Headache patterns in patent foramen ovale patients: beyond migraine with aura.

Patent foramen ovale (PFO) is a common cardiac anomaly linked with cryptogenic strokes and migraine, particularly migraine with aura. This study aims to explore the spectrum of headache disorders in PFO patients, focusing on identifying patterns beyond the well-established migraine-PFO connection. A retrospective observational study was conducted on patients diagnosed with PFO. Headache types were classified using the International Classification of Headache Disorders, 3rd edition. The study analyzed headache prevalence and patterns in PFO patients, comparing those with and without a history of stroke. Of 177 participants, 63 (35.59%) reported headaches. Tension-type headache was the most common (15.25%), followed by migraine without aura (11.30%) and migraine with aura (8.47%). Notably, migraine without aura was more prevalent than migraine with aura, contrasting previous assumptions. No significant differences were found in headache types based on stroke history. The study reveals a diverse spectrum of headache types in PFO patients, with migraine without aura being more common than migraine with aura. These findings suggest a need for broader diagnostic perspective and individualized treatment approaches in PFO patients with headaches.

Why antiplatelet treatment in spontaneous internal carotid dissection?

Spontaneous dissection of the internal carotid artery is a leading cause of stroke and TIA, particularly in young patients. The antithrombotic treatment with or without an interventional procedure is a unanimously accepted indication for the prevention of the ischemic events in these patients. Whether anticoagulants or antiplatelets as antithrombotics are a better option is a matter of debate. The authors, based on clinical and pathophysiological data in the published studies and their own experience argue in favour of antiplatelets in most cases, without excluding the need of anticoagulants in some cases, due to the lack of objective proofs for the superiority of anticoagulants in this pathology and at the same time, a better safety profile of antiplatelets. To have a clear-cut answer to this debate, a large comparative randomized clinical trial between the two types of treatment is desirable.

Performance of neuroretinal rim thickness measurement by Cirrus high-definition optical coherence tomography in myopic eyes.

Neuroretinal rim (NRR) measurement can aid the diagnosis of glaucoma. A few studies reported that Cirrus optical coherence tomography (OCT) had NRR segmentation errors. The current study investigated segmentation success of NRR in myopic eyes using the Cirrus built-in software and to determine the number of acquisitions required to identify NRR thinning. Right eye of 87 healthy adult myopes had an optic disc scanned using Cirrus HD-OCT for five successive acquisitions. A masked examiner evaluated 36 radial line images of each scan to screen for segmentation errors using the built-in software at the Bruch's membrane opening (BMO) and/or internal limiting membrane (ILM). Participants with three accurate NRR acquisitions had their average NRR thickness determined. This result was compared with average of the two acquisitions and the first acquisition. Among 435 OCT scans of the optic disc (87 eyes × 5 acquisitions), 129 (29.7%) scans had segmentation errors that occurred mainly at the ILM. The inferior-temporal and superior meridians had slightly more segmentation errors than other meridians, independent of axial length, amount of myopia, or presence of peripapillary atrophy. Sixty-five eyes (74.7%) had at least three accurate NRR measurements. The three acquisitions had high reliability in NRR thickness in the four quadrants (intraclass correlation coefficient > 0.990, coefficient of variation < 3.9%). NRR difference between the first acquisition and the average of three acquisitions was small (mean difference 2 ± 13 µm, 95% limits of agreement within ± 30 µm) among the four quadrants. Segmentation errors in NRR measurements appeared regardless of axial length, amount of myopia, or presence of peripapillary atrophy. Cirrus segmentation lines should be manually inspected when measuring NRR thickness.

Sonography of acute right side colonic diverticulitis.

