Speech-controlled generation of radiology reports

Voice entry has been successfully employed to generate radiology reports with a word recognizer with a 1,000-word lexicon capacity. About 50% of reports were able to be dictated with a single 900-word lexicon. This was split into five sections by anatomic or subspecialty application. Each was augmented to 900 words. By switching from one lexicon to another, it was possible to dictate more than 70% of reports. With exclusive use of three lexicons in subspecialty areas (gastrointestinal radiology, neuroradiology, and mammography), and with further modification of the respective vocabulary, it has been possible to employ the system 88% of the time. Twelve percent of cases included wording that was beyond the scope of the lexicon. Computer subsets that allow different translations of some words when used in different contexts have been used. Some of these are used as triggers that will print whole lines, sentences, or even complete reports. Dictation times with voice entry take about 20% longer. Recognition reliability has been greater than 95%.     

Chiari Type I malformation presenting with bilateral hearing loss

Chiari Type I malformations can present with several clinical signs and symptoms. We describe a 44-year-old female patient presenting with bilateral hearing loss with hydrocephalus coexisting with Chiari Type I malformation and a unilateral arachnoid cyst. Thus, sensorineural hearing loss may be caused by hydrocephalus with Chiari Type I malformation. The placement of a ventriculoperitoneal shunt without a posterior fossa decompression is an effective treatment.     

Association of SNAP-25 Gene Ddel and Mnll Polymorphisms with Adult Attention Deficit Hyperactivity Disorder

Objective

The synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters. Previously, several studies reported association between SNAP-25 and attention deficit hyperactivity disorder (ADHD). We investigated whether these SNAP-25 polymorphisms (MnlI T/G and DdelI T/C) were also associated with ADHD in the Turkish population.

Methods

Our study comprised unrelated 139 subjects who met DSM-IV criteria for ADHD and 73 controls and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with Wender-Utah Rating Scale and Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale.

Results

SNAP-25 DdelI polymorphism was not associated with ADHD but there was a statistically significant difference between ADHD patients and controls for SNAP-25 MnlI polymorphism. For SNAP-25 MnlI polymorphism patients with G/G genotype of the SNAP-25 gene MnlI polymorphism had higher Wender-Utah scores and higher scores in the 1st and 3rd parts of adult ADD/ADHD Scale.

Conclusion

We detected a significant association of the MnlI polymorphism in our ADHD sample which was similar to previous findings. Our study also revealed that SNAP-25 MnlI polymorphism was also associated with symptom severity of ADHD. This study is also, the first report on the association of SNAP-25 with ADHD in the Turkish population.     

Serotonin transporter gene polymorphisms in patients with chronic tension-type headache: a preliminary study

Background and Objectives: This study is designed to understand the pathophysiology of one of the most serious health problems, chronic tension-type headache (CTTH). Two polymorphic sites in serotonin transporter protein gene attracted much interest. These are: the variable number of tandem repeats (VNTR) and 5'-flanking promoter region (5-HTTLPR). Materials and Methods: VNTR and 5-HTTLPR polymorphisms were investigated in 126 CTTH patients and 138 healthy control subjects. The patients were being treated with amitripytyline or citalopram or sertraline (SSRI). The polymerase chain reaction (PCR) method was used to investigate the polymorphisms in the serotonin transporter protein gene. Results: There were no statistically significant results based on the 5-HTTLPR gene alleles, however, STin 2.12/12 genotype and STin 2.12 allele were seen to predominate the control group. In order to investigate the combined effect of the two polymorphic loci on the 5-HTT gene expression, samples were separated into nine groups. Genotypes (S/S-12/10) and (L/S-12/10) displayed statistically significant frequency in the CTTH group than in the control group. No significant differences were noticed between the 5-HTTLPR and VNTR haplotype groups and success in treatment. Conclusion: It is possible to make reliable comparisons and hypothesis about the homozygous and/or heterozygous presence of S and STin 12/10 alleles which may be in interaction with CTTH. On the other hand, the presence of homozygous L and STin12 alleles may play a protective role against CTTH. It is also possible that heterogeneity among diseases showing the same clinical research will require a lot of effort for individual identification.     

Motor Axonal Neuropathy During Treatment With Simvastatin

Simvastatin is a cholesterol-lowering drug that acts by inhibiting hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol synthesis. Abnormal laboratory findings include transient increases in serum creatine kinase (CK) due to a myopathic syndrome. Rarely, neurological side effects include axonal sensory-motor peripheral neuropathy, characterized in some cases by a prevalent motor involvement accompanied by subclinical sensory damage. We report a case of purely motor axonal neuropathy associated with simvastatin. A 72-year-old woman, after five years of treatment with simvastatin, developed progressive weakness, cramps and fasciculations mainly involving proximal muscles in the lower limbs, though without sensory symptoms or signs. Deep reflexes were lost in the lower limbs. There was no sign of upper motor-neuron involvement. CK was elevated (up to 2000 U/l). EMG showed marked neurogenic damage with fibrillations and fasciculations in the lower limbs. ENG showed motor fiber loss within the lower limb nerves without involvement of sensory fibers. CSF examination was normal. Deltoid muscle biopsy showed neurogenic changes and some ragged-red fibers. One year after simvastatin withdrawal the patient's state of weakness improved and the cramps resolved. The CK level dropped to 700 U/l.     

