Cerebellar volume decline in normal aging, alcoholism, and Korsakoff's syndrome: relation to ataxia

The authors used magnetic resonance imaging to measure gray and white matter volumes in cerebellar hemispheres and 4 vermian regions in 61 normal control (NC) men aged 23-72 years, 25 men with uncomplicated alcoholism (ALC), and 8 men and 1 woman with alcoholic Korsakoff s syndrome (KS). NC and ALC took quantitative gait and balance tests. Gray but not white matter volume declined with normal age in both hemispheres and anterior-superior vermis. ALC had gray but not white matter cerebellar hemisphere volume deficits, whereas KS had deficits in both tissue types. ALC and KS had gray and white matter volume deficits in anterior superior but not posterior inferior vermis. ALC had a 1 SD ataxia deficit, significantly and selectively correlated with white matter volume in anterior superior vermis. Regional distribution but not severity of cerebellar volume deficits is similar in alcoholic individuals whether or not complicated by KS and relates to ataxia.

Sex differences in the effects of alcohol on brain structure

OBJECTIVE

This study investigated whether alcoholic women manifest deficits in cortical gray and white matter volumes and ventricular enlargement similar to those seen in alcoholic men.

METHOD

Volumetric measures of intracranium, cortical gray matter, white matter and sulci, and lateral and third ventricles were obtained from magnetic resonance images of 42 women and 44 men with DSM-III-R alcoholism and age-matched healthy comparison groups (37 women and 48 men). Groups of alcoholic men and women were matched on age and length of sobriety, but men had a 2.5 times higher lifetime alcohol consumption than women.

RESULTS

Women, regardless of diagnosis, had less cortical gray and white matter and smaller third ventricles than men, consistent with sex-related differences in intracranial volume. Alcoholics had larger volumes of cortical sulci and lateral and third ventricles than comparison subjects. Diagnosis-by-sex interactions for cortical white matter and sulcal volumes were due to abnormalities in alcoholic men but not alcoholic women, relative to same-sex comparison subjects. This interaction persisted for cortical sulci after covarying for lifetime alcohol consumption. Slopes relating cortical gray matter and sulcal volumes to age were steeper in alcoholic than in comparison men. Slopes relating lateral ventricle volume to age were steeper in alcoholic than in comparison women. In alcoholic women, longer sobriety was associated with larger white matter volumes.

CONCLUSIONS

Alcoholic men and women show different brain morphological deficits, relative to same-sex comparison subjects. However, age and alcoholism interact in both sexes, which puts all older alcoholics at particular risk for the negative sequelae of alcoholism.

Contribution of alcohol abuse to cerebellar volume deficits in men with schizophrenia

BACKGROUND

It is controversial whether cerebellar tissue volume deficits occur in schizophrenia and, if so, what regions and tissue types are affected. Complicating such investigations is the high incidence of alcoholism comorbidity in patients with schizophrenia that itself can contribute to cerebellar abnormalities.

METHOD

We studied 61 healthy men (control subjects), 25 men with alcoholism, 27 men with schizophrenia, and 19 men comorbid for schizophrenia and alcoholism with the use of magnetic resonance imaging. Cerebellar structures were outlined manually, tissue classification was determined statistically, and regional volumes were corrected for normal variation in head size and age.

RESULTS

Patients with schizophrenia alone had enlarged fourth ventricles (1.5 SD relative to controls) but showed no cerebellar tissue volume deficits. The alcoholic group had gray and white matter vermian deficits (-0.5 SD), most prominent in anterior superior lobules, and gray matter hemisphere deficits (-0.8 SD), but not fourth ventricle enlargement. The comorbid group had cerebellar hemisphere (-1.3 SD) and vermian gray matter volume deficits (-0.7 SD) and fourth ventricular enlargement (1.6 SD); these abnormalities were greater than in either single-diagnosis group, despite significantly lower levels of alcohol consumption compared with the alcoholic group. Gray matter volume in the anterior superior vermis correlated with lifetime alcohol consumption in the schizophrenic and comorbid groups when combined.

CONCLUSIONS

Cerebellar tissue volume deficits were detected in schizophrenia only when accompanied by alcoholism. By contrast, fourth ventricular enlargement occurred in schizophrenia even without alcoholism, although it was exacerbated by alcoholism. These findings support a model of cerebellar supersensitivity to alcohol-related tissue volume deficits in schizophrenia.

