Differentiation between germinoma and other pineal region tumors using diffusion-and susceptibility-weighted MRI.

PURPOSE: To evaluate the effectiveness of diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) for differentiation between germinoma and other pineal region tumors. METHOD: This retrospective study consisted of 72 patients with pathologically proven pineal region tumors between January 2010 and August 2020. Tumors were classified as germinomas (40), non-germinomatous germ cell tumors (11) (NGGCT), pineal parenchymal tumors (10) (PPT), and other types of tumors (11). Visual scale score, ADC values and SWI intratumoral susceptibility signal (ITSS) score were analyzed and compared to histopathology data. RESULTS: The mean apparent diffusion coefficient (ADCmean) and minimum apparent diffusion coefficient (ADCmin) ratio of germinoma were significantly lower than NGGCT. ADCmean or ADCmin cut-off ratio of ≤ 1.48 or ≤ 1.32 allowed for discrimination between germinoma and NGGCT with sensitivity and specificity of 100 % and 63.6 %. An ADCmin cut-off ratio of ≥ 0.93 allowed for discrimination between germinoma and PPT with sensitivity and specificity of 60 % and 80.0 %. ADCmin cut-off ratio of ≤ 1.15 allowed for discrimination of germinoma from other types of tumors with sensitivity and specificity of 87.5 % and 54.5 %. CONCLUSIONS: ADC ratio can differentiate germinoma from other types of pineal region tumors. Our initial results suggest that ITSS score was not significantly correlated with specific histology subtype.

Prevalence of Sclerotic Pterygoid Plate in Pretreatment Nasopharyngeal Carcinoma.

OBJECTIVES: The objective of our study was to determine the prevalence of sclerotic pterygoid plate in pretreatment CT of nasopharyngeal carcinoma compared with the control group. MATERIALS AND METHODS: A total of 51 nasopharyngeal carcinoma patients (37 men, 14 women) with a mean age of 51.94±13 years, and 51 controls (30 men, 21 women) with a mean age, 49.31±15 years were included in this study in a retrospective fashion. All computed tomographic (CT) images were evaluated by two neuroradiologists. Sclerosis of pterygoid plate and other findings included pterygoid plate erosion, adjacent tumor enhancement, and parapharyngeal extension which were assessed. MRI findings were also recorded. The prevalence of pterygoid plate sclerosis was compared using Chi-square statistical tests. Imaging findings were analyzed by binary logistic regression analyses. RESULTS: The prevalence of pterygoid plate sclerosis in nasopharyngeal carcinoma was 53.9% compared to the control group (16.7%) and the difference was statistically significant (P-value< 0.001). In nasopharyngeal carcinoma, the prevalence of tumor adjacent to the pterygoid plate, parapharyngeal extension and pterygoid plate erosion were 69.6%, 81.4%, 38.2%, respectively. No erosion of pterygoid plate was detected in the control group. The odds of adjacent tumor enhancement and pterygoid plate erosion was 7.29 and 20.56 times higher in the sclerotic pterygoid plate (p-values of 0.019 and 0.000, respectively). MRI was available for four nasopharyngeal carcinoma cases with five sclerotic pterygoid plates, where two showed enhancements. All non-sclerotic pterygoid plates showed no enhancement on MRI. CONCLUSION: The prevalence of sclerotic pterygoid plate is significantly higher in patients with nasopharyngeal carcinoma with a considerably higher chance of adjacent tumor enhancement and pterygoid plate erosion.

What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

BACKGROUND: Although there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator. METHODS: This was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2. RESULTS: There were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2. DISCUSSION: Open skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI. LEVEL OF EVIDENCE: III.

Diffusion MRI in Evaluation of Pediatric Posterior Fossa Tumors.

