High frequency multiphase 4DCT for the detection of parathyroid adenomas, a pictorial essay

4DCT for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. In our center we introduced a high frequency multiphase 4DCT protocol obtaining 16 phases, including 11 different arterial phases. Exposure to this multiphase 4DCT technique is comparable to that for classic helical 4DCT. In this pictorial essay we reconstructed our multiphase 4DCT series in the manner of a classic helical 4DCT and compare both techniques. We illustrate how multiphase 4DCT may aid in the detection of parathyroid adenomas. We find 17 out of 19 lesions demonstrating a type A pattern of enhancement, therefore suggesting this pattern could be more prevalent than previously thought. Some parathyroid adenomas may be mistaken for enlarged lymph nodes using classic 4DCT whereas high frequency multiphase 4DCT can detect a temporary rise in enhancement, thus suggesting the lesions in question to be of parathyroid origin. Smaller lesions may prove more obvious as the difference in enhancement between parathyroid and thyroid can become more prominent.

Exophoria: clinical features, diagnosis, treatment. The modern view on the problem. Literature review

Purpose. Create a summary classification of exophoria. To propose an optimal algorithm for optometric and surgical methods of treatment. A modern view of the problem. It is optimal to subdivide exophoria according to the state of the vergent-duction balance into divergence excess, basic exophoria, convergence insufficiency, divergence pseudo-excess, lateral gaze incomitance. By the degree of compensation for compensated, subcompensated, uncompensated, decompensated. In combination with alphabetic pattern for exophoria without pattern, exophoria in combination with horizontal type A pattern, exophoria in combination with vertical type A pattern, exophoria in combination with horizontal type V pattern, exophoria in combination with vertical type V pattern. Features of optimal optical and prismatic correction depend on the state of the vergent-duction balance. In cases of exophoria without pattern surgical treatment is carried out during the transition from a state of subcompensation to non-compensation. In case of exophoria with horizontal-type alphabetical pattern, combined horizontal-transpositional surgery is optimal: elimination of exophoria, the protocol is based on the amount of deviation in the direct gaze position; elimination of the pattern, the protocol is based on vertical transposition of muscles of horizontal action. In cases of exophoria with vertical-type pattern, it is necessary to perform staged vertical-horizontal surgery: stage 1 – elimination of vertical heterotropy in adduction; stage 2 – elimination of exophoria (the protocol is based on the amount of deviation in the direct gaze position). Conclusions. The treatment protocol should be based on a reliably diagnosed diagnosis and consists at the pre-surgical stage in the optimal optical and prismatic correction, the appointment of orthopto-diplopto-prismatic treatment. The effectiveness of treatment is assessed by the dynamics of the disease: the magnitude of exodeviation and the stage of compensation. The protocol of surgical treatment must be reasonable and timely. Key words: exophoria, divergence excess, convergence insufficiency, basic exotropia, lateral gaze incomitance, alphabet pattern.

Multilevel Spinal Injury: Incidence, Distribution and Neurological Patterns

Introduction Fractures and dislocation of spine are serious injuries that most commonly occur in young people. Spinal injury at more than one level is not uncommon. Awareness of multilevel injury of the spine and associated neurological patterns is important for the proper initial management of the patient. MethodsThis was a prospective observational study carried out in Department of Orthopedics, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal from February 2012 to September 2013. Sixty cases of age group between 18 to 63 years of traumatic spinal injury were enrolled. Patients were examined clinically and radiographically. ResultsOut of 60 patients, multilevel spinal injury occurred in 26 (43.3%) patients; 10 (16.67%) had contiguous spinal injury and 16 (26.67%) had non-contiguous spinal injury. There were 5 type A pattern spinal injury. Contiguous spinal injury most commonly occurred at level L1/L2 (n=4, 40%) and most had Frankel grade E neurology (n=6, 60%) followed by Frankel grade D (n=2, 20%). Non-contiguous lesions most commonly occurred at thoracic spine and had Frankel grade E neurology in most cases (n=10, 16.67%) followed by grade B and C (n= 2, 2.33% each). ConclusionMultiple spinal injury was a common pattern of injury, which occurred in 26 (43.3%) patients out of 60 patients enrolled in our study. Multilevel spinal injury is common. We should be aware about its occurrence. We should evaluate for multilevel spinal injuries, so as not to miss them, especialy non-contiguous injuries, in the patients presenting with spinal injury.

Periventricular Lesions Help Differentiate Neuromyelitis Optica Spectrum Disorders from Multiple Sclerosis

Objective.To compare periventricular lesions in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOsd).Materials and Methods.Sagittal and axial fluid attenuated inversion recovery (FLAIR) sequences of 20 NMOsd and 40 group frequency-matched MS patients were evaluated by two neuroradiologists. On axial FLAIR, periventricular area was characterized as free of lesions/smooth-bordered (“type A”) or jagged-bordered (“type B”) pattern. On sagittal FLAIR, the images were evaluated for presence of “Dawson’s fingers.”Results.Type A pattern was observed in 80% of NMOsd patients by Reader 1 and 85% by Reader 2 but only in 5% MS patients by either Reader. Type B was seen in 15% NMOsd patients by Reader 1 and 20% by Reader 2 and in 95% MS patients by either Reader. Dawson’s fingers were observed in no NMOsd patients by Reader 1 and 5% by Reader 2. In MS, Dawson’s fingers were seen in 92.5% patients by Reader 1 and 77.5% by Reader 2. The differences in periventricular patterns and Dawson’s finger detection between NMOsd and MS were highly significant (P<0.001).Conclusions. Dawson’s fingers and “jagged-bordered” periventricular hyperintensities are typical of MS and almost never seen in NMOsd, which suggests a practical method for differentiating the two diseases.

A Study of the Relationships between Personal Characteristics, Life Events, the Type a Behavior Pattern, and Well-Being in Older Adults

21 men and 76 women between the ages of 68.0 and 97.0 yr. of age were administered the Geriatric Scale of Recent Life Events, the Jenkins Activity Survey, the Framingham Type A Scale, and the Memorial University of Newfoundland Happiness Scale. A Type A pattern of behavior was noted for this sample, aspects of well-being were observed differentially by sex, and Type A behavior was predictive of illness for this age group.

Health-Risk Behavior and the Type a Behavior Pattern

Although the Type A pattern has been established as a risk factor for coronary heart disease, it is not clear whether the pattern is associated with other health-risk behaviors. 26 men and 59 women completed the student version of the Jenkins Activity Survey and a questionnaire concerning smoking, drinking, exercise, and seatbelt use. Type A behavior was not related to these behavioral risk factors. Smokers, however, reported using seatbelts less often than nonsmokers. In addition, men drank more and women exercised more.