Effect of a trypsin inhibitor from soybeans (Bowman-Birk) on the secretory activity of the human pancreas

This study was undertaken to clarify the issue of whether feedback regulation of pancreatic enzyme secretion occurs in humans. A naturally occurring inhibitor of trypsin and chymotrypsin, the Bowman-Birk inhibitor of soybeans, was used to reduce the activities of these enzymes normally secreted by the pancreas into the duodenum. Pure pancreatic juice was collected by endoscopic retrograde cannulation of the pancreatic duct in a protocol consisting of three periods: period 1 (15 min), collections of juice without return to the duodenum ("washout phase"); period 2 (35 min), intraduodenal infusion of juice to which buffered saline or heat-inactivated Bowman-Birk inhibitor had been added; and period 3 (55 min), intraduodenal infusion of juice in which greater than 90% of the trypsin and chymotrypsin activities had been abolished by treatment with the active inhibitor. Control experiments were included in which untreated juice was infused in period 3 as well as period 2. Enzyme analyses (trypsin, chymotrypsin, elastase, and amylase) of samples of juice collected at 5-min intervals revealed a twofold to threefold increase in the output and concentration of all four enzymes in period 3 compared with period 2. These results thus confirm the existence of feedback control in humans.

Management of pterygium with surgery and radiation therapy. The North Florida Pterygium Study Group

PURPOSE

To compare our results in the management of pterygium using a higher total dose with other reported results.

METHODS AND MATERIALS

Between 1971 and 1991, 690 patients were treated with complete surgical excision followed by beta irradiation for primary or recurrent pterygium. Of these patients, 129 had two or more areas involving both eyes for a total of 825 lesions treated. Only 17 patients (2%) had temporal lesions with the rest of the patients having nasal pterygia. All patients underwent complete surgical resection of the pterygium before undergoing radiation therapy. One hundred forty-nine patients had undergone previous surgical resection alone but developed recurrence. After surgical excision, all patients were treated with Strontium-90 applicators starting immediately within 24 hr of surgery. Our standard policy was six weekly applications, each delivering a surface dose of 1000 cGy. The total dose delivered was 6000 cGy. Minimum follow-up was 1 year with a median of greater than 8 years.

RESULTS

There were only fourteen recurrences (1.7%) out of a total of 825 lesions treated. Nine of the fourteen patients received suboptimal therapy undergoing less than five applications of Strontium-90. There were no major complications.

CONCLUSION

The combination of surgical excision followed by adequate Strontium-90 applications is highly effective in the management of pterygium. The optimal total dose appears to be in the range of 2000 cGy to 6000 cGy.

Lorazepam in the treatment of refractory neonatal seizures. A pilot study

Seven neonatal patients with severe seizures unresponsive to conventional anticonvulsant therapy were treated with lorazepam. Immediate cessation of seizure activity occurred in all patients within five minutes. Although seizures recurred in two infants eight hours later, frequency and severity diminished. There were no apparent significant side effects attributed to the medication.

Primary extragonadal retroperitoneal teratoma in an adult

Primary retroperitoneal teratoma is a rare entity in adults. It has a distinctive imaging appearance. We describe a case of a 22-year-old patient who was referred to our hospital with the complaint of abdominal distension. Radiological work-up disclosed a retroperitoneal teratoma. Laparotomy with tumour resection was performed. Pathological examination revealed a benign cystic teratoma. The patient is doing well at follow-up.

Impact of fluorodeoxyglucose positron emission tomography on the clinical management of patients with glioma

The past decade has seen the identification of many clinical settings in the treatment of primary brain tumors in which information from fluorodeoxyglucose positron emission tomography (FDG-PET) might be useful, if not essential, to therapeutic formulation. FDG-PET is currently used at referral centers in the management of primary brain tumors. The clinical pattern of FDG-PET use was assessed and its value compared to other information sources in clinical decision making. The clinical records of 75 glioma patients who were evaluated by FDG-PET were reviewed. The range of circumstances in which FDG-PET was employed included: pretherapeutic baseline studies for monitoring the effect of a therapy (1% of all cases), mapping of hypermetabolic regions before surgery or biopsy (2%), mapping of hypermetabolic regions before radiotherapy (2%), postsurgical evaluation for residual tumor (2%), assessment of the malignancy of a mass as a substitute for biopsy (11%), and distinguishing between radiation necrosis and recurrent tumor (87%). Other sources of information that contributed to the therapeutic management of patients included: gadolinium-enhanced MRI, contrast-CT, and clinical findings.

