The clinical spectrum of intracerebral hematoma, hemorrhagic infarct, non-hemorrhagic infarct, and non-lesional venous stroke in patients with cerebral sinus-venous thrombosis.

BACKGROUND AND PURPOSE: The clinical spectrum of different neuroradiological features of cerebral sinus-venous thrombosis (CSVT) varies considerably. We sought the relationship between different neuroradiological aspects and clinical presentations in these patients. METHODS: The diagnosis of cerebral sinus-venous thrombosis has been confirmed by conventional angiography, MRI combined with MR venography following established diagnostic criteria. We analyzed clinical data, symptoms and signs, imaging findings, location and extent of the thrombus, and parenchymal lesions, retrospectively. RESULTS: There were 220 consecutive patients with cerebral sinus-venous thrombosis; 98 (45%) had non-lesional sinus-venous thrombosis (NL CSVT), 51 (23%) had non-hemorrhagic infarct (NHI), 45 (20%) had hemorrhagic infarct (HI), and 26 (12%) had intracerebral hemorrhage (ICH). In patients with hemorrhagic lesion (HI+ICH), advanced age, headache (99%), behavioral disturbances (55%), consciousness disturbances (35%), seizures (41%), and language deficits (42%) were significantly higher than the other patients (NL+NHI) (P < 0.001). High blood pressure at admission, puerperium, sigmoid and straight sinus thrombosis, multiple sinus and vein involvement were more frequent in patients with hemorrhagic lesion than those with non-hemorrhagic lesion. Patients with hemorrhagic lesion were more dependent or died (32%) than the other patients (12%) (P < 0.001), and most of the patients with NL and NHI had no disability compared with the other patients at the 3 month of follow-up (96% and 65%; P < 0.001). CONCLUSION: Headache, convulsion, behavioral disorder, seizures, and speech disorders were the most frequent clinical symptoms of patients with hemorrhagic CSVT. Specific risk factors, including pregnancy/puerberium, early and extended thrombosis of large sinus, and presence of high blood pressure at admission, are associated with hemorrhagic lesion and unfavorable outcome.

Prognostic significance of p63, p53 and ki67 expression in laryngeal basaloid squamous cell carcinomas.

BACKGROUND: It is well known that basaloid squamous call carcinoma (BSCC) is more aggressive than the usual form of squamous cell carcinoma. However, current information about the prognostic significance of basaloid squamous cell carcinoma in the larynx is sparse. We investigated p63, p53 and Ki67 in BSCC of the larynx. METHODS: In a retrospective study conducted from January 2000 to June 2006, we used immunohistochemistry to analyse the protein expression of p63, p53, and Ki-67 in paraffin-embedded tumour samples from 22 BSCC patients and compared the clinicopathological parameters with the survival outcome. RESULTS: Positive p63 expression was found in 16 of 22 BSCC specimens (72.7%). Expression was higher in cases without lymph node metastasis than in cases with lymph node metastasis. This investigation found an inverse correlation between the expression of p63 and lymph node status in BSCC. CONCLUSION: To our knowledge, this is the first clinical study of p63 expression in laryngeal BSCC.

Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging.

