Correlation between symptoms and radiological findings in patients with chronic rhinosinusitis: an evaluation study using the Sinonasal Assessment Questionnaire and Lund-Mackay grading system

Computerised tomography (CT) scans are routinely performed prior to endoscopic sinus surgery (ESS) in order to confirm the diagnosis, assess the response to medical treatment and provide important landmarks for surgery. However, the correlation between the findings of CT scans and the patient's symptoms remains ambiguous. The objective was to assess the correlation between preoperative symptom scores using the validated Sino-Nasal Assessment Questionnaire and CT scores in patients undergoing ESS. Twenty-two patients who attended otolaryngology clinics with chronic rhinosinusitis (CRS) were prospectively enrolled in the study. All of these patients completed Sinonasal Questionnaires (SNAQ) before they had ESS. Their CT scans were scored blindly by the surgeon and a radiologist following Lund-Mackay grading. Patients with high preoperative SNAQ scores had high or low CT scores. The same applied for patients with low preoperative SNAQ scores. There was no statistically significant correlation between SNAQ and Lund-Mackay scores (P = 0.5). However, there was a very strong correlation (P < 0.001) between the scoring of scans by the surgeon and the radiologist, while there was a moderate degree of discrepancy in the grading of anterior ethmoid sinuses and osteo-meatal complexes. Morbidity of patients with CRS cannot be predicted from the magnitude of changes in their CT scans. Significant inter-rater variability exists in the grading of pathological changes in anterior ethmoid sinus and osteo-meatal complex as recorded in CT scans.

Primary neurological manifestations of lung cancer--a retrospective analysis of 8 patients

Neurological manifestations are reported in 5 to 10% of cases of lung cancer. We present a series of 216 consecutive patients of lung cancer of which 8 patients presented first with neurological manifestations without overt respiratory symptoms. The present study aimed to identify the number of patients of lung cancer presenting with primary neurological symptoms, the nature of the presentations, and the outcome of these patients among 216 patients who presented over a 2 year period in the Institute of Postgraduate Medical Education and Research, Kolkata. Out of 8 patients, 3 patients presented with seizures, 3 patients with hemiparesis and 2 patients with paraparesis. Thus, 3.7% (8/216) of patients in our series presented with a neurological manifestation. We concluded that primary neurological manifestations are rare in lung cancer. The lungs should be the first site of evaluation in a case of a cerebral metastasis with an unknown primary.

Comparison of IOL power calculations by the IOLMaster vs theoretical calculations

PURPOSE

This study evaluates the agreement between the calculations performed by IOLMaster and as performed according to the published methods, for three formulas, Holladay I, Hoffer Q, and SRK-T.

METHOD

Hypothetical and identical data were used as input variables for calculations by IOLMaster and by a computer program written in visual basic to perform calculations with the three formulas. Results were compared and statistical significance carried out.

RESULTS

Significant disagreement was found using Hoffer-Q formula between the results shown by the study program and IOLMaster, while identical results were obtained using Holladay I and SRK-T formulas. For an average eye (AL 23.45 mm and K 45D, ACD constant 6.15, vertex 12 mm), the mean difference in the predicted postoperative (postop) SE between the study-set and IOLMaster dataset was 0.13 D (+/-0.03 D), which is a measure for the systematic error (relative bias). In such eyes, the mean predicted postop ACD in IOLMaster dataset was 0.11 mm (+/-0.04 mm) less than in the study-set, and the data spread of the predicted postop ACD was much higher (+/-0.042 mm) indicating more discrepancy in predicting ACD with IOLMaster.

CONCLUSION

When using Hoffer-Q formula, the mean predicted postop SE with IOLMaster was 0.13 D less than the computation in this study, that is, IOLMaster was showing a consistently myopic overestimation, or, a mean undercorrection of necessary intraocular lens power by 0.13 D, or, a residual hyperopic error of 0.13 D. This translates to a consistently more anterior estimation (0.11 mm mean) of predicted postop ACD by IOLMaster, as compared with theoretical analysis.

Is echocardiography a valid tool to screen for left ventricular systolic dysfunction in chronic survivors of acute myocardial infarction? A comparison with radionuclide ventriculography

OBJECTIVE

To assess the accuracy of echocardiography with Simpson's apical biplane method in screening for left ventricular systolic dysfunction (LVSD) in patients six months after acute myocardial infarction (AMI) as compared with radionuclide ventriculography by assessing the proportion of clinically significant errors that occur with echocardiography.

