cervical spine were evaluated for bullet/bone fragments, subcutaneous air, bullet path, hematoma, spine fractures, and pharyngoesophageal compromise. The distance of fragments to a major vessel was calculated. CT findings that correlated significantly with major arterial injury included the presence of fragments (bullet/bone) close to a major vessel (2.5 mm) and spine fractures. Visualizing fragments <5 mm from a vessel or a transcervical bullet trajectory predicted 12 of 13 major arterial injuries. We conclude that CT clearly depicts anatomic damage. Specific findings, such as the location of fragments and bullet trajectory adjacent to a vessel and spine fractures, indicate a higher probability of vascular damage, thus directing more definitive evaluation.     

Simulated assembly line performance following ingestion of cetirizine or hydroxyzine.

Twelve healthy subjects participated in three daytime work periods, in a double-blind repeated measures Latin square design. Subjects received cetirizine (10 mg), hydroxyzine (25 mg), or placebo at 0800. Performance was measured each day during eight 50-minute test periods on a simulated assembly line task between 0830 and 1700. Before entry into the study, subjects were trained to a minimum 80% correction rate on the performance task. Performance decrements were consistently associated with hydroxyzine but not with cetirizine. Subjects made fewer correct responses with hydroxyzine compared with both cetirizine and placebo. Subjectively, participants reported feeling sleepier and performing worse during the hydroxyzine condition than following placebo. Cetirizine, however, did not differ from the other two conditions on self-assessments of alertness or performance. These findings support the hypothesis that objective measures of human functioning are more specific than are subjective measures.