The accuracy of limited CT in the evaluation of chronic rhinosinusitis and for endoscopic sinus surgery: a multicenter study.

Objective: To compare the accuracy of Limited CT with the Full CT as the standard evaluation for inflammatory disease of PNS and the identification of anatomical variations. Methods: From Full CT of PNS, Limited CT were retrieved. Computerized tomographic scans were performed for the preoperative planning of endoscopic sinus surgery (ESS) in 3 tertiary care university hospitals in Thailand. The two types of examinations were reviewed independently and in random order by two experienced radiologists. Using Full CT as the standard, the accuracy of Limited CT were evaluated for 1) the radiologic staging of rhinosinusitis (Lund-Mckay scoring system) and 2) the anatomic variations which are an important landmark for surgical operations in rhinosinusitis. Results: Totally 132 patients were included. Two hundred and sixty four half-faces were reviewed. Lund-McKay radiographic sinus staging system showed 97-99% specificity except for the ostiomeatal complex region. Regarding anatomic variation, Limited CT was able to yield accurate results for the frontal cell type II-IV, Haller cell, Agger nasi cell, paradoxical middle turbinate, concha bullosa and the protrusion of the optic nerve. Conclusion: Limited CT can be used as a surgical roadmap for the cases with the anterior group of sinus involvement. It may be utilized for surgical planning of chronic CRS involving the anterior group of sinuses. For the posterior group of sinuses, it may not yield enough accuracy and the standard Full CT should be requested to prevent erroneous estimation.

Very high dose phenobarbital for refractory status epilepticus.

BACKGROUND: Refractory status epilepticus (RSE), defined as status epilepticus that fails to respond to first, second and third-line therapy. The RSE is associated with high morbidity and mortality. Treatment guidelines of RSE give a spectrum of options, such as, continuous intravenous (i.v.) midazolam (MDL), or continuous i.v. propofol (PRO) as alternatives to phenobarbital (PB) or continuous i.v. pentobarbital (PTB). OBJECTIVE: To study the efficacy of very-high-dose phenobarbital (VHDPB) for treatment RSE. STUDY DESIGN: Retrospective study MATERIAL AND METHOD: The authors collected and analyzed data from adult patients who were diagnosed with RSE. RESULTS: The authors present 10 patients with RSE who were treated with VHDPB. All of them were generalized convulsive status epilepticus (GCSE). Ages ranged from 16-86 years old (mean.: 43 years). PB dosage ranged 40-140 mg/kg/day (mean: 70 mg/kg/day). The duration of status epilepticus (SE) varied widely, ranged 1-44 days (mean: 7 days). PB level ranged 35.29-218.34 ug/mL (mean 88.1 ug/mL). RSE was controlled by VHDPB 70%, 30% were not controlled. ConclusioN: VHDPB were considered as alternative treatment for RSE.

Abnormal diffusivity of normal appearing brain tissue in multiple sclerosis: a diffusion-weighted MR imaging study.

OBJECTIVE: To assess whether water diffusivity in normal appearing brain tissue including white and gray matter of multiple sclerosis (MS) patients shown by diffusion-weighted imaging (DWI) differs from normal individuals. MATERIAL AND METHOD: Conventional MRI and DWI were performed in 37 multiple sclerosis patients and 31 control subjects, matched for age and sex. Quantitative diffusivity values were obtained from variable locations of normal appearing white and gray matter from both hemispheres by using a standardized region of interest template. +/- 2. 9 x 10(-5) mm2/s and 85.90 x 10(-5) +/- 2.45 x 10(-5) mm2/s) than normal control subjects (NAWM: 73.46 x 10(-5) +/- 1.77 x 10(-5) mm2/s and NAGM: 82.90 x 10(-5) +/- 0.91 x 10(-5) mm2/s) with p-value < 0.0001. CONCLUSION: Water diffusivity was higher in all NAWM regions, deep gray matter regions, and some cortical gray matter region of MS patients than normal controls. DWI can quantify the presence and extent of MRI-undetectable pathology in the normal appearing brain tissue that were the disease burden.

Basic knowledge of epilepsy among medical students.

BACKGROUND: The medical students' knowledge about basic medical neuroscience in the preclinical level may be fragmented and incomplete. OBJECTIVE: Evaluate the knowledge of students prior to a lecture on epilepsy in clinical level. MATERIAL AND METHOD: One hundred ten fourth-year medical students' knowledge was accessed by a self-administered questionnaire. RESULTS: The presented results revealed that 91.8% of respondents knew that epilepsy arose from a transient dysfunction in the brain. Generalized tonic-clonic seizures (GTCs) were the most common type (91.5%) they knew and absence seizures were the least common type (33.6%) they knew. All of them knew that eating pork and punishment of gods did not cause epilepsy. However 50% thought that genetics was a cause and 80.3% did not know that stroke and sleep deprivation (92.7%) cause epilepsy. About treatment and prognosis, only 28.2% of respondents thought epilepsy can be cured and patients should take antiepileptic drugs (AEDs) for seizure free 2-5 years (48.2%), life long (33.6%). They knew that the patients should be prohibited from driving (80%), working on machinery (74.5%), and (27.3%) avoid drinking. However, they knew that the patients could marry (100%), get pregnant (98.2%), and lactate (91.9%). Regarding the first aid management, 50.9% of them recommended that placing a piece of wood between the teeth during a seizure and perform chest compressions (20.0%). Means knowledge scores is about 60%, the highest score is the definition of epilepsy (90.2%) and the lowest is type of seizure (43%). CONCLUSION: The findings indicated that lecturers should review aspects ofpathophysiology and emphasize on type of seizure, cause, consequences, and prognosis including first-aid management.

