Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images.

OBJECTIVES: To compare MR imaging features in patients with incidental mastoid T2-hyperintensity with those of clinical acute mastoiditis, to ascertain characteristic differences between them. METHODS: MR images of 35 adult and paediatric patients with clinical acute mastoiditis and 34 consecutive age-matched controls without relevant middle ear pathology and with incidental T2-hyperintensity that covered ≥ 50 % of the mastoid were retrospectively analysed with regard to signal, diffusion, and enhancement characteristics, and presence of complications. RESULTS: Incidental mastoid T2-hyperintensity that covered ≥ 50 % of the mastoid volume was found in 4.6 % of reviewed MR scans (n = 2341), and associated significantly (p < 0.05) less with the involvement of the tympanic cavity (38 % vs. 74 %) and mastoid antrum (56 % vs. 80 %), hypointense-to-CSF signal intensity on T2 FSE (6 % vs. 86 %), intramastoid diffusion restriction (0 % vs. 62 %), intense intramastoid enhancement (0 % vs. 51 %), periosteal enhancement (3 % vs. 69 %), perimastoid dural enhancement 3 % vs. 43 %), bone destruction (0 % vs 49 %), intratemporal abscess or cholesteatoma (0 % vs. 24 %), labyrinth involvement (0 % vs. 14 %), and extracranial abscesses (0 % vs. 20 %). CONCLUSION: Hypointense-to-CSF signal intensity on T2WI, restricted diffusion, intense intramastoid enhancement among other MR imaging characteristics favoured an acute mastoiditis diagnosis over clinically non-relevant incidental mastoid pathology. KEY POINTS: • Intramastoid T2-hyperintensity alone is not a reliable sign for acute mastoiditis. • In acute mastoiditis, intramastoid T2-weighted signal intensity is usually hypointense to CSF. • Diffusion restriction and intense intramastoid enhancement are absent in incidental mastoid effusion. • An ADC value ≥ 1.72 × 10 (-3) mm (2) /s contradicts the AM diagnosis.

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism.

BACKGROUND AND PURPOSE: Minimally invasive parathyroidectomy requires accurate preoperative localization of suspected adenomas, and multiphase CT allows adenoma characterization while providing detailed anatomic information. The purpose of this study was to assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism. MATERIALS AND METHODS: We identified 278 patients with primary hyperparathyroidism who had undergone 2-phase CT with surgical cure. All scans were read prospectively by board-certified neuroradiologists. A neuroradiology fellow retrospectively reviewed images and reports and classified suspected adenomas on the basis of anatomic location. Accuracy was determined by comparing imaging results with surgical findings. The ability of 2-phase CT to localize adenomas to 1 of 4 neck quadrants and lateralize them to the correct side was assessed. Accuracy of identifying multigland disease was also evaluated. RESULTS: In patients with single-gland disease, the sensitivity and specificity of 2-phase CT to correctly localize the quadrant were 55.4% and 85.9%, respectively. The sensitivity and specificity of correct lateralization were 78.8% and 67.8%, respectively. The sensitivity and specificity to identify multigland disease were 22.9% and 79.5%, respectively. CONCLUSIONS: While the 2-phase CT protocol in this study demonstrates lower accuracy compared with reports of other techniques, its lower radiation compared with 3- and 4-phase techniques may make it a feasible alternative for preoperative parathyroid localization. Further prospective studies are needed to identify patients for whom this technique is most suitable.

MR imaging features of acute mastoiditis and their clinical relevance.

BACKGROUND AND PURPOSE: MR imaging is often used for detecting intracranial complications of acute mastoiditis, whereas the intratemporal appearance of mastoiditis has been overlooked. The aim of this study was to assess the imaging features caused by acute mastoiditis in MR imaging and their clinical relevance. MATERIALS AND METHODS: Medical records and MR imaging findings of 31 patients with acute mastoiditis (21 adults, 10 children) were analyzed retrospectively. The degree of opacification in the temporal bone, signal and enhancement characteristics, bone destruction, and the presence of complications were correlated with clinical history and outcome data, with pediatric and adult patients compared. RESULTS: Most patients had ≥50% of the tympanic cavity and 100% of the mastoid antrum and air cells opacified. Compared with CSF, they also showed intramastoid signal changes in T1 spin-echo, T2 TSE, CISS, and DWI sequences; and intramastoid, outer periosteal, and perimastoid dural enhancement. The most common complications in MR imaging were intratemporal abscess (23%), subperiosteal abscess (19%), and labyrinth involvement (16%). Children had a significantly higher prevalence of total opacification of the tympanic cavity (80% versus 19%) and mastoid air cells (90% versus 21%), intense intramastoid enhancement (90% versus 33%), outer cortical bone destruction (70% versus 10%), subperiosteal abscess (50% versus 5%), and perimastoid meningeal enhancement (80% versus 33%). CONCLUSIONS: Acute mastoiditis causes several intra- and extratemporal changes on MR imaging. Total opacification of the tympanic cavity and the mastoid, intense intramastoid enhancement, perimastoid dural enhancement, bone erosion, and extracranial complications are more frequent in children.

