The clue is in the kidneys: greater renal contrast medium accumulation on ipsilateral side down CT myelogram after lateral decubitus digital subtraction myelogram as a predictor of laterality of cerebrospinal fluid leak.

AIM: To assess the potential correlation of the laterality of a cerebrospinal fluid (CSF)-venous fistula with the laterality of decubitus computed tomography (CT) myelogram (post decubitus digital subtraction myelogram) based on which side demonstrated more renal contrast medium excretion. MATERIALS AND METHODS: Patients with CSF-venous fistulas diagnosed at lateral decubitus digital subtraction myelograms were reviewed retrospectively. Patients who did not have CT myelogram following one or both left and right lateral decubitus digital subtraction myelograms were excluded. Two neuroradiologists independently interpreted the CT myelogram for the presence or absence of renal contrast, and whether subjectively more renal contrast medium was visualised on the left or right lateral decubitus CT myelogram. RESULTS: Renal contrast medium was seen in lateral decubitus CT myelograms in 28 of 30 (93.3%) patients with CSF-venous fistulas. Having more renal contrast medium in right lateral decubitus CT myelogram was 73.9% sensitive and 71.4% specific for the diagnosis of a right-sided CSF-venous fistula, whereas having more renal contrast medium in the left lateral decubitus CT myelogram was 71.4% sensitive and 82.6% specific for a left-sided CSF-venous fistula (p=0.02). CONCLUSION: When the CSF-venous fistula lies on the dependent side of a decubitus CT myelogram performed after decubitus digital subtraction myelogram, relatively more renal contrast medium is visualised compared to when the fistula lies on the non-dependent side.

Neutron time-of-flight detectors (nTOF) used at Sandia's Z-Machine.

Neutron time-of-flight (nTOF) detectors have been used on Sandia National Laboratories' Z-Machine for inertial confinement fusion and magnetized liner fusion experiments to infer physics parameters including the apparent fuel-ion temperature, neutron yield, the magnetic-radius product (BR), and the liner rho-r. Single-paddle, dual-paddle, and co-axial scintillation nTOF detectors are used in axial lines-of-sight (LOS) and LOS that are 12° from the midplane. Detector fabrication, characterization, and calibration are discussed.

Rapidly progressive orbital intravascular papillary endothelial hyperplasia in a newborn.

Intravascular papillary endothelial hyperplasia (IPEH), also known as "vegetant intravascular haemangioendothelioma", is a rare benign proliferation of vascular endothelial cells secondary to intravascular thrombosis and thrombus organisation. It can develop from vascular lesions such as haemangiomas, pyogenic granulomas or varicose veins. This vascular tumour of the skin and subcutaneous tissue may exhibit rapid and progressive growth, and is usually located in the neck or head. Ocular presentation is unusual and orbital involvement is even rarer. We report a case of a preterm newborn male with a rapidly growing left orbital mass that was histologically diagnosed as intravascular papillary endothelial hyperplasia. He was successfully managed with total excision of the tumour and propranolol therapy and remains recurrence free after an eight-year follow-up.

Hiperplasia endotelial papilar intravascular orbitaria rápidamente progresiva en un recién nacido / Rapidly progressive orbital intravascular papillary endothelial hyperplasia in a newborn

La hiperplasia endotelial papilar intravascular (IPEH), también conocida como «hemangioendotelioma vegetante intravascular», es una proliferación benigna y rara de células endoteliales vasculares, secundaria a trombosis intravascular u organización del trombo. Puede desarrollarse a partir de lesiones vasculares como hemangiomas, granulomas piógenos o várices. Este tumor vascular de la piel y del tejido subcutáneo puede presentarse como crecimiento rápido y progresivo, y es usualmente localizado en cuello o cabeza. La presentación ocular es inusual y la afectación orbitaria es todavía más rara. Presentamos un caso de un varón recién nacido pretérmino, el cual presentó una masa orbitaria izquierda de crecimiento rápidamente progresivo y se obtuvo el diagnóstico por histología de hiperplasia endotelial papilar intravascular. El paciente fue exitosamente tratado mediante una escisión total del tumor y terapia con propranolol. Actualmente, después de un seguimiento de ocho años, ha permanecido sin recurrencias (AU)

Intravascular papillary endothelial hyperplasia (IPEH), also known as “vegetant intravascular haemangioendothelioma”, is a rare benign proliferation of vascular endothelial cells secondary to intravascular thrombosis and thrombus organisation. It can develop from vascular lesions such as haemangiomas, pyogenic granulomas or varicose veins. This vascular tumour of the skin and subcutaneous tissue may exhibit rapid and progressive growth, and is usually located in the neck or head. Ocular presentation is unusual and orbital involvement is even rarer. We report a case of a preterm newborn male with a rapidly growing left orbital mass that was histologically diagnosed as intravascular papillary endothelial hyperplasia. He was successfully managed with total excision of the tumour and propranolol therapy and remains recurrence free after an eight-year follow-up (AU)

A Novel Endovascular Therapy for CSF Hypotension Secondary to CSF-Venous Fistulas.