Pseudocyst formation: a rare complication of wandering spleen

Wandering spleen is a rare entity, in which the spleen is abnormally mobile due to its attachment by a long vascular pedicle. This long vascular pedicle predisposes it to various complications, the most common being torsion. Here, we present a case in which a wandering spleen in a young female was complicated by pseudocyst formation, and discuss the possible aetiology, pathogenesis, diagnosis and therapeutic implications of this extremely rare complication.

Cardiac MRI for the evaluation of cardiac neoplasms

Primary cardiac neoplasms are extremely rare and are far outnumbered by metastases. These are difficult to diagnose and differentiate clinically due to lack of specific clinical manifestations. Technological advances have revolutionised cardiac imaging, with the cardiac magnetic resonance imaging (CMRI) showing promising results in the non-invasive evaluation of cardiac masses. Further, CMRI may envisage the malignant potential of a lesion based on its location, morphology, and signal characteristics, in addition to determining its impact on cardiac function. With the ever-increasing application of CMRI in the evaluation of neoplasms, comprehensive knowledge of their imaging characteristics becomes crucial.

Management of thyroid carcinoma with radioactive 131I

PURPOSE

To evaluate the role of radioactive 131I in the management of patients with well differentiated carcinoma of the thyroid.

METHODS AND MATERIALS

Between 1965 and 1995, a total of 117 patients with well-differentiated carcinoma of the thyroid underwent either lobectomy or thyroidectomy followed by 100-150 mCi of 131I.

RESULTS

With a median follow-up of 8 years, only four patients (3%) developed a recurrence of their disease. The 5-year actuarial survival was 97% with a 10-year survival of 91%. There were no severe side effects noted after 131I therapy.

CONCLUSIONS

Radioactive 131I is a safe and effective procedure for the majority of patients with well-differentiated thyroid carcinoma. We currently recommend that all patients undergo a subtotal or total thyroidectomy followed by 131I thyroid scanning approximately 4 weeks after surgery. If the thyroid scan shows no residual uptake and all disease is confined to the thyroid, we recommend following patients with annual thyroid scans and serum thyroglobulin levels. If there is any residual uptake detected in the neck or if the tumor extends beyond the thyroid, we recommend routine thyroid ablation of 100-150 mCi of radioactive 131I.

Utility of PET in unknown primary with cervical metastasis: a retrospective study

BACKGROUND

FDG-PET is recommended as an investigation in unknown primary tumors, but its definitive role and cost effectiveness are yet to be established.

AIMS

dditional value of FDG-PET over conventional imaging in unknown primary tumors with cervical metastasis.

SETTING AND DESIGN

Retrospective study in a tertiary level oncology centre.

MATERIALS AND METHODS

A total of 112 patients were divided into three groups; 53 with conventional modalities (either computed tomography or magnetic resonance imaging) (group I), 59 with FDG-PET (group II), and group III (subgroup of group II) with both (40 patients).

STATISTICAL ANALYSIS

Sensitivity and specificity of both conventional modality and PET were calculated. Association between neck nodes and distant metastasis was analysed using multivariate logistic regression analysis.

RESULTS

Sensitivity and specificity for conventional modalities was 92.3% and 50% and sensitivity and specificity of FDG-PET was 92.8% and 71.4%, respectively. FDG-PET detected metastasis in 52.54% of patients. Multivariate logistic regression analysis showed statistically significant association between distant metastasis and multiplicity of nodes (N2b, N2c) (P = 0.007). Among all patients with low neck nodes in group II, FDG-PET detected primaries in 12 patients, 9 of which were infraclavicular (75%). FDG-PET added information to conventional imaging in 32.5% of patients and influenced an overall change in management in 38.9% of patients.

CONCLUSIONS

FDG-PET is a valuable tool influencing change of management in unknown primary with cervical metastasis. It is recommended especially in the presence of low or multiple neck nodes in view of high incidence of infraclavicular primary and distant metastasis, respectively.

