Vagal neuropathy: evaluation with CT and MR imaging

The vagus nerve, as a result of its protracted course from the brain stem to the abdomen, can present a difficult imaging problem when it is compromised by a clinically occult lesion. The clinical and radiologic records of 48 patients with suspected vagus nerve dysfunction were reviewed to derive an efficient and effective approach to imaging this patient population. An imaging algorithm is proposed in which vagal neuropathies are divided both clinically and radiologically into proximal and distal categories. Proximal vagal lesions are part of a cranial neuropathy complex and have associated oropharyngeal signs and symptoms (e.g., abnormal gag reflex, uvular deviation). Distal vagal lesions occur as an isolated paralysis of the vagus nerve with no symptoms or signs referable to the oropharynx. Either computed tomography (CT) or magnetic resonance imaging can be used to diagnose proximal or distal lesions. However, CT will be insensitive in the detection of the more cephalic proximal lesions, especially those in the brain stem, basal cisterns, and skull base.     

Mortality in Dutch hospitals: Trends in time,place and cause of death after admission for myocardial infarction and stroke. An observational study

Background  

Patterns in time, place and cause of death can have an important impact on calculated hospital mortality rates. Objective is to quantify these patterns following myocardial infarction and stroke admissions in Dutch hospitals during the period 1996–2003, and to compare trends in the commonly used 30-day in-hospital mortality rates with other types of mortality rates which use more extensive follow-up in time and place of death.     

Is the screening for celiac disease useful in anorexia nervosa?

The main objective of the study was to prospectively assess if the prevalence of celiac disease (CD) in patients with anorexia nervosa (AN) is higher than that reported in the general population to require a regular screening program. The study was conducted at the Neuropsychiatry Unit of “Bambino Gesù” Children’s Hospital in Rome from January 2005 to December 2010. All patients with diagnosis of AN according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria were screened for CD. One hundred and seventy-seven patients (33 males and 144 females) were enrolled. Only one patient was found to be affected with CD as confirmed by intestinal biopsy. The overall prevalence of CD in AN patients was 0.6 % which is similar to that observed in the general population. In conclusion, AN patients do not seem to require a regular screening program for CD. The screening for CD may be useful in selected AN patients in which the symptoms are only partially responding to psychiatric interventions.     

Reassessment of cochlear dead regions in hearing-impaired teenagers with severe-to-profound hearing loss

The aim of this study was to reassess cochlear dead regions after an interval of twelve months, using the Threshold Equalising Noise (TEN) test. Thirty-four ears of 24 teenagers (mean age of 14 years) with longstanding severe-to-profound sensorineural hearing impairment were tested. Testing was repeated after an interval of 12 months using the same experimental set-up. A total of eight (23.5%) out of 34 ears changed category on retest: this decreased to two (7.1%) out of 27 ears when the inconclusive category was removed from the analysis. In both of these ears (of the same participant) the criteria were met at a single frequency, and the masked threshold was only 10 dB above the TEN level per ERB_N. When all of the data were examined on a frequency-by-frequency basis, the instances that changed category ranged from 15 to 51%. The range decreased to between 4 and 34% when the inconclusive category was removed from the analysis.