BACKGROUND: To evaluate the role of diffusion MRI in differentiating pediatric posterior fossa tumors and determine the cut-off values of ADC ratio to distinguish medulloblastoma from other common tumors. METHODS: We retrospectively reviewed MRI of 90 patients (7.5-year median age) with pathologically proven posterior fossa tumors (24 medulloblastoma, 7 ependymoma, 4 anaplastic ependymoma, 13 pilocytic astrocytoma, 30 diffuse intrinsic pontine glioma (DIPG), 4 ATRT, 3 diffuse astrocytoma, 2 high grade astrocytoma, 2 glioblastoma, and 1 low grade glioma). The conventional MRI characteristics were evaluated. Two readers reviewed DWI visual scale and measured ADC values by consensus.  ADC measurement was performed at the solid component of tumors. ADC ratio between the tumors to cerebellar white matter were calculated. RESULTS: The ADC ratio of medulloblastoma was significantly lower than ependymoma, pilocytic astrocytoma and DIPG. The ADC cut-off ratio of ≤ 1.115 allowed discrimination medulloblastoma from other posterior fossa tumors with sensitivity, specificity, PPV and NPV of 95.8%, 81%, 67.6% and 97.9%, respectively. ADC ratio cut-off level to differentiate medulloblastoma from ependymoma was ≤ 0.995 with area under the curve (AUC)= 0.8693. ADC ratio cut-off level for differentiate medulloblastoma from pilocytic astrocytoma at ≤ 1.17 with AUC = 0.9936. ADC cut-off level for differentiate medulloblastoma from DIPG at ≤ 1.195 with AUC = 0.9681. The ADC ratio was correlated with WHO grading by the lower ADC ratio associated with the higher grade. Furthermore, High DWI visual scale was associated with high grade tumor. CONCLUSION: Diffusion MRI has a significant role in diagnosis of pediatric posterior fossa tumors. ADC ratio can be used to distinguish medulloblastoma from other posterior fossa tumor with good level of diagnostic performance.

Intramedullary Conus Medullaris Tuberculoma: A Case Report and Review of the Literature.

Intramedullary tuberculoma (IMT) of the conus medullaris is extremely rare. We present a case of intramedullary conus medullaris tuberculoma in which the diagnosis was based on there being very high levels of adenosine deaminase (ADA) in the patient's cerebrospinal fluid (CSF) and improvement with antituberculous therapy. A 78-year-old man presented after having had a dull ache in both thighs and progressive paraparesis. The patient's medical history included diffuse large B-cell lymphoma, which had undergone remission due to chemotherapy two years earlier, and long-term, well-controlled diabetes. A chest X-ray showed no evidence of tuberculosis. The results of CSF analysis were compatible with Froin's syndrome. An initial diagnosis was made of an intramedullary tumor of the conus medullaris, based on magnetic resonance imaging (MRI). A myelotomy and multiple punch out biopsy were performed, and histopathology of the tissues revealed mild reactive gliosis. Due to the patient having high levels of CSF-ADA, IMT of the conus medullaris was suspected. The patient was treated with an 18-month course of antituberculous therapy. The dull ache gradually disappeared, and motor power improved slightly. A follow-up MRI of the lumbosacral (LS) spine revealed that the lesion had completely disappeared. Intramedullary tuberculoma of the conus medullaris should be considered in patients with underlying malignancy and no symptoms of systemic tuberculosis. CSF adenosine deaminase levels can be helpful in determining the presence of central nervous system tuberculosis when other systemic signs of disease are lacking.

Case Report: Sparganosis of the Cauda Equina.

Spinal sparganosis of the cauda equina has been rarely reported. A 54-year-old man presented at the hospital after having experienced lower back pain for 10 months, progressive weakness and numbness of the left leg for 4 months, and urinary incontinence for 3 weeks. Magnetic resonance imaging of the lumbosacral spine revealed a heterogeneous enhancing mass at the T12-S1 level. Spinal sparganosis was diagnosed by histological examination and molecular identification of the parasite in the tissue section. The patient was treated with a high dose of praziquantel because the parasitic mass was only partially removed and symptoms worsened following surgery.

Brain Metabolite Changes After Anodal Transcranial Direct Current Stimulation in Autism Spectrum Disorder.