PURPOSE: In this retrospective study, we evaluated the contribution and role of diffusion-weighted imaging (DWI) in differentiating acute and chronic forms of brucellar spondylodiscitis. We also describe the characteristics and some indistinguishable features of brucellar spondylodiscitis on magnetic resonance imaging (MRI) to emphasise the importance and limitations of MRI. MATERIALS AND METHODS: MRI examinations of 25 patients with brucellar spondylodiscitis were retrospectively reviewed and analysed by two experienced radiologists. Signal and morphological changes were assessed. The imaging characteristics of acute and chronic forms of spondylodiscitis were compared. Both discriminative imaging findings of brucellar spondylodiscitis and some uncommon findings were interpreted. RESULTS: Of 25 patients with spinal brucellosis, eight had thoracic, ten had lumbar, five had both thoracic and lumbar and two had both lumbar and sacral vertebral involvement. We detected posterior longitudinal ligament elevation in 11 patients, epidural abscess formation in 11 and paravertebral abscess formation in nine. Ten patients had cord compression and eight had root compression. Three patients had facet-joint involvement, and one had erector spinae muscle involvement. Eight patients (32%) were in the acute stage, six (24%) in the subacute stage and 11 (44%) in the chronic stage. Vertebral bodies, vertebral end plates and intervertebral disc spaces were hypointense and hyperintense in the acute stage, whereas they were hypointense and heterogeneous in the subacute and chronic stages on T1- and T2-weighted images, respectively. In the acute stage on the DWI series, vertebral bodies, end plates and discs were all hyperintense but hypointense in the chronic stage. CONCLUSIONS: Although conventional MRI has several advantages over other imaging modalities and is very useful in the differential diagnosis between brucellar spondylodiscitis and other spinal pathologies, it has some difficulties in discriminating acute and chronic forms of spondylodiscitis. DWI is a sensitive, fast sequence that has the potential for differentiating acute and chronic forms of spondylodiscitis, which makes it crucial in spinal imaging.

Radiotherapy for Kimura's disease: case report and review of the literature.

Kimura's disease is a chronic inflammatory disease of uncertain etiology which involves subcutaneous tissue, presents as a tumor-like lesion and predominantly occurs in the head and neck region. Radiotherapy has been used for treating unresectable or recurrent lesions. We report a 32-year-old male who presented with a mass on the right side of the neck. The mass measured 52 x 40 mm. Peripheral eosinophilia and 5-fold increase in serum IgE level were found. Pathological evaluation following subtotal excision of the mass confirmed Kimura's disease and the patient was given prednisolone p.o. Local recurrence was observed one month later for which the patient received local radiotherapy. No recurrence has been observed up to 30 months in the post-radiotherapy period. Effective radiotherapy given in a favorable schedule and dosage could be a highly effective alternative when other treatment modalities are unsuccessful.

Subspecialisation in Emergency Radiology: Proposal for a harmonised European curriculum.

Introduction: Radiology plays a crucial role in the emergency care setting by delivering early and precise diagnoses under pressure of time, right at the beginning of patient treatment. Although there is a need for postgraduate education in emergency radiology, most of the national bodies responsible do not offer it in a uniform fashion and a general proof of qualification is missing in Europe. Therefore, the European Society of Radiology (ESR) has founded the (Sub-)Society of Emergency Radiology (ESER), prompting them to develop a European curriculum. This trend, which is currently also encouraged in many other non-radiological specialties which demand the highest professional qualifications, often lacks expertise in medical education. Goals: The goal of this article is the general description of the curricular planning process for a European postgraduate subspecialisation programme, using the example of Emergency Radiology (European Diploma in Emergency Radiology, EDER), including the utilisation of TOOLS and recommendations derived from comparable projects. Project description: The project was divided into partial steps: the timeline displayed in a GANTT chart, and tasks and responsibilities assigned in a RASCI matrix. The curriculum was iteratively developed using the KERN approach and steps were prioritised using the PARETO principle. Furthermore, the following TOOLS were used: limitations and needs assessment, SWOT analysis, formulating learning objectives and categorising them after MILLER and SCLO, and using BLOOM's taxonomy for cognitive learning objectives and operationalising them according to MAGER. Psychomotoric and affective learning objectives were assigned to CANMEDS roles, grouped by topic using CLUSTERING, and then mapped by MATRIX analysis to appropriate learning and evaluation methods. Striving for continuous improvement, the curriculum was finally embedded in curricular quality management. Results: The standardisation of the EDER access, considering the different national conditions, the minimisation of European learners' attendance phases, restricting expenses by best possible use of existing structures, respecting the requirements and retaining the support of the European umbrella society ESR, finishing the project by a specific deadline and the demands of continuous improvement were particular challenges. A curriculum with the eligibility of five years' speciality training in general radiology has evolved on schedule. The subspeciality training lasts at least one year and is divided into webinars, workshops during congresses (e.g. the annual ESR and ESER congresses) and one year practical training at the individual learner's corresponding local hospitals, which adhere to a catalogue of requirements, comparable to national educational policies. The curriculum is completed by passing a written and oral exam (diploma) and re-accreditation every five years. Conclusions: Despite complex requirements, the TOOLS utilised allowed an almost seamless, resource-minimised, professional, location-independent distributed development of a European subspeciality curriculum within one year. The definitive implementation is still due. If any deviations from the draft presented should become necessary in the future, the embedment in the curricular quality management will lead to a redirection in the right way and, furthermore, secure a continuous improvement in the best way possible.

