Comparison of anesthetic agents on otoacoustic emissions in children: propofol vs ketamine.

BACKGROUND: Otoacoustic emission (OAE) tests are important evaluation tools for diagnosis of peripheral auditory pathology. Sedation or general anesthesia may be required for the performance of the OAE tests. The aim of this retrospective study was to compare the effects of anesthetic agents, propofol and ketamine, on OAEs in children. METHODS: Fifty healthy children who underwent tonsillectomy and/or adenoidectomy under general anesthesia were included in this study. Three anesthesia induction protocols were defined for this study and the anesthesiologist applied his or her own choice. Transient evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs) were automatically recorded in both ears of each patient prior to anesthetic (predrug) and following the loss of consciousness 5 min later (postdrug) by an audiologist blinded to the method of anesthesia. Acceptable TEOAEs were defined as signal noise ratio (S/N) of above 3 dB SPL (decibel sound pressure level) and DPOAEs of 6 dB SPL or above. Between-group and within-group comparisons and correlations were performed for statistical analysis. RESULTS: Retrospective review of the anesthesia charts from 44 cases that completed the study showed that propofol, ketamine, and sevoflurane induction protocols were used in 21, 18, and 5 cases, respectively. Measurements of 36 ears in the propofol group and 34 ears in the ketamine group were included in the final analysis. Postdrug TEOAE and DPOAE amplitudes were significantly lower than predrug amplitudes except at 8 kHz in the ketamine group. There was no significant statistical difference in postdrug DPOAE measurements between propofol and ketamine groups but a significant difference was observed at 2 and 3 kHz of postdrug TEOAE measurements. TEOAE measurements were below 3 dB in 8 of 34 ears after ketamine and in 1 of 36 ears after propofol administration. There was a significant difference between the groups with respect to the incidence of successful measurements of TEOAEs. The DPOAE measurements were affected less by these drugs. CONCLUSION: DPOAE measurements were reduced similarly by propofol and ketamine anesthesia. Lower false outcome ratio in TEOAE measurements made propofol a better option than ketamine.

Non-pituitary origin sellar tumours mimicking pituitary macroadenomas.

Although the large majority of sellar tumours are pituitary adenomas, several other pituitary and non-pituitary origin tumours arise in the sellar and parasellar regions. Given their location, non-adenomatous lesions frequently mimic pituitary macroadenomas and can pose a diagnostic challenge for the radiologist. Distinguishing rare sellar lesions from the common macroadenoma helps to direct the correct surgical approach and reduce the risk of incomplete resection and/or complications such as cerebrospinal fluid leak with the potential for meningitis. The purpose of this article is to review the imaging features of non-pituitary-origin sellar tumours, focusing on characteristics that may distinguish them from pituitary macroadenomas. Lesions include meningioma, metastatic disease, epidermoid cyst, germinoma, chondrosarcoma, giant cell tumour, and giant aneurysm.

Chordoid Meningioma: Differentiating a Rare World Health Organization Grade II Tumor from Other Meningioma Histologic Subtypes Using MRI.

BACKGROUND AND PURPOSE: Meningiomas are very commonly diagnosed intracranial primary neoplasms, of which the chordoid subtype is seldom encountered. Our aim was to retrospectively review preoperative MR imaging of intracranial chordoid meningiomas, a rare WHO grade II variant, in an effort to determine if there exist distinguishing MR imaging characteristics that can aid in differentiating this atypical variety from other meningioma subtypes. MATERIALS AND METHODS: Ten cases of WHO grade II chordoid meningioma were diagnosed at our institution over an 11-year span, 8 of which had preoperative MR imaging available for review and were included in our analysis. Chordoid meningioma MR imaging characteristics, including ADC values and normalized ADC ratios, were compared with those of 80 consecutive cases of WHO grade I meningioma, 21 consecutive cases of nonchordoid WHO grade II meningioma, and 1 case of WHO grade III meningioma. RESULTS: Preoperative MR imaging revealed no significant differences in size, location, signal characteristics, or contrast enhancement between chordoid meningiomas and other meningiomas. There were, however, clear differences in the ADC values and normalized ADC ratios, with a mean absolute ADC value of 1.62 ± 0.33 × 10(-3) mm(2)/s and a mean normalized ADC ratio of 2.22 ± 0.47 × 10(-3) mm(2)/s in chordoid meningiomas compared with mean ADC and normalized ADC values, respectively, of 0.88 ± 0.13 × 10(-3) mm(2)/s and 1.17 ± 0.16 × 10(-3) mm(2)/s in benign WHO grade I meningiomas, 0.84 ± 0.11 × 10(-3) mm(2)/s and 1.11 ± 0.15 × 10(-3) mm(2)/s in nonchordoid WHO grade II meningiomas, and 0.57 × 10(-3) mm(2)/s and 0.75 × 10(-3) mm(2)/s in the 1 WHO grade III meningioma. CONCLUSIONS: Chordoid meningiomas have statistically significant elevations of ADC and normalized ADC values when compared with all other WHO grade I, II, and III subtypes, which enables reliable preoperative prediction of this atypical histopathologic diagnosis.

