Reliability study of white matter rating scale for the dementia and disability in Thai Elderly Project.

OBJECTIVE: To study the reliability of white matter rating scale on magnetic resonance imaging (MRI) of elderly patients in the urban community of Bangkok. MATERIAL AND METHOD: One hundred elderly with clinical diagnosis of cognitive impairment in the urban community around Siriraj Hospital underwent cranial MRI according to the Dementia and Disability in Thai Elderly Project. The axial T1wi, T2wi, and fluid attenuated inversion recovery (FLAIR) were separately assessed by two neuroradiologists. The assessment included white matter change by using Scheltens' rating scale, atrophy, and evidence of infarction. The inter-rater agreements were analyzed. RESULTS: The inter-rater agreement of periventricular hyperintensities, white matter, basal ganglion and infratentorial foci of hyperintensities were very good (ICC = 0.89-0.98). The agreement was good for central atrophy (Kw = 0.66) and moderate for cortical atrophy (Kw = 0.49). The silent infarction was found in the study population and divided into cortical (15%), subcortical (26%), brainstem (3%), and infratentorial infarction (8%). CONCLUSION: White matter hyperintensities was an important radiological criteria for diagnosis of vascular dementia. Appropriate rating scale is necessary especially in research study. The authors found that Scheltens rating scale needed some training and slightly time consuming at the beginning but was a good reliable tool.

Cranial dural arteriovenous fistula: Predisposing factors to aggressive symptoms.

Objective: To evaluate the clinical and angiographic data of cranial dural arteriovenous fistula in Thai patients and to determine the predisposing factors to aggressive symptoms. Methods: Retrospective review of 71 patients with cranial dural arteriovenous fistula who underwent cerebral angiography at Siriraj Hospital between July 2002 – February 2006. Their clinical manifestations were classified as benign or aggressive symptoms. The relationship between aggressive symptoms and the following factors were studied: gender, location of the fistula, classification according to venous drainage pattern, presence of cerebral sinus thrombosis, and shunt multiplicity. Linear-by-linear association and chi-square test were used to determine statistical significance. Results: Sixteen (22.5%) of 71 patients with cranial dural arteriovenous fistula had aggressive presenting symptoms. Factors that significantly correlate with aggressive symptoms were location of the fistula, retrograde leptomeningeal venous drainage, presence of cerebral sinus thrombosis, and multiplicity. Factor which was not significantly correlated with aggressive symptoms was gender. Conclusion: This study evaluated clinical data and angiographic features of cranial dural arteriovenous fistula in Thai patients. Predisposing factors to aggressive symptoms were location of the fistula, retrograde leptomeningeal venous drainage, presence of cerebral sinus thrombosis, and multiplicity.

Necessary for CT whole abdomen in post chemoradiation of rectosigmoid cancer stage 3: A comparative study.

Objective: To study the reliability of CT Scan interpretation in pre and post operative chemoradiation of rectosigmoid cancer. Methods: Retrospective review CT scan of 12 patients with diagnosis of rectosigmoid cancer stage 3 or more in pre and post operative chemoradiation were done by 2 radiologists. Data analysis included Maximum Wall Thickness, Distance of Lesion above Anal Verge, Perirectal Involvement, Regional node, Distant Metastasis. Chest radiograph (CXR), Endorectal Ultrasound (ERUS), Barium enema ( BE), Colonoscopy and treatment information were reviewed. Results: Reliability of TNM staging by CT scan interpretation were .66, .50 and .75, respectively total reliability is .75 and overall validation of CT scan staging is .40 with statistic significant at .05 reference with Pathological staging. Conclusion: There was CT scan interpretation reliability in pre and post chemoradiation for rectosigmoid cancer patients.

Bronchial artery embolization for massive hemoptysis.

Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. Therefore, significant hemoptysis calls for swift detection of the anatomic source of the hemorrhage so that definite therapy can be initiated to stop bleeding. Bronchoscopy, chest roengenography and CT scans may point to the likely source of the hemorrhage. Since the bronchial circulation is the major source of hemoptysis, therapeutic embolization of bronchial arteries can be performed to stop bleeding. Angiographic and clinical data from 30 patients (35 sessions) with hemoptysis who were referred for embolotherapy between 1998-2002 were retrospectively reviewed. The most frequent causes of hemoptysis were tuberculosis (66%), bronchiectasis (11%) and other various conditions resulting in bronchpulmonary anastomoses (11%). The bronchial embolization was attempted in 27/35 sessions with percentage grading successful rate of embolization. Recurrent hemoptysis could be as high as 100% if the initial embolization success rate was less than 50%. Overall, 14/27 patients suffered a bleeding relapse. Note that nine of these patients experienced a bleeding relapse within 30 days, whereas the rest occurred more than 30 days after embolization. Note that, repeat embolization can be performed safely.

Radio-pathological conference, Siriraj Hospital wegener's granulomatosis.

A case report of male with history of headache, right eye swelling and blood-tinged nasal discharge was shown with typical findings of CT chest and MRI brain of the wegener's granulomatosis. The pathological finding was also shown and correlated.