In vivo tissue response and durability of five novel synthetic polymers in a rabbit model.

Alloplastic materials are frequently used in facial plastic surgeries such as rhinoplasty and nasal reconstruction. Unfortunately, the ideal alloplastic material has not been found. This experimental study evaluates the tissue response and durability of five novel polymers developed as an alloplastic material. In this experimental study involving a tertiary university hospital, six subcuticular pockets were formed at the back of 10 rabbits for the implantation of each polymer and sham group. Each pocket was excised with its adjacent tissue after three months, and collected for histopathological examination. Semi-quantitative examination including neovascularisation, inflammation, fibrosis, abscess formation, multinucleated foreign body giant cells was performed, and integrity of polymer was evaluated. A statistical comparison was performed. No statically significant difference was detected in neovascularisation, inflammation, fibrosis, abscess formation and multinucleated foreign body giant cells when a paired comparison between sham and polymer II, III and IV groups was performed individually. Nevertheless, the degree of fibrosis was less than sham group in polymer I (p = .027) and V (p = .018), although the other variables were almost similar. The integrity of polymers III (9 intact, 1 fragmented) and IV (8 intact, 2 absent) was better than the other polymers. These novel synthetic polymers could be considered as good candidates for clinical applicability. All polymers provided satisfactory results in terms of tissue response; however, fibrovascular integration was higher in polymers II, III and IV. In addition, the durability of polymer III and IV was better than the others.

Hypertrophic cranial pachymeningitis involving dural sinuses: a pseudo signal-void appearance on MRI.

A case of hypertrophic cranial pachymeningitis with an unusual and misleading manifestation is reported. CT detected calcified tentorium and superior sagittal sinus. MR imaging and MR angiography depicted tentorial thickening as well as occlusion of all major dural sinuses. Fibrocalcific occlusion of dural sinuses showed interestingly signal-void appearance on spin-echo images which could readily be interpreted as being patent sinuses.

Transcatheter arterial embolization of internal mammary artery in a hepatocellular carcinoma with abdominal wall invasion.

Transcatheter arterial embolization (TAE) is alternatively employed to surgical resection in the management of hepatocellular carcinoma (HCC). TAE through the hepatic artery is sometimes insufficient since the blood supply to HCC may be from the collateral vessels as well. We report a case of HCC with abdominal wall invasion who underwent TAE through the right internal mammary artery after insufficient embolization of the tumor through the hepatic artery.

Two siblings with juvenile hyaline fibromatosis: case reports and review of the literature.

In this paper, we describe two siblings with Juvenile Hyaline Fibromatosis (JHF) who were diagnosed at the age of 34 and 29 years respectively. JHF is a very congenital disease, mainly diagnosed in the first few years of life, with less than 40 published cases in literature. All the main clinical features of this syndrome, which may be summarised as multiple subcutaneous tumours, marked gingival hypertrophy, flexion contractures and osteolytic lesions were present in both of these cases. Clinical, radiological and histological differential diagnosis of JHF were made. Recent information about histopathology, treatment and prognosis of JHF was also reviewed.