OBJECTIVES: Previous research has provided evidence that transcranial direct current stimulation (tDCS) can reduce severity of autism spectrum disorder (ASD); however, the exact mechanism of this effect is still unknown. Magnetic resonance spectroscopy has demonstrated low levels of brain metabolites in the anterior cingulate cortex (ACC), amygdala, and left dorsolateral prefrontal cortex (DLPFC) in individuals with ASD. The aim of this study was to investigate the effects of anodal tDCS on social functioning of individuals with ASD, as measured by the social subscale of the Autism Treatment Evaluation Checklist (ATEC), through correlations between pretreatment and posttreatment concentrations of brain metabolites in the areas of interest (DLPFC, ACC, amygdala, and locus coeruleus) and scores on the ATEC social subscale. METHODS: Ten participants with ASD were administered 1 mA anodal tDCS to the left DLPFC for 20 min over five consecutive days. Measures of the ATEC social subscale and the concentrations of brain metabolites were performed before and immediately after the treatment. RESULTS: The results showed a significant decrease between pretreatment and immediately posttreatment in the ATEC social subscale scores, significant increases in N-acetylaspartate (NAA)/creatine (Cr) and myoinositol (mI)/Cr concentrations, and a decrease in choline (Cho)/Cr concentrations in the left DLPFC and locus coeruleus after tDCS treatment. Significant associations between decreased ATEC social subscale scores and changed concentrations in NAA/Cr, Cho/Cr, and mI/Cr in the locus coeruleus were positive. CONCLUSION: Findings suggest that beneficial effects of tDCS in ASD may be due to changes in neuronal and glia cell activity and synaptogenesis in the brain network of individuals with ASD. Further studies with larger sample sizes and control groups are warranted.

Grading Gliomas Capability: Comparison between Visual Assessment and Apparent Diffusion Coefficient (ADC) Value Measurement on Diffusion-Weighted Imaging (DWI).

BACKGROUND: To compare diagnostic accuracy between DWI visual scale assessment and ADC value measurement of solid portion of the tumor in grading gliomas. METHODS: This retrospective study included 38 patients who had pathologically proven gliomas between January 2013 and August 2018 with 18 low grade and 20 high grade tumors. All patients underwent MRI and biopsy. Two readers reviewed DWI visual scale independently. Disagreement was resolved by consensus. One reviewer measured ADC value of entire solid part of the tumor in single axial slice with greatest dimension of tumor which was chosen by consensus. Two data sets of visual scale and ADC value were analyzed and comparison of diagnostic accuracy in glioma grading was done by using area under the curve (AUC) of receiver operating characteristic curve (ROC). RESULTS: Visual scale and ADC value could be used to distinguish between low and high grade gliomas with a statistically significant difference. (P-value 0.002 and <0.001). Almost all high grade gliomas had visual scale 5. The sensitivity, specificity, PPV NPV and accuracy were 50%, 100%, 100% , 64.3%,73.68% respectively. The cutoff level for the ADC value was determined to be 1119.48 x10-6 mm2/s in differentiation between low and high grade gliomas with the sensitivity, specificity, PPV, NPV, accuracy of 90%, 88.89% , 90%, 88.9% and 89.47% respectively. There was no statistically significant difference(P-value = 0.163). CONCLUSION: Both Visual scale and ADC value were capable of differentiating between low and high grade gliomas. Although visual scale may not replace ADC measurement, larger scale prospective study is needed for validate this initial result.
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Interrater Reliability of Various Thyroid Imaging Reporting and Data System (TIRADS) Classifications for Differentiating Benign from Malignant Thyroid Nodules

