A technique for core biopsies of head and neck masses.

A technique for performing core biopsies of indeterminate masses of the extracranial head and neck is described. Four patients with suspicious masses of the extracranial head and neck underwent coaxial core biopsies through an 18-gauge Hawkins-Akins blunt tip needle. Three of the four patients had diagnostically adequate samples. There were no neurologic or vascular complications.     

Irradiated paragangliomas of the head and neck: CT and MR appearance.

PURPOSETo present the spectrum of CT and MR findings of glomus tumors of the head and neck successfully treated with radiation therapy.METHODSThe patient charts and all CT and MR studies of 24 patients (25 tumors) who had been successfully treated with radiation therapy were retrospectively reviewed. Eighteen patients had pre- and posttreatment imaging studies. Tumor size, internal morphology, enhancement pattern, visualization of flow voids, and bone erosion were evaluated before and after radiation therapy. Statistical evaluation of the presence of flows voids and tumor size was performed using the Fischer Exact Test.RESULTSAll patients had residual tumor after radiation therapy. Sixty-one percent of tumors demonstrated a reduction in size. Only one tumor with pretreatment bone destruction demonstrated healing of the bone. MR findings after radiation therapy included variable alteration in T2 signal, decreased heterogeneous enhancement, and a reduction in flow voids. There was a significant difference in the presence of flow voids based on tumor size.CONCLUSIONSSuccessfully irradiated paragangliomas demonstrate residual masses, the presence of which does not by itself indicate treatment failure. Stabilization or reduction in size, decreased enhancement, diminished flow voids, and reduced T2 signal after radiation therapy are a result of therapy and are indicative of local control. Persistent bone demineralization and erosion without progression is commonly seen in successfully controlled tumors. Paragangliomas are relatively homogeneous in internal morphology except for areas of flow void. Flow voids are not a reliable criterion for diagnosis in lesions less than 2.5 cm.     

Postcricoid region and cervical esophagus: normal appearance at CT and MR imaging

PURPOSE: To establish the normal variations of the postcricoid portion of the hypopharynx, esophageal verge, and cervical esophagus, as seen on computed tomographic (CT) and magnetic resonance (MR) images. MATERIALS AND METHODS: One hundred twenty-one CT and 92 MR images were reviewed. Diameter and wall thickness were measured at multiple levels. Depiction of the layers of the musculature and adjacent fat planes was evaluated. The frequency and size of the tracheoesophageal lymph nodes were noted. RESULTS: An esophageal anteroposterior diameter greater than 16 mm and lateral diameter greater than 24 mm were considered abnormal. The average wall thickness was 4.8 mm laterally and 3.8 mm posteriorly. Demonstration of the intramural fat planes of the postcricoid region decreased from the upper to the lower region of the cricoid cartilage. The ability to separate the esophageal wall from the trachea was highest at the esophageal verge and declined markedly more distally. The tracheo-esophageal groove nodes were seen more often on the right (mean size [+/- SD], 4.5 mm +/- 2.2). CONCLUSION: Knowledge of the normal appearance and variations of the post-cricoid region and cervical esophagus is essential in detecting abnormalities in these areas.     

Cervical length at 16-22 weeks' gestation and risk for preterm delivery

OBJECTIVE: To determine whether cervical length, as measured by transvaginal sonogram in asymptomatic gravidas at 16-22 weeks, is associated with risk of spontaneous preterm delivery. METHODS: In a prospective observational study in an unselected urban tertiary care population, cervical length was measured by transvaginal ultrasound during routine anatomic surveys in 760 gravidas at 16 0/7 to 22 6/7 weeks. The predictor variable was cervical length and the outcome variable was gestational age at delivery. Care providers were not masked to the results. Spontaneous preterm delivery was analyzed as before 37, 35, and 32 weeks. Shortened cervical length was defined by the tenth, fifth, and two and a half percentiles for our population. Yates-corrected chi(2) was used to evaluate the significance on univariate analysis of the relative risk (RR) and 95% confidence intervals (CI). Multiple logistic regression analysis was used to control for background variables in evaluating the probability of preterm delivery at less than 35 weeks. Sensitivity, specificity, positive and negative predictive values also were calculated. RESULTS: Cervical lengths were normally distributed (mean 38.5 +/- 8.0 mm at 19.9 +/- 1.5 weeks) independent of gestational age at measurement, and the tenth, fifth, and two and a half percentiles were 30, 27, and 22 mm, respectively. Eighty-five women delivered before 37 weeks, 51 before 35 weeks, and 27 before 32 weeks. Relative risks (95% CI) for spontaneous preterm delivery before 37 weeks were 3.8 (2.6, 5.6), 5.4 (3.3, 9.0), and 6.3 (3.0, 13.0) for the tenth, fifth, and two and a half percentiles, respectively; RRs for before 35 weeks were 4.5 (2.9, 6.9), 7.5 (4.5, 12.5), and 7.8 (3.6, 16.7); and for before 32 weeks were 5.2 (3.3, 8.3), 9.7 (5.8, 16.1), and 8.4 (3.6, 19.9), respectively. Multiple logistic regression analysis confirmed that cervical length was a significant predictor of preterm birth before 35 weeks, and that paras had a 43% greater risk compared with nulliparas. Sensitivity ranged from 13-44%, specificity 90-99%, positive predictive value 15-47%, and negative predictive value 80-98%. CONCLUSION: Transvaginal measurement of cervical length during routine ultrasound at 16-22 weeks' gestation in asymptomatic gravidas might help identify women at risk for spontaneous preterm delivery.     

Specificity of disgust vulnerability in the distinction and treatment of OCD

A growing body of research has implicated disgust as a potential risk factor for the development and maintenance of obsessive-compulsive disorder (OCD). The first aim of the present study was to determine whether related, yet distinct, disgust vulnerabilities are endorsed more strongly by individuals with OCD than by those with another anxiety disorder. The second aim was to examine the unique contributions of changes in disgust to symptom improvement observed with exposure-based treatment for OCD. In study 1, individuals with OCD, generalized anxiety disorder (GAD), and nonclinical controls (NCCs) completed a measure of disgust propensity and disgust sensitivity. Compared to NCCs and individuals with GAD, those with OCD more strongly endorsed disgust propensity. However, individuals with OCD did not significantly differ from individuals with GAD in disgust sensitivity, although both groups reported significantly higher disgust sensitivity levels compared to NCCs. Study 2 comprised mediation analyses of symptom improvement among individuals with OCD and revealed that decreases in disgust propensity over time mediated improvement in OCD symptoms, even after controlling for improvements in negative affect. The implications of these findings for conceptualizing the role of disgust in the nature and treatment of OCD are discussed.