We report an uncommon case report of total anomalous pulmonary venous returns into the right atrium at the base of the superior caval vein’s ostium without a sinus venosus defect, in situs solitus, without vertical vein or a posterior pulmonary venous confluence.

Computed tomography (CT) studies have demonstrated that lateral ventricular size measured by ventricular brain ratio (VBR), as well as third ventricle width, is statistically enlarged in schizophrenics. Moreover, these cerebral abnormalities differ according to symptomatology evaluated with a positive and negative symptom scale. The aim of this study was to investigate, using CT scans, healthy siblings of schizophrenics, and relate the results to their ill siblings. Nineteen healthy siblings of 12 previously studied schizophrenics underwent CT scans, which were compared to those of their related schizophrenic sibling and to 17 unrelated control subjects. The results showed that in ten of 12 families, schizophrenics have larger ventricles (lateral and third ventricles) than their healthy siblings. Ventricular enlargement of healthy siblings was correlated with severity of negative