ABSTRACT
BACKGROUND: Patients with acute disseminated encephalomyelitis (ADEM) may relapse and some may ultimately convert to multiple sclerosis (MS); however, no criteria that can predict MS conversion are available to date. Our aim was to describe the clinical and magnetic resonance imaging (MRI) features of patients with an initial ADEM attack and evaluate which MRI criteria can predict conversion to MS. METHODS: We retrospectively reviewed the records of 36 patients diagnosed with ADEM. We determined clinical signs/symptoms, examined the cerebrospinal fluid (CSF), and performed brain MRI scans and compared the findings between patients who did and did not convert to MS. RESULTS: Clinical signs/symptoms, and CSF analysis show no significant difference between the two groups. The rate of conversion to MS from ADEM in Taiwanese patients is low (11%) after a mean follow-up period of 28.36 months. Modified McDonald criteria were fulfilled in 19/36 patients: 21% (4/19) of those patients developed MS according to Poser criteria subsequently. Of the other patients (17/36) who did not fulfill these criteria, none converted to MS. (log rank test; P=0.027). CONCLUSIONS: It is difficult to predict from initial clinical presentations to address which patients with ADEM will convert to MS. Patients with ADEM whose brain MRI findings met the modified McDonald criteria may have clinically isolated syndrome because they have a significantly higher probability of conversion to MS. In contrast, patients whose brain MRI findings did not meeting these criteria may be considered as having classic ADEM because they have a lower probability of conversion to MS.
Subject(s)
Encephalomyelitis, Acute Disseminated/complications , Encephalomyelitis, Acute Disseminated/pathology , Multiple Sclerosis/etiology , Multiple Sclerosis/pathology , Adult , Child, Preschool , Disease Progression , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , TaiwanABSTRACT
OBJECTIVE: To establish an animal model of Stanford type B aortic dissection using a two-end intimal flap suturing. DESIGN: Twelve adult mongrel dogs of either sex were studied and followed up, at intervals, up to 1 year. MATERIALS AND METHODS: A lateral clamp was placed on the proximal descending aorta after general anaesthesia and left thoracotomy. Half the circumference of the aorta, including the media and adventitia, was cut open transversely, leaving the intima intact. The aortic wall was separated inferiorly. The intima was transversely cut and both ends of the distal intimal flap were sutured to the adjacent aorta. To close, the distal adventitia and media were sutured to the proximal aorta. Before thoracic cavity closure, digital subtraction angiography (DSA) and colour Doppler ultrasound were performed. RESULTS: Formation and distal extension was observed immediately after removal of the partial aortic clamp in 11 dogs. True and false lumens were seen in eight dogs; the false lumen was larger than the true lumen. Sacrifice at set intervals, 7 days to 12 months after surgery, showed a typical dissection tear, intima, septum, adventitia, thrombi and distal dissection blind pocket. CONCLUSION: This model of aortic dissection using the two-end aortic intimal flap suturing method is similar to human Stanford type B aortic dissection.
Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/etiology , Aortic Dissection/etiology , Disease Models, Animal , Surgical Flaps , Suture Techniques , Tunica Intima/surgery , Aortic Dissection/diagnostic imaging , Angiography, Digital Subtraction , Animals , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortography/methods , Constriction , Disease Progression , Dogs , Female , Male , Thoracotomy , Time Factors , Ultrasonography, Doppler, ColorSubject(s)
Fabry Disease/physiopathology , Forearm/blood supply , Microcirculation , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Child , Cold Temperature , Female , Forearm/physiopathology , Humans , Male , Middle Aged , Pedigree , Perfusion , Young AdultABSTRACT
High resolution real-time ultrasound scans were obtained through the anterior fontanelle to measure the lateral ventricles of 540 neonates of various gestational ages. Coronal scans showed that the distance between the falx and the lateral wall of the body of the lateral ventricle (ventricular index) and the greatest axis of the lateral ventricle (ventricular axis) were correlated with increasing gestational age. Growth charts were constructed for neonates of various gestational ages, from 24 to 40 weeks. The greatest distance perpendicular to the ventricular axis was defined as the ventricular depth. The depth of normal lateral ventricles was 0.18 cm (range, 0.13-0.23 cm). Hopefully, the data concerning ventricular sizes obtained in this survey can be utilized for the early diagnosis and control of posthemorrhagic ventriculomegaly.