BACKGROUND: To describe the prevalence and sonographic findings and ultrasound diagnostic accuracy of the right side colonic diverticulitis in patients having right lower abdominal pain with indeterminate nature. METHODS: A total of 934 patients with acute right lower abdominal pain of clinically indeterminate nature were referred for ultrasound examination (US). US studies were performed with 3.5 to 7.0 (or occasionally 10) MHz transducers using graded compression method. Twenty-three patients were finally diagnosed to have an uncomplicated acute diverticulitis of the right colon. The gray-scale sonographic images were reviewed. A retrospective study was undertaken to evaluate diagnostic contribution of US. RESULTS: The prevalence of acute right side colonic diverticulitis was 2.5% in patients with clinically indeterminate acute right lower abdominal pain. Locations of the inflamed diverticula include cecum in 6 patients, proximal ascending colon in 15 patients, and distal ascending colon in only 2 patients. Sonography detected 21 inflamed diverticula with 1 false positive and 2 false negative results. The most typical sonographic feature of an inflamed diverticulum of right side colon was a rounded or oval-shaped hypoechoic or nearly anechoic structure (52%) protruding out from the segmentally thickened colonic wall. Some of them might contain strong echoes representing gas or feces (43%), or stone in the lumen (5%). Regional pericolic or peridiverticular fat thickening was noted in 57% of patients, and segmental colon wall thickening in 38%. US examination yielded a sensitivity of 91.3%, a specificity of 99.8%, an overall accuracy of 99.5%, a positive predictive value of 95.5%, and a negative predictive value of 99.7%. A positive sonogram made the likelihood of acute right side diverticulitis 456.5 times greater compared with the pretest clinical impression. US differentiated acute right side colonic diverticulitis from acute appendicitis with a 100% accuracy. CONCLUSIONS: Ultrasound can be extremely useful in diagnosing acute right side colonic diverticulitis. Careful ultrasound evaluation of the right colon and the cecum may facilitate a correct diagnosis and help differentiate from acute appendicitis, and steer the surgeon to a more effective management.

Stepwise logistic regression analysis of tumor contour features for breast ultrasound diagnosis.

To assist the ultrasound (US) differential diagnosis of solid breast tumors by using stepwise logistic regression (SLR) analysis of tumor contour features, we retrospectively reviewed 111 medical records of digitized US images of breast pathologies. They were pathologically proved benign breast tumors from 40 patients (i.e., 40 fibroadenomas) and malignant breast tumors from 71 patients (i.e., 71 infiltrative ductal carcinomas). Radiologists, before analysis by the computer-aided diagnosis (CAD) system, segmented the tumors manually. The contour features were calculated by measuring the radial length of tumor boundaries. The features selection process was accomplished using a stepwise analysis procedure. Then, an SLR model with contour features was used to classify tumors as benign or malignant. In this experiment, cases were sampled with "leave-one-out" test methods to evaluate the SLR performance using a receiver operating characteristic (ROC) curve. The accuracy of our SLR model with contour features for classifying malignancies was 91.0% (101 of 111 tumors), the sensitivity was 97.2% (69 of 71), the specificity was 80.0% (32 of 40), the positive predictive value was 89.6% (69 of 77), and the negative predictive value was 94.1% (32 of 34). The CAD system using SLR can differentiate solid breast nodules with relatively high accuracy and its high negative predictive value could potentially help inexperienced operators to avoid misdiagnoses. Because the SLR model is trainable, it could be optimized if a larger set of tumor images were supplied.

Breast mass due to alveolar soft part sarcoma of the pectoris major muscle.

We present a case of alveolar soft part sarcoma (ASPS) of the pectoris major muscle in a 20-year-old female. She felt a mass in her right side breast for 7 years. The lesion was almost the same size with occasional throbbing pain and tenderness. Fine needle aspiration of the tumor was performed in the OPD and suspicious abnormal cells were reported. Ultrasound (US) examination of the breast revealed a large heterogeneously hypoechoic lesion contiguous to the pectoris major muscle. Profound color flow signals were evident in both central and peripheral regions of the mass. Spectral Doppler US showed high flow velocity in the tumor vessels with resistivity index of 0.73. Surgical intervention was performed and the histological examination yielded a diagnosis of ASPS.

Hereditary haemorrhagic telangiectasia: hepatic lesions demonstrated with colour Doppler and power Doppler sonography.

