Renovascular hypertension accounts for 51–52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal va...
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Publication date: Available online 28 December 2015
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Alpaslan Akbas, Murat Tolga Gulpınar, Eyüp Burak Sancak, Mustafa Gunes, Murat Ucar, Muammer Altok, Mehmet Umul
The prognostic importance of platelet–lymphocyte ratio (PLR) is already known for various artery diseases. In this study, the relationship between PLR and severity of erectile dysfunction (ED) is examined in patients with impotence. The data from patients suffering from erection problems was screened retrospectively. Detailed medical history, age, International Index of Erectile Function-5 (IIEF-5) scores, fasting blood glucose, lipid, whole blood count, and hormone profile values were examined. Patients with no ED were selected as the control group. All men answered the IIEF-5 questions and were then classified according to their scores. Patients were determined to have severe ED (scores 5–7), moderate ED (scores 8–16), or mild ED (scores 17–21). An IIEF-5 score greater than 21 was accepted for the control group. The PLR values from both patient and control groups were evaluated. Demographic data were similar in both groups. Mean PLR value was 104 in control and 118 in the patient group (p < 0.001). PLR value increased depending on the severity of ED. Mean PLR values were 108 in mild, 116 in moderate, and 130 in severe ED groups. Compared with the control group, this value was statistically significant for patients with moderate and severe ED (p = 0.04 and p < 0.001). PLR showed weak negative but significant correlation with IIEF-5 scores (r = −0.27 and p < 0.001). The PLR value was found to be higher in patients with ED. PLR value may be related to ED and its severity in patients with impotence.
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Renovascular hypertension accounts for 51–52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal va...
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Publication date: Available online 28 December 2015
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Alpaslan Akbas, Murat Tolga Gulpınar, Eyüp Burak Sancak, Mustafa Gunes, Murat Ucar, Muammer Altok, Mehmet Umul
The prognostic importance of platelet–lymphocyte ratio (PLR) is already known for various artery diseases. In this study, the relationship between PLR and severity of erectile dysfunction (ED) is examined in patients with impotence. The data from patients suffering from erection problems was screened retrospectively. Detailed medical history, age, International Index of Erectile Function-5 (IIEF-5) scores, fasting blood glucose, lipid, whole blood count, and hormone profile values were examined. Patients with no ED were selected as the control group. All men answered the IIEF-5 questions and were then classified according to their scores. Patients were determined to have severe ED (scores 5–7), moderate ED (scores 8–16), or mild ED (scores 17–21). An IIEF-5 score greater than 21 was accepted for the control group. The PLR values from both patient and control groups were evaluated. Demographic data were similar in both groups. Mean PLR value was 104 in control and 118 in the patient group (p < 0.001). PLR value increased depending on the severity of ED. Mean PLR values were 108 in mild, 116 in moderate, and 130 in severe ED groups. Compared with the control group, this value was statistically significant for patients with moderate and severe ED (p = 0.04 and p < 0.001). PLR showed weak negative but significant correlation with IIEF-5 scores (r = −0.27 and p < 0.001). The PLR value was found to be higher in patients with ED. PLR value may be related to ED and its severity in patients with impotence.
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Vol. 110 / No. 4 / Pages 670-674
CASE REPORT
Case report
1Division of Neurological Surgery; and 2Department of Pathology, Division of Neuropathology, University of Texas Medical Branch, Galveston, Texas
Abbreviations used in this paper: GTR = gross-total resection; IAM = internal auditory meatus.
Address correspondence to: Jaime Gasco, M.D., Division of Neurological Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0517. email: jagascot @utmb.edu.
DOI: 10.3171/2008.8.17645.
By Keywords:angioleiomyoma,angiomyoma, cerebellar tumor,smooth muscle tumor, vascular leiomyoma
Angioleiomyomas are benign neoplasms most often located in the subcutaneous tissue of middle-aged individuals and usually confined to the subcuticular and deep dermal layers of the lower extremities. An intracranial site for this tumor is exceedingly rare, with very few reports documenting locations in the neuraxis. To the authors' knowledge the present case represents the first reported instance of an infratentorial angioleiomyoma. The authors conducted a review of selected English-language papers published since 1960 describing well-documented cases of intracranial vascular leiomyomas, with detailed information on the clinical presentation, radiology, pathology, and particulars of surgical management in each case.
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Publication date: Available online 2 January 2016
Source:World Neurosurgery
Author(s): Richard W. Williamson, Robert F. Spetzler
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Publication date: Available online 2 January 2016
Source:World Neurosurgery
Author(s): Saad Akhtar Khan, Muhammad Waqas, Badar Uddin Ujjan, Adnan Salim, Gohar Javed, Syed Ijlal Ahmed, Malikah Surani, Marium Khan
BackgroundNeuro-rehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing is frequently unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by professional nurse.MethodsThis was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of two groups. Group 1 (consisted of patients cared for by professional nurse) included 94 patients and group 2(patients cared for by family members) included 102. All these patients had Activity of daily living (ADL) score of ≥ 3. Glasgow Outcomes Scale (GOS), time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow up.ResultsThe study included 196 patients. Traumatic Brain Injury was the most common diagnosis. Nursing requirements were similar between the two groups and included tracheostomy care, PEG tube care, PICC line care, care of patients with no bone flap and logrolling. The outcomes of the two groups were comparable and included bedsore development/ worsening of grade, GOS at follow-up, time to decannulation and 30-day mortality.ConclusionsThere was no statistically significant difference in outcomes of patients nursed by family members when compared to the patients looked after by professional nurses.
