A retrospective study of neuroradiological abnormalities detected on structural magnetic resonance imaging of the brain in elderly patients with cognitive impairment

BACKGROUND: The aim of the study was to investigate the relationship between neuroradiological and clinical diagnosis in patients presenting with cognitive impairment, and also the relationship between the neuroradiological abnormalities and cognitive function as assessed by the Mini-Mental State Examination (MMSE) score. METHODS: One hundred and four elderly subjects (65 years and over) with cognitive impairment, referred to secondary hospital services and who had brain magnetic resonance imaging (MRI) scans as part of routine clinical investigations, were studied by review of their MRI scans using a standardized procedure and by examination of the case notes. RESULTS: In patients with a clinical diagnosis of senile dementia Alzheimer-type (SDAT), the diagnosis was reviewed in 11.1%. In patients with vascular dementia, the diagnosis was reviewed in 62. 5%. In patients without a firm clinical diagnosis, radiological features compatible with SDAT were seen in 44.4% and with vascular dementia in 27.0%. Only 2/104 patients showed a significant focal lesion on MRI. Of the variables studied (age, sex, degree of hippocampal atrophy, extent of T2 hyper-intensities, and enlargement of the sulcal and ventricular cerebrospinal fluid (CSF) spaces) only hippocampal atrophy predicted the MMSE score ( p < 0.002). CONCLUSION: MRI brain scanning has an important role in aiding and refining the clinical diagnosis of cognitive impairment/dementia in the elderly.     

Mineral content of complementary foods

Objective  To document mineral contents iron, zinc, calcium, energy contents and nutrient densities in complementary foods commonly given to young urban slum children. Methods  Information on dietary intake was collected from 892 mothers of children aged13-24 months, using 24 hour dietary recall and standardized measures. Three variations of 27 most commonly prepared recipes were analyzed and their energy (Kcal/g) and nutrient densities (mg/100Kcal) were calculated. Results  Considerable variations were observed in preparation of all items fed to the children. Cereal-based items predominated their diets with only small amount of vegetables/fruits. Fenugreek was the only leafy vegetable included, but was given to only 1–2% of children. Iron, calcium, zinc contents of staple complementary foods ranged from: 0.33mg to 3.73 mg, 4mg to 64 mg, and 0.35mg to 2.99 mg/100 respectively. Recipes diluted with less water and containing vegetables, spices had higher mineral content. Minerals densities were higher for dals, fenugreek vegetable, khichdi and chapatti. Using the median amounts of the various recipes fed to children, intakes of all nutrients examined especially calcium and iron was low. Conclusion  There is an urgent need to educate mothers about consistency, dilution, quantity, frequency, method of preparation, inclusion of micronutrient-rich foods, energy-dense complementary foods and gender equality.     

Impact on late toxicity of using transabdominal ultrasound for prostate cancer patients treated with intensity modulated radiotherapy

An analysis of the effects of using the B-mode ultrasound Acquisition and Targeting (BAT) system for positioning of prostate cancer patients receiving external beam radiotherapy (EBRT) on late gastrointestinal (GI) and genitourinary (GU) toxicity is provided. The records of 49 consecutive patients treated using the BAT were reviewed; additionally, a comparison (No-BAT) group treated in a similar manner was identified, consisting of 49 patients treated immediately prior to this BAT group. There were no other fundamental differences between the two groups. The daily BAT movements were charted and late toxicity was scored for all patients using established toxicity scales. The results demonstrated similar GU toxicity rates between the two groups, but slightly lower rates of GI toxicity in the BAT group vs. the No-BAT group. However, regression analyses revealed that no factors, including BAT use, were significantly correlated with late GI or GU toxicity. Further efforts, perhaps better undertaken in a multi-institutional setting, are needed to determine whether BAT use can significantly reduce late GI toxicity.     