DESIGN

Comparison of results of echocardiography and radionuclide ventriculography in assessing left ventricular ejection fraction among patients six months after AMI.

SETTING

District general hospital.

PATIENTS

86 patients thrombolysed for AMI at six month follow up.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Correlation coefficients, mean differences, 95% limits of agreement, and differences of clinical significance between left ventricular ejection fraction on echocardiography and on radionuclide ventriculography.

RESULTS

The correlation coefficient between techniques was 0.90, mean difference 1% (p = 0.04), and 95% limits of agreement -13.0% to 10.3%. Only one patient (1.2%, 0.0% to 6.3%) was classified as having normal systolic function on one imaging modality but significant LVSD on the other. Overall accuracy between the two techniques was 86%, kappa value of agreement 0.78.

CONCLUSION

Echocardiography is a valid tool to screen for LVSD in patients six months after AMI, accurately differentiating normal from abnormal systolic function and showing excellent agreement with radionuclide ventriculography. This study supports the use of echocardiography in screening for LVSD in chronic stable patients after AMI or alternative high risk patients, with few differences of major clinical significance likely to occur.

Acute myopia induced by topiramate: Report of a case and review of the literature

Topiramate, a new anticonvulsant, is also used for the prophylaxis of migraine and cluster headache. A serious but not often discussed side effect of the drug is the development of acute myopia and acute angle-closure glaucoma in the early stage of therapy that subsides rapidly with prompt discontinuation. One such case is reported here and the relevant literature in this regard is also reviewed.

In situ chromosomal localization of rDNA sites in "Safed Musli" Chlorophytum ker-gawl and their physical measurement by fiber FISH

Fluorescence In Situ Hybridization (FISH) technique has been applied on somatic chromosomes and extended DNA fibers in the medicinally important species of Chlorophytum to elucidate physical localization and measurement of the rDNA sites using two rRNA multigene families homologous to 45S and 5S rDNA. The two species of Chlorophytum, namely C. borivillianum and C. comosum, both with 2n = 28, reveal diversity for copy number and localization of rDNA sites. C. borivillianum is comprised of five 45S-rDNA sites:one each in the secondary constriction region of chromosomes 7, 8, 9; one in the subtelomeric region of the short arm of chromosome 2 and the telomeric region of the short arm of chromosome 12; and one 5S-rDNA site in the subtelomeric region of the long arm of chromosome 1. In C. comosum, there are three 45S-rDNA sites (one each in the short arm of chromosomes 12, 13, and 14) and two 5S-rDNA sites (in the secondary constriction regions of chromosomes 2 and 13). Fiber FISH analysis conducted on extended DNA fibers revealed variation in the size of continuous tandem strings for the two r-DNA families. Taking the standard value of native B DNA equivalent to 3.27 kb for 1 mum, it was estimated that the physical size of continuous DNA strings is of the order of approximately 90 kb, 180 kb, and 300 kb for 45S-rDNA and of the order of 60 kb, 150 kb for 5S-rDNA in C. comosum, grossly in correspondence to their respective physical sizes at metaphase.

Oxidative Stress and Changes in α- and γ-Tocopherol Levels during Coronary Artery Bypass Grafting

We studied whether cardiopulmonary bypass (CPB) has any immediate impact on the initiation of antioxidative defenses in the body by measuring F(2)-isoprostanes and alpha- and gamma-tocopherol, respectively. 8-iso-PGF(2alpha) levels increased significantly within 3 minutes and until the end of CPB. alpha-Tocopherol levels increased gradually at 20 min during CPB and continued until 6 hours after CPB. gamma-Tocopherol levels followed a similar fashion at the end of CPB. 8-iso-PGF(2alpha) and tocopherol levels kept at basal level 12 and 24 hours post CPB. These findings suggest that an increased free radical-induced oxidative stress together with a gradual appearance of antioxidative defense system during and after CPB.

Comparing and contrasting undergraduate competence in musculoskeletal medicine with cardiovascular medicine and neurology

OBJECTIVES

With an increasing prevalence of musculoskeletal conditions within the UK, specialty bodies are concerned that graduating medical students may lack appropriate knowledge in this system. We investigated the knowledge base of final year Sheffield medical students in the musculoskeletal system, compared with other major body systems.

