Evaluation of chronic headache by computed tomography: a retrospective study

Objective: To find out the proportion of intracranial abnormalities in patients with chronic headache without neurologic abnormality with the use of computed tomography (CT) and to compare the results with similar studies done previously. Materials and methods: CT images of 56 patients with chronic/recurrent headache and normal neurological findings were reviewed retrospectively. In 38 of 56 patients, both plain and contrast enhanced CT were done. Patients were divided into three groups according to the CT findings: those with no abnormality, those with minor abnormality (that did not alter patient management) and those with clinically significant abnormality. Proportion of patients in each group was found out and results were compared with previous studies with similar study design. Z test was used to evaluate whether the difference in proportions of patients in our study and previous study was statistically significant or not. Results: Of the 56 patients, 50 had normal CT (89.28 %), four had minor abnormality (7.14%) that did not alter patient management and two had significant lesions (3.57%). Contrast enhanced CT did not improve lesion detection. The minor findings detected were sub-ependymal calcifications of Tuberous sclerosis, calcified neurocysticercosis and old lacunar infarctions in external capsule. Clinically significant lesions detected were small ring enhancing lesion (neurocysticercosis or tuberculoma) and pineal cyst. Results of this study were compared with previous study with similar study design. The Z test showed that the difference in proportions in these studies was not statistically significant (p =0.0708 for minor findings and p =0.2033 for significant findings). Conclusion: The proportion of intracranial abnormalities detected by CT in this study was similar to that of previous studies. The use of intravenous contrast material administration did not improve its yield. This corroborates the evidence that the ability of CT scan in detecting significant intracranial pathology is poor in patients with chronic headache without neurologic abnormality.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7301 Journal of Nobel Medical College (2012), Vol.1 No.2 p.57-63

Characterization of Mice Lacking the Tetraspanin Superfamily Member CD151

ABSTRACT The tetraspanin membrane protein CD151 is a broadly expressed molecule noted for its strong molecular associations with integrins, especially α3β1, α6β1, α7β1, and α6β4. In vitro functional studies have pointed to a role for CD151 in cell-cell adhesion, cell migration, platelet aggregation, and angiogenesis. It has also been implicated in epithelial tumor progression and metastasis. Here we describe the generation and initial characterization of CD151-null mice. The mice are viable, healthy, and fertile and show normal Mendelian inheritance. They have essentially normal blood and bone marrow cell counts and grossly normal tissue morphology, including hemidesmosomes in skin, and expression of α3 and α6 integrins. However, the CD151-null mice do show phenotypes in several different tissue types. An absence of CD151 leads to a minor abnormality in hemostasis, with CD151-null mice showing longer average bleeding times, greater average blood loss, and an increased incidence of rebleeding occurrences. CD151-null keratinocytes migrate poorly in skin explant cultures. Finally, CD151-null T lymphocytes are hyperproliferative in response to in vitro mitogenic stimulation.

Detection of cervical neoplasia using measurement of Brn-3a in cervical smears with persistent minor abnormality

Measurement of the Brn-3a cellular transcription factor in cervical smears from women referred for colposcopy may improve the detection of underlying cervical neoplasia. In those women referred with persisting borderline or mildly dyskaryotic smears, those who had histologically proven underlying CIN II/III, had statistically significant higher Brn-3a levels than those with a similar smear but histologically shown to have HPV, CIN I, or no cervical abnormality. These results indicate that Brn-3a could play an important role in the near future in improving cervical cancer screening.

Antenatal Diagnosis of Renal Tract Anomalies: Has it Increased the Sum of Human Happiness?

When used as a screening procedure, ultrasound examination of the fetal urinary tract seldom leads to beneficial interventions. There is also a cost in terms of parental anxiety and unnecessary investigation and treatment. A formal screening programme would therefore be unjustified. However, screening of women for obstetric purposes will continue to reveal fetal abnormalities, and a strategy for dealing with these is needed. Antenatal treatments remain experimental; for most of the common conditions postnatal treatment has no urgency; and, in cases of minor abnormality detected by ultrasound, the best course may be to do nothing.

NEW VARIANT FORMS OF von WILLEBRAND'S DISEASE

Two unusual variants of von Willebrand's Disease (vWD) have been observed; one resembling Type Ic vWD and one an unclassified variant form of the disease. Both are associated with a history of mild bleeding and with a prolonged bleeding time.Two related patients (father and daughter) presented with reduced vWF activity (RiCoF) and vWF:Ag. Multimer analysis showed the presence of all molecular weight multimers but with a lack of triplet structure. This was confirmed in 3% agarose gels and resembled the pattern of multimers previously described as Type Ic vWD. Both patients responded well to DDAVP.In the second case the patient had a lowered vWF activity (RiCoF) but normal vWF:Ag, analogous to a Type Ila vWD pattern. Mutimer analysis however demonstrated the presence of all MW multimers with a normal triplet structure. This defect was not detected with two monoclonal antibodies that recognise the GPIb binding site on vWF and is thought to represent a minor abnormality in the vWF molecule in this patient.