We report a consecutive case series of patients who underwent transvenous embolization of the paraspinal vein, which was draining the CSF-venous fistula, for treatment of spontaneous intracranial hypotension. These are the first-ever reported cases of this treatment for CSF-venous fistulas. All patients underwent spinal venography following catheterization of the azygous vein and then selective catheterization of the paraspinal vein followed by embolization of the vein with Onyx. All patients had improvement of clinical and radiologic findings with 4 patients having complete resolution of headaches and 1 patient having 50% reduction in headache symptoms. Pachymeningeal enhancement resolved in 4 patients and improved but did not resolve in 1 patient. Brain sag resolved in 4 patients and improved but did not resolve in 1 patient. There were no cases of permanent neurologic complications. All patients were discharged home on the day of the procedure.

Superlinearity, saturation, and the PMT-Tailoring and calibration methodology for prompt radiation detectors.

This work illustrates predominant measureable nonlinearities in photomultiplier tubes (PMTs) and introduces a controllable one called "Superlinearity," signifying both a positive nonlinear response and the ability to extend linear operation by counteracting gain saturation mechanisms - charge depletion, space-charge field limitation, and secondary emission surface effects. Recognizing superlinearity and its effect on the temporal step response leads to a true definition of linearity, free of a small-signal linear assumption. Furthermore, given the prevalent use of glass microchannel-plate (MCP) PMTs in favor of a faster impulse response in spite of a small charge limit, we are motivated to examine their nonlinear amplitude response and deploy tailored gain bias string methods to fully harness the maximum linear gain as is usually done for transmissive metal mesh and reflective metal dynode PMTs. Our characterization methodology applies standard NIST-traceable calibrated laboratory equipment with absolute input-referenced techniques, examining step responses over many orders of magnitude in controlled illumination. By doing so, we quantitatively reveal the superlinearity strength independent of charge depletion, yielding true linear responsivity and effectively doubling the small-signal linear limit; this is very relevant to PMT modeling and charge deconvolution efforts. With further development, the tailoring strategies we introduce could be applied to MCP detectors, extracting all useful capillary charge with a significant improvement in large linear signal quality.

Donor-transmitted HTLV-1-associated myelopathy in a kidney transplant recipient--case report and literature review.

Clinical disease due to human T cell lymphotropic virus type 1 (HTLV-1), a retrovirus endemic in certain regions of the world, is rarely reported after solid organ transplantation. In 2009, universal deceased donor organ screening for HTLV-1 was discontinued in the United States. We report the first case of donor-derived HTLV-1-associated myelopathy in a kidney transplant recipient from the United States. The patient, who was HTLV-1-seronegative prior to transplantation, likely acquired HTLV-1 infection from a seropositive organ donor. In this era when screening of donors and recipients for HTLV infection is not mandatory, clinicians should be vigilant in recognizing the risk and potential occurrence of this donor-derived infection in recipients with epidemiologic exposures.

Development and characterization of sub-100 ps photomultiplier tubes.

We describe the evaluation of a microchannel plate (MCP) photomultiplier tube (PMT), incorporating a 3 µm pore MCP and constant voltage anode and cathode gaps. The use of the small pore size results in PMTs with response functions of the order of 85 ps full-width-half-maximum, while the constant electric field across the anode and cathode gaps produces a uniform response function over the entire operating range of the device. The PMT was characterized on a number of facilities and employed on gas Cherenkov detectors fielded on various deuterium tritium fuel (DT) implosions on the Omega Laser Facility at the University of Rochester. The Cherenkov detectors are part of diagnostic development to measure Gamma ray reaction history for DT implosions on the National Ignition Facility.

The trigeminal trophic syndrome: an unusual cause of face pain, dysaesthesias, anaesthesia and skin/soft tissue lesions.