METHODS

A computer-based assessment was designed covering core topics that a pre-registration house officer should know about in musculoskeletal medicine, cardiology and neurology, using a predesigned testing format. The test was blueprinted against internal and external guidelines. It comprised 24 extended matching questions, each with three stems. A sample of 74 volunteer students from the final year (year 5) of the medical course at the University of Sheffield took part in the assessment.

RESULTS

Overall scores of students on the test ranged from a baseline of 45% to a maximum of 85%. Test reliability was 0.75 (Cronbach's alpha). On stratifying the overall percentages into marks for individual systems, it was found that there were no significant differences between scores in musculoskeletal medicine, cardiovascular medicine or neurology.

CONCLUSIONS

Despite the disparity of teaching between musculoskeletal medicine and other major organ systems within Sheffield's integrated medical curriculum, the knowledge base of medical students in the basic and clinical musculoskeletal sciences appears to be similar to that for cardiovascular medicine and neurology by the time of graduation. Nevertheless, several important issues must be addressed before these findings can be generalized.

Becker's variant of myotonia congenita in two siblings--a clinico-genetic study

We report a family of a brother and sister of myotonia congenita, conforming to autosomal recessive transmission (Becker's variety). To the best of our knowledge, no account of a family of autosomal recessive myotonia (Becker's disease), has earlier been reported from India.

Gastric and intestinal trichobezoar--a case report

Trichobezoars can occur in young females usually with a history of some underlying behaviour disorder. An eighteen-year-old female presented with a fixed right upper quadrant mass. On investigation, a huge mass consisting of hair was found in the stomach, extending into the small intestine. The mass was removed in toto by a standard gastrotomy incision.

Medium-Dependent Electron and H Atom Transfer between 2‘-Deoxyadenosine and Menadione: A Magnetic Field Effect Study

The interaction between 2'-deoxyadenosine and the model antitumor drug menadione has been studied in organic solvent and in micellar medium. The aim of the work is to elucidate the mechanism of this drug-nucleoside interaction and to determine the environmental effects. Laser flash photolysis and magnetic field effect are used to detect the transients and their spin states. The results indicate that H atom transfer and electron transfer are the operative mechanisms depending upon the medium.

Steric-controlled excimer formation in naphthalene analogues of chalcone

Naphthalene analogues of chalcone (typical vinylarenes) are well known for their intramolecular charge transfer (CT) process. The all four possible isomers NC1, NC2, NC3 and NC4 were observed to give structure-less broad CT bands, whereas, excimer formation at higher concentration was reported only for NC4 [Res. Chem. Intermed. 25 (1999) 903]. However, conventional GMMX calculation data reveals that the naphthalene portion of all the isomers are planar, hence, excimer emission is expected from all of them, i.e., if NC4 can form an excimer, then the rests are also capable of doing it. In this paper we have actually succeeded in resolving the excimer peaks for all these four isomers by optimization of concentration, though the extent of excimer formation was observed to be the maximum for NC4. These differential tendencies of excimer formation can be explained by the change in extent of intermolecular stacking interaction of the naphthalene moieties. Variation occurs here due to steric perturbation arising from the specific orientation of the near resident non-planar aroyl component with respect to the naphthalene moiety.

Incorporation of thiosemicarbazide in Amberlite IRC-50 for separation of astatine from alpha-irradiated bismuth oxide

A chelating resin was synthesized by incorporating thiosemicarbazide into Amberlite IRC-50, a weakly acidic polymer. Astatine radionuclides produced by alpha-irradiating bismuth oxide were separated using the newly synthesized chelating resin. The resin showed high selectivity for astatine. The adsorbed astatine was recovered using 0.1M EDTA at pH approximately 10.

Separation of 90Y from 90Sr using zirconium vanadate as the ion exchanger

The sorption and desorption behaviour of several radionuclides, including 241Am, 152,154Eu, 233U, 137Cs, 90Sr and 90Y was studied under varying acidities using zirconium vanadate as ion exchanger. The sorption follows the order: Cs > Eu > Am >Y > U, while Sr was not taken up by the ion exchanger. A radiochemical separation scheme for the 90Y daughter from its 90Sr parent using zirconium vanadate ion exchanger has been developed. The exchanger was synthesized and characterized in our laboratory.

