Preoperative MR Imaging to Differentiate Chordoid Meningiomas from Other Meningioma Histologic Subtypes.

BACKGROUND AND PURPOSE: Chordoid meningiomas are uncommon WHO grade II primary intracranial neoplasms that possess unique chordoid histology and follow an aggressive clinical course. Our aim was to assess the utility of qualitative MR imaging features and quantitative apparent diffusion coefficient values as distinguishing preoperative MR imaging metrics to identify and differentiate chordoid histology from other meningioma histologic subtypes. MATERIALS AND METHODS: Twenty-one patients with meningiomas with chordoid histology, which included both chordoid meningiomas (>50% chordoid histology) and meningiomas with focal chordoid histology (<50% chordoid histology) with available preoperative MR imaging examinations, including diffusion-weighted imaging, were identified. Qualitative imaging features and quantitative ADC values were compared between meningiomas with chordoid histology and 42 nonchordoid meningiomas (29 WHO grade I, eleven WHO grade II, and 2 WHO grade III). RESULTS: The median ADC (10-3mm2/s) of meningiomas with chordoid histology was significantly higher than nonchordoid meningiomas (1.16 versus 0.92, P < .001), as was the median normalized ADC (1.60 versus 1.19, P < .001). In subgroup analysis, the median and normalized ADC values of chordoid meningiomas (n = 11) were significantly higher than those in meningiomas with focal chordoid histology (n = 10, P < .001 and P < .001, respectively) or nonchordoid meningiomas (n = 42, P < .001 and <0.001, respectively). Median and normalized ADC values were not significantly different between the meningiomas with focal chordoid histology and nonchordoid meningiomas (P = .816 and .301, respectively). Among the qualitative imaging features, only DWI signal intensity was significantly associated with meningiomas with chordoid histology diagnosis. CONCLUSIONS: ADC values are higher in chordoid compared with nonchordoid meningiomas and may be used to discriminate the degree of chordoid histology in meningiomas. While qualitative MR imaging features do not strongly discriminate chordoid from nonchordoid meningiomas, DWI may allow preoperative identification of chordoid meningiomas.

Valvular heart disease.

Given the high prevalence of valvular heart disease, primary care physicians need to be familiar with the most common valvular heart diseases and their clinical manifestations. Knowledge of the natural history of the most common valvular heart diseases is important because the onset of symptoms often is the point at which intervention becomes necessary. Most valvular heart diseases are amenable to surgical intervention, which can afford a symptom-free and relatively normal life span. Therefore, primary care physicians must be familiar with the indications for therapeutic interventions and the most appropriate interventions currently recommended.

The red eye: diagnosis and treatment.

Many common ophthalmologic conditions may present as a red eye. Most are not vision-threatening and can be easily treated. Vision-threatening symptoms and signs include sudden diminution in visual acuity, ocular pain, photophobia and the presence of circumcorneal injection (the so-called cilary flush) on examination. Corneal, uveal tract and anterior chamber problems often require ophthalmologic consultation, but these conditions are less common than blepharitis, lid problems, dry eyes and conjunctivitis.

Screening asymptomatic patients for colorectal lesions.

PURPOSES: To determine: 1) prevalence of significant colorectal lesions by demographics and risk factors; 2) frequency of 1 and 2 or more lesions by type, location, and size; 3) relation among villous component, location, and size of adenomas; and 4) frequency of nonsignificant lesions among patients with and without significant lesions.; METHOD: One thousand asymptomatic patients, 45 years of age and older, with negative fecal occult blood tests, were screened using 60-cm flexible sigmoidoscopy and, if indicated, using colonoscopy. RESULTS: Thirty-six of the patients had 62 significant lesions (11 patients had 2 or more lesions). Fifty-four of the lesions were discovered by sigmoidoscopy in 1,000 patients, and 8 additional lesions were discovered in 5 of the 36 patients by colonoscopy. Lesions with villous components were more likely to be found in patients with 2 or more lesions (P = 0.0006). Smokers were more likely than nonsmokers to have significant lesions (P = 0.002). Among these patients, smoking and drinking were associated (P = 0.007). Males were more likely to have significant lesions than females (P = 0.006). Hemorrhoids, diverticulosis, and hyperplastic polyps were not associated with significant lesions. CONCLUSIONS: The relationship between smoking and significant lesions provides further evidence that asymptomatic patients should stop smoking. Physicians should pay particular attention to men who smoke, even if they have negative occult blood tests.

Screening flexible sigmoidoscopy in a low-risk, highly screened population.

BACKGROUND: The efficacy of screening flexible sigmoidoscopy in patients with a prior history of a negative screening sigmoidoscopy has not been previously studied. METHODS: Charts from 866 consecutive asymptomatic patients undergoing baseline or rescreening flexible sigmoidoscopy were reviewed. Any previously screened patient with a history of polyps was excluded from the study. Findings on sigmoidoscopy, including size, location, and histopathology of lesions and number of prior examinations, if any, were recorded. RESULTS: Polyps were found in only 12 of 866 patients (1.4%). The effect of prior screening was significant. Ten of 414 (2.4%) patients who had not undergone prior screening sigmoidoscopy were found to have polyps. In contrast, only two of 452 (0.4%) patients who had undergone prior screening were found to have polyps. CONCLUSIONS: Screening flexible sigmoidoscopic examinations provided a low positivity yield in this study, a finding that is likely explained by the exclusion of previously screened patients with a history of polyps and by the significant number of previously screened patients. The relation between the prevalence of lesions and the patients' previous examination statuses suggests that multiple screenings for asymptomatic, low-risk patients at 3- to 5-year intervals as recommended by the American Cancer Society may be unnecessary.

Flexible sigmoidoscopy in asymptomatic patients with negative fecal occult blood tests.

BACKGROUND: Although the American Cancer Society and others have established guidelines for colorectal cancer screening, questions of who and how to screen still exist. METHODS: A 60-cm flexible sigmoidoscopy was performed on 1000 asymptomatic patients, 45 years of age or older, with negative fecal occult blood tests, who presented for routine physical examinations. Patients with clinically significant lesions were referred for colonoscopy. The proportion of lesions that would not have been found if the 24-cm rigid or the 30-cm flexible sigmoidoscope had been used was identified. RESULTS: Using the 60-cm flexible sigmoidoscope, lesions were found in 3.6% of the patients. Eighty percent of the significant lesions were beyond the reach of the 24-cm rigid sigmoidoscope and 37% were beyond the reach of the 30-cm sigmoidoscope. Thirty-six patients with lesions were referred for colonoscopy; additional lesions were found in 14%. A total of 62 lesions were discovered, including tubular adenomas, villous adenomas, tubular villous adenomas (23 of the adenomas with atypia), and one adenocarcinoma. The highest percentage of lesions discovered were in the sigmoid colon and the second highest percentage were in the ascending colon. CONCLUSIONS: The 60-cm flexible sigmoidoscope was able to detect more lesions than either the 24-cm or 30-cm sigmoidoscope when used in asymptomatic patients, 45 years of age and over, with negative fecal occult blood tests. When significant lesions are discovered by sigmoidoscopy, colonoscopy should be performed.