The trigeminal trophic syndrome is an unusual consequence of trigeminal nerve injury that results in facial anaesthesia, dysaesthesia and skin ulceration. Limited knowledge is available. The aim of this study was to increase the knowledge of this syndrome by performing a retrospective medical record review and case series report. Fourteen cases were identified. The female:male ratio was 6:1. Mean age of onset was 45 years (range 6-82). The cause was iatrogenic in most. Latent period to onset ranged from days to almost one decade. The majority (n = 12) had bothersome dysaesthesias. Most (n = 9) self-manipulated the face; a third (n = 5) did not. Most ulcers affected the second trigeminal division, mainly in the infraorbital nerve distribution. Neuropathic and/or neuralgic facial pain occurred in 50% (n = 7). Pain intensity was severe in most (n = 6). Gabapentin gave relief in two. To conclude, trigeminal trophic syndrome follows injury to the trigeminal nerve or its nuclei. For unclear reasons, most ulcerations follow infraorbital nerve distribution. Self-manipulation may contribute to ulcer development rather than being required. Gabapentin may help pain.

Community level cancer control in a Texas barrio: Part I--Theoretical basis, implementation, and process evaluation.

A theory-based program that used peer modeling and a network of peer communicators to promote breast and cervical cancer screening was designed and implemented in a barrio of San Antonio with a population of approximately 25,000 adult women. The implementation process was evaluated and documented through field notes, archival documents, content analyses, interviews, surveys, etc. Over a 21-month period, a total of 156 new stories and a network for distribution of more than 80,000 print pieces carried messages about positive role models who were receiving Pap smears and mammograms. A group of 85 volunteers were recruited to promote screening; these volunteers reached 2000-3000 women each month with personal contacts in which cancer screening was encouraged. A small group of volunteers offered particularly intensive assistance to their peers, e.g., helping them to make and keep appointments for screening examinations. The theoretical communication model for the program, which maximizes audience and community participation as sources and channels for messages, was well suited for the cross-cultural application presented here.

Ineffectiveness of a mass mailing campaign to improve poison center awareness in a rural population.

The distribution of poison prevention and education literature represents a significant part of poison center outreach programs. Yet the effectiveness, in terms of cost and impact, of mailing this material in an unsolicited fashion has not been investigated. We questioned the effectiveness of poison education literature through mass mailing to increase poison center awareness and improve one's ability to comprehend and retain appropriate first aid response in the event of a poisoning emergency. Two poison education brochures, in English and Spanish translation, and 2 telephone stickers were mailed third class to all 8,948 households in 1 rural county at a total cost of $3,420. A total of 397 (4.4%) households were randomly selected and successfully completed a 23-question telephone survey 6 mo after the mailing. The primary language spoken by the respondents were English, 311 (78%) and Spanish, 86 (22%). Children under the age of 6 y were present in 101 (25%) households. Only 50 (13%) respondents remembered having received any poison education brochures. Although 147 (37%) responded that they had heard of the regional poison center, only 63 (16%) said they would call the poison center first in the event of a poisoning. Forty-four percent indicated they would call 911 first. Only a small increase in penetrance rate was found when comparing 6 mo periods before and after the mailing. We conclude that mass mailing of poison education brochures made little impact in improving poison center awareness and first aid response and was not a cost effective method of poison education.

Isoenzyme patterns of Entamoeba histolytica isolates from asymptomatic carriers: use of gradient acrylamide gels.

A vertical polyacrylamide gradient gel (3% to 7%) was designed to facilitate the electrophoretic resolution and classification of isoenzyme patterns of Entamoeba histolytica isolates. The following enzyme systems were used: phosphoglucomutase (PGM), hexokinase (HX), glucosephosphate isomerase (GPI), and malate dehydrogenase (ME). The modifications in the electrophoretic procedure and sample preparation allowed the reproducible comparison of enzyme patterns of axenic, monoxenic, and mixed cultures of E. histolytica isolated from humans. The clear distinction obtained in gradient polyacrylamide gels, between amebic isoenzyme bands and those from bacteria, renders this technique adequate for application to epidemiological studies where mixed cultures are used. The isoenzyme patterns of eight isolates from asymptomatic carriers, rigorously characterized by the absence of clinical, endoscopic, and serological findings were studied and compared with three well characterized pathogenic strains, cultured under axenic conditions. Our observations confirm the existence of distinct isoenzyme patterns for PGM, HX, and GPI in pathogenic and nonpathogenic strains, and reveal the consistent presence of more than one band for GPI. In addition, a previously undescribed band for GPI with an Rf of 0.64 in a carrier strain was found. The results suggest that while carriers usually harbor amebas with nonpathogenic isoenzyme patterns, pathogenic patterns also may be found in carriers.