Visceral vascular abnormalities in patients with hereditary haemorrhagic teleangiectasia (HHT) include teleangiectasis, arteriovenous fistula (AVF), and aneurysms. Sonographic findings and colour Doppler ultrasound (CDU) features of HHT in the liver have been described in a few reports. Presented here is the CDU finding of liver with HHT involvement in two patients, aged 52 and 29 years, respectively. Power Doppler sonography was also performed in the first patient in whom both CDU and power Doppler sonography could demonstrate the abnormal vascular channels in the liver. In the second patient, aneurysms in the left hepatic lobe and of the splenic artery were noted. Angiography was performed in both patients and confirmed the abnormal vascular lesions demonstrated by CDU and/or power Doppler sonographic findings.

Ultrasound-guided interventional procedures in splenic abscesses.

The results of ultrasound (US)-guided interventional procedures over a period of 12 years in 21 consecutive patients with splenic abscess were reviewed. The interventional procedures were done with 21- or 18-gauge needles for aspiration of relatively small abscesses (< 3.5 cm) in eight patients and with an 8.3-9.0 French pigtail catheter for continuous drainage in 13 patients with larger abscesses (> or = 3.5 cm). In some patients, multiple abscesses were treated separately according to their various sizes. More than one catheterization were done in three patients because of detached catheter or recurrent abscesses. The interventional procedures were followed by at least eight weeks of appropriate antibiotic therapy. Only one patient had the complication of minimal subcapsular hematoma which needed no further treatment. All the patients had uneventful clinical courses. US-guided interventional procedure proved to be a treatment-of-choice for splenic abscess, and may avoid splenectomy by conserving the spleen.

Role of antral puncture in the treatment of sinusitis in the intensive care unit.

OBJECTIVE: The objective of this study was to determine whether maxillary sinus puncture caused an alteration in antibiotic treatment and thus affected the outcome of sinusitis in the intensive care unit. STUDY DESIGN: A retrospective review was done of cases of maxillary sinus puncture between 1991 and 1994. RESULTS: Forty-two patients were identified. All patients had findings suggestive of sinusitis on plain sinus films or CT scans of the sinuses. Twenty-five punctures (60%) recovered pus, of which 80% grew organisms. Fourteen patients (33%) had a negative lavage, and 12% of these samples grew organisms (p = 0.001). Sixty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram-negative organisms were found most commonly, followed by anaerobes. In 57% of the cases antibiotic therapy was changed. In 77% of the cases the change was directed by the culture result and in 35% the therapy was changed despite a negative culture result (p = 0.002). Resolution of symptoms occurred in 83% of patients who had antibiotics changed whereas with no change in antibiotics only 42% had resolution (p = 0.001). CONCLUSION: A sinus puncture seems to be helpful in patients with fever and positive findings on sinus films. If pus is obtained by maxillary puncture, a positive culture may be found in 80% of the cases. Changes in antibiotic regimen on the basis of culture findings seem to give a better outcome.

Transient-evoked otoacoustic emissions in children after cisplatin chemotherapy.

Little is known about cisplatin ototoxicity in pediatric patients. Measurement of otoacoustic emissions is a rapid, reproducible, objective method of evaluating hearing. We examined whether transient-evoked otoacoustic emissions in pediatric patients exposed to cisplatin in the past correlated with audiographic findings. Twelve patients were entered into the study (mean age at treatment 7.8 years, mean cumulative dose 442.5 mg/mm2, mean 7.1 doses). Hearing at 3000 Hz was preserved in 82.6% of patients. In the higher frequencies significant sensorineural hearing loss was noted: 43.5% at 4 kHz; 81.0% at 6 kHz; and 90.5% at 8 kHz. Transient-evoked otoacoustic emissions were measurable in 11 of 12 patients. Middle ear disease accounted for abnormal otoacoustic emission seen in three patients (1 with effusion, 2 with significant negative middle ear pressure). When the middle ear was normal, a statistically significant correlation was seen between the transient-evoked otoacoustic emissions reproducibility and pure-tone threshold (correlation coefficient = -0.69, p = 0.008). Increased hearing loss was also associated with young age at first dose of cisplatin (p = 0.044), high number of chemotherapy cycles (p = 0.042), and high cumulative dose (p = 0.042).