ADC measurements in various patterns of multiple sclerosis lesions.

OBJECTIVE: To determine the difference of mean apparent diffusion coefficients (ADC) among different patterns of focal multiple sclerosis (MS) lesions, to compare mean lesion ADC between 2 clinical subgroups and to correlate mean lesion ADC with disability. MATERIAL AND METHOD: Thirty seven patients (26 with relapsing-remitting multiple sclerosis (MS) and 11 with secondary-progressive MS) underwent both conventional and diffusion-weighted MR imaging of the brain. After creating ADC maps, region identification was done by using b = 0 images and T2-weighted images. ADC values were measured for MS lesions and (NAWM). RESULTS: A total of 288 lesions were identified on the images. The mean ADC for the lesions was significantly higher than that of NAWM Hypointense T1 lesions (n = 221) had a significantly higher mean ADC than isointense T1 lesions (n = 67) in both nonenhancing lesions (n = 250) and enhancing lesions (n = 38). The enhanced rim of ring-enhancing lesions (n = 18) had lower ADC than the central nonenhanced portions. Confluent lesions (n = 62) had a substantially higher mean ADC than discrete lesion (n = 226). Mean lesion ADC of secondary progressive MS was significantly higher than relapsing remitting MS. No correlation between mean lesion ADC and (EDSS) score was found CONCLUSION: Quantitative diffusion-weighted imaging is useful to elucidate the heterogeneous pathological substrate of MS in different patterns of MS lesions, to differentiate 2 major clinical subgroups.

Knowledge of epilepsy among teachers in Khon Kaen Province, Thailand.

INTRODUCTION: Epileptic patients face social stigmatization due to negative attitudes and incorrect knowledge on epilepsy. OBJECTIVES: To evaluate knowledge of epilepsy among teachers in Khon Kaen province. MATERIAL AND METHOD: A self-administered questionnaire distributed to 102 teachers who attended the training lectures on epilepsy. The number of correct responses for each item were collected. The statistical analysis included the percentage of correct response and the means of the total scores. RESULTS: Most (78.4%) respondents understood that a seizure is an abnormal electrical discharge in the brain, while 54.9% thought it included a form of abnormal movement and 1% demonic possession. The generalized tonic-clonic seizure (GTCs) was the type of seizure with which most respondents were familiar (90.2%), while 23.5% had knowledge of absence seizures. The respondents identified the following as causes for epilepsy: 1) head injury (84%); 2) genetic disease (74.5%); 3) high fever (68%); and, 4) brain tumor (57%). A small minority associated epilepsy with eating pork (11%) and even fewer (2%) with a non-organic/non-physical cause. Only 16% of respondents thought epilepsy was incurable, and a quarter (27%) of the teachers thought epileptics required anti-epileptic drugs (AEDs) life long, while 20 and 9 percent believed patients would take AEDs for 3-6 months and only for episodes, respectively. About 57% of the teachers thought epileptics needed AEDs for 2-5 years. Most (77-79%) respondents thought epileptics were prohibited from using machinery or driving, and 63% thought alcohol would be prohibited. Almost two-thirds of the teachers (64%) thought they should try to place an object between the teeth of a person having an episode in order to prevent a biting injury to the tongue and 27% would restrain the person and perform chest compressions (CPR). The average total score for correct answers on the questionnaire was about 60% (29.26/50). Respondents generally understood that epilepsy is controllable (82%) and were able to identify a seizure (78.4%). The lowest scores were found in the section on identifying the types of seizures (37.8%). CONCLUSION: Teachers' knowledge of epilepsy was incomplete; thus, an epilepsy education campaign is needed and should emphasize the types of seizures, the causes of epilepsy, and management.

Prostatic abscesses: radiographic findings and treatment.

OBJECTIVE: To analyze the medical images and therapeutic strategies in patients with prostatic abscesses. METHOD: From April 1999 to August 2002, 12 patients with prostatic abscesses at Srinagarind Hospital, Khon Kaen, Thailand were reviewed The average age was 47 years (range 29 to 75). Diagnostic procedures included analysis of midstream urine, abscess fluid for pathogens and medical imaging with TRUS, CT and MRI. Therapeutic options were transrectal ultrasound-guided drainage or conservative medical treatment. RESULTS: Almost all patients had predisposing diseases. All patients showed hypo-echoic masses, plus internal septation in 5 cases. Most lesions were located at the central gland. Their sizes ranged from 0.5 to 2.75 cm (average 1.51 cm) in diameter. The main pathogen was B. pseudomallei. On TRUS imaging, patients with melioidosis had one or more hypo-echoic areas with internal septation, thickened wall and surrounding multiple small daughter abscesses. All abscesses resolved within 4 weeks, with no difference in the duration of treatment, despite different sizes or pathogens. CONCLUSIONS: Transrectal ultrasonography is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Our data showed sonographic patterns in prostatic abscess, especially with melioidosis.