Sphygmomanometer calibration: a survey of one inner-city primary care group

Sphygmomanometers are the cornerstone of blood pressure management and yet there is no national standard for the regulation of this equipment in the UK. It is known that these machines may often be inaccurate, particularly those used in the community. We embarked upon a survey of all sphygmomanometers in current use in one inner city primary care group. Contrary to our initial hypothesis, inaccuracy rates were lower than in other reported community surveys with 2.3% of mercury and 14.8% of anaeroid sphygmomanometers failing the test. Surprisingly, inaccurate machines did not cluster in the less well developed practices. The implication is that all practices need to have procedures in place for the regular calibration of their sphygmomanometers.

Ancient schwannoma of the parapharynx causing dysphagia: a rare entity

A schwannoma is a benign, encapsulated tumour that is derived from neural sheath (Schwann) cells. Approximately 25-40% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck; oropharyngeal occurrence is extremely rare. Among the various histological types of schwannomas reported to date, the ancient (degenerative) variant is the most rare. To our knowledge, this is the first report of an ancient schwannoma in the parapharynx with an extensive oropharyngeal component causing dysphagia. Dysphagia was the prominent symptom because of the location and volume of the lesion. The tumour was excised via a transcervical approach.

Massive post-transplant proteinuria. Biopsy proven nil disease

A case of massive proteinuria following an A-match living donor transplantation is described. All attempts to define the cause of the proteinuria failed. The proteinuria resolved while the patient was on triple-drug therapy. Presently, the patient remains well with minimal proteinuria and excellent renal function.

Splenic artery embolisation for portal hypertension in children

BACKGROUND

Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices.

PATIENTS AND METHODS

Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years.

RESULTS

Out of 25 patients treated, ten belonged to sclerotherapy (group A), eight to combined sclerotherapy and embolisation (group B), and seven to only embolisation (group C). The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow.

CONCLUSION

In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients.

Influence of Dy3+ co-doping on the luminescence properties of bluish-green Ba1−0.5ySr1−0.5yAl2SiO7:yEu2+ phosphors

The emission intensity of Ba_0.985Sr_0.985Al₂SiO₇:0.03Eu²⁺ is enhanced due to the incorporation of Dy³⁺. The emission intensity of Ba_0.975Sr_0.975Al₂SiO₇:0.03Eu²⁺, 0.02Dy³⁺ was about 350% that of the Ba_0.985Sr_0.985Al₂SiO₇:0.03Eu²⁺ phosphor.

The subcutaneous implantation of xenogeneic decalcified teeth

Decalcified matrices obtained from bone and dentin have been used in xenogeneic implantation experiments. It is observed that such implants generally do not induce new bone but in many cases result in recalcification of old matrices. Treatment of the matrices with the enzyme inhibitor, iodoacetic acid, prior to implantation also did not enhance or improve the osteoinductive potentiality of these matrices. It is therefore suggested that the bone morphogenetic protein (BMP) to which the osteoinductive potentiality has been attributed by Urist et al. is a highly species-specific moiety and that the xenogeneic implant is hence a poor choice for its determination.

Giant congenital intrapericardial left atrial aneurysm diagnosed by contrast-enhanced computed tomography

A left atrial aneurysm is a rare cardiac anomaly. The etiology is usually congenital, but it can also occur as an acquired pathology secondary to mitral valve disease or a degenerative process. We report a case which, on routine PA chest radiography, presented as cardiomegaly with a bulge on the left cardiac contour. Further evaluation by contrast-enhanced computed tomography proved it to be caused by a large left atrial aneurysm.

The use of a thermoelectric osmometer to measure the osmotic coefficients of aqueous solutions of sodium salicylate at 25 degrees

The use of a thermoelectric osmometer to measure osmotic coefficients for the binary system water-sodium salicylate at low concentrations (0·0 to 0·3 molal) is described. The accuracy and reproducibility of the instrument have been enhanced by employing a microscope to measure sample and reference drop sizes. Activity coefficients, calculated from the osmotic coefficients obtained in these experiments, have been combined with density and diffusional measurements to calculate frictional coefficients for the system.

Primary angiosarcoma of the larynx: a rare entity

Angiosarcomas are extremely rare malignant tumours of the larynx. We present a case of laryngeal angiosarcoma in a 58-year-old man who presented with hoarseness of voice, dysphagia and neck swelling. The patient underwent a total laryngectomy with a pre-operative and frozen section diagnosis of a poorly differentiated carcinoma of the larynx. Histopathological and immunohistochemical evaluation revealed features of a laryngeal angiosarcoma. The case is presented for its rarity and diagnostic difficulty.