A choroid plexus papilloma arising from an incidental pineal cyst.

We report a case of an incidental pineal cyst discovered on MR imaging that progressed to a choroid plexus papilloma. The MR features of pineal cysts, the difficulty of distinguishing benign cysts from cystic neoplasms, and the implications for surgical management are discussed.

Diagnostic imaging management in Manitoba: 1995-2000.

As part of a 5-year imaging management plan being developed for the single insurance carrier in Manitoba, the radiologic utilization for the province was reviewed. For the fiscal year 1993 (April 1, 1992, through March 31, 1993), 1,056,694 imaging studies were performed in a total patient population of 1,133,117 in 81 hospitals and 39 offices in which 648 units of equipment were operated by 773.4 full-time personnel at a cost of $100,302,812 ($75,227,109 in U.S. dollars). The skin dose for the total population for the year was 40,112 Gy, compared with 35,513 Gy in 1979. Since 1979, there has been a 9% increase in the number of radiologic examinations (from 972,426 examinations), a greater need for more personnel to conduct ultrasound, mammography, computed tomography, and magnetic resonance imaging examinations, and striking costs escalation (from $25,082,500 to $100,302,812). Reduction of total funding for imaging services will be possible only if the medical service infrastructure and physician behavior are altered, since imaging is a support service. Hospital services must be integrated and the infrastructure reduced, and physicians must adhere to guidelines and practice protocols for requesting consultations.

The influence of referral protocols on the utilization of magnetic resonance imaging: evidence from Manitoba.

The relative scarcity of magnetic resonance imaging (MRI) capacity in most Canadian jurisdictions has created pressures to develop guidelines on appropriate clinical indications for examination by this method. The objective of this study was to assess the influence of referral protocols on the utilization of MRI services. Three neuroradiologists and one radiologist reviewed the indications for MRI for 198 referrals to the facility at St. Boniface General Hospital in Winnipeg (99 from outside Manitoba and 99 from within the province), selected at random from patients seen between Jan. 1 and Dec. 31, 1991, for suspected disorder of the brain or the spine. Out-of-province referrals had not been subject to referral protocols, whereas those from within Manitoba had been subject to such protocols. At least three of the four radiologists agreed on whether an examination was appropriate in 175 of the 198 cases (88.4%). Out-of-province referrals were significantly more likely to be considered inappropriate for MRI: 24 (24%) of the referrals from outside Manitoba were judged inappropriate by three or more reviewers, whereas only 10 (10%) of the referrals from within Manitoba were judged inappropriate (chi 2, p < 0.01). Of the 19 cases that were judged inappropriate for MRI by three or more reviewers and that yielded abnormal findings, unique clinical information was derived from the examination in only 1 (5%); in contrast, of the 85 cases that were judged appropriate for MRI by three or more reviewers and that yielded abnormal findings, unique information was found in 47 (55%).(ABSTRACT TRUNCATED AT 250 WORDS)

Phenotypic variability in glutaric aciduria type I: Report of fourteen cases in five Canadian Indian kindreds.

We describe 14 patients with glutaric aciduria type 1 in five Canadian Indian kindreds living in Manitoba and northwest Ontario. The patients had marked clinical variability of the disease, even within families. Eight followed the typical clinical course of normal early growth and development until the onset of neurologic abnormalities, often precipitated by infection, between 6 weeks and 7 1/2 months of age. Five patients had early developmental delay; one was thought to be normal until 8 years of age. Three patients died, seven are severely mentally and physically handicapped, and four have only mild mental retardation or incoordination. Six patients had macrocephaly in the neonatal period. Computed tomography was done for 12 patients, and findings were abnormal in 11. Glutaric acid and 3-hydroxyglutaric acid were detected in increased amounts in the urine of all patients, but the concentrations were much lower than those in most other reported patients. Glutaryl coenzyme A dehydrogenase activity in skin fibroblasts, interleukin-2-dependent lymphocytes, or both, ranged from 0% to 13% of control values. There was no correlation between clinical severity and urine glutaric acid concentration or level of residual enzyme activity. We recommend that organic acid analysis of the urine be done in patients with unexplained cerebral palsy-like disorders, especially if the computed tomographic scan is abnormal. If there is suspicion of glutaric aciduria, glutaryl-coenzyme A dehydrogenase should be measured in fibroblasts or lymphocytes even if glutaric acid is not increased in the urine.

Early metabolic and neurologic predictors of long-term quality of life after closed head injury.

Research has begun to identify early markers that predict survival after traumatic brain injury. In this study, trauma and biochemical indicators of severity were used to predict quality of life in 61 adults with traumatic brain injury and no damage to other organ systems. Severity markers available within 24 hours of injury were predictive of later psychosocial, behavioural and social role functioning. Multiple regression analyses demonstrated that the Glasgow Coma Scale, plasma glucose levels, leukocyte cell count and serum potassium concentration accounted for 12% to 66% of variance in certain measures of later quality of life. The importance of health-care resource allocation and psychosocial and behavioural intervention to the outcome after moderate traumatic brain injury is discussed.

CT-scan findings in an infant with glutaric aciduria type I.

An infant presented at three weeks of age with a rapidly enlarging head and hypertonicity. The diagnosis of glutaric aciduria type I (GAI) was confirmed by the absence of the enzyme glutaryl-CoA dehydrogenase in fibroblast culture. A CT scan at that time showed diffuse attenuation of cerebral white-matter. Scans at five and 10 months of age showed loss of white-matter volume and diffuse cerebral atrophy, most prominent in the frontal and temporal regions. GAI should be considered in the differential diagnosis of infants and children with neurological dysfunction who have CT-scan findings of white-matter attenuation and/or cerebral atrophy, most prominent in the frontal and temporal regions, and/or changes in the basal ganglia or thalamus.

CT and intracranial manifestations of otorhinologic disease.

Most inflammatory and neoplastic diseases of the ear, nose, nasopharynx, and paranasal sinuses have the capability of intracranial extension. CT is extremely important in defining such lesions, and surpasses complex motion tomography in delineating the extracranial soft tissue involvement and intracranial spread. Trauma can simultaneously affect both intracranial and extracranial compartments but because of its scope, is not dealt with in this submission.

Tropical diseases encountered in Canada: 1. Chagas' disease.

Chagas' disease, or South American trypanosomiasis, is an endemic South American disease now being seen in Canada in both acute and chronic forms. It is characterized by an initial parasitemia that elicits a brisk immune response. Evidence is mounting that the debilitating chronic form, which is characterized by cardiac and visceral organ failure, results from antigenic cross-reactivity between the parasite and the human host, which generates an aberrant, destructive, cell-mediated immune response. Diagnosis, treatment and potential areas for investigation are discussed.