Validating a threshold of ocular gaze deviation for the prediction of acute ischaemic stroke.

AIM: To determine a threshold at which the degree of ocular gaze deviation (OGD) on axial imaging is highly specific for the prediction of acute ischaemic stroke. MATERIALS AND METHODS: A retrospective analysis of 517 patients who had received MRI with diffusion-weighted imaging (DWI) for suspected acute stroke was performed. The degree of OGD was measured in all patients and the presence and location of infarction determined. The difference in OGD between groups was compared using the independent t-test for normally distributed data and the Mann-Whitney test for non-normal data. The sensitivity and specificity for degrees of OGD in the prediction of acute infarction was calculated using a receiver operating curve (ROC) analysis. RESULTS: The imaging of 448 patients meeting the inclusion criteria was reviewed. Acute infarct was demonstrated in 34.8% (n=156). There was a significant difference in the degree of OGD between patients with an acute infarct and those without evidence of acute ischaemia (p<0.001). ROC curve analysis for OGD demonstrated area under the curve (AUC) = 0.619 with increasing degrees of OGD more specific for acute infarct. OGD >11.95° had a sensitivity of 17% and specificity of 95.9% in predicting acute infarction. CONCLUSION: Significant OGD>11.95° has a high specificity for acute infarct. This threshold may provide a helpful additional sign in the detection of subtle acute infarct, particularly on axial CT brain imaging.

Vocal cord paralysis secondary to a benign parathyroid cyst: a case report with clinical, imaging and pathological findings (2008:6b).

Parathyroid cysts are uncommon entities. Symptomatic parathyroid cysts are extremely rare with approximately only 200 cases reported in the literature. Only ten cases have been reported with recurrent laryngeal nerve paralysis and none in the radiological literature. We present a case of parathyroid cyst and recurrent laryngeal nerve paralysis with illustrations of the clinical, radiological and pathological appearances as well as discussion on the management of this condition.

Incidental vertebral fractures on multidetector CT images of the chest: prevalence and recognition.

AIM: To investigate the prevalence, demographics, fracture site, and the rate of vertebral fracture recognition by radiologists on multidetector computed tomography (MDCT) images of the chest. METHOD: The images of 200 consecutive patients who underwent a MDCT examination of the chest over a 4-month period were reviewed. The thoracic spine, viewed using bone windows in sagittal reformats, was reviewed in consensus by three radiologists. Vertebral fractures were assessed using a validated semi-quantitative method. RESULTS: The mean age was 61 years (range 18-92 years); 48% were female. There were 70 (35%) fractures, of which 51 (73%) were mild grade 1 fractures, 13 (19%) moderate grade 2 fractures, and six (9%) severe grade 3 fractures. Fractures commonly affected patients above the age of 50. The most common site was in the lower thoracic region (53%). The overall recognition rate on the radiologists' reports was 6 (9%). CONCLUSIONS: One in three patients who underwent MDCT of the chest had vertebral fractures. There is significant underreporting of these fractures, and the importance of fracture identification should be emphasized to avoid under-diagnosis.

Computed tomography and magnetic resonance imaging appearances of cystic lesions in the suprahyoid neck: a pictorial review.

Cystic lesions in the head and neck are important entities that are increasingly investigated by cross-sectional imaging. The patient usually presents with a neck swelling and, after initial clinical examination, an ultrasound scan may demonstrate the cystic nature of the lesion. Further imaging with CT and MRI are often necessary to elucidate the aetiology and deep extent of the lesion. This pictorial review describes and illustrates the typical appearances and locations of a range of cystic lesions in the suprahyoid neck on CT and MRI.

Imaging of muscular denervation secondary to motor cranial nerve dysfunction.

The effects of motor cranial nerve dysfunction on the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of head and neck muscles are reviewed. Patterns of denervation changes are described and illustrated for V, VII, X, XI and XII cranial nerves. Recognition of the range of imaging manifestations, including the temporal changes in muscular appearances and associated muscular grafting or compensatory hypertrophy, will avoid misinterpretation as local disease. It will also prompt the radiologist to search for underlying cranial nerve pathology, which may be clinically occult. The relevant cranial nerve motor division anatomy will be described to enable a focussed search for such a structural abnormality.

Case report: myoepithelial carcinoma of the breast: a case report with imaging and pathological findings.

We present a case of myoepithelial carcinoma of the breast together with illustrations of the imaging and pathological appearances as well as discussion on the management of this condition.

Neurothekeomas of the upper limb--case series and clinicopathological review.

Neurothekeomas are rare, benign soft tissue tumours that are considered to be of nerve sheath origin. We present a case series of three patients who have neurothekeomas of the upper limb. There was a remarkably high tumour recurrence rate. The factors contributing to this outcome were studied and a clinicopathological review was performed.

Infections related to breast implants reported to the Food and Drug Administration, 1977-1997.

The FDA has a surveillance system for monitoring adverse events related to medical devices. Infection reports submitted to the FDA by breast implant manufacturers between 1977 and 1997 are characterized. Two cases of death caused by toxic shock syndrome after mammoplasty reported to the FDA are presented. Overall, 1,971 reports with a principal adverse event of infection were reported in this time frame. There was a large increase in the number of reports on infections related to breast implants between 1992 and 1995 due to the publicity and litigation surrounding breast implants. When an organism was identified in the report, the most common organism reported was Staphylococcus sp. Information on the time between the implantation and the onset of the infection or the explantation of the implant was not always reported. However, in reports that did contain this information, there were differences between the length of time to infection onset reported for saline breast implants (earlier) compared to silicone gel breast implants (later). More than half of the reports (56.6%) asserted only that there was an infection and that breast implants were explanted as a result; the remaining reports asserted that infection and other signs, symptoms, or diagnoses had afflicted the patient.