Removal of ionic dyes from water by solvent extraction using reverse micelles

Several methods (e.g., UV/H2O2 oxidation, adsorption, flocculation-precipitation) are normally employed to remove dye from water. A new technique based on liquid/liquid extraction using reverse micelles is proposed whereby recovery of solvent and reuse of dye is possible. Experiments were conducted by mixing a known quantity of dye in aqueous phase and solvent-containing surfactants in a simple mixer. The separation of solvent phase, containing encapsulated dye in reverse micelles, from aqueous phase due to gravity results in separation of dye from water. The removal of different ionic dyes (e.g., eosin yellow, methylene blue, malachite green, methyl orange, orange G) from aqueous phase in the presence of different cationic and anionic surfactants [e.g., sodium dodecylbenzene sulfonate, sodium bis(2-ethylhexyl) sulfosuccinate, hexadecyltrimethylammonium bromide, and cetyl pyridinium chloride] in different solvents (e.g., amyl alcohol, benzyl alcohol, methyl benzoate, and isooctane) were studied by conducting experiments. The percentage removal of dye from aqueous phase increases with the decrease in dye concentration or with the increase in surfactants concentration. Furthermore, the percentage COD removal of dye is increased with the increase in surfactant concentration. The nature of solvent has minimal effect on percentage removal of dye. The ratio of solventto aqueous phase volume required for the removal of dye decreases with the increase in surfactant concentration. It is possible to back-extract dye into aqueous phase and recover solvent by using counterionic surfactants. The separation of aqueous phase from the aqueous-phase solvent dispersion is faster for amyl alcohol as compared to benzyl alcohol and methyl benzoate. A theoretical model based on ion-exchange reaction between surfactants and dye is used to analyze the experimental data.

Magnetic field effect on indole exciplexes: a comparative study

A comparative magnetic field effect (MFE) study was done on indole exciplexes with various acceptors, anthracene, pyrene, all-s-trans-1,4-diphenylbuta-1,3-diene and 9-cyanophenanthrene. A surprisingly low magnetic field effect was detected for the 9-cyanophenanthrene exciplexes and was correlated with exciplex geometry. The wavelength dependence of magnetic field effect confirms the presence of single charge-transfer complex for all the exciplexes with 1,2-dimethylindole.

99Tcm(V)DMSA scintigraphy in skeletal metastases and superscans arising from various malignancies: diagnosis, treatment monitoring and therapeutic implications

Skeletal metastases arising from a wide variety of malignancies including a few cases with superscan appearance were evaluated using (99)Tc(m) MDP bone scanning and (99)Tc(m)(V)DMSA scintigraphy. Whole body planar scans were obtained at 3 h and 24 h after injection of 740 MBq (99)Tc(m) MDP and 5 days later at similar times after injection of 555 MBq of (99)Tc(m)(V)DMSA. A qualitative as well as quantitative comparison was made between the (99)Tc(m) MDP bone scan and the (99)Tc(m)(V)DMSA scan in detection of osseous metastases. The reference methods used for discordant or equivocal lesions were correlative morphological imaging modalities, for example additional conventional radiography, CT or MRI. The present pictorial review deals with the results of qualitative analysis of the study. A total of 75 cases have been evaluated. The vignettes illustrated in the present article demonstrate avid (99)Tc(m)(V)DMSA concentration in skeletal metastases from a wide variety of malignancies and thus expand the potential therapeutic indications for 188/186 Re(V)DMSA. The study also demonstrates the valuable supporting role a (99)Tc(m)(V)DMSA scan can play in the confirmation as well as evaluation of the extent of malignant infiltration in a suspected superscan in routine skeletal scintigraphy. In addition, a (99)Tc(m)(V)DMSA scan detected a number of metastatic lesions in and around joints and regions with previous surgical intervention that were inconclusive in the bone scan. The results in a few patients who were available for repeat scintigraphy following treatment, support the convincing evidence that (99)Tc(m)(V)DMSA accumulation may be a sensitive indicator of patient response to therapy. This might have an important bearing in the context of increasing "cold" bisphosphonate usage in the treatment of skeletal metastases, where skeletal scintigraphy with a radiolabelled bisphosphonate derivative can often be fallacious because of competitive inhibition by the non-labelled form.