Hypoplastic lumbar pedicle in association with conjoined nerve root MRI demonstration.

We report a case of aberrant hypoplastic pedicle of the fourth lumbar vertebra and ipsilateral conjoined nerve root. Ipsilateral retroisthmic laminar defect, dysplastic lamina and transverse process, enlargement of neural foramen, hypoplasia of superior and inferior articular facet were present as associated with other neural arch anomalies. The extent of these anomalies was well demonstrated by MR imaging.

Partially thrombosed hepatic artery aneurysm mimicking pancreatic head carcinoma.

A 43-year-old man with hepatic artery aneurysm which mimicked pancreatic head carcinoma on computed tomography (CT) was studied with B-mode ultrasonography, color doppler ultrasonography, and angiography and the findings are discussed comparing the imaging modalities.

Spinal cord compression due to costal Echinococcus multilocularis.

We present computerized tomography (CT) and magnetic resonance imaging (MRI) findings of a costal hydatid cyst (Echinococcus multilocularis) causing spinal cord compression. The hydatid disease was proved histologically. MRI was not only very useful for determining the spinal extension of the disease by its multiplanar imaging capability, but also gave important information about the texture of the cyst, thus aiding the preoperative diagnosis.

Varix of the inferior pulmonary vein: computed tomography and magnetic resonance angiography findings.

A 37-yr-old male presented with a 2-week history of intermittent episodes of mild haemoptysis. Computed tomography and magnetic resonance imaging revealed a varix of the inferior pulmonary vein. The diagnosis was confirmed using magnetic resonance angiography and conventional angiography. This condition is relatively rare, and few cases have previously been demonstrated by means of magnetic resonance imaging and angiography.

Cervical osseous changes associated with vertebral artery tortuosity.

Vertebral artery tortuosity causing neural foraminal widening is a well described abnormality that should not be confused with other causes of neural foraminal enlargement, particularly on conventional roentgenograms. We, hereby, describe CT features of another cervical osseous change due to the vertebral artery tortuosity, the so called "tubular shaped vertebral artery canal", which is embedded in the vertebral body instead of causing neural foramen enlargement. Catheter and MR angiographic studies have also been performed to confirm the vertebral artery tortuosity causing the osseous changes.

Retroclival epidural hematoma secondary to decompressive craniectomy in cerebellar infarction: MR demonstration.

Epidural hematomas of the clivus are very uncommon. We, hereby, present a case of retroclival epidural hematoma as a complication of posterior fossa decompressive surgery for the management of acute cerebellar infarction. Serial MRI examinations of the patient was documented and demonstrated. In addition, the etiology of retroclival epidural hematomas were also discussed.

Proton MR spectroscopy in the diagnosis and differentiation of encephalitis from other mimicking lesions.

In this study, proton magnetic resonance spectroscopy (1H MRS) findings of encephalitis were reported. For comparison, other lesions mimicking encephalitis on conventional magnetic resonance (MR) imaging were included in the study. These lesions consisted of acute infarctions and low grade infiltrative gliomas. The 1H MRS findings of encephalitis and gliomas were almost the same whereas infarctions revealed high lactate levels differentiating the disorder from other two pathologies. The differentiation of encephalitis and gliomas based on MR findings could reliably made with short time follow up MR examinations where gliomas tend to grow in contrast to encephalitis which showed regression.

Mast cells positive for cluster of differentiation 117 protein: are they players or conductor in the orchestra of cholesteatoma?