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Cavernous Angiomyoma of the Internal Auditory Canal
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Vol. 110 / No. 4 / Pages 670-674
CASE REPORT
Case report
1Division of Neurological Surgery; and 2Department of Pathology, Division of Neuropathology, University of Texas Medical Branch, Galveston, Texas
Abbreviations used in this paper: GTR = gross-total resection; IAM = internal auditory meatus.
Address correspondence to: Jaime Gasco, M.D., Division of Neurological Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0517. email: jagascot @utmb.edu.
DOI: 10.3171/2008.8.17645.
By Keywords:angioleiomyoma,angiomyoma, cerebellar tumor,smooth muscle tumor, vascular leiomyoma
Angioleiomyomas are benign neoplasms most often located in the subcutaneous tissue of middle-aged individuals and usually confined to the subcuticular and deep dermal layers of the lower extremities. An intracranial site for this tumor is exceedingly rare, with very few reports documenting locations in the neuraxis. To the authors' knowledge the present case represents the first reported instance of an infratentorial angioleiomyoma. The authors conducted a review of selected English-language papers published since 1960 describing well-documented cases of intracranial vascular leiomyomas, with detailed information on the clinical presentation, radiology, pathology, and particulars of surgical management in each case.
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Publication date: Available online 2 January 2016
Source:World Neurosurgery
Author(s): Richard W. Williamson, Robert F. Spetzler
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Publication date: Available online 2 January 2016
Source:World Neurosurgery
Author(s): Saad Akhtar Khan, Muhammad Waqas, Badar Uddin Ujjan, Adnan Salim, Gohar Javed, Syed Ijlal Ahmed, Malikah Surani, Marium Khan
BackgroundNeuro-rehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing is frequently unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by professional nurse.MethodsThis was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of two groups. Group 1 (consisted of patients cared for by professional nurse) included 94 patients and group 2(patients cared for by family members) included 102. All these patients had Activity of daily living (ADL) score of ≥ 3. Glasgow Outcomes Scale (GOS), time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow up.ResultsThe study included 196 patients. Traumatic Brain Injury was the most common diagnosis. Nursing requirements were similar between the two groups and included tracheostomy care, PEG tube care, PICC line care, care of patients with no bone flap and logrolling. The outcomes of the two groups were comparable and included bedsore development/ worsening of grade, GOS at follow-up, time to decannulation and 30-day mortality.ConclusionsThere was no statistically significant difference in outcomes of patients nursed by family members when compared to the patients looked after by professional nurses.
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Cavernous Angiomyoma of the Internal Auditory Canal
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Renovascular hypertension accounts for 51–52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal va...
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): Chih-Wei Lee, Hwa-Koon Wu, Hung-Wen Lai, Wen-Pei Wu, Shou-Tung Chen, Dar-Ren Chen, Chih-Jung Chen, Shou-Jen Kuo
PurposeDuctal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery.Materials and MethodsPatients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components.ResultsOf the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens.ConclusionInvasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): S.A. Hayes, M.C. Pietanza, D. O'Driscoll, J. Zheng, C.S. Moskowitz, M.G. Kris, M.S. Ginsberg
PurposeTo examine the correlations between uni-dimensional RECIST and volumetric measurements in patients with lung adenocarcinoma and to assess their association with overall survival (OS) and progression-free survival (PFS).Materials and methodsIn this study of patients receiving chemotherapy for lung cancer in the setting of a clinical trial, response was prospectively evaluated using RECIST 1.0. Retrospectively, volumetric measurements were recorded and response was assessed by two different volumetric methods at each followup CT scan using a semi-automated segmentation algorithm. We subsequently evaluated the correlation between the uni-dimensional RECIST measurements and the volumetric measurements and performed landmark analyses for OS and PFS at the completion of the first and second follow-ups. Kaplan–Meier curves together with log-rank tests were used to evaluate the association between the different response criteria and patient outcome.ResultsForty-two patients had CT scans at baseline, after the first follow up scan and second followup scan, and then every 8 weeks. The uni-dimensional RECIST measurements and volumetric measurements were strongly correlated, with a Spearman correlation coefficient (ρ) of 0.853 at baseline, ρ=0.861 at the first followup, ρ=0.843 at the 2nd followup, and ρ=0.887 overall between-subject. On first follow-up CT, partial responders and non responders as assessed by an "ellipsoid" volumetric criteria showed a significant difference in OS (p=0.008, 1-year OS of 70% for partial responders and 46% for non responders). There was no difference between the groups when assessed by RECIST criteria on first follow-up CT (p=0.841, 1-year OS rate of 64% for partial responders and 64% for non responders).ConclusionVolumetric response on first follow-up CT may better predict OS than RECIST response.Clinical relevance statementAssessment of tumor size and response is of utmost importance in clinical trials. Volumetric measurements may help to better predict OS than uni-dimensional RECIST criteria.