11 alpha-Hydroxylation of progesterone in biphasic media using alginate-entrapped Aspergillus ochraceus gel beads coated with polyurea.

A novel cell-immobilization technique was developed in this study for increasing substrate partition to the gel matrix by coating a polyurea thin layer on the surface of Ca-alginate beads. The proposed method was simple and could be performed under mild conditions. The bioconversion of progesterone to 11 alpha-hydroxyprogesterone with these polyurea-coating alginate-entrapped Aspergillus ochraceus cells was investigated using different organic solvents in biphasic media. The reaction medium of ethyl acetate could markedly enhance the bioconversion rate with the existence of a hydrophobic layer, most likely resulting from the increasing partition of substrate to gel matrix. Bioconversion with higher substrate concentration was possible using an ethyl acetate-water medium. The conversion rate increased almost linearly with increasing substrate concentration from 10 to 80 g l-1. The rate with 80 g l-1 progesterone increased up to six times greater than the rate with the immobilized cells without coating, and also exhibited a much higher rate than that reported in the literature.

11 alpha-hydroxylation of progesterone using modified alginate-immobilized cells.

The major disadvantage of using alginate-immobilized Aspergillus ochraceus for 11 alpha-hydroxylation of progesterone is its instability in phosphate solutions. In this study, different gel-hardening methods were used to improve the stability of alginate gels. Addition of Fe3+ and Fe2+ ions increased the activity of hydroxylation, but Fe2+ was not a good gelling agent. Replacement of CaCl2 by FeCl3 as the gelling agent increased the activity of the immobilized cells by about 33%. Hardening the alginate-immobilized cells with polyacrylamide (PAA) increased their stability in a 0.1 M phosphate buffer from 0.35 h to over 36 h. The productivity was increased by a factor of 1.8 compared to those without hardening, and the maximum yield was also increased from 84.3% to 90.8%. The physical properties and biocatalytic characteristics of PAA-hardened, immobilized cells were found to be feasible for application in a steroid bioconversion system.

Texture analysis of breast tumors on sonograms.

We performed a feasibility study to determine if the texture features extracted from sonograms can be used to predict malignant or benign breast pathology by the proposed artificial neural network and to compare the diagnostic results with the radiologists' results. A total of 1,020 images (4 different rectangular regions from the 2 orthogonal imaging planes of each tumor) from 255 patients were used as samples. When a sonogram was performed, 1 physician identified the region of interest in the sonogram; then, a neural network model, using 24 autocorrelation texture features, classified the tumor as benign or malignant. Three radiologists who were unfamiliar with the samples also classified these images. The receiver operating characteristic (ROC) area index for the proposed neural network system is 0.9840 +/- 0.0072. The neural network identified 35 of 36 malignancies and 211 of 219 benign tumors using all 4 regions of interest. The radiologists, on average, identified 19 of 36 malignancies, with 12 tumors called indeterminate and 4 tumors called benign. We conclude that benign and malignant breast tumors can be distinguished using interpixel correlation in digital ultrasonic images.

Epithelioid hemangioendothelioma of spleen with intrasplenic metastasis: ultrasound and computed-tomography appearance.

The US and CT appearances of epithelioid hemangioendothelioma of the spleen with intrasplenic metastasis have not been previously reported. We described a 29-yr-old female with such a disease. Abdominal US study revealed a large mass in the upper pole and multiple small nodules in the rest of the spleen. CT scan also showed similar lesions of hypodensity which were not apparently enhanced by contrast medium.

CT and myelogram findings of os odontoideum.

We reviewed the findings of CT and myelogram of cases of os odontoideum. The diagnosis was confirmed by conventional tomogram in all these cases. Four cases were further confirmed by trans-oral decompression. Cartilage was found between the os odontoideum and the odontoid process during operation in these 4 cases. Four of them had no history of trauma and 2 of them had an associated anomaly; one was Down's syndrome, and the other was barrel chest and congenital dislocation of hips. CT findings of os odontoideum in these cases were a constriction and/or a gap of bony structure between the os odontoideum and the odontoid process. Myelograms showed spinal stenosis as a result of atlanto-axial dislocation, or anterior extradural compression from overgrown cartilage and posteriorly dislocated tip of shortened odontoid process.