BACKGROUND: The pathogenesis of cholesteatoma remains unclear, despite several theories. Alterations in the density of mast cells positive for cluster of differentiation 117 protein (also known as CD117) can be critical to cholesteatoma formation, due to the effect on keratinocyte growth factor production. This study aimed to investigate the potential role of these mast cells in cholesteatoma pathogenesis. METHODS: The number and density of mast cells positive for cluster of differentiation 117 protein were immunohistochemically analysed in 52 patients: 22 with chronic otitis media alone (group one), 25 with chronic otitis media with cholesteatoma (group two) and five controls. RESULTS: The number of these mast cells was much higher in group two (in cholesteatoma matrix tissue) than in group one (in chronic otitis media granulation tissue) or the controls (in normal post-auricular skin). The density of these mast cells was significantly greater in group two than in group one or the controls (p < 0.05). The number and density of these mast cells was much greater in group one than in controls (p < 0.01). CONCLUSION: Mast cells positive for cluster of differentiation 117 protein could play a role in cholesteatoma formation. Further investigation of the role of these mast cells in cholesteatoma may suggest new ways of addressing this disorder, and may enable the development of targeted treatments.

Intracerebral metastasis showing restricted diffusion: correlation with histopathologic findings.

OBJECTIVE: We aimed to detect the frequency of restricted diffusion in intracerebral metastases and to find whether there is correlation between the primary tumor pathology and diffusion-weighted MR imaging (DWI) findings of these metastases. MATERIAL AND METHODS: 87 patients with intracerebral metastases were examined with routine MR imaging and DWI. 11 hemorrhagic metastatic lesions were excluded. The routine MR imaging included three plans before and after contrast enhancement. The DWI was performed with spin-echo EPI sequence with three b values (0, 500 and 1000), and ADC maps were calculated. 76 patients with metastases were grouped according to primary tumor histology and the ratios of restricted diffusion were calculated according to these groups. ADCmin values were measured within the solid components of the tumors and the ratio of metastases with restricted diffusion to that which do not show restricted diffusion were calculated. Fisher's exact and Mann-Whitney U tests were used for the statistical analysis. RESULTS: Restricted diffusion was observed in a total of 15 metastatic lesions (19, 7%). Primary malignancy was lung carcinoma in 10 of these cases (66, 6%) (5 small cell carcinoma, 5 non-small cell carcinoma), and breast carcinoma in three cases (20%). Colon carcinoma and testicular teratocarcinoma were the other two primary tumors in which restricted diffusion in metastasis was detected. There was no statistical significant difference between the primary pathology groups which showed restricted diffusion (p>0.05). ADCmin values of solid components of the metastasis with restricted diffusion and other metastasis without restricted diffusion also showed no significant statistical difference (0.72+/-0.16x10(-3)mm(2)/s and 0.78+/-21x10(-3)mm(2)/s respectively) (p=0.325). CONCLUSION: Detection of restricted diffusion on DWI in intracerebral metastasis is not rare, particularly if the primary tumor is lung or breast cancer. However we found that there is no correlation between the metastasis showing restricted diffusion and primary pathology. Prospective studies with larger groups and more information are necessary regarding the correlation between the primary tumor histopathology and the ADC values of metastasis with restricted diffusion.

Testing intra-hemocelic injection of antimicrobials against Encephalitozoon sp. (Microsporidia) in an insect host.

Encephalitozoon spp. are the primary microsporidial pathogens of humans and domesticated animals. In this experiment, we test the efficacy of four commercial antimicrobials against an Encephalitozoon sp. in an insect host by intra-hemocelic injection. All four antimicrobials, viz., thiabendazole, quinine, albendazole, and fumagillin, significantly reduced but did not eliminate microsporidia spore counts in the grasshopper host. Among these four drugs, thiabendazole was most effective in reducing the microsporidia spore level up to 90%, followed by quinine (70%), albendazole (62%), and fumagillin (59%). No control or quinine-treated animals died, whereas 45% of albendazole animals died. Despite the high mortality induced by albendazole, this drug significantly reduced spore counts, a result not seen in previous per os trials. Among the treatment groups, grasshoppers injected with thiabendazole lost a significant mass. Our study suggests that quinine and related alkaloids should be further examined for antimicrosporidial activity.