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): Juan Peng, Hang Qu, Jing Peng, Tian-You Luo, Fa-Jin Lv, Li chen, Zhuo-Nan Wang, Yu Ouyang, Qing-Feng Cheng
PurposeTo investigate whether global spontaneous brain activity changes in type 2 diabetes mellitus (T2DM) patients and these changes vary according to the degree of microangiopathy.Materials and MethodsT2DM patients with (M+, n=26) and without (M−, n=22) microangiopathy as well as 28 healthy nondiabetic subjects were enrolled in this study. All the subjects completed a resting-state functional magnetic resonance imaging (rs-fMRI) examination and neuropsychological assessment. Regional homogeneity (ReHo) values, representing spontaneous brain activity, were calculated and compared between M+ and M− T2DM patients and nondiabetic controls.ResultsIn both M+ and M− T2DM patients, ReHo values were decreased in the occipital lobe, temporal lobe, postcentral gyrus, and cerebellum, while increased in the bilateral precuneus, superior/middle frontal gyrus, and insula. Compared with the M− group, M+ patients showed decreased ReHo values in the left cuneus and superior occipital gyrus. The ReHo values in the lingual gyrus/calcarine cortex and MTG were related to clinical parameters in T2DM patients.ConclusionThe abnormalities of spontaneous brain activity revealed by ReHo values in both M＋and M－ T2DM patients may provide insights into the neurological pathophysiology underlying diabetes-related cognitive impairments. M+ patients showed more decreased brain activity related to severely impaired function of visual processing and visual memory.
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Lumbar Intradural Ganglion Cyst: A Rare Case Report.
World Neurosurg. 2015 Dec 24;
Authors: Tai PA, Li TC
Abstract
BACKGROUND: Lumbar intraspinal ganglion cysts are a rare cause of lumbar radiculopathy. Often these cysts are extradural and next to facet joints. Sometimes they are related to ligamentum flavum or posterior longitudinal ligament. Lumbar intradural ganglion cyst has never been reported to date.
CASE DESCRIPTION: Herein, the authors report on a fifth lumbar intradural ganglion cyst in an elderly patient presenting with insidious onset of left-sided lower limb pain. A lumbar spine magnetic resonance imaging (MRI) revealed a left-sided ventrolateral intraspinal cystic lesion abutting on the fifth lumbar vertebral body with ring enhancement of the cyst wall. At operation, no lesion was found related to the facet joint or in the epidural space. Instead, a dura-based septated ganglion cyst was noted intradurally. The patient's discomfort was completely relieved postoperatively. A follow-up MRI showed complete removal of the cyst.
CONCLUSIONS: The authors showed the first case report on a lumbar intradural dura-based ganglion cyst in an elderly patient, leading to compressive radiculopathy. After surgery, total removal of the cyst was achieved and the patient's discomfort was completely relieved. The origin and pathogenesis of the lumbar intradural ganglion cyst are still unknown. Surgical extirpation is regarded as the treatment of choice.
PMID: 26724636 [PubMed – as supplied by publisher]
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Congenital malrotation of atlas with unilateral hypertrophy of atlanto-ocipital joint – A rare anomaly of cranio-vertebral junction and its management: A case report.
World Neurosurg. 2015 Dec 24;
Authors: Nath PC, Mishra SS, Deo RC, Mahanta I
Abstract
Congenital anomalies are commonly encountered in cranio-vertebral junction (CVJ) due to its unique embryological development. CVJ usually comprises occiput, atlas and axis. However malrotation of atlas (C1) in between occiput (C0) and axis (C2) with Chiari -1 malformation as well as hypertrophy of unilateral atlanto-ocipital joint and lateral mass manifesting features of high cervical myelopathy is hardly reported anomaly. Here we report a case of successfully managed 22 years old female who presented to us with high cervical compressive myelopathy. Imaging revealed rotation of C1 vertebra around 20 degrees towards left side with right atlanto-ocipital joint dislocation and hypertrophy. It also revealed hypertrophy of right lateral mass of C1, Chiari -1 malformation and right atlanto axial dislocation exposing right C2 superior facet. She underwent right extreme far lateral approach comprising right C1 posterior arch excision and medialization of right vertebral artery with excision of hypertrophied atlanto -occipital joint extradurally and posteromedial excision of superior articular facet of C1. The patient's compressive myelopathy features improved post operatively. We report the management of this rare congenital anomaly with review of literatures.
PMID: 26724634 [PubMed – as supplied by publisher]
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Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.
World Neurosurg. 2015 Dec 24;
Authors: Dellaretti M, Dourado J, de Souza RF, Fontoura RR, de Sousa AA
Abstract
OBJECT: During CEA, carotid cross-clamping is performed to allow for artery incision and plaque removal. There is a very small subgroup of patients who can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurological deficit. These patients are described as having "cross-clamp intolerance". The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition.
METHODS: From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to ICA occlusion for less than 30 s were considered to have cross-clamp intolerance.
RESULTS: Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in less than 30 s, i.e. these patients presented cross-clamp intolerance. The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion.
CONCLUSION: Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.