Background: Thyroid ultrasound(US) is used as the first diagnostic tool to assess the management of disease but is operator dependent. There have been few reports evaluating interrater variability in US assessment. Therefore, we evaluated interrater reliability in US assessment of thyroid nodules and estimated its diagnostic accuracy for various TIRADS systems. Methods: This retrospective study included 24 malignant nodules and 84 benign nodules from January 2015 to October 2017. Two blinded observers independently reviewed stored US images by using TIRADS. All analyses followed guidelines proposed by ACR-TR, Siriraj-TR and EU-TR systems. Interrater reliability was calculated using Cohen's Kappa statistics. Diagnostic accuracy were also calculated. Results: Interobserver agreement showed substantial agreement for composition (K=0.616); echogenicity and echogenic foci showed fair agreement (K=0.327 and 0.288, respectively); margin showed slight agreement (K=0.143). Interrater reliability for the final assessment; moderate agreement for ACR-TIRADS system (K=0.500); fair agreement for EU-TIRADS system (K=0.209) and slight agreement (K=0.114) for Siriraj-TIRADS system. The diagnostic performance from the two observers; ACRTIRADS system; sensitivities were 75% and 79.2%, specificities were 58.3% and 56%, positive predictive value (PPV) were 34% and 33.9% and negative predictive value (NPV) were 89.1% and 90.4%. For the Siriraj-TIRADS system, sensitivities were 41.7% and 25%, specificities were 84.5% and 89.3%, positive predictive value (PPV) were 43.5% and 40% and negative predictive value (NPV) were 83.5% and 80.6%. For the EU-TIRADS system, sensitivities were 45.8% and 66.7%, specificities were 79.8% and 72.6%, positive predictive value (PPV) were 39.3% and 41% and negative predictive value (NPV) were 83.8% and 88.4%. Conclusion: The ACR-TIRADS had highest interobserver agreement, a trend to have highest sensitivity and negative predictive value for diagnosis of malignant thyroid nodules. Siriraj-TIRADS had higher specificity and accuracy, but lower interobserver agreement.

Preoperative MRI evaluation of meningioma consistency: A focus on detailed architectures.

OBJECTIVES: Meningioma is one of the most common primary intracranial tumors. Diagnosis by imaging is not difficult. However evaluation of tumor consistency is an important factor affecting the surgical outcomes. The purpose of our study is to discover the relationship of different findings on pre-operative MRI, with a focus on detailed architectures, and different degrees of intra-operative stiffness of meningioma. Consistency of meningioma is also analyzed in compression to semi-quantitative pathological grading of fibrosis. PATIENTS AND METHODS: Sixty patients who underwent pre-operative MRI and primary surgery at our hospital were included in prospective fashion. Pre-operative MRI parameters, including general data and detailed internal architectures, were recorded. Intra-operative grading of tumor consistency was performed by the neurosurgeon. Pathological report according to WHO 2007 was performed with additional semi-quantitative grading of fibrosis. This study is focused on correlation of operative grade and MRI findings. RESULTS: Meningioma with hard consistency shows significant correlation with several features including en plaque appearance (p = 0.0427), higher ADC value (p = 0.0046) and ratio (p = 0.0016), absent of prominent enhanced rim (p = 0.0306), absent of enostotic spur (p = 0.0040) and absent of vascular core (p = 0.0133) in univariate analysis but no significant correlation is found in multivariate analysis in all except ADC ratio. Higher ADC ratio increase relative risk of hard consistency of meningioma by a factor of 41.22 (ORs = 41.22; 95%CI = 1.19-1426.24, P = 0.04). Good to very good inter-rater agreements are found. No significant correlation between tumor consistency and WHO grading was shown (p = 0.606). However, near significant p-value (p = 0.055) is found with increase degree of fibrosis in pathology as increase degree of tumor consistency. CONCLUSION: We found that en plaque appearance, higher ADC value and ADC ratio, absent of prominent capsular enhancement and absent of vascular core were suggestive of hard consistency in univariate analysis but not independent factors. Additionally, semi-quantitative pathological grading of fibrosis showed near significant correlation with tumor consistent.

Effects of Whole Body Vibration on Glycemic Indices and Peripheral Blood Flow in Type II Diabetic Patients.

