Abdominal MR imaging with a volumetric interpolated breath-hold examination.

PURPOSE: To compare a T1-weighted, three-dimensional (3D), gradient-echo (GRE) sequence for magnetic resonance (MR) imaging of the body (volumetric interpolated breath-hold examination, or VIBE) with a two-dimensional (2D) GRE breath-hold equivalent. MATERIALS AND METHODS: Twenty consecutive patients underwent 1.5-T MR imaging. The examinations included pre- and postcontrast (20 mL gadopentetate dimeglumine) fat-saturated 2D GRE breath-hold imaging and fat-saturated volumetric interpolated breath-hold imaging before, during (arterial phase), and after injection, with thin (2-mm source images) and thick (8-mm reconstruction images) sections. The three images were compared qualitatively and quantitatively (signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]). RESULTS: Qualitatively, the 2-mm source images had poorer pancreatic edge definition on precontrast images compared with the other two data sets (P < .05). On gadolinium-enhanced images, scores for clarity of pancreatic edge, number of vessels visualized, and arterial ghosting were significantly lower for the postcontrast 2D GRE images. Quantitatively, SNR measurements in the liver, aorta, and renal cortex on pre- and postcontrast images were significantly higher for the 8-mm reconstruction images than for the 2D GRE or 2-mm source images (P < .05). Aorta-to-fat CNR was significantly higher on the 8-mm reconstruction images. CONCLUSION: Fat-saturated volumetric interpolated breath-hold images have quality comparable to that of conventional fat-saturated 2D GRE images.

Adrenoleukodystrophy: unusual clinical and radiographic manifestation.

Adrenoleukodystrophy is an X-linked recessive peroxisomal disorder, characterized by progressive neurologic deterioration due to cerebral white matter demyelination and adrenal insufficiency. Onset is usually in childhood between ages 5 and 10, and its course is fatal within approximately 5 years. Initial symptoms are behavioral, gait, and auditory disturbances and may be a diagnostic dilemma. Abnormally raised plasma very long chain fatty acids (VLCFA) are diagnostic; computed tomography and magnetic resonance imaging findings show symmetrical occipital white matter lesions which progress in a rostralcaudal direction.

Limited benefit of electrophysiological studies during dorsal rhizotomy.

Using a formula for standard deviation and several assumptions, the potential benefit of electrophysiological recording (ER) during dorsal rhizotomy for cerebral palsy is calculated and expressed in a ratio, the electrophysiological recording benefit ratio (ERBR). ERBR is approximately 1.1 in most of the examples, but other factors may reduce this ratio. Severing an additional rootlet appears to be a viable alternative to ER in most of the examples. Advantages of dorsal rhizotomy without ER include reduced expense and operative time. Prospective studies are recommended to evaluate further the benefit of ER during dorsal rhizotomy. If stimulation of dorsal rootlets is abandoned during dorsal rhizotomy, stimulation of whole dorsal and ventral roots may still be necessary to prevent inadvertent severing of motor fibers.

Uniform performance of high-efficiency room-temperature GaInAsSb/GaSb photodiodes for 1.75 < lambda < 2.2 mum.

A group of 126 experimental, packaged, backilluminated, 1.75-2.2-microm wavelength, GaInAsSb mesa (~85-microm diameter) photodetectors have been assembled and evaluated. Average room-temperature properties were peak quantum efficiency, 86%; zero-bias capacitance, 3.9 pF; dark current at -0.5-V bias, 7.4 microA.

Suprascapular nerve lesions at the spinoglenoid notch: report of three cases and review of the literature.

Lesions of the suprascapular nerve can occur at the supraspinatus notch (SSN) or at the spinoglenoid notch (SGN). Electromyographic (EMG), evaluation of the infraspinatus, and especially the supraspinatus muscles distinguishes SGN from SSN lesions. Three cases of SGN lesions, which are more common than SSN lesions, are presented.

Mickey Mouse neurology. Neurological disorders in children visiting central Florida.

Seizures are the most common cause of pediatric neurological admissions in children visiting central Florida. In approximately 50%, seizures are brief, generalized and associated with fever. Most of the afebrile seizures leading to hospitalization occur in children not previously recognized as having a seizure disorder. Sleep-associated seizures ("benign epilepsy of childhood," rolandic seizures) may be recognized more easily during vacations when children often share a hotel room with parents or fall asleep in the family car.

Need for better severity indexes of acute myocardial infarction under diagnosis-related groups.

Clinical, demographic and administrative data, including length of stay and institutional charges, were examined for 219 patients hospitalized for acute myocardial infarction (AMI). Neither length of stay nor charges differed among AMI patients with or without cardiovascular complications as defined by Medicare's diagnosis-related group (DRG) categories (DRG 121 and 122, respectively) for patients who are discharged alive. Myocardial enzyme peak levels are the best predictors of hospital resource consumption for patients with AMI when considered alone or in combination with other factors. The "cardiovascular complications" designated by discharge diagnoses did not reflect resource consumption in our patient population. Sixteen percent of the patients studied underwent cardiac catheterization during hospitalization. These patients stayed in the hospital longer and incurred 70% higher charges; nevertheless, they were grouped with the remaining AMI patients in the current DRG formulation. Clinical evaluations such as cardiovascular complications are subject to interpretation, and are therefore less credible than enzyme measurements for recognizing the severity of a patient's AMI. Reimbursement based on objective measurements may avoid payment inequities.

Pediatric intensive care: who, why, and how much.