The association between symptoms of sexual dysfunction and age at onset in Parkinson’s disease

Objective

Age at onset in Parkinson’s disease (PD) seems to be related nonmotor symptoms. In this study we investigated the effect of the age at onset on symptoms of sexual dysfunction (SSD) in patients with PD.

Methods

This prospective study comprised 22 consecutive outpatients with early onset PD (EOPD—onset of the disease before 55 years), and 66 outpatients with late onset PD (LOPD—onset of PD over 55 years). They were all recruited from the Department of Movement Disorders, Clinic of Neurology. The diagnosis was established according to the UK PD Brain Bank Criteria by a movement disorders specialist. The Unified PD Rating Scale (UPDRS) motor was used to assess motor disability and Hoehn and Yahr (H&Y) stage was used to establish disease severity. The sexual functions of the patients were rated by applying the Arizona Sexual Experiences Scale (ASEX).

Results

Thirteen EOPD patients (59.09 %) and 53 of the LOPD patients (80.3 %) (p 0.047) reported dissatisfaction with at least one item of ASEX. There were no differences between H&Y stages (p 0.205) UPDRS total (p 0.267) and motor scores (p 0.100) between groups. LOPD patients had significantly higher ASEX scores than EOPD patients (p 0.001).

Interpretation

Sexual dysfunciton occurs more frequently and more severely in LOPD than EOPD patients. PD patients with different ages at onset clinically present differently in terms of SSD.

     

Does appendectomy increase the risk of colorectal adenocarcinoma?

Colorectal cancer ranks third as the most common malignancy in the United States and represents the second leading cause of cancer-related mortality. The appendix is thought to have a productive effect against colorectal carcinoma by the immune function based on its association with substantial lymphatic tissue. But, an appendectomy is still the most commonly performed emergency surgical procedure. It is aimed to assess the association between colorectal cancer and appendicectomy. The medical records of 455 patients who received medical and/or surgical treatment with the diagnosis of colorectal carcinoma in two medical centers in a-five-year period were reviewed. The patients were divided into subgroups according to the colonic localization of the tumor, appendectomy status and their body mass indexes (BMI). In order to define independent predictors of colon adeno-cancer, multiple logistic regression analysis was used. Statistically significant variables according to the univariate statistics were selected as candidate variables for multiple logistic regression analysis. A p-value<0.05 was considered statistically significant. Out of 455 colorectal adenocarcinoma patients, 122 (26.81%) were in right colon adenocarcinoma (CA) group, 267 (56.68%) were in left CA group and 66 (14.5%) were in the rectum adenocarcinoma group. Appendectomy was found as the second highest risk factor in rectum and right colon adenocarcinoma. Being appendectomized increases the risk of rectum adenocarcinoma 3.232 times (95%CI: 1.670–6.254), left CA 2.537 times (95%CI: 1.544–4.168) and right CA 3.607 times (95%CI: 2.056–6.330). In the light of our findings, we suggest that being appendectomized might increase the risk of colorectal adenocarcinoma in sporadic cases.     

糖尿病视网膜病变患者玻璃体样本中白细胞介素-8和肿瘤坏死因子-α水平

目的:测量糖尿病性视网膜病变(DR)行玻璃体切除术(PPV)患者玻璃体样品中白细胞介素-8(IL-8),肿瘤坏死因子-α(TNF-α)的水平,与对照组比较结果并探讨其对DR的影响。方法:将伊斯坦布尔Bilim大学眼科系的57例(57眼)DR患者和22例黄斑裂孔未伴有增生性玻璃体视网膜病变患者分为研究组和对照组。对所有79例患者行3切口,20G PPV。PPV手术眼内灌注前,用Vitrector抽吸0.5mL玻璃体样品并稀释。样品转至冷藏室,存放在-70℃。IL-8和TNF-α的测量结果用酶联免疫吸附法以pg/mL为单位计算。结果:DR患者玻璃体样本中IL-8水平[82.7891±74.08700(0.08-307.09)pg/mL]明显高于对照组患者[2.9805±3.77546(0.08-18.53)pg/mL](P<0.001)。同样,DR患者TNF-α水平[18.0007±13.90015(2.32-51.11)pg/mL]也显着高于对照组[1.7005±1.26949(0.1-5.17)pg/mL](P<0.001)。结论:在视网膜新生血管形成中起重要作用的TNF-α和作为炎症和血管生成介体的IL-8水平在DR患者玻璃体样本中明显高。     

Striated intramural gallbladder lucencies on US studies: predictors of acute cholecystitis

Ultrasound scans of 51 consecutive patients with gallbladder wall thickening were reviewed, and specific sonographic features were correlated with surgical and clinical follow-up. Two patterns of thickening were identified as specific indicators of the presence or absence of acute cholecystitis. "Striated" wall thickening, consisting of several alternating, irregular, discontinuous, lucent and echogenic bands, was seen in eight of 13 patients (62%) with acute cholecystitis. This pattern was not encountered in any of the patients who did not have acute cholecystitis. Conversely, "three-layer" thickening, consisting of a single circumferential lucent zone between two relatively uniform echogenic layers, was seen in only one of 13 patients (8%) with acute cholecystitis but in 11 of 38 patients (29%) with other diagnoses. Other abnormalities, including the presence of intramural echogenic foci and wall irregularities, were more frequently seen in patients with acute cholecystitis but were not as helpful. Use of these features may suggest or help exclude a diagnosis of acute cholecystitis in those patients in whom the cause of gallbladder wall thickening is otherwise not apparent.