ABSTRACT
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
Subject(s)
Obsessive-Compulsive Disorder , Radiosurgery , Humans , Brazil , Obsessive-Compulsive Disorder/diagnostic imaging , Obsessive-Compulsive Disorder/surgery , Radiosurgery/methods , Treatment Outcome , Internal Capsule/diagnostic imaging , Internal Capsule/surgeryABSTRACT
En el presente articulo se presenta un caso de un paciente con hipertrofia linfoepitelial benigna de parotida teniendo como enfermedad de base, infeccion por el Virus de Inmunodeficiencia Humana. Hacemos además una corta discusion del tema exponiendo su diagnostico y tratamiento
Subject(s)
Humans , Male , Adult , HIV , Parotid NeoplasmsABSTRACT
Doppler indexes were measured in 14 renal arteries in 13 patients before and after percutaneous transluminal angioplasty to determine if changes in these parameters occurred after the procedure. Angioplasty was technically and clinically successful in 12 cases, and adequate Doppler signals were obtained from 13 of 14 arteries. The pulsatility index, resistive index, and acceleration of the distal main renal artery Doppler waveform increased significantly after angioplasty, while the time to systolic peak and the renal-aortic ratio remained unchanged. The former may be useful noninvasive indexes to screen patients for restenosis of the renal artery before it becomes clinically evident. A long-term follow-up study is needed to test this hypothesis.