PMID: 26724635 [PubMed – as supplied by publisher]
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): S.A. Hayes, M.C. Pietanza, D. O'Driscoll, J. Zheng, C.S. Moskowitz, M.G. Kris, M.S. Ginsberg
PurposeTo examine the correlations between uni-dimensional RECIST and volumetric measurements in patients with lung adenocarcinoma and to assess their association with overall survival (OS) and progression-free survival (PFS).Materials and methodsIn this study of patients receiving chemotherapy for lung cancer in the setting of a clinical trial, response was prospectively evaluated using RECIST 1.0. Retrospectively, volumetric measurements were recorded and response was assessed by two different volumetric methods at each followup CT scan using a semi-automated segmentation algorithm. We subsequently evaluated the correlation between the uni-dimensional RECIST measurements and the volumetric measurements and performed landmark analyses for OS and PFS at the completion of the first and second follow-ups. Kaplan–Meier curves together with log-rank tests were used to evaluate the association between the different response criteria and patient outcome.ResultsForty-two patients had CT scans at baseline, after the first follow up scan and second followup scan, and then every 8 weeks. The uni-dimensional RECIST measurements and volumetric measurements were strongly correlated, with a Spearman correlation coefficient (ρ) of 0.853 at baseline, ρ=0.861 at the first followup, ρ=0.843 at the 2nd followup, and ρ=0.887 overall between-subject. On first follow-up CT, partial responders and non responders as assessed by an "ellipsoid" volumetric criteria showed a significant difference in OS (p=0.008, 1-year OS of 70% for partial responders and 46% for non responders). There was no difference between the groups when assessed by RECIST criteria on first follow-up CT (p=0.841, 1-year OS rate of 64% for partial responders and 64% for non responders).ConclusionVolumetric response on first follow-up CT may better predict OS than RECIST response.Clinical relevance statementAssessment of tumor size and response is of utmost importance in clinical trials. Volumetric measurements may help to better predict OS than uni-dimensional RECIST criteria.
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Neurosurgical Skills Assessment: Measuring Technical Proficiency in Neurosurgery Residents through Intraoperative Video Evaluations.
World Neurosurg. 2015 Dec 24;
Authors: Sarkiss CA, Philemond S, Lee J, Sobotka S, Holloway TD, Moore M, Costa AB, Gordon EL, Bederson JB
Abstract
OBJECTIVE/BACKGROUND: Although technical skills are fundamental in neurosurgery, there is little agreement on how to describe, measure, or compare skills among surgeons. The primary goal of this study was to develop a quantitative grading scale for technical surgical performance that distinguishes operator skill when graded by domain experts (residents, attendings, and non-surgeons). Scores provided by raters should be highly reliable with respect to scores from other observers.
METHODS: Neurosurgery residents were fitted with a head-mounted video camera while performing craniotomies under attending supervision. Seven videos, one from each PGY level (1-7), were anonymized and scored by 16 attendings, 8 residents, and 7 non-surgeons using a grading scale. Seven skills were graded; these were incision, efficiency of instrument use, cauterization, tissue handling, drilling/craniotomy, confidence, and training level.
RESULTS: A strong correlation was found between skills score and PGY year (p< .001, ANOVA). Junior residents (PGY 1-3) had significantly lower scores than senior residents (PGY 4-7, p< .001, t-test). Significant variation among junior residents was observed, while senior residents' scores were not significantly different from one another. Inter-rater reliability, measured against other observers, was high (r= 0.581 ± 0.245, Spearman) as was assessment of resident training level (r= 0.583 ± 0.278, Spearman). Both variables were strongly correlated (r = 0.90, Pearson). Attendings, residents, and non-surgeons did not score differently (p=0.46, ANOVA).
CONCLUSIONS: Technical skills of neurosurgery residents recorded during craniotomy can be measured with high inter-rater reliability. Surgeons and non-surgeons alike readily distinguish different skill levels. This type of assessment could be used to coach residents, to track performance over time, and potentially to compare skill levels. Developing an objective tool to evaluate surgical performance would be useful in several areas of neurosurgery education.
PMID: 26724633 [PubMed – as supplied by publisher]
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Aortoenteric fistula is an uncommon but life-threatening cause of gastrointestinal blood loss. We report a case of a 70-year-old man who presented to the emergency department with an episode of melena and infection in the left inguinal region. Diagnosis of secondary aortoenteric fistula was made between the left limb of the aortobifemoral graft and the descending colon. We performed excision of the infected graft and in situ silver acetate coating of prosthetic vascular graft replacement (aortoleft femoral) on the patient. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment. Antimicrobial coating of prosthetic vascular grafts may be a good alternative in the presence of graft infection associated with aortoenteric fistula because in situ grafts may carry an increased risk of reinfection.
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Software development life cycle has been characterized by destructive disconnects between activities like planning, analysis, design, and programming. Particularly software developed with prediction based results is always a big challenge for designers. Time series data forecasting like currency exchange, stock prices, and weather report are some of the areas where an extensive research is going on for the last three decades. In the initial days, the problems with financial analysis and prediction were solved by statistical models and methods. For the last two decades, a large number of Artificial Neural Networks based learning models have been proposed to solve the problems of financial data and get accurate results in prediction of the future trends and prices. This paper addressed some architectural design related issues for performance improvement through vectorising the strengths of multivariate econometric time series models and Artificial Neural Networks. It provides an adaptive approach for predicting exchange rates and it can be called hybrid methodology for predicting exchange rates. This framework is tested for finding the accuracy and performance of parallel algorithms used.
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Urachal mucinous cystic tumours are rare pathological findings with only 23 previously reported cases in the literature. We present the case of a 54-year-old man with an incidentally found urachal mucinous cystic tumour laparoscopically excised. With its known potential to cause pseudomyxoma peritonei, complete surgical excision is important. Long-term cystoscopic and radiological surveillance is also required.
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Erythema ab igne is an asymptomatic cutaneous condition caused by exposure to heat. Cases of erythema ab igne may prove to be diagnostically challenging due to lack of familiarity with the condition. While this dermatosis carries a favorable prognosis, nonmelanoma skin cancers have been reported to arise within lesions of erythema ab igne. Erythema ab igne is preventable, and, thus, clinicians should provide education regarding safe use of heating devices to patients using these products in both outpatient and inpatient settings.