A case of acute renal artery thrombosis caused by blunt trauma: computed tomographic and Doppler ultrasonic findings.

A 16-year-old girl who was involved in a traffic accident subsequently received emergency surgery for facial lacerations and an exploratory laparotomy. She had gross hematuria which was ignored initially. A left renal infarction, detected by computed tomography on the 12th post-operative day, showed no enhancement of the left renal artery with the cortical rim sign. Further study by color and pulsed Doppler ultrasound revealed the absence of normal renal arterial flow with only venous flow detected, confirming the diagnosis of acute renal artery thrombosis.

Endometriosis of the appendix presenting as acute appendicitis.

While endometriosis is fairly common, endometriosis of the appendix is a very rare occurrence. Correct pre-operative diagnosis is uncommon and definitive diagnosis is established by histology of the appendix. We present a case of endometriosis of the appendix that manifested as acute appendicitis in a 40-year-old woman.

Utility of different cardiovascular disease prediction models in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis comes with a 30% higher probability for cardiovascular disease than the general population. Current guidelines advocate for early and aggressive primary prevention and treatment of risk factors in high-risk populations but this excess risk is under-addressed in RA in real life. This is mainly due to difficulties met in the correct risk evaluation. This study aims to underline the differences in results of the main cardiovascular risk screening models in the real life rheumatoid arthritis population. METHODS: In a cross-sectional study, patients addressed to a tertiary care center in Romania for an biannual follow-up of rheumatoid arthritis and the ones who were considered free of any cardiovascular disease were assessed for subclinical atherosclerosis. Clinical, biological and carotidal ultrasound evaluations were performed. A number of cardiovascular disease prediction scores were performed and differences between tests were noted in regard to subclinical atherosclerosis as defined by the existence of carotid intima media thickness over 0,9 mm or carotid plaque. RESULTS: In a population of 29 Romanian rheumatoid arthritis patients free of cardiovascular disease, the performance of Framingham Risk Score, HeartSCORE, ARIC cardiovascular disease prediction score, Reynolds Risk Score, PROCAM risk score and Qrisk2 score were compared. All the scores under-diagnosed subclinical atherosclerosis. With an AUROC of 0,792, the SCORE model was the only one that could partially stratify patients in low, intermediate and high-risk categories. The use of the EULAR recommended modifier did not help to reclassify patients. CONCLUSION: The only score that showed a statistically significant prediction capacity for subclinical atherosclerosis in a Romanian rheumatoid arthritis population was SCORE. The additional calibration or the use of imaging techniques in CVD risk prediction for the intermediate risk category might be warranted.

Efficacy and safety of Cerebrolysin in patients with hemorrhagic stroke.

UNLABELLED: The purpose of the study was to investigate the efficacy and safety of Cerebrolysin in patients with hemorrhagic stroke. The primary objective of this trial was to assess the clinical efficacy and safety of a 10-days course of therapy with a daily administration of Cerebrolysin (50 mL i.v. per day). The trial had to demonstrate that Cerebrolysin treatment is safe in hemorrhagic stroke. METHODS: The study was performed as a prospective, randomized, double blind, placebo-controlled, parallel group study with 2 treatment groups. Efficacy measures were the Unified Neurological Stroke Scale, Barthel Index, and Syndrome Short Test. The duration of the trial was of 21 days for each patient. Out of 100 randomized patients, a total of 96 (96%) completed the study. RESULTS: Overall, no statistically significant group effects were observed based on single average comparisons at the individual visits. It could be shown that the treatment of hemorrhagic stroke with Cerebrolysin is safe and well tolerated. CONCLUSION: In the changes of UNSS, BI and SST from baseline to day 21, the group differences are not statistically significant; however, the use of Cerebrolysin in hemorrhagic stroke is safe and well tolerated and studies with a larger sample size may provide statistical evidence of Cerebrolysin's efficacy in patients with hemorrhagic stroke.