Uncovertebral and facet joint dislocations in cervical articular pillar fractures: CT evaluation.

Computed tomographic (CT) scans and plain radiographs of 21 patients with surgically treated fractures or dislocations of the cervical spine were reviewed. CT effectively demonstrated the locked or perched facets and half of the 13 articular pillar fractures. The fracture lines through the articular pillar were difficult to detect in some cases or to distinguish from a facet joint in others. However, distraction of an adjacent uncovertebral or facet joint was demonstrated by CT in each case of articular pillar fracture or locked or perched facet. Therefore, CT demonstration of a distracted facet or uncovertebral joint is an indirect sign of an unstable fracture or of a dislocation that may be more readily recognized on plain radiographs or pluridirectional tomograms.

MR measurement of normal and pathologic brainstem diameters.

The dimensions of the brainstem were measured on magnetic resonance (MR) images to provide criteria for detecting brainstem enlargement. Twenty-eight normal adult subjects had MR imaging with sagittal partial-saturation and spin-echo sequences. Four patients with brainstem gliomas and three with cerebellar atrophy were also studied. Five measurements were made: (A) the distance between the interpeduncular fissure and the aqueduct, (B) the distance from the anterior surface of the cerebral peduncles to the aqueduct, (C) the distance between the anterior surface of the pons midway between the mesencephalon and medulla to the fourth ventricular floor, (D) the shortest anteroposterior diameter of the medulla at the pontomedullary junction, and (E) the shortest anteroposterior diameter of the medulla at the medullospinal junction. Pontine diameter could be measured more reproducibly and accurately than mesencephalic or medullary diameters. In four patients with glioma, one or more of the measured diameters were more than 2 SDs above the average in normal volunteers, and abnormally small measurements were found in the patients with atrophy.

Functional magnetic resonance imaging of the central auditory pathway following speech and pure-tone stimuli.

Functional magnetic resonance imaging (FMRI) is a new noninvasive technique for imaging cerebral function. Studies of the human central auditory pathway examined responses in eight normal hearing volunteers following auditory stimuli, including narrative speech and pure-tone audiometry. The activation demonstrated by FMRI is modeled on an increase in regional blood flow with increased neuronal activity. The FMRI signals represent deoxyhemoglobin concentration changes in capillaries within the region of the brain that is activated. Brain activation was imaged in the superior temporal gyrus during text reading and pure tones. Activation in both text and pure-tone presentation did not vary with the intensity of the auditory stimulus and elicited a dominant response in the left temporal lobe. These observations demonstrate the capability of FMRI to correlate anatomic and functional relationships in the human central auditory pathway.

Atypical demyelinating lesions in patients with multiple sclerosis.

We describe an atypical MRI appearance of multiple sclerosis (MS). Lesions characterized on T2-weighted images by a well-defined rim of increased signal intensity and a concentric region of higher signal intensity were seen in 6 of 132 patients with MS. On T1-weighted images these lesions were evident as regions of low signal intensity, often with a rim of contrast enhancement or increased signal intensity. These appearances tended to be shown by new, evolving lesions.

Gas in spinal articulations.

The purpose of this review is to illustrate, some for the first time, a variety of gas collections in lumbar facet joints and intervertebral discs and in the sacroiliac joint.

Artifacts in functional magnetic resonance imaging from gaseous oxygen.

Unexpectedly large fluctuations in signal intensity were identified in the functional MRI (FMRI) of normal subjects breathing pure oxygen intermittently. To test the hypothesis that the signal changes were due to fluctuating concentrations of gaseous (paramagnetic) oxygen in the magnetic field, echo planar gradient echo images were acquired of a phantom contiguous to an oxygen mask through which pure oxygen was administered intermittently via plastic tubing. As a control, room air was administered intermittently or oxygen continuously in the same experimental protocol. Signal intensity changes of up to 60% temporally correlated with the administration of oxygen were produced in the phantom. In functional images prepared from the echo planar images, the signal intensity changes resulted in artifacts especially at interfaces in the phantom. The intermittent administration of pure oxygen during acquisition of data for FMRI may produce signal intensity changes that stimulate or obscure function.