Isolated Upward Rotation of the Fetal Cerebellar Vermis (Blake’s Pouch Cyst) Is a Normal Variant: An Analysis of 111 Cases

2021 ◽  
pp. 1-7
Author(s):  
Ginevra Salsi ◽  
Grazia Volpe ◽  
Elisa Montaguti ◽  
Tiziana Fanelli ◽  
Francesco Toni ◽  
...  
Keyword(s):  
Cerebellar Vermis ◽  
Normal Variant ◽  
Sonographic Diagnosis ◽  
Clinical Consequences ◽  
Prenatal Magnetic Resonance Imaging ◽  
Study Population ◽  
Neurologic Development ◽  
Magnetic Resonance Imaging Mri ◽  
Fetal Karyotype

<b><i>Introduction:</i></b> The objective of the study was to provide more detailed data about fetal isolated upward rotation of the cerebellar vermis rotation (Blake’s pouch cyst) in particular regarding pregnancy outcome. <b><i>Methods:</i></b> This is a retrospective study of all cases of fetal isolated upward rotation of the cerebellar vermis (URCV) diagnosed in 3 referral centers in Italy from January 2009 to November 2019. Whenever possible, prenatal magnetic resonance imaging (MRI) was performed and a fetal karyotype was obtained. A detailed follow-up was obtained by consultation of medical records, interview with the parents, and the pediatricians. <b><i>Results:</i></b> Our study population included 111 patients with a prenatal diagnosis of isolated URCV made at a median gestational age of 21 weeks +3 days (interquartile range (IQR) 21 + 0–22 + 2). The median brain stem-vermis (BV) angle was 27° (IQR 24–29°). In 37.9% of the cases, a regression of the finding with restoration of normal anatomy was noted at a follow-up scan or at postnatal checks. A BV angle of 25° or less predicted regression with a probability in excess of 90%. MRI was performed in utero or at birth in 101 patients and always confirmed sonographic diagnosis. Fetal CGH array and/or karyotype was available in 97 cases and was always normal, but in 1 case. A postnatal follow-up was available in 102 infants (mean 7 months, range 0–10 years of age) and documented a normal neurologic development in all the cases. <b><i>Conclusions:</i></b> Isolated URCV is most likely a normal variant of fetal anatomy without clinical consequences, at least at an early follow-up. A BV angle of 25° or less predicts intrauterine regression of the finding, but the outcome is good in all the cases. When a confident sonographic diagnosis is made, MRI is not mandatory. The risk of a chromosomal anomaly in these cases is probably low.

Colao A, Di Sarno A, Cappabianca P, et al: Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349:2023–2033, 2003

2004 ◽  
Vol 16 (1) ◽  
pp. 1-2 ◽  
Author(s):  
William T. Couldwell ◽  
Martin H. Weiss ◽  
Edward R. Laws
Keyword(s):  
Optic Chiasm ◽  
Treatment Withdrawal ◽  
Dopamine Receptor Agonist ◽  
Recurrence Rates ◽  
Gonadal Dysfunction ◽  
Kaplan Meier ◽  
Mri Scans ◽  
Study Population ◽  
Magnetic Resonance Imaging Mri