BACKGROUND: Whole body vibration (WBV) training is a regime of training on a vibration platform that provides oscillatory movement to the body. Vibration training may be a potentially useful therapeutic strategy to control diabetes and its complications. This study aimed to evaluate the effect of WBV on glycemic indices and peripheral blood flow in type II diabetic patients. METHODS: A parallel group clinical trial was conducted with 1:1 allocation ratio at Khon Kaen University between February and May 2010. The study included diabetic patients receiving diet or oral medication control over the previous year and excluded patients with serious medical and musculoskeletal disorders. Forty type II diabetic patients [14 males, 26 females, 63.2 (7.7) y, mean (SD)] were randomised into two groups (WBV and control) by computer software using a block of four design. The WBV group was given two sets of six one-minute vibration squats, three times per week for twelve weeks. The control group maintained their normal physical activity levels. The primary outcome was the patients glycemic indices. RESULTS: We found no significant difference in glycosylated haemoglobin (HbA1c), fasting blood sugar, insulin level and insulin sensitivity between WBV and control groups. Compared to the control group, WBV training resulted in a substantial reduction in resting diastolic blood pressure -7.1 mmHg (95% CI: -10.9, -3.3, P = 0.001) and peak systolic velocity -7.3 cm.sec-1 (95% CI: -14.7, -0.03, P = 0.049), but made little difference to resting heart rate, systolic blood pressure, end diastolic velocity, and popliteal artery diameter. CONCLUSION: Whole body vibration improved resting diastolic blood pressure and peak systolic velocity, however, any beneficial effect of WBV on glycemic indices remains unclear.

Transient Changes in Brain Metabolites after Transcranial Direct Current Stimulation in Spastic Cerebral Palsy: A Pilot Study.

BACKGROUND: Muscle spasticity is a disability caused by damage to the pyramidal system. Standard treatments for spasticity include muscle stretching, antispastic medications, and tendon release surgeries, but treatment outcomes remain unsatisfactory. Anodal transcranial direct current stimulation (tDCS) in patients with muscle spasticity is known to result in significant improvement in spastic tone (p < 0.001). However, the mechanism of action by which tDCS treatment affects spasticity remains unclear. This pilot study aimed to investigate the effect of anodal tDCS upon brain metabolites in the left basal ganglia and ipsilateral primary motor cortex (M1) in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: This study consisted of three steps: a baseline evaluation, a treatment period, and a follow-up period. During the treatment period, patients were given 20 min of 1 mA anodal tDCS over the left M1 for five consecutive days. Outcomes were compared between pre- and immediate posttreatment in terms of brain metabolites, Tardieu scales, and the quality of upper extremity skills test. RESULTS: Ten patients with spastic CP were enrolled. Following tDCS, there were significant increases in the ratio of N-acetylaspartate (NAA)/creatine (Cr) (p = 0.030), choline (Cho)/Cr (p = 0.043), and myoinositol (mI)/Cr (p = 0.035) in the basal ganglia. Moreover, increased glutamine-glutamate (Glx)/Cr ratio in the left M1 (p = 0.008) was found. In addition, we also observed improvements in the extent of spasticity and hand function (p = 0.028). CONCLUSION: Five consecutive days of anodal tDCS over the left M1 appeared statistically to reduce the degree of spasticity and increase NAA, Cho, mI, and Glx. Future research studies, involving a larger sample size of spastic CP patients undergoing tDCS is now warranted.

The roles of the diffusion-weighted imaging in orbital masses.

INTRODUCTION: Causes of orbital masses can be either benign or malignant. An MRI with diffusion-weighted imaging (DWI) may be helpful to differentiate causes of orbital masses. This study aimed to evaluate the diagnostic properties of an apparent diffusion coefficient (ADC) in orbital masses. METHODS: We retrospectively reviewed patients with orbital masses who underwent DWI and had histopathological results. Orbital lesions were categorized as benign or malignant and compared with respect to the ADC and ADC ratio. A receiver operating characteristic curve (ROC) was plotted to evaluate the sensitivity and specificity of the ADC and ADC ratio threshold. RESULTS: The mean age of all 42 patients in this study was 36.31 years (S.D. 22.12) and 26 of the patients were male (61.9%). The malignant orbital masses accounted for 43% (18 patients). The most common cell type was meningioma (10 patients; 23.8%). There was no statistical difference between the ADC values of benign and malignant tumours (1.18 vs 0.99 ×10-3  mm2 /s; P-value 0.200). The myxoid tumours had significantly higher ADC values than the non-myxoid (1.58 vs 0.99; P-value 0.008) tumours. Non-metastatic non-myxoid tumours also had significantly lower ADC values than metastatic non-myxoid tumours (0.73 vs 1.32; P-values 0.006). The ADC cut-off point of greater than or equal to 0.95 × 10-3  mm2 /s was given a sensitivity of 87.50% for myxoid orbital masses, while the cut-off point of greater than or equal to 1.01 × 10-3  mm2 /s was given a sensitivity of 80.00% for metastatic, non-myxoid malignant orbital masses. CONCLUSIONS: Benign and malignant orbital masses cannot be distinguished by using the ADC values. However, the ADC values were useful in differentiating between myxoid vs non-myxoid orbital masses and metastatic non-myxoid vs non-metastatic non-myxoid orbital masses.

CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes.

PURPOSE: To determine whether the Alberta Stroke Program Early CT Scores (ASPECTS) can predict posttreatment functional outcomes in hyperacute stroke patients who receive recombinant tissue-type plasminogen activator (rt-PA) treatment within 4.5 h. MATERIALS AND METHODS: We studied 162 patients treated with rt-PA within 4.5 h of clinical onset. Of those, 29 patients (17.90 %) received rt-PA treatment between 3 and 4.5 h. Systematic CT scoring with the ASPECTS method was done. The primary outcome was the correlations between ASPECTS and the functional status at 3 months follow-up using the modified Rankin Scale. RESULTS: Clinical variables between those who received rt-PA treatment before and after 3 h were mostly comparable except the proportion of male gender. There were 116 patients (71.60 %) who were classified as independent. Time to receive CT scan or rt-PA treatment was not significantly associated with patients' functional status. Baseline NIHSS and ASPECTS scores were significant factors associated with dependent status or death at 3 months after rt-PA treatment. The adjusted odds ratios were 1.133 [95 % confidence interval (CI), 1.047-1.226] and 0.844 (95 % CI, 0.720-0.990), respectively. CONCLUSION: The ASPECTS predicts the functional status of acute stroke patients who received rt-PA treatment within the 4.5-h golden period.

The appropriate neuroimaging study in persons with epilepsy.

This article presents the appropriate neuroimaging for persons with epilepsy (PWE) in resource-limited facilities. PWE from the Epilepsy Clinic, Srinagarind Hospital between November 1, 2003 and January 30, 2005 were enrolled. The inclusion criteria were PWE aged more than 15 years who underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. We compared the abnormal neuroimaging findings by both imaging modalities. A total of 180 out of 370 PWE met the inclusion criteria, comprising 101 men (56.1%) and 79 women (43.9%). There were 75 PWE who underwent only CT imagings, 85 PWE who underwent only MRI and 20 PWE who underwent both CT and MRI studies. CT scan significantly detected brain abnormalities more than MRI in PWE (P = 0.0131). It was also found that CT scan was superior than MRI in detecting stroke and cysticercosis in PWE, whereas MRI was significantly better in the diagnosis of hippocampal sclerosis. Clinicians should be able to choose appropriate brain imaging for PWE, particularly in resource-limited countries. MRI should be preserved for particular brain lesion owing to availability and cost effectiveness.

Predictive risk factors of seizure-related injury in persons with epilepsy.

OBJECTIVE: The clinical risk factors for seizure-related injuries (SRI) in adult persons with epilepsy (PWE) were studied and analyzed to develop a predictive model. METHODS: We enrolled 300 consecutive cases from three epilepsy clinics in Northeast, Thailand. Subjects were eligible if reported to have at least one seizure attack during the past 12 months. Face-to-face questionnaire was used to evaluate SRI, baseline characteristics and other seizure-related variables. RESULTS: There were 247 and 91 PWE who met a criterion and had SRI, respectively. By multivariate logistic regression method, GTC seizure type, having history of seizure attacks at least 12 times/year, and daytime seizure were significant risk factors of having SRI with odds ratio of 2.376, 2.460, and 3.562, respectively. We developed the predictive model for having SRI in PWE and it gave 90.3% sensitivity and 46.7% specificity on the occurrence of SRI. The estimated probability of SRI can be found online at http://sribykku.webs.com/. CONCLUSIONS: The significant predictive factors for SRI in PWE were the occurrence of GTCs, seizures at least 12 times/year or daytime seizures. Clinicians or PWE can easily evaluate the risk of having SRI in individuals by the online predictive model.