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Anthraquinone compounds are one of the abundant polyphenols found in fruits, vegetables, and herbs. However, the in vivo anti-inflammatory activity and molecular mechanisms of anthraquinones have not been fully elucidated. We investigated the activity of anthraquinones using acute inflammatory and nociceptive experimental conditions. Anthraquinone-2-carboxylic acid (9,10-dihydro-9,10-dioxo-2-anthracenecarboxylic acid, AQCA), one of the major anthraquinones identified from Brazilian taheebo, ameliorated various inflammatory and algesic symptoms in EtOH/HCl- and acetylsalicylic acid- (ASA-) induced gastritis, arachidonic acid-induced edema, and acetic acid-induced abdominal writhing without displaying toxic profiles in body and organ weight, gastric irritation, or serum parameters. In addition, AQCA suppressed the expression of inflammatory genes such as cyclooxygenase- (COX-) 2 in stomach tissues and lipopolysaccharide- (LPS-) treated RAW264.7 cells. According to reporter gene assay and immunoblotting analyses, AQCA inhibited activation of the nuclear factor- (NF-) κB and activator protein- (AP-) 1 pathways by suppression of upstream signaling involving interleukin-1 receptor-associated kinase 4 (IRAK1), p38, Src, and spleen tyrosine kinase (Syk). Our data strongly suggest that anthraquinones such as AQCA act as potent anti-inflammatory and antinociceptive components in vivo, thus contributing to the immune regulatory role of fruits and herbs.
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Aim. We aimed to determine the effect of external apple vinegar application on the symptoms and social appearance anxiety of varicosity patients who were suggested conservative treatment. Method. The study was planned as an experimental, randomized, and controlled study. 120 patients were randomly selected and then were randomly allocated to either experimental or control group by simple blind random sampling method. In the collection of research data, a questionnaire questioning sociodemographic and clinical characteristics, the Visual Analog Scale (VAS) for pain, and the Social Appearance Anxiety Scale (SAAS) were used. The patients in the study group were suggested to apply apple vinegar to the area of the leg with varicosity alongside the treatment suggested by the doctor. The patients in the control group received no intervention during the study. Results. The sociodemographic and clinic characteristics of both groups were found to be similar (). The patients were evaluated with regard to cramps, pain, leg fatigue perception, edema, itching, pigmentation, and weight feelings in the leg, VAS, and SAAS averages in the second evaluation; the control group had a decrease in such symptoms () although the decrease in the application group was higher and statistically meaningful (). Conclusion. We determined that the external application of apple vinegar on varicosity patients, which is a very easy application, increased the positive effects of conservative treatment.
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Renovascular hypertension accounts for 51–52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal va...
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): Chih-Wei Lee, Hwa-Koon Wu, Hung-Wen Lai, Wen-Pei Wu, Shou-Tung Chen, Dar-Ren Chen, Chih-Jung Chen, Shou-Jen Kuo
PurposeDuctal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery.Materials and MethodsPatients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components.ResultsOf the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens.ConclusionInvasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): S.A. Hayes, M.C. Pietanza, D. O'Driscoll, J. Zheng, C.S. Moskowitz, M.G. Kris, M.S. Ginsberg
PurposeTo examine the correlations between uni-dimensional RECIST and volumetric measurements in patients with lung adenocarcinoma and to assess their association with overall survival (OS) and progression-free survival (PFS).Materials and methodsIn this study of patients receiving chemotherapy for lung cancer in the setting of a clinical trial, response was prospectively evaluated using RECIST 1.0. Retrospectively, volumetric measurements were recorded and response was assessed by two different volumetric methods at each followup CT scan using a semi-automated segmentation algorithm. We subsequently evaluated the correlation between the uni-dimensional RECIST measurements and the volumetric measurements and performed landmark analyses for OS and PFS at the completion of the first and second follow-ups. Kaplan–Meier curves together with log-rank tests were used to evaluate the association between the different response criteria and patient outcome.ResultsForty-two patients had CT scans at baseline, after the first follow up scan and second followup scan, and then every 8 weeks. The uni-dimensional RECIST measurements and volumetric measurements were strongly correlated, with a Spearman correlation coefficient (ρ) of 0.853 at baseline, ρ=0.861 at the first followup, ρ=0.843 at the 2nd followup, and ρ=0.887 overall between-subject. On first follow-up CT, partial responders and non responders as assessed by an "ellipsoid" volumetric criteria showed a significant difference in OS (p=0.008, 1-year OS of 70% for partial responders and 46% for non responders). There was no difference between the groups when assessed by RECIST criteria on first follow-up CT (p=0.841, 1-year OS rate of 64% for partial responders and 64% for non responders).ConclusionVolumetric response on first follow-up CT may better predict OS than RECIST response.Clinical relevance statementAssessment of tumor size and response is of utmost importance in clinical trials. Volumetric measurements may help to better predict OS than uni-dimensional RECIST criteria.