The impact of acute disease, chronic disease, age, and therapeutic goals on resource utilization was evaluated by surveying 397 consecutive admissions to a pediatric ICU. Resource consumption was estimated using ICU days of care and the Therapeutic Intervention Scoring System. Resource consumption was greatest for patients with the therapeutic goal of palliation with hope for definitive repair in the future, patients with acute congenital disease, and children less than one month of age. Significant chronic disease was common (33.5%) but was not associated with increased resource consumption.

Neocortical death in infants: behavioral, neurologic, and electroencephalographic characteristics.

Neocortical death is a form of the persistent vegetative state characterized by the maintenance of sleep/wakeful cycles and spontaneous respirations and the lack of cognitive function. It is difficult to diagnose in neonates and young infants because their cognitive skills are limited by inexperience and by immaturity of the central nervous system. Because neocortical death has not been described previously for this age group, we report the neurologic, behavioral, electroencephalographic, and computed tomographic characteristics of three infants who survived in the persistent vegetative state following severe brain injury. Each infant appeared to exhibit some complex behaviors, including interaction with the environment and the examiners, although the electroencephalograms documented no electrical activity of cerebral origin. Computed tomography revealed extensive destruction of the cerebral hemispheres. Infants and newborns with a history suggesting brain injury and with the neurologic and behavioral characteristics described here should be evaluated with serial electroencephalograms and computed tomography to diagnose the syndrome of neocortical death.

Seizures in adolescence. A review of patients admitted in an adolescent service.

The admissions of new seizure patients to an adolescent service over a 10-year period were retrospectively reviewed with regard to the patient's etiology, work-up, and outcome. Head trauma and pseudoseizures were common, 21% and 19%, respectively. In general, the outcome in adolescents appears to depend more on the underlying diagnosis than on how the seizure presents.

Ipecac-induced myopathy simulating dermatomyositis.

We studied a young woman with an eating disorder. To induce vomiting, she took syrup of ipecac daily for 2 years, and then developed insidious, progressive muscle weakness. Skin findings were similar to those of dermatomyositis. Muscle biopsy, however, was similar to experimental emetine myopathy and lacked inflammatory features. Upon cessation of ipecac abuse, strength returned. We believe that this patient had ipecac-induced muscle weakness.

Congenital facial palsy and ipsilateral deafness: association with maternal diabetes mellitus.

Congenital facial palsy and ipsilateral deafness were found in two children of unrelated insulin-requiring diabetics. Multidirectional tomography showed hypoplasia of the internal auditory canal in each case but the cochlea, vestibule and semicircular canals were radiologically normal. The malformation in these patients must have been determined before 23 weeks of gestational age when ossification of the inner ear is complete. The association of this malformation and maternal diabetes is unlikely to be coincidental.

Velopharyngeal insufficiency in neurofibromatosis.

This report describes 7 patients with hypernasal speech associated with neurofibromatosis. Multi-view videofluoroscopic and nasopharyngoscopic examinations of the velopharyngeal sphincter showed a variety of velopharyngeal valving failures amongst the 7 patients. Extensive evaluation failed to find the pathogenesis of velopharyngeal insufficiency in these patients.

Sleep apnea studies in an infant with congenital primary hypoventilation ("Ondine's curse").

Recurrent apneic episodes were typically associated with sleep, not wakefulness, in an infant with congenital primary hypoventilation ("Ondine's Curse"). Quiet sleep (SLQ) was shown to constitute a higher risk condition than active sleep (SLA) at the ages she was recorded polygraphically (2-4 months old). This infant's respiratory disorder was complicated by recurrent pneumonia, seizures and deficient growth which resulted in death at the age of eight months. Necropsy revealed bronchopulmonary dysplastic fibrosis and cor pulmonale. Neuropathologic examination failed to reveal pathologic changes in the brainstem.

Fatal paratracheal abscess in multiple sclerosis.

Upper airway obstruction resulting from a paratracheal abscess developed insidiously and led to the death of a 43-year-old woman with multiple sclerosis. Repeated nasogastric intubation, required by an exacerbation of bulbar symptoms, may have initiated this unusual infection. Corticotropin and corticosteroid therapy may have impaired immunologic competence and masked fever and other symptoms of inflammation. Hoarseness and inspiratory stridor should not be attributed to laryngeal paresis in patients with multiple sclerosis unless other causes of airway obstruction have been excluded by appropriate diagnostic studies.

Long-term prognosis of patients with infantile spasms following ACTH therapy.

The influence of ACTH on the prognosis of patients with infantile spasms remains controversial. We have examined retrospectively the long-term benefits of initially successful ACTH therapy in patients treated at this institution between 1961 and 1974. Individuals with equivocal or minimal improvement during ACTH therapy were excluded from this study. Eighteen affected infants showed a favorable early response consisting of cessation of seizures for at least 3 weeks during ACTH therapy and concurrent disappearance of the hypsarhythmic EEG pattern. Modal age at last follow-up was 5 years (range, 15 months to 16 years). Infantile spasms recurred in 7 patients (39%), and 8 patients subsequently had other seizure types. All epileptiform (spike) activity disappeared from the EEGs of 8 patients during ACTH therapy, but in 4 of these cases epileptiform activity was present in later tracings. In the remaining 10 patients the hypsarhythmic pattern disappeared in association with ACTH therapy, but the EEG remained epileptiform (often only in sleep). Later EEGs were free of epileptiform activity in 5 of the 10 patients whose tracings contained spike discharges in the early follow-up period. Four patients (22%) were seizure free and without intellectual impairment when last evaluated.