Ultrasound biomicroscopic quantitative analysis of light-dark changes associated with pupillary block.

PURPOSE: To quantitatively analyze the changes in anterior chamber angle and iris configuration induced by varying illumination in patients with narrow angles and pupillary block. METHODS: Twenty-four eyes of 24 patients with pupillary block (mean age, 52.5 years) had ultrasound biomicroscopic images of the angle and iris structures obtained superiorly, nasally, inferiorly, and temporally. Images were performed in the light and the dark. We measured the angle opening distance, iris thickness, iris chord length, iris-lens touch, and iris curvature. RESULTS: Changes in iris and angle configuration occurred within a few seconds of a change in lighting. The mean dark measurements were statistically significantly less than the mean light measurements for angle opening distance (96 +/- 18 vs 185 +/- 26 microm, P = .0001), iris chord length (2,505 +/- 61 vs 3,001 +/- 69 microm, P = .0001), and iris-lens touch (350 +/- 20 vs 693 +/- 35 microm, P = .0001). The mean dark measurements were statistically significantly greater than the mean light measurements for iris thickness at 500 microm from the scleral spur (367 +/- 10 vs 307 +/- 25 microm, P = .0001), and 1,500 microm from the scleral spur (404 +/- 14 vs 347 +/- 12 microm, P = .0001). Iris curvature in all four quadrants was statistically significantly greater in the dark than the light. CONCLUSIONS: This study quantitatively confirms that angle narrowing in the dark in eyes with pupillary block is associated with iris shortening, increased iris thickness, and increased iris convexity. Iris-lens touch is relatively small in pupillary block and decreases with dilation. Angle narrowing with dilation is not related to increased iris-lens touch and occurs promptly without requiring time for aqueous pressure buildup behind the iris.

Silicone gel breast implant adverse event reports to the Food and Drug Administration, 1984-1995.

OBJECTIVES: To characterize the adverse event reports on silicone gel breast implants (SGBIs), including death reports, submitted to the Food and Drug Administration (FDA) from 1984 through 1995 and to analyze changes in the type and complexity of reports following extensive media coverage of breast implants. METHODS: The authors analyzed mandatory and voluntary reports from the adverse events reporting system for medical devices at the FDA. RESULTS: In 1988, adverse event reports related to SGBIs accounted for 2.4% of the 14,473 mandatory reports entered into the FDA database on medical devices. In 1992, SGBI-related reports accounted for 30.3% of the total 66,476 mandatory reports of adverse events. The most frequently reported adverse event in 1988, before the widespread publicity on breast implants, was implant burst or rupture. In contrast, in 1992 the most frequently reported event was reaction, a term used to describe a range of adverse effects. CONCLUSIONS: The numbers of mandatory and voluntary reports of SGBI-related adverse events increased exponentially, as did the complexity of the reports, following publicity over the lack of safety data on breast implants and a short voluntary moratorium on their sale. A significant proportion of reports lacked information on specific medical symptoms or diagnoses.

Infusion pump adverse events: experience from medical device reports.

Infusion pumps are used in the hospital setting, nursing home, and increasingly, in the home. Medical Device Reports to the Food and Drug Administration of adverse events during the use of infusion pumps for a 10-year period are described. Examples of cases reported to the Food and Drug Administration are provided. The problems reported by medical facilities (hospitals, medical centers, hospital pharmacies, or nursing homes) are compared with those that occur in the home or reported by home health care agencies. Overall, there were no differences in the types of adverse events reported by medical facilities when compared with reports from home health care agencies. However, there were differences in the location of use of some of the infusion pumps studied, which could reflect the trend toward home care over the past decade.

Neurological manifestations of systemic lupus erythematosus: a prospective study.

A prospective study of the neurological manifestations in all patients with systemic lupus erythematous (SLE) was conducted between February 1985 to January 1989. Excluding herpes zoster infection of peripheral or cranial nerves, post-herpetic neuralgia and migraine, 36 neurological episodes occurred in 33 patients. The presenting symptoms were mental confusion (10), psychosis (five), seizures (six), focal neurological deficit (three), coma (two), headache (five), blurring of vision (three), neuropathy (one) and myelopathy (one). Of these manifestations, only eight episodes were due to primary involvement by SLE: psychosis (two), seizure (two), multiple cerebral infarcts (one), papillitis (one), neuropathy (one) and myelopathy (one). Infection was the most common secondary cause of neurological episodes: all 10 episodes of mental confusion (fungal seven, pyogenic two, tuberculous one, nocardial one); two of six seizures (tuberculous one, pyogenic one); all five headaches (tuberculous meningitis three, cryptococcal meningitis two). The other secondary causes included steroid psychosis (two), hypertensive encephalopathy with seizure (one) and hypertensive retinopathy (one). Three of five cases of focal neurological deficit were due to macrovascular disease rather than to vasculitic infarction. We concluded that cerebral psychosis was a relatively rare presentation in our patients with SLE. In patients who presented with a neurological problem, especially mental confusion, efforts should be made to ascertain the underlying cause, especially if this may be an infection.