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): Juan Peng, Hang Qu, Jing Peng, Tian-You Luo, Fa-Jin Lv, Li chen, Zhuo-Nan Wang, Yu Ouyang, Qing-Feng Cheng
PurposeTo investigate whether global spontaneous brain activity changes in type 2 diabetes mellitus (T2DM) patients and these changes vary according to the degree of microangiopathy.Materials and MethodsT2DM patients with (M+, n=26) and without (M−, n=22) microangiopathy as well as 28 healthy nondiabetic subjects were enrolled in this study. All the subjects completed a resting-state functional magnetic resonance imaging (rs-fMRI) examination and neuropsychological assessment. Regional homogeneity (ReHo) values, representing spontaneous brain activity, were calculated and compared between M+ and M− T2DM patients and nondiabetic controls.ResultsIn both M+ and M− T2DM patients, ReHo values were decreased in the occipital lobe, temporal lobe, postcentral gyrus, and cerebellum, while increased in the bilateral precuneus, superior/middle frontal gyrus, and insula. Compared with the M− group, M+ patients showed decreased ReHo values in the left cuneus and superior occipital gyrus. The ReHo values in the lingual gyrus/calcarine cortex and MTG were related to clinical parameters in T2DM patients.ConclusionThe abnormalities of spontaneous brain activity revealed by ReHo values in both M＋and M－ T2DM patients may provide insights into the neurological pathophysiology underlying diabetes-related cognitive impairments. M+ patients showed more decreased brain activity related to severely impaired function of visual processing and visual memory.
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Lumbar Intradural Ganglion Cyst: A Rare Case Report.
World Neurosurg. 2015 Dec 24;
Authors: Tai PA, Li TC
Abstract
BACKGROUND: Lumbar intraspinal ganglion cysts are a rare cause of lumbar radiculopathy. Often these cysts are extradural and next to facet joints. Sometimes they are related to ligamentum flavum or posterior longitudinal ligament. Lumbar intradural ganglion cyst has never been reported to date.
CASE DESCRIPTION: Herein, the authors report on a fifth lumbar intradural ganglion cyst in an elderly patient presenting with insidious onset of left-sided lower limb pain. A lumbar spine magnetic resonance imaging (MRI) revealed a left-sided ventrolateral intraspinal cystic lesion abutting on the fifth lumbar vertebral body with ring enhancement of the cyst wall. At operation, no lesion was found related to the facet joint or in the epidural space. Instead, a dura-based septated ganglion cyst was noted intradurally. The patient's discomfort was completely relieved postoperatively. A follow-up MRI showed complete removal of the cyst.
CONCLUSIONS: The authors showed the first case report on a lumbar intradural dura-based ganglion cyst in an elderly patient, leading to compressive radiculopathy. After surgery, total removal of the cyst was achieved and the patient's discomfort was completely relieved. The origin and pathogenesis of the lumbar intradural ganglion cyst are still unknown. Surgical extirpation is regarded as the treatment of choice.
PMID: 26724636 [PubMed – as supplied by publisher]
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Congenital malrotation of atlas with unilateral hypertrophy of atlanto-ocipital joint – A rare anomaly of cranio-vertebral junction and its management: A case report.
World Neurosurg. 2015 Dec 24;
Authors: Nath PC, Mishra SS, Deo RC, Mahanta I
Abstract
Congenital anomalies are commonly encountered in cranio-vertebral junction (CVJ) due to its unique embryological development. CVJ usually comprises occiput, atlas and axis. However malrotation of atlas (C1) in between occiput (C0) and axis (C2) with Chiari -1 malformation as well as hypertrophy of unilateral atlanto-ocipital joint and lateral mass manifesting features of high cervical myelopathy is hardly reported anomaly. Here we report a case of successfully managed 22 years old female who presented to us with high cervical compressive myelopathy. Imaging revealed rotation of C1 vertebra around 20 degrees towards left side with right atlanto-ocipital joint dislocation and hypertrophy. It also revealed hypertrophy of right lateral mass of C1, Chiari -1 malformation and right atlanto axial dislocation exposing right C2 superior facet. She underwent right extreme far lateral approach comprising right C1 posterior arch excision and medialization of right vertebral artery with excision of hypertrophied atlanto -occipital joint extradurally and posteromedial excision of superior articular facet of C1. The patient's compressive myelopathy features improved post operatively. We report the management of this rare congenital anomaly with review of literatures.
PMID: 26724634 [PubMed – as supplied by publisher]
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Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.
World Neurosurg. 2015 Dec 24;
Authors: Dellaretti M, Dourado J, de Souza RF, Fontoura RR, de Sousa AA
Abstract
OBJECT: During CEA, carotid cross-clamping is performed to allow for artery incision and plaque removal. There is a very small subgroup of patients who can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurological deficit. These patients are described as having "cross-clamp intolerance". The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition.
METHODS: From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to ICA occlusion for less than 30 s were considered to have cross-clamp intolerance.
RESULTS: Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in less than 30 s, i.e. these patients presented cross-clamp intolerance. The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion.
CONCLUSION: Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.
