Case of a palatal tic resembling palatal tremor in a patient with Tourette syndrome.

We describe a case of a palatal tic resembling palatal tremor (PT) in a young female patient with a previously unrecognized mild Tourette syndrome. At the time of her visit, the patient complained about ear clicks that were audible to others. We discuss the differential diagnoses of hyperkinetic palatal movements emphasizing the ongoing discussion about essential PT representing a more heterogeneous disorder than previously thought.     

Touch-Screen Computerized Education for Patients with Brain Injuries

The use of computer technology for patient education has increased in recent years. This article describes a study that measures the attitudes and perceptions of healthcare professionals and laypeople regarding the effectiveness of a multimedia computer, the Brain Injury Resource Center? (BIRC), as an educational tool. The study focused on three major themes: (a) usefulness of the information presented, (b) effectiveness of the multimedia touch-screen computer methodology, and (c) the appropriate time for making this resource available. This prospective study, conducted in an acute care medical center, obtained healthcare professionals' evaluations using a written survey and responses from patients with brain injury and their families during interviews. The findings have yielded excellent ratings as to the ease of understanding and usefulness of the BIRC. By using sight, sound, and touch, such a multimedia learning center has the potential to simplify patient and family education.     

Efficacy of radiology of the esophagus for evaluation of dysphagia

The efficacy of radiology in evaluating dysphagia was studied in 86 patients by comparison to endoscopic findings. In the 66 patients with endoscopic abnormalities radiology was correct in 54, for a sensitivity of 82%. Sensitivity of radiology improved to 95% if mild esophagitis was excluded. In the 20 patients with normal endoscopy, radiology was normal in 18 (90%). Thus radiology proved to be a reliable means of evaluating the esophagus in patients with dysphagia.     

Cholecystokinin-peptides--new knowledge and possibilities for clinical use

This issue comprises selected topics of CCK peptides. CCK peptides are linear peptides and were found within and outside the CNS. There is growing evidence that CCK peptides play a physiological role in food intake, contraction of gallbladder and regulation of motility of the gastrointestinal system. New aspects of the CCK research are concentrated on interaction with other transmitter systems especially with the dopamine and opioid system. The therapeutic action to improve clinical symptoms in human is unclear up to new. World-wide, the interest is focused to determine the potential of CCK peptides as an antipsychotic agent by controlled clinical studies.     

Large colloid cyst in lateral ventricle simulating brain tumour

Summary This case report describes a patient presenting with symptoms of increased intracranial pressure, whose computerized tomographic (CT) scan was highly suggestive of a large low-grade glioma invading the basal ganglia. Magnetic resonance imaging (MRI) revealed a well-demarcated space-occupying mass of increased intensity in the left lateral ventricle and adjacent white matter. Following stereotactic biopsy, which yielded a homogeneous jelly-like material, the mass was removed microsurgically and was found to be most like a colloid cyst on histological examination. Discussion focusses on the clinical and differential diagnostic implications of this very unusual combination of findings.     

Genotype determining low catechol-O-methyltransferase activity as a risk factor for obsessive-compulsive disorder

In the present study, we address the role of the gene for catechol-O-methyltransferase (COMT), a key modulator of dopaminergic and noradrenergic neurotransmission, in the genetic predisposition to obsessive-compulsive disorder (OCD). We show that a common functional allele of this gene, which results in a 3- to 4-fold reduction in enzyme activity, is significantly associated in a recessive manner with susceptibility to OCD, particularly in males. This association is further supported by psychiatric evaluation of patients who carry microdeletions encompassing the comt gene. The mechanism underlying this sex-selective association remains to be defined and may include a sexual dimorphism in COMT activity, although close linkage with a nearby disease susceptibility locus cannot be excluded at this point.     

Dural sinus thrombosis: study using intermediate field strength MR imaging

The magnetic resonance (MR) images of six patients with thrombosis of a dural sinus were reviewed. The diagnosis had been verified by computed tomographic scans in three patients and arteriograms in two; in the sixth patient, only MR imaging was used to confirm the clinical syndrome. In all patients, high-intensity signal was seen from the thrombus within the affected dural sinus on all echoes. This persistent signal intensity allowed intravascular clot to be distinguished from normal causes of increased signal such as flow-related enhancement (entry phenomenon) and even-echo rephasing. MR imaging demonstrated the cause of the thrombosis in three patients: two were secondary to adjacent tumors, and one was secondary to unsuspected mastoiditis. Complications such as infarction were also demonstrated. Using MR imaging, one can easily and safely diagnose thrombosis of a dural sinus. MR should be the imaging method of choice in patients suspected of having thrombosis of a dural sinus.     

Endoscopically controlled erbium:YAG goniopuncture versus trabeculectomy: effect on intraocular pressure in combination with cataract surgery

PURPOSE:. To compare the efficacy of endoscopic erbium:YAG laser goniopuncture in glaucoma treatment to trabeculectomy, both methods as adjuncts to cataract surgery. METHODS:. Fifty-nine eyes of 59 glaucoma patients with coexistent cataract were treated by phacoemulsification and endoscopic Er:YAG goniopuncture in a combined fashion. The primary study endpoints were intraocular pressure (IOP), number of antiglaucomatous drugs, postoperative complications, hospitalisation time and visual acuity at 1 year after surgery. To date, 24 eyes have finished the 1-year follow-up. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by trabeculectomy and cataract surgery in a single procedure. RESULTS:. In the laser-treated group, the mean IOP dropped by 30% from 23.4+/-3.7 mmHg to 16.3+/-6 mmHg ( P<0.0001) after 12 months. Without reoperation, treatment was successful in 71% of these eyes. In the control group, the IOP decreased by 33.5% from 22.7+/-3.3 mmHg to 15.1+/-3.8 mmHg ( P<0.0001). The success rate without reoperation was 46%. The number of antiglaucomatous drugs needed decreased from 1.48+/-0.95 to 0.48+/-0.7 ( P<0.0001) in the laser-treated group and from 2.0+/-0.9 to 0.39+/-0.6 ( P<0.0001) in the control group. Postoperative complications were found more frequently in the control group ( P<0.0001). Hospitalisation was shorter in the laser group ( P<0.0001). Postoperative visual acuity was lower in the control group ( P=0.004). CONCLUSION:. Combined Er:YAG goniopuncture and cataract surgery lowers the IOP to an extent comparable to combined trabeculectomy and cataract surgery. Due to fewer postoperative complications, Er:YAG goniopuncture seems to be superior to standard fistulation surgery as the primary approach within the first year.