Therapeutic effect of sildenafil on blast-induced tinnitus and auditory impairment.

Blast-induced tinnitus, along with associated auditory impairment and traumatic brain injury, is a primary concern facing military service members. To search for treatment, we investigated the therapeutic effects of sildenafil, a phosphodiesterase-5 inhibitor, given its vasodilatory effects and evidence suggesting its beneficial effects on noise-induced hearing loss. Rats were subjected to three consecutive blast exposures at 22 psi and were monitored for tinnitus using a gap-detection acoustic startle reflex paradigm. Hearing thresholds and detection were tested using auditory brainstem responses and prepulse inhibition, respectively. Blasted rats were either treated with sildenafil or tap water following blast exposure, while age-matched sham control rats were treated with sildenafil and no blast exposure. Our results showed that sildenafil did not effectively prevent acute tinnitus onset and hearing impairment. Instead, sildenafil significantly suppressed high-frequency tinnitus from 3 to 6 weeks after blast exposure and reduced hearing impairment during the first week after blast exposure. Complex results were observed in the startle force data, where sildenafil-treated rats displayed significantly reduced startle force compared to the untreated blasted group, suggesting possible mitigation of traumatic brain injury and suppression of hyperacusis-like percepts. Taken together, sildenafil showed a therapeutic effect on blast-induced tinnitus and audiological impairment in a time-dependent manner. Other regimens such as higher dosage prior to blast exposure and combination with other treatments deserve further investigation to optimize the therapeutic effects.

Evaluation of 100 cases of ascites.

This has been a descriptive cross sectional study on 100 consecutive adult cases of ascites. They were studied regarding the incidence of underlying causes, variable clinical presentations and the co-relation of investigations with clinical features during the period of September, 2006 to August, 2007 in Sher-e-Bangla Medical College Hospital, Barisal, Bangladesh. Diagnosis of ascites was based on history, clinical examination & USG examination. Among the 100 cases, male were 68 & female were 32, age range was 13-61 years. Causes of ascites were cirrhosis of liver 68%, tubercular peritonitis 9%, hepatocellular carcinoma 8%, congestive cardiac failure 6%, malignancy 4%, nephrotic syndrome 3%, lymphoma 2% and others 4%. Cirrhosis of liver is the major cause of ascites in our study. Many of the patients with cirrhosis & hepatocellular carcinoma were positive for HBsAg & anti HCV implying that hepatitis B & C viruses play a positive role in this condition.

Burden of gynaecological disease in a tertiary hospital: two years audit of outpatient department at PIMS.

OBJECTIVE: To estimate the pattern of gynaecological morbidity in women seeking services. METHODS: All women seeking advice for gynaecological problems in the outpatients department of Obstetrics and Gynaecology, Pakistan Institute of Medical Sciences Islamabad, from January 1997 to December 1998 were included. RESULTS: The total reproductive morbidity presenting at the outpatients department was 29,196. Of these 18,289 (62.7%) presented with obstetric morbidity and 10,851 (37.2%) with gynaecological morbidity. Menstrual irregularity was the commonest gynaecological problem encountered (41.1%). The rest included reproductive tract infections (27.8%), subfertility (18.2%), urogynaecological problems (5.3%), menopausal symptoms (4%), benign genital tract tumors (2. 8%), gynaecological malignancies (0.7%) and others (0.1%, including sexual dysfunction, congenital malformations and genital tract injuries) CONCLUSION: A number of women are seeking help for the varying severity of gynaecological morbidity, ranging from mild discomfort to overt disability. The major gnaecological morbidities identified are menstrual irregularities and reproductive tract infections. This study highlights the need for addressing and prioritising resources towards these women health issues which affect women's ability to fulfill a wide range of diverse roles.

Incidence of helminthic infections and comparative study of pyrantel pamoate with levamisole and mebendazole in hospital patients at Barisal, Bangladesh.

A study was carried out to find out the incidence of helminthic infections in hospitalized patients at Sher-e-Bangla Medical College, Barisal and to determine the comparative efficacy of pyrantel pamoate, levamisole, and mebendazole. It was observed that 76.2 per cent of total hospitalized patients were infected with intestinal helminths. Polyparasitism (52.6 per cent) was more frequent than single infection (21.8 per cent). Amongst these, 47.5 per cent was suffering from Asearis lumbricoides (AL), 42.5 per cent from Hookworm (H.W) and 65.8 per cent from trichuris trichura (TT). Out of 255 cases examined separately, 40 per cent was suffering from Enterobious vermicularis (EV) infection. The comparative study showed that mebendazole produced egg negative stool in 90.9 per cent of AL, 95.6 per cent of HW and 86.8 per cent of TT after eight days of treatment. On the other hand, pyrantel pamoate cured AL in 93.3 per cent, HW in 78.5 per cent and TT in 34.2 per cent eases. Levamisole cured 75 per cent AL, 4.1 per cent H.W. and 22.2 per cent TT within the same period.