PMID: 26724635 [PubMed – as supplied by publisher]
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Publication date: Available online 2 January 2016
Source:European Journal of Radiology
Author(s): S.A. Hayes, M.C. Pietanza, D. O'Driscoll, J. Zheng, C.S. Moskowitz, M.G. Kris, M.S. Ginsberg
PurposeTo examine the correlations between uni-dimensional RECIST and volumetric measurements in patients with lung adenocarcinoma and to assess their association with overall survival (OS) and progression-free survival (PFS).Materials and methodsIn this study of patients receiving chemotherapy for lung cancer in the setting of a clinical trial, response was prospectively evaluated using RECIST 1.0. Retrospectively, volumetric measurements were recorded and response was assessed by two different volumetric methods at each followup CT scan using a semi-automated segmentation algorithm. We subsequently evaluated the correlation between the uni-dimensional RECIST measurements and the volumetric measurements and performed landmark analyses for OS and PFS at the completion of the first and second follow-ups. Kaplan–Meier curves together with log-rank tests were used to evaluate the association between the different response criteria and patient outcome.ResultsForty-two patients had CT scans at baseline, after the first follow up scan and second followup scan, and then every 8 weeks. The uni-dimensional RECIST measurements and volumetric measurements were strongly correlated, with a Spearman correlation coefficient (ρ) of 0.853 at baseline, ρ=0.861 at the first followup, ρ=0.843 at the 2nd followup, and ρ=0.887 overall between-subject. On first follow-up CT, partial responders and non responders as assessed by an "ellipsoid" volumetric criteria showed a significant difference in OS (p=0.008, 1-year OS of 70% for partial responders and 46% for non responders). There was no difference between the groups when assessed by RECIST criteria on first follow-up CT (p=0.841, 1-year OS rate of 64% for partial responders and 64% for non responders).ConclusionVolumetric response on first follow-up CT may better predict OS than RECIST response.Clinical relevance statementAssessment of tumor size and response is of utmost importance in clinical trials. Volumetric measurements may help to better predict OS than uni-dimensional RECIST criteria.
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Neurosurgical Skills Assessment: Measuring Technical Proficiency in Neurosurgery Residents through Intraoperative Video Evaluations.
World Neurosurg. 2015 Dec 24;
Authors: Sarkiss CA, Philemond S, Lee J, Sobotka S, Holloway TD, Moore M, Costa AB, Gordon EL, Bederson JB
Abstract
OBJECTIVE/BACKGROUND: Although technical skills are fundamental in neurosurgery, there is little agreement on how to describe, measure, or compare skills among surgeons. The primary goal of this study was to develop a quantitative grading scale for technical surgical performance that distinguishes operator skill when graded by domain experts (residents, attendings, and non-surgeons). Scores provided by raters should be highly reliable with respect to scores from other observers.
METHODS: Neurosurgery residents were fitted with a head-mounted video camera while performing craniotomies under attending supervision. Seven videos, one from each PGY level (1-7), were anonymized and scored by 16 attendings, 8 residents, and 7 non-surgeons using a grading scale. Seven skills were graded; these were incision, efficiency of instrument use, cauterization, tissue handling, drilling/craniotomy, confidence, and training level.
RESULTS: A strong correlation was found between skills score and PGY year (p< .001, ANOVA). Junior residents (PGY 1-3) had significantly lower scores than senior residents (PGY 4-7, p< .001, t-test). Significant variation among junior residents was observed, while senior residents' scores were not significantly different from one another. Inter-rater reliability, measured against other observers, was high (r= 0.581 ± 0.245, Spearman) as was assessment of resident training level (r= 0.583 ± 0.278, Spearman). Both variables were strongly correlated (r = 0.90, Pearson). Attendings, residents, and non-surgeons did not score differently (p=0.46, ANOVA).
CONCLUSIONS: Technical skills of neurosurgery residents recorded during craniotomy can be measured with high inter-rater reliability. Surgeons and non-surgeons alike readily distinguish different skill levels. This type of assessment could be used to coach residents, to track performance over time, and potentially to compare skill levels. Developing an objective tool to evaluate surgical performance would be useful in several areas of neurosurgery education.
PMID: 26724633 [PubMed – as supplied by publisher]
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Aortoenteric fistula is an uncommon but life-threatening cause of gastrointestinal blood loss. We report a case of a 70-year-old man who presented to the emergency department with an episode of melena and infection in the left inguinal region. Diagnosis of secondary aortoenteric fistula was made between the left limb of the aortobifemoral graft and the descending colon. We performed excision of the infected graft and in situ silver acetate coating of prosthetic vascular graft replacement (aortoleft femoral) on the patient. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment. Antimicrobial coating of prosthetic vascular grafts may be a good alternative in the presence of graft infection associated with aortoenteric fistula because in situ grafts may carry an increased risk of reinfection.
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Software development life cycle has been characterized by destructive disconnects between activities like planning, analysis, design, and programming. Particularly software developed with prediction based results is always a big challenge for designers. Time series data forecasting like currency exchange, stock prices, and weather report are some of the areas where an extensive research is going on for the last three decades. In the initial days, the problems with financial analysis and prediction were solved by statistical models and methods. For the last two decades, a large number of Artificial Neural Networks based learning models have been proposed to solve the problems of financial data and get accurate results in prediction of the future trends and prices. This paper addressed some architectural design related issues for performance improvement through vectorising the strengths of multivariate econometric time series models and Artificial Neural Networks. It provides an adaptive approach for predicting exchange rates and it can be called hybrid methodology for predicting exchange rates. This framework is tested for finding the accuracy and performance of parallel algorithms used.
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Urachal mucinous cystic tumours are rare pathological findings with only 23 previously reported cases in the literature. We present the case of a 54-year-old man with an incidentally found urachal mucinous cystic tumour laparoscopically excised. With its known potential to cause pseudomyxoma peritonei, complete surgical excision is important. Long-term cystoscopic and radiological surveillance is also required.
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Erythema ab igne is an asymptomatic cutaneous condition caused by exposure to heat. Cases of erythema ab igne may prove to be diagnostically challenging due to lack of familiarity with the condition. While this dermatosis carries a favorable prognosis, nonmelanoma skin cancers have been reported to arise within lesions of erythema ab igne. Erythema ab igne is preventable, and, thus, clinicians should provide education regarding safe use of heating devices to patients using these products in both outpatient and inpatient settings.
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Anthraquinone compounds are one of the abundant polyphenols found in fruits, vegetables, and herbs. However, the in vivo anti-inflammatory activity and molecular mechanisms of anthraquinones have not been fully elucidated. We investigated the activity of anthraquinones using acute inflammatory and nociceptive experimental conditions. Anthraquinone-2-carboxylic acid (9,10-dihydro-9,10-dioxo-2-anthracenecarboxylic acid, AQCA), one of the major anthraquinones identified from Brazilian taheebo, ameliorated various inflammatory and algesic symptoms in EtOH/HCl- and acetylsalicylic acid- (ASA-) induced gastritis, arachidonic acid-induced edema, and acetic acid-induced abdominal writhing without displaying toxic profiles in body and organ weight, gastric irritation, or serum parameters. In addition, AQCA suppressed the expression of inflammatory genes such as cyclooxygenase- (COX-) 2 in stomach tissues and lipopolysaccharide- (LPS-) treated RAW264.7 cells. According to reporter gene assay and immunoblotting analyses, AQCA inhibited activation of the nuclear factor- (NF-) κB and activator protein- (AP-) 1 pathways by suppression of upstream signaling involving interleukin-1 receptor-associated kinase 4 (IRAK1), p38, Src, and spleen tyrosine kinase (Syk). Our data strongly suggest that anthraquinones such as AQCA act as potent anti-inflammatory and antinociceptive components in vivo, thus contributing to the immune regulatory role of fruits and herbs.
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Aim. We aimed to determine the effect of external apple vinegar application on the symptoms and social appearance anxiety of varicosity patients who were suggested conservative treatment. Method. The study was planned as an experimental, randomized, and controlled study. 120 patients were randomly selected and then were randomly allocated to either experimental or control group by simple blind random sampling method. In the collection of research data, a questionnaire questioning sociodemographic and clinical characteristics, the Visual Analog Scale (VAS) for pain, and the Social Appearance Anxiety Scale (SAAS) were used. The patients in the study group were suggested to apply apple vinegar to the area of the leg with varicosity alongside the treatment suggested by the doctor. The patients in the control group received no intervention during the study. Results. The sociodemographic and clinic characteristics of both groups were found to be similar (). The patients were evaluated with regard to cramps, pain, leg fatigue perception, edema, itching, pigmentation, and weight feelings in the leg, VAS, and SAAS averages in the second evaluation; the control group had a decrease in such symptoms () although the decrease in the application group was higher and statistically meaningful (). Conclusion. We determined that the external application of apple vinegar on varicosity patients, which is a very easy application, increased the positive effects of conservative treatment.
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Renovascular hypertension accounts for 51–52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal va…
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Early life adversity increases the risk of mental disorders later in life. Chronic early life stress may alter neurotrophic factor gene expression including those for brain derived neurotrophic factor (BDNF) and glial cell derived neurotrophic factor (GDNF) that are important in neuronal growth, survival, and maintenance. Maternal separation was used in this study to model early life stress. Following unilateral injection of a mild dose of 6-hydroxydopamine (6-OHDA), we measured corticosterone (CORT) in the blood and striatum of stressed and nonstressed rats; we also measured DNA methylation and BDNF and GDNF gene expression in the striatum using real time PCR. In the presence of stress, we found that there was increased corticosterone concentration in both blood and striatal tissue. Further to this, we found higher DNA methylation and decreased neurotrophic factor gene expression. 6-OHDA lesion increased neurotrophic factor gene expression in both stressed and nonstressed rats but this increase was higher in the nonstressed rats. Our results suggest that exposure to early postnatal stress increases corticosterone concentration which leads to increased DNA methylation. This effect results in decreased BDNF and GDNF gene expression in the striatum leading to decreased protection against subsequent insults later in life.
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Salmonella enterica serotype Heidelberg (S. Heidelberg) is frequently implicated in human foodborne Salmonella infections and often produces more severe clinical disease than other serotypes. Livestock and poultry products represent a potential risk for transmission to humans. The purpose of this study was to evaluate 49 S. Heidelberg veterinary isolates for exponential growth rate (EGR), PFGE pattern, and antimicrobial resistance to evaluate these parameters as mechanisms by which S. Heidelberg emerged as a virulent foodborne pathogen. Isolates were categorized by species of origin; clinical or environmental sources; and time frame of recovery. Growth rates were determined in nutrient media using serial dilutions and colony counts; PFGE was performed according to the CDC PulseNet protocol. Minimum inhibitory concentration and susceptibility determinations were performed against antimicrobials important in human medicine. Eighteen unique PFGE patterns were detected in the isolates tested. Antimicrobial resistance was significantly greater () for ten of 15 drugs in clinical over environmental isolates; for four drugs between the time frames; and for ten drugs between species of origin. The large genetic diversity present in isolates of this serotype may convey competitive advantages to this organism, while the presence of antimicrobial resistance represents a potential zoonotic risk via animal-source food products.
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Renovascular hypertension accounts for 51–52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal va…
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