Diagnostic performance of gray-scale versus combined gray-scale with colour doppler ultrasonography in the diagnosis of malignancy in thyroid nodules.

OBJECTIVE: To compare diagnostic performance of gray-scale ultrasound and combined gray-scale ultrasound with color Doppler ultrasound in predicting malignancy of thyroid nodules by using tissue diagnosis as the reference standard. DESIGN: Diagnostic test with prospective data collection. MATERIALS AND METHODS: Between November 2007 and October 2008, 31 patients (16 with solitary thyroid nodules and 15 with multiple thyroid nodules) were preoperatively evaluated with gray-scale ultrasound and color Doppler ultrasound. The nodules were classified as benign or malignant according to the established ultrasound criteria and were later compared with histologic findings obtained from surgical specimens. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of gray-scale US and combined gray-scale with color Doppler US were evaluated using histology as the reference. RESULTS: The sensitivity, specificity, PPV and NPV of gray-scale ultrasonography were 80.0%, 84.6%, 50.0% and 95.7%, respectively. The sensitivity, specificity, PPV and NPV of preoperative combined gray-scale US with color Doppler ultrasonography were 40.0%, 96.2%, 66.7% and 89.3%, respectively. CONCLUSION: Combination of gray-scale US with color Doppler US findings improves specificity and PPV in the diagnosis of malignancy in thyroid nodules.

Is the routine pressure dressing after thyroidectomy necessary? A prospective randomized controlled study.

BACKGROUND: An acute complication of thyroidectomy is fatal hematoma, which can produce an upper airway obstruction needing immediate intubation or tracheostomy. After neck surgery, we usually apply a pressure dressing with a non-woven, adhesive fabric to reduce bleeding and fluid collection at the operative bed. We conducted a prospective, randomized, controlled study to evaluate a pressure vs. a non-pressure dressing after thyroid surgery by monitoring blood and serum in the operative bed. METHODS: We studied 108 patients who underwent 116 thyroid surgeries at Srinagarind Hospital, Khon Kaen University, between December 2006 and September 2007. The patients were randomized to either the pressure dressing or non-pressure dressing group. Ultrasound of the neck was performed 24 +/- 3 hours after surgery. The volume of fluid collection in the operative bed was calculated. All patients were observed for any post-operative respiratory distress, wound complications, tingling sensation or tetany. RESULTS: The distributions of age, sex, surgical indications and approaches were similar between the two groups. There was no statistically significant difference in the volume of fluid collection in the operative bed (p = 0.150) and the collected drained content (p = 0.798). The average time a drain was retained was 3 days. One patient in the pressure dressing group suffered cutaneous bruising while one patient in the non-pressure dressing group developed immediate hemorrhage after the skin sutures. CONCLUSION: Pressure dressing after thyroidectomy does not have any significant impact on decreasing fluid collection at the operative bed. The use of pressure dressing after thyroidectomy may not therefore be justified. TRIAL REGISTRATION: NCT00400465, ISRCTN52660978.

MRI findings in acute disseminated encephalomyelitis following varicella infection in an adult.

There are no abnormal magnetic resonance imaging (MRI) findings in children with acute disseminated encephalomyelitis (ADEM) after varicella infection. Here, we report abnormal MRI findings in an adult, namely: hyperintense signal in the right medullary olive, the right side of the pons, the left middle cerebellar peduncle, the dorsal aspect of both thalami and the periventricular white matter of both cerebral hemispheres. The patient's condition improved after 1 week of corticosteroid treatment. Four months later, MRI of the brain showed almost complete resolution and there were no further attacks of motor weakness at 18-months follow-up.

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.