Tumor invasion of the anterior skull base: a comparison of MR and CT studies

Seven patients who had tumors arising in the anterior face or paranasal sinuses and invasion of the anterior skull base were evaluated with magnetic resonance (MR) and high resolution CT. Magnetic resonance was superior in evaluating tumor encasement of the carotid artery and invasion of the cavernous sinus; for assessing the relationship of the tumor to the anterior brain, optic nerves, and optic chiasm; in providing coronal images free from dental artifact; and in determining tumor extent within the infratemporal fossa. Bone destruction was more easily observed on CT than MR.     

Patients and families desire a patient to be told the diagnosis of dementia: a survey by questionnaire on a Dutch memory clinic

BACKGROUND: Controversy exists as to whether dementia patients should be told their diagnosis. OBJECTIVE: This study examined as to whether, both patients with subdued memory impairment and their accompanying relatives want a diagnosis of dementia or somatic disease disclosed to the referred patient. METHOD: Fifty consecutive out-patients referred to a memory clinic and their accompanying relatives filled in a questionnaire regarding their views on telling the diagnosis to the patient in case of a somatic disease and in case of a dementia. An ordinal scoring system was used (not important 1; little important 2; important 3 and very important 4). RESULTS: Forty-six (92%) questionnaires were completed. All the patients and their accompanying relatives thought it was at least important that physicians should tell the patient their diagnosis in case of a somatic disease, and 96% of the patients, 100% of the spouse and 94% of the non-spouse accompanying relatives stated the same in case of a dementia. All the spouses and most of the accompanying relatives showed similar desires for a dementia or somatic diagnosis. CONCLUSION: In The Netherlands, out-patients with subdued memory impairment, mostly suffering from a dementing illness, wish to be informed of their diagnosis, therefore should not automatically be considered incompetent.     

Acute bilateral diffuse pulmonary shadowing after evacuation of hydatid mole

Acute bilateral diffuse pulmonary shadowing complicates the resection of hydatid mole approximately 10% of the time. Etiologic factors include trophoblastic emboli, pulmonary emboli, high output congestive failure, and DIC. Prompt recognition and emergency oxygen therapy with PEEP are imperative for survival.     

Ultrasonic evaluation of therapeutic response in tumors: Its value and implications

Not only may ultrasound demonstrate the presence of a tumor mass at various sites in the abdomen, but it may also be useful in measuring the size of the mass. The rate of tumor growth or regression was followed by ultrasound in 28 patients with ovarian carcinoma undergoing chemotherapy. The ability of ultrasound to make precise measurements of tumor size is discussed, and the value of these measurements is explored. This quantification may be valuable in the assessment of therapeutic response in pelvic cancer, and the technique may be applicable to other intra-abdominal mass lesions.     

The variable nature of the mediastinal contour lines: CT/chest radiography correlation

Interfacing of the lung with the mediastinum produces a number of mediastinal lines including those due to the innominate veins, left subclavian artery, paratracheal stripe, both anterior and posterior junction lines, the azygo-esophageal recess, descending aorta and paraspinal lines. Displacement or absence of one or more of these lines may be due to an abnormality of mediastinal contour or may indicate a mediastinal mass, but can occur in normal subjects. Correlative findings between chest radiography and chest computed tomography in 50 normal subjects illustrate the variable nature of these lines.     

Energy failure in multiple sclerosis and its investigation using MR techniques

Energy failure is an emerging concept in multiple sclerosis research. Pathological studies have indicated that axonal modifications in response to demyelination may increase neuronal energy demand. At the same time, soluble mediators of inflammation may impair mitochondrial function, and brain perfusion may also be decreased. Insufficient energy production for demand can lead to intracellular sodium accumulation, calcium influx and cell death. Magnetic resonance (MR) is a promising technique to investigate these pathology driven hypotheses in vivo. MR spectroscopy can inform on mitochondrial function with measures of N acetyl aspartate (NAA), and requirement for extra-mitochondrial glycolysis via measurement of lactate. MR measurement of phosphorous (³¹P) and sodium (²³Na) allows direct assessment of energy availability and axonal sodium handling. MR techniques for imaging perfusion can quantify oxygen delivery and nascent MR techniques that exploit the paramagnetism of deoxyhaemaglobin may be able to quantify oxygen utilization. This report reviews the physical principles underlying these techniques, their implementation for human in vivo imaging, and their application in neurological conditions with an emphasis on multiple sclerosis. Combination of these techniques to obtain a comprehensive picture of oxygen delivery, energy production and utilization may provide new insights into the pathophysiology of multiple sclerosis and may provide outcome measures for trials of novel treatments.     

Cerebral arterial bolus arrival time is prolonged in multiple sclerosis and associated with disability

Alterations in the overall cerebral hemodynamics have been reported in multiple sclerosis (MS); however, their cause and significance is unknown. While potential venous causes have been examined, arterial causes have not. In this study, a multiple delay time arterial spin labeling magnetic resonance imaging sequence at 3T was used to quantify the arterial hemodynamic parameter bolus arrival time (BAT) and cerebral blood flow (CBF) in normal-appearing white matter (NAWM) and deep gray matter in 33 controls and 35 patients with relapsing–remitting MS. Bolus arrival time was prolonged in MS in NAWM (1.0±0.2 versus 0.9±0.2 seconds, P=0.031) and deep gray matter (0.90±0.18 versus 0.80±0.14 seconds, P=0.001) and CBF was increased in NAWM (14±4 versus 10±2 mL/100 g/min, P=0.001). Prolonged BAT in NAWM (P=0.042) and deep gray matter (P=0.01) were associated with higher expanded disability status score. This study demonstrates alteration in cerebral arterial hemodynamics in MS. One possible cause may be widespread inflammation. Bolus arrival time was longer in patients with greater disability independent of atrophy and T₂ lesion load, suggesting alterations in cerebral arterial hemodynamics may be a marker of clinically relevant pathology.     

Epidemiology of animal trypanosomiasis on a cattle ranch in Kilifi, Kenya

A study of the epidemiology of animal trypanosomiasis was carried out on a 2500 ha cattle ranch, with a history of trypanosomiasis, in the Coast Province of Kenya in 1982. The tsetse survey on the ranch revealed one breeding focus of Glossina austeni in a thicket of approximately 50 ha. Trypanosomes were detected in 20% of the 46 dissected tsetse. During the study period of 9 months, 0.8% of the 3315 samples collected from 2300 Ayrshire X Sahiwal crossbred cattle were found infected with trypanosomes; 32% of 5909 samples collected from the same cattle had a packed cell volume (PCV) of 30% or less. Animals with a PCV of 30% or less were treated with a trypanocide (Berenil, Ethidium or Novidium). Antibody to trypanosomes was detected in 22.1% of the 343 sera collected from the cattle. A sentinel herd of 20 cattle was exposed for 182 days inside the tsetse infested thicket. All animals became infected with Trypanosoma congolense, on average after 53 days; they were subsequently treated with Berenil (6 mg/kg). A second, third and fourth T. congolense infection was diagnosed in 17, 11 and 1 animals, respectively. The cattle were treated similarly with Berenil after each of these infections. T. vivax and T. brucei were not diagnosed in the sentinel cattle. The results suggest that acquired immunity to T. congolense infection did not play a significant role in the sentinel cattle.