Prospective randomized study of internal oblique aponeurotic flap repair for tension-free reinforcement of the posterior inguinal wall: a new technique

In recent years, Lichtenstein's tension-free hernioplasty has emerged as the gold standard for hernia surgery. However, it entails placement of a mesh and thus is costlier material-wise compared with herniorrhaphies. A new technique of internal oblique aponeurosis flap (IOAF) has been devised by the author that incorporates the advantages of Lichtenstein's technique (low recurrence, less pain) without its additional costs. A prospective study was carried out to compare the two techniques. The mean time for surgery was significantly less for the IOAF repair compared with the Lichtenstein's repair. Complications were fewer with the IOAF repair, especially local heaviness and induration. IOAF repair also had less material cost than Lichtenstein's repair. The technique of IOAF repair for inguinal hernia is fast, safe, and has less material cost compared with the Lichtenstein tension-free repair.     

Opacity transfer function optimization for volume-rendered computed tomography images of the prostate

RATIONALE AND OBJECTIVES: The selection of an opacity transfer function is essential for volume visualization. Computed tomography (CT) scans of the pelvis were used to determine an optimal opacity transfer function for use in radiotherapy. MATERIALS AND METHODS: On sample datasets (a mathematical phantom and a patient pelvis CT scan), standard viewing orientations were selected to render the prostate. Opacity functions were selected via (1) trapezoidal manual selection, (2) trapezoidal semiautomatic selection, and (3) histogram volume-based selection. Using an established metric, the errors using each of these methods were computed. RESULTS: Trapezoidal manual opacity function optimization resulted in visually acceptable images, but the errors were considerable (6.3-9.1 voxel units). These errors could be reduced with the use of trapezoidal semiautomatic selection (4.9-6.2 voxel units) or with histogram volume-based selection (4.8-7.9 voxel units). As each visualization algorithm focused on enhancing the boundary of the prostate using a different approach, the scene information was considerably different using the three techniques. CONCLUSION: Improved volume visualization of soft tissue interfaces was achieved using automated optimal opacity function determination, compared with manual selection.     

Predictive factors for recurrent haemorrhagies in patients with brain cavernoma

Haemorrhage is most important sequelae of brain cavernoma, so the surgical treatment is very important for treatment that complication. There are two types of bleeding chronic subclinical microhaemorrhage and acute real haemorrhage. Pathophysiological factors wich are responsible for bleeding are not still understanding. The reason for this study is understanding of clinical curse of cavernomas and identification of factors of influence. This is retrospective and prospective study. We analised 36 patients with simpthomatic brain cavernoma, surgicaly treated in Institute of neurosurgery KCS in 10 years period (1987-1997). Female were dominant but without statistical significance (p > 0.05). Male patients were older (32,1:29,8), but without statistical significance (p > 0.05). Almost 75% lesions were supratentorial, 25% infratentorial (p < 0.05). Focal neurological deficite (FND) was dominant clinical presentation in 52.8%. FND was dominant in 52.6% female, but without statistical singnificans (p > 0.05). Clinical presentation according the age was not statisticaly significant (p > 0.05). Clinical presentation was very diferent according the size of lesion (p < 0.001). FND as a sign of bleeding was in 57.9% supratentorial cavernomas and in 42.1% infratentorial (p < 0.005). More than 1/3 patients have recurent bleeding with 21 atack of haemorrhage or almost 2 atack per patient. We find that dominant predictive factors for recurent haemorrhages are localisation and size of lesion.     

Inner-city victims of violence and trauma care: the importance of trauma-center discharge and aftercare planning and violence prevention programs

Inner-city trauma centers often provide care for disproportionately indigent populations who are victims of violence. Many of these victims of violence often return to the trauma center with more violent injuries. Research has shown that a majority of these individuals who return to the trauma center for care are expensive to treat, are uninsured and have significant social problems. Two potential policy approaches are discussed: (1) the use of violence prevention programs to attempt to reduce violence in the immediate community and subsequently reduce the number of victims of violence who are treated in trauma centers and (2) the use of aftercare and discharge models that form an alliance between the trauma center and social service providers in the community. Nontraditional interventions will require the collaboration with hospital departments (emergency medicine, surgery, trauma, social work) and outside agencies, such as the courts and probation and parole. Case management, discharge planning, continuous care treatment teams, and violence intervention models offer positive alternatives to the current method of addressing the multiple problems of victims of violence who frequent the ED.