Neuroimaging in Pineal Tumors

BACKGROUND AND PURPOSE: The authors report radiological findings in 11 tumors in the pineal region, which were histologically diagnosed as germinomas, pineocytomas pineoblastomas, ependymomas, teratomas, and astrocytomas. METHODS: Computed tomography (CT) was performed in seven patients and magnetic resonance imaging (MRI) was performed in all patients. RESULTS: CT showed a solid or solid/cystic mass with variable contrast enhancement. MRI showed a heterogeneous mass, with hypointense signal on T1 and iso/hyperintense signal on T2-weighted images (WI) and gadolinium enhancement. Extension to adjacent structures occurred in five patients and spread through the cerebral spinal fluid (CSF) in two. CONCLUSIONS: Pineal region tumors have no pathognomonic imaging pattern. MRI and CT are complementary in diagnosis and are important to determine localization, extension, and meningeal spread.     

Deep venous thrombosis: rate of spontaneous lysis and thrombus extension.

AIM: Although recanalization occurs after an episode of venous thrombosis, the exact timing for this process, the rate of clearing at the different venous segments and the nature of the mechanisms involved and their progression are not well known. Recognition of these competing events is important in understanding the natural history and the mechanisms responsible for lysis of the thrombus and for the development of the post-thrombotic syndrome METHODS: During the course of 5 consecutive years, 110 patients (126 legs) with deep vein thrombosis (DVT) were prospectively followed using ultrasonic duplex. Follow-up studies were performed at intervals of 1 and 7 days, 1 month, every 3 months for the 1(st) year, and yearly thereafter. Mean duration of follow-up was 329 days. RESULTS: When only legs with initial complete occlusion are considered, the prevalence of occlusion progressively decreases to 33% after 6 months, 17% after the 1(st) year, and 0% after 3 years. Recanalization of individual segments occurred even more rapidly. After 3 months, recanalization of completely occluded segments was present in 93% of common femoral veins, 79% of superficial femoral veins (proximal segment), 84% of popliteal veins, and 72% of posterior tibial veins. The rate of recanalization was highest for multisegmental disease. Propagation of thrombi to adjacent venous segments occurred in 15% of the limbs. Propagation was usually limited to 1 or 2 adjacent segments. CONCLUSION: Lysis occurred early and was progressive. After 1 year most legs have recanalized. After 3 years recanalization occurred in all legs although residual thrombosis (partial obstruction) was still present in 50% of the limbs. Propagation of the thrombus was a limited process.     

Quantification of bone healing. Comparison of QCT, SPA, MRI, and DEXA in dog osteotomies

Four noninvasive imaging modalities were used to quantitatively evaluate and compare tibial osteotomy healing in dogs. Quantitative computed tomography (QCT), magnetic resonance imaging (MRI), single-photon absorptiometry (SPA), and dual-energy x-ray absorptiometry (DEXA) were the four techniques examined. Bilateral tibial osteotomies were performed in 32 dogs divided into four groups. The osteotomies were stabilized with a 2-mm gap using unilateral external skeletal fixation. Dogs were anesthetized, imaged with the four noninvasive techniques, and killed at 2-12 weeks. Invasive techniques were used to determine: 1) the torsional properties of the bone; and 2) the local stiffness properties and calcium content within the bone. The techniques which had the strongest associations with the torsional properties of the osteotomies were QCT, SPA and DEXA. Generally, QCT and SPA had marginally stronger correlations than DEXA; but, overall, there were no differences between the techniques. MRI had the poorest associations with the torsional properties of the osteotomies. Generally, QCT had the strongest correlations with local material properties, such as indentation stiffness and calcium content. SPA had the second strongest correlations with calcium content and had the third strongest correlations with indentation stiffness behind DEXA. DEXA had the third strongest correlations for calcium content. With the exception of some of the correlations with indentation stiffness, MRI had the poorest associations with the local parameters studied.     

At-risk persons' attitudes toward presymptomatic and prenatal testing of Huntington disease in Michigan

One hundred fifty-five individuals at 50% risk of inheriting Huntington disease (HD) were given a questionnaire surveying their sociodemographic characteristics, experience with HD, and attitudes toward presymptomatic and prenatal testing in HD. About two-thirds (63.2%) of the persons indicated they would take a presymptomatic test even if no specific treatment was available. Although one-half (49%) of the respondents stated they would make use of a prenatal test, only 43% of these individuals would decide to terminate a heterozygous fetus. Presymptomatic test results indicating carrier status would influence some of the respondents' decisions about marriage and childbearing. This strong interest of at-risk persons to make use of both presymptomatic and prenatal diagnosis in HD indicates the need for well-organized testing programs. These programs must be designed to address the genetic, psychosocial, and ethical issues that may arise in the use of this type of genetic test.     

Is the outcome of in-vitro fertilization and embryo transfer treatment improved by spontaneous or surgical drainage of a hydrosalpinx?

A pilot study was designed to examine whether the outcome of embryo transfer in women with a hydrosalpinx might be improved by surgical drainage of the hydrosalpinx at the time of oocyte collection for in- vitro fertilization treatment. A comparative, controlled but retrospective analysis of the results was performed of all women with infective tubal damage aged <40 years old, who had ovulatory cycles, a normal uterus and a partner with normal spermatozoa. A standardized treatment regimen was used. A maximum of three embryos were transferred. Hydrosalpinx was defined by prior hysterosalpingography and/or laparoscopy with transcervical dye injection. A total of 237 embryo transfer cycles in women with hydrosalpinges (tubal distension not visible in 151, visible but not drained in 30 and drained in 56) were compared with 705 embryo transfer cycles in women with tubal disease but no hydrosalpinx. Results were analysed in the first three cycles but also separately in the first cycle to check for bias. Success rates were higher in the first cycle, but did not significantly influence overall differences. Implantation rates were significantly reduced overall in the hydrosalpinx group (8.0 versus 13.2% for controls; P < 0.001), being 8.3% (P < 0.01) in the subgroup without evident tubal distension and 7.5% (not significant) in the drained hydrosalpinx group. This study shows that tubal damage with distal occlusion is associated with a marked reduction in embryo implantation, even in the absence of obvious fluid distension. Surgical drainage of distended hydrosalpinges appears to offer no benefit.      

住院精神分裂症患者十年前后用药情况对比分析

目的对十年前后精神分裂症患者用药情况的变化进行调查分析.方法对十年前后两个五年段的各500份符合精神分裂症诊断标准的病历进行回顾性调查,并对各项指标进行对比分析.结果两组折算用药剂量经t检验差异无显著性(P>0.05);两组合并用药、合并抗胆碱药及疗效经χ2检验差异有显著性(P<0.01);十年后非典型抗精神病药物氯氮平在临床上的应用比例明显增大并上升为首位.结论十年前后两组抗精神病药的应用发生了明显变化,疗效好、副作用轻的非典型抗精神病药的应用比例明显增加.     

Left ventricular pseudoaneurysm after mitral valve replacement

Development of left ventricular pseudoaneurysm is a rare complication of mitral valve surgery and requires urgent surgical intervention. We describe a case of pseudoaneurysm of membranous septum following repeat mitral valve replacement with the use of multimodality imaging.