Background Whether the withdrawal of treatment in patients with nontumoral hyperprolactinemia, microprolactinomas, or macroprolactinomas is safe and effective has been unclear. We performed an observational, prospective study of cabergoline (a dopamine-receptor agonist) withdrawal in such patients. Methods The study population included 200 patients—25 patients with nontumoral hyperprolactinemia, 105 with microprolactinomas, and 70 with macroprolactinomas. Withdrawal of cabergoline was considered if prolactin levels were normal, magnetic resonance imaging (MRI) showed no tumor (or tumor reduction of 50 percent or more, with the tumor at a distance of more than 5 mm from the optic chiasm, and no invasion of the cavernous sinuses or other critical areas), and if follow-up after withdrawal could be continued for at least 24 months. Results Recurrence rates two to five years after the withdrawal of cabergoline were 24 percent in patients with nontumoral hyperprolactinemia, 31 percent in patients with microprolactinomas, and 36 percent in patients with macroprolactinomas. Renewed tumor growth did not occur in any patient; in 10 female patients (22 percent) and 7 male patients (39 percent) with recurrent hyperprolactinemia, gonadal dysfunction redeveloped. In all diagnostic groups, prolactin levels at the time of recurrence were significantly lower than at diagnosis (p < 0.001). The Kaplan–Meier estimated rate of recurrence at five years was higher among patients with macroprolactinomas and those with microprolactinomas who had small remnant tumors visible on MRI at the time of treatment withdrawal than among patients whose MRI scans showed no evidence of tumor at the time of withdrawal (patients with macroprolactinomas, 78 percent vs. 33 percent, P = 0.001; patients with microprolactinomas, 42 percent vs. 26 percent, P = 0.02). Conclusions Cabergoline can be safely withdrawn in patients with normalized prolactin levels and no evidence of tumor. However, because the length of follow-up in our study was insufficient to rule out a delayed increase in the size of the tumor, we suggest that patients be closely monitored, particularly those with macroprolactinomas, in whom renewed growth of the tumor may compromise vision.

Desmoid tumour of the distal forearm involving the distal radioulnar joint

2020 ◽  
Vol 13 (11) ◽  
pp. e237097
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Avijeet Prasad ◽  
Manoj Bhagirathi Mallikarjunaswamy
Keyword(s):  
Distal Radioulnar Joint ◽  
Treatment Modalities ◽  
Desmoid Tumour ◽  
X Rays ◽  
Distal Forearm ◽  
Left Wrist ◽  
Radioulnar Joint ◽  
Magnetic Resonance Imaging Mri ◽  
Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

scholarly journals THE RELATIONSHIP BETWEEN INFLAMMATORY DIETARY PATTERN AND INCIDENCE OF PERIODONTITIS

2021 ◽  
pp. 1-36
Author(s):  
Ahmed A. Alhassani ◽  
Frank B. Hu ◽  
Bernard A. Rosner ◽  
Fred K. Tabung ◽  
Walter C. Willett ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Periodontal Disease ◽  
Secondary Analysis ◽  
Hazard Ratio ◽  
Reduced Rank Regression ◽  
Rank Regression ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
Study Population

ABSTRACT The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food based, reduced rank regression (RRR) derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34,940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years, and dietary data through validated semi-quantitative food frequency questionnaires every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) to the lowest quintile was 0.99 (95% confidence interval: 0.89 -1.10, p-value for trend = 0.97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile to the lowest was 1.39 (95% confidence interval: 0.98 -1.96, p-value for trend = 0.03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated EDIP was significantly associated with increased risk of periodontitis only among nonsmokers who were obese. Hence, this association must be interpreted with caution.

scholarly journals Analysis of risk scores and duration of hospital stay in prognosis of STEMI patients after pPCI

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
SR Thangasami ◽  
JS Prajapati ◽  
GL Dubey ◽  
VR Pandey ◽  
PM Shaniswara ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Early Discharge ◽  
Risk Scores ◽  
Timi Score ◽  
Study Population ◽  
Event Rates ◽  
Grace Score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Advances in the immediate management of ST elevation myocardial infarction (STEMI) have led to a dramatic decline in mortality and reduction in hospital length of stay (LOS). We analysed the prognostic value of selected risk models in STEMI treated with primary percutaneous coronary intervention (PPCI) and to identify additional parameters to strengthen risk scores in categorizing patients for safe early discharge and to identify parameters prolonging hospital stay. Purpose To assess parameters and risk scores to categorize patients for safe early discharge following STEMI and to assess the composite of death, MI, unstable angina (UA), stroke, unplanned hospitalization at the end of 30 days, 6 months and at 1year follow up. Methods The study included 222 patients, who were diagnosed as STEMI, treated with successful pPCI. The risk scores like TIMI score, GRACE score, ZWOLLE score, CADILLAC score were calculated for all patients from the baseline clinical data collected on admission. Routine blood investigations along with Brain natri-uretic peptide (BNP) were done for all patients. The entire cohort was divided into three groups on the basis of length of stay: ≤3 days (n = 150), 4–5 days (n = 47), and &gt;5 days (n = 25). All-cause mortality and major cardiovascular events (MACEs) were assessed up to 1 year. Results The mean age group (yrs) of the study population was 53.92 ± 12.9. Patients in LOS &lt;3 days had a mean age (yrs) of 52.41 ± 11.74, patients in LOS 4-5 days group had 54.19 ±13.59 and patient with LOS &gt;5 days had 62.52 ± 15.32. The most important parameters that predicted hospital stay in our study are BNP levels OR: 1.003, 95% CI: 1.002-1.004, P &lt; 0.001, GRACE score OR: 1.02 ,95% CI: 1.01-1.03, P &lt; 0.001, TIMI score OR: 1.35, 95% CI: 1.18-1.55, P = 0.007, ZWOLLE score OR: 1.26, 95% CI: 1.16-1.37, P &lt; 0.001, CADILLAC score OR: 1.24, 95% CI; 1.15-1.3: P &lt; 0.001. 32 (14.4%) patients expired in the study population. 36% patients of LOS &gt;5 days expired in 1year follow up with maximum mortality in the first 6 months. 56% of the patients in LOS &gt; 5 days had an adverse cardiac event in 1 year follow up. Patients in LOS &gt;5 days had increased event rates in 30 days,6 months and in 1 year follow up. Patients with LOS 4-5 days (30%) had increased event rates than patients in LOS &lt; 3 days (19%).Unadjusted Kaplan Meir survival curves for 1 year mortality among hospital survivors showed a significant increase in mortality at 6 months in length of stay&gt; 5 days group. (P value &lt; 0.001). CONCLUSION Long hospital stay after PCI among patients with STEMI was associated with increased long-term all-cause mortality. Addition of BNP to this risk scores can better predict the course of hospital stay and adverse clinical outcomes in follow up. Long hospital stay may be used as a marker to identify patients at higher risk for long-term mortality. Abstract Figure. Kaplan meir survival curve

scholarly journals Brain atrophy and clinical characteristics predicting SDMT performance in multiple sclerosis: A 10-year follow-up study

2021 ◽  
Vol 7 (1) ◽  
pp. 205521732199239
Author(s):  
Cecilie Jacobsen ◽  
Robert Zivadinov ◽  
Kjell-Morten Myhr ◽  
Turi O Dalaker ◽  
Ingvild Dalen ◽  
...  
Keyword(s):  
Clinical Data ◽  
Grey Matter Volume ◽  
Lesion Volume ◽  
Information Processing Speed ◽  
Disability Status ◽  
Mri Scans ◽  
Patients At Risk ◽  
Magnetic Resonance Imaging Mri ◽  
Specific Volumes

Objectives To identify Magnetic Resonance Imaging (MRI), clinical and demographic biomarkers predictive of worsening information processing speed (IPS) as measured by Symbol Digit Modalities Test (SDMT). Methods Demographic, clinical data and 1.5 T MRI scans were collected in 76 patients at time of inclusion, and after 5 and 10 years. Global and tissue-specific volumes were calculated at each time point. For the primary outcome of analysis, SDMT was used. Results Worsening SDMT at 5-year follow-up was predicted by baseline age, Expanded Disability Status Scale (EDSS), SDMT, whole brain volume (WBV) and T2 lesion volume (LV), explaining 30.2% of the variance of SDMT. At 10-year follow-up, age, EDSS, grey matter volume (GMV) and T1 LV explained 39.4% of the variance of SDMT change. Conclusion This longitudinal study shows that baseline MRI-markers, demographic and clinical data can help predict worsening IPS. Identification of patients at risk of IPS decline is of importance as follow-up, treatment and rehabilitation can be optimized.

scholarly journals Cross-sectional analysis of follow-up chest MRI and chest CT scans in patients previously affected by COVID-19

2021 ◽  
Author(s):  
Martina Pecoraro ◽  
Stefano Cipollari ◽  
Livia Marchitelli ◽  
Emanuele Messina ◽  
Maurizio Del Monte ◽  
...  
Keyword(s):  
Chest Ct ◽  
Ct Scans ◽  
Imaging Biomarker ◽  
Cross Sectional ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Sectional Analysis ◽  
Ct And Mri ◽  
Interlobular Septal Thickening

Abstract Purpose The aim of the study was to prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. Materials and methods Fifty-two patients underwent both follow-up chest CT and MRI scans, evaluated for ground-glass opacities (GGOs), consolidation, interlobular septal thickening, fibrosis, pleural indentation, vessel enlargement, bronchiolar ectasia, and changes compared to prior CT scans. DWI/ADC was evaluated for signal abnormalities suspicious for inflammation. Agreement between CT and MRI was assessed with Cohen’s k and weighted k. Measures of diagnostic accuracy of MRI were calculated. Results The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. Conclusions The agreement between MRI and CT was overall good. MRI was very sensitive for GGOs, consolidation and interlobular septal thickening and overall specific for most findings. DWI could be a reputable imaging biomarker of inflammatory activity.

scholarly journals Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study

2021 ◽  
Author(s):  
Maria Värendh ◽  
Christer Janson ◽  
Caroline Bengtsson ◽  
Johan Hellgren ◽  
Mathias Holm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Health ◽  
Smoking Status ◽  
Northern Europe ◽  
Nasal Breathing ◽  
Nasal Symptoms ◽  
Increased Risk ◽  
Study Population ◽  
Independent Risk Factors

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

scholarly journals Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare

2021 ◽  
pp. 140349482110224
Author(s):  
Mikael O. Ekblad ◽  
Hanna P. Wallin ◽  
Marjukka Pajulo ◽  
Päivi E. Korhonen
Keyword(s):  
Pregnant Women ◽  
Study Design ◽  
Primary Healthcare ◽  
Routine Data ◽  
Smoking Behaviour ◽  
Self Report ◽  
Health Clinic ◽  
Follow Up Study ◽  
Study Population

Aims: The primary aim of the study is to explore different factors affecting parents’ smoking behaviour, and especially how smoking may be connected with individual differences in the psychological process of becoming a parent. In the current paper, we present the study design together with basic information on the study population. Methods: The Central Satakunta Maternity and Child Health Clinic (KESALATU) Study is an ongoing prospective follow-up study in primary healthcare of the Satakunta region of southwest Finland. Families were recruited during their first maternity clinic visit between 1 September 2016 and 31 December 2019, and participation will continue until the child is 1.5 years of age. The study combines different sources and types of data: e.g. routine data obtained from primary healthcare clinic records, specific parental self-report data and data from a new exhaled carbon monoxide meter indicating maternal smoking. The data are collected using frequently repeated assessments both during pregnancy and postnatally. The methods cover the following areas of interest: family background factors (including smoking and alcohol use), self-reported parental–foetal/infant attachment and mentalization, self-reported stress, depression and quality of life. Results: 589 pregnant women and their partners were asked to participate in the study during the collection time period. The final study population consisted of 248 (42.1%) pregnant women and 160 (27.1%) partners. Conclusions: The new methods and study design have the potential to increase our understanding about the link between early parenting psychology, prenatal psychosocial risk factors and parental health behaviour.

scholarly journals Prenatal findings and postnatal follow-up of a midline dural sinus malformation

2021 ◽  
Vol 10 (4) ◽  
pp. 205846012110063
Author(s):  
Hana Shabana ◽  
Johannes Leidinger ◽  
Johan Wikström ◽  
Ove Axelsson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spontaneous Regression ◽  
Rare Condition ◽  
Present Knowledge ◽  
Magnetic Resonance Imaging Examination ◽  
Dural Sinus ◽  
Resonance Imaging ◽  
Prenatal Magnetic Resonance Imaging ◽  
Dural Sinus Malformation

Dural sinus malformation is a rare condition. We describe a prenatally detected case followed by repeated ultrasound scans and a prenatal magnetic resonance imaging examination. A substantial spontaneous regression was observed, which is associated with a favorable outcome. We believe that our observations, including a long postnatal follow-up, will add to the present knowledge of prenatally detected cases, and thus improve management of the pregnancies as well as our possibilities to counsel the parents-to-be.

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