Association Between Diaphragmatic Paralysis and Ipsilateral Cervical Spondylosis on MRI

Lung - Diaphragmatic paralysis (DP) is an important cause of dyspnea with many underlying etiologies; however, frequently no cause is identified despite extensive investigation. We hypothesized...     

Pathology of colposcopic findings in 2635 diethylstilbestrol-exposed young women

An analysis of 6055 colposcopically directed biopsy specimens from 2635 diethylstilbestrol (DES)-exposed women and 445 biopsy specimens from 277 nonexposed women was undertaken to correlate microscopic findings with colposcopic patterns. All examinations were performed using a standardized protocol which required that each participant have colposcopy, cytologic smears, and biopsy of abnormal colposcopic lesions. The findings of colposcopic "columnar epithelium, gland openings, and Nabothian cysts" correlated most often with glandular epithelium in the biopsy specimen. "White epithelium," which includes three related colposcopic patterns, mosaicism, punctation, and white epithelium, was associated most frequently (82-93% of cases) with squamous metaplasia, but occasionally with dysplasia and carcinoma in situ (CIS)(0-6%). The presence of dysplasia or CIS in any individual biopsy specimen occurred most frequently with the observation of higher graded lesions by colposcopy or a prior diagnosis of dysplasia.     

Carcinoid tumor metastases to the extraocular muscles: MR imaging and CT findings and review of the literature

Although a relatively rare neoplasm, primary carcinoid tumor has an unusual propensity to metastasize to the orbits. Within the orbit, metastatic EOM lesions have been described in scattered reports in the ophthalmology literature but have received little to no attention in the radiology literature. After a retrospective review, we identified CT and MR imaging studies of 7 patients with carcinoid tumor metastatic to the EOM. Our findings suggest that in patients with known carcinoid tumor, well-defined, round, or fusiform masses of the EOM should strongly suggest metastatic involvement. Our series suggests that bilateral lesions may occur and that any EOM can be involved. Knowledge of this pattern of metastatic disease may spare biopsies in some patients, and with current orbit-sparing therapy for patients with localized orbital disease, early and accurate diagnosis can significantly improve patient outcomes.     

Protrusion of the Infraorbital Nerve into the Maxillary Sinus on CT: Prevalence,Proposed Grading Method,and Suggested Clinical Implications

BACKGROUND AND PURPOSE:The infraorbital nerve arises from the maxillary branch of the trigeminal nerve and normally traverses the orbital floor in the infraorbital canal. Sometimes, however, the infraorbital canal protrudes into the maxillary sinus separate from the orbital floor. We systematically studied the prevalence of this variant.MATERIALS AND METHODS:We performed a retrospective review of 500 consecutive sinus CTs performed at our outpatient centers. The infraorbital nerve protruded into the maxillary sinus if the entire wall of the infraorbital canal was separate from the walls of the sinus. We recorded the length of the bony septum that attached the infraorbital canal to the wall of the maxillary sinus and noted whether the protrusion was bilateral. We also measured the distance from the inferior orbital rim where the infraorbital canal begins to protrude into the sinus.RESULTS:There was a prevalence of 10.8% for infraorbital canal protrusion into the maxillary sinus and 5.6% for bilateral protrusion. The median length of the bony septum attaching the infraorbital canal to a maxillary sinus wall, which was invariably present, was 4 mm. The median distance at which the infraorbital nerve began to protrude into the sinus was 11 mm posterior to the inferior orbital rim.CONCLUSIONS:Although this condition has been reported in only 3 patients previously, infraorbital canal protrusion into the maxillary sinus was present in >10% of our cohort. Identification of this variant on CT could help a surgeon avoid patient injury.

CT of the paranasal sinuses is an important diagnostic technique in the work-up of patients with known or suspected disease of the nasal cavity and paranasal sinuses. CT gives the surgeon a roadmap for surgery and alerts the surgeon to the presence of potentially clinically relevant anatomic variants. Many sinonasal variants are important to identify since their presence may increase the risk of surgical error.¹ With the advent of endoscopic techniques, surgery of the paranasal sinuses has expanded to involve complex procedures that were once reserved for open approaches. Thus, it is extremely important to identify such variations from the normal sinus anatomy, especially in patients who are likely to require extended endoscopic sinus surgery for etiologies such as inverted papilloma, mucocele, trauma, or malignant tumor.The infraorbital nerve is the distal portion of the maxillary nerve (V2), which originates as the second division of the trigeminal nerve (fifth cranial nerve). After the maxillary nerve traverses the foramen rotundum, it enters the pterygopalatine fossa and gives off nasal and palatine branches before exiting through the inferior orbital fissure and terminating as the infraorbital nerve (ION). The ION then enters the infraorbital canal (IOC) through the infraorbital groove. The IOC is a bony canal typically within the orbital process of the maxilla, synonymous with the floor of the orbit. The ION exits the IOC through the infraorbital foramen of the anterior maxilla. Variably, the IOC can protrude into the maxillary sinus separate from the floor of the orbit. This may leave the ION susceptible to injury during endoscopic or open sinus surgery. To date, just 3 case reports exist in the literature describing this variant,^2,3 with no large studies describing the frequency with which it occurs. The aim of this study was to establish the prevalence of infraorbital nerve protrusion into the maxillary sinus and define its common characteristics. This variation is of clinical importance in sinus surgery, and we suggest an accompanying grading scale to relay the degree of protrusion to the surgeon.     

MR Myelography for Identification of Spinal CSF Leak in Spontaneous Intracranial Hypotension

BACKGROUND AND PURPOSE:CT myelography has historically been the test of choice for localization of CSF fistula in patients with spontaneous intracranial hypotension. This study evaluates the additional benefits of intrathecal gadolinium MR myelography in the detection of CSF leak.MATERIALS AND METHODS:We performed a retrospective review of patients with spontaneous intracranial hypotension who underwent CT myelography followed by intrathecal gadolinium MR myelography. All patients received intrathecal iodine and off-label gadolinium-based contrast followed by immediate CT myelography and subsequent intrathecal gadolinium MR myelography with multiplanar T1 fat-suppressed sequences. CT myelography and intrathecal gadolinium MR myelography images were reviewed by an experienced neuroradiologist to determine the presence of CSF leak. Patient records were reviewed for demographic data and adverse events following the procedure.RESULTS:Twenty-four patients met both imaging and clinical criteria for spontaneous intracranial hypotension and underwent CT myelography followed by intrathecal gadolinium MR myelography. In 3/24 patients (13%), a CSF leak was demonstrated on both CT myelography and intrathecal gadolinium MR myelography, and in 9/24 patients (38%), a CSF leak was seen on intrathecal gadolinium MR myelography (P = .011). Four of 6 leaks identified independently by intrathecal gadolinium MR myelography related to meningeal diverticula. CT myelography did not identify any leaks independently. There were no reported adverse events.CONCLUSIONS:Present data demonstrate a higher rate of leak detection with intrathecal gadolinium MR myelography when investigating CSF leaks in our cohort of patients with spontaneous intracranial hypotension. Although intrathecal gadolinium is an FDA off-label use, all patients tolerated the medication without evidence of complications. Our data suggest that intrathecal gadolinium MR myelography is a well-tolerated examination with significant benefit in the evaluation of CSF leak, particularly for patients with leak related to meningeal diverticula.

Spontaneous intracranial hypotension (SIH) is a debilitating condition with protean symptoms, which is often misdiagnosed at initial presentation.^1,2 The most common cause of SIH is a spinal CSF leak. Patients often have an underlying connective tissue disorders, though underproduction or increased absorption of CSF, dural elasticity, and minor trauma, including disk herniation, may all be contributing factors.^3,4 A reduction in CSF volume leads to compensatory dilation of venous structures in the brain, which may result in headache and subdural collections via meningeal traction.^5,6 Severe untreated cases of SIH can lead to coma and stroke.⁷CT myelography (CTM) has historically been considered the study of choice for the detection and localization of CSF leak, though a criterion standard test is difficult to establish, given the varied etiologies for SIH.⁸ Recent literature has questioned whether CTM is the most sensitive technique for the detection and localization of CSF leaks.^9,10 More recent techniques have been described, including dynamic CTM, digital subtraction myelography, heavily T2-weighted spinal MR imaging, and intrathecal gadolinium MR myelography (MRM). Both dynamic CT and digital subtraction myelography have been advocated in cases with significant spinal extra-arachnoid fluid collections on preprocedural spinal MR imaging.¹¹ MRM with intrathecal gadolinium has been shown to have a high rate of leak detection and appears safe in small doses used for myelography.¹²The mainstay of treatment for SIH is autologous epidural blood patch, initially effective in about one-third of patients.¹³ Directed epidural blood patch at the site of CSF fistula with CT guidance has been shown to be effective.¹⁴ Targeted therapy may improve clinical outcomes with evidence of benefit when the blood patch is performed as close as possible to the site of CSF fistula.¹³ Therefore, diagnostic techniques that precisely localize a CSF leak are important for guiding therapy, particularly for treatments such as fibrin glue injection and surgical repair.²Our study evaluates the relative benefit of intrathecal gadolinium MRM compared with CTM in detecting and localizing CSF leaks in patients with previously confounding diagnostic work-up to guide treatment in patients with SIH.     

Interleukin 7 is a T-cell growth factor.

Interleukin 7 (IL-7) is a 25-kDa cytokine which was purified and its corresponding cDNA was cloned based upon its ability to stimulate the proliferation of pre-B cells. It has been shown that IL-7 can also function as a costimulator with Con A for the proliferation of T lymphocytes by inducing the production of interleukin 2 (IL-2). We demonstrate here that IL-7 in combination with phorbol 12-myristate 13-acetate can directly drive the proliferation of purified T cells and that this response is not inhibited by cyclosporine A or by antibodies to IL-2 and IL-4. Stimulation of T cells with phorbol myristate acetate and IL-2, IL-4, or IL-7 prepared T cells to respond to any of the three lymphokines. Although T cells activated in vitro by anti-CD3 or allogeneic cells failed to proliferate when challenged with IL-7, T cells primed in vivo to the same stimuli demonstrated a significant proliferative response when restimulated in vitro with IL-7. IL-7 can, therefore, function both as a growth factor for T cells in an IL-2-independent manner and as a competence factor for the induction of lymphokine responsiveness. The ability to induce IL-7 responsiveness via stimulation of the T-cell receptor complex in vivo, but not in vitro, raises the possibility that IL-7 may play a role in T-cell growth and differentiation in vivo.     

Treatment of otitis media caused by Hemophilus influenzae: evaluation of three antimicrobial regimens.

Ninety young children with otitis media, proven by tympanocentesis culture to be due to Hemophilus influenzae, were treated in a prospective double-blind study with one of three antimicrobial regimens: ampicillin, erythromycin ethylsuccinate, or erythromycin ethylsuccinate with concomitant trisulfapyrimidines. Results of efficacy evaluation indicated that the combination was as effective as ampicillin and statistically superior to erythromycine alone. Of the strains of H influenzae identified, 15/9 were typable with 12/9, type b. In vitro sensitivity tests indicated that the strains were sensitive to the amtimicrobials studied in clinically attainable levels; however, comparison of individual efficacy ratings with sensitivity results indicated that some children in each treatment group failed to respond as predicted.     

In vitro photosensitization of tumour cell enzymes by photofrin II administered in vivo

The ability of injected Photofrin II, a preparation enriched in hydrophobic dihaematoporphyrin ethers and esters, to photosensitize selected mitochondrial and cytosolic enzymes during illumination in vitro was examined. Preparations of R3230AC mammary tumours, obtained at designated times after a single dose of Photofrin II, displayed a time-dependent photosensitivity. Maximum inhibition of mitochondrial enzymes occurred at 24 hours post-treatment, whereas no inhibition of the cytosolic enzyme, pyruvate kinase, was observed over the 168 hour time course. At the selected 24 hour time point, mitochondrial enzyme photosensitisation was found to be drug dose (5.25 mg kg-1 Photofrin II) and light dose dependent, the rank order of inhibition being cytochrome c oxidase greater than F0F1 ATPase greater than succinate dehydrogenase greater than NADH dehydrogenase. We conclude that porphyrin species contained in Photofrin II accumulate in mitochondria of tumour cells in vivo and produce maximum photosensitisation at 24-72 hours after administration to tumour-bearing animals. The time course observed here with Photofrin II is similar to that seen previously with the more heterogenous haematoporphyrin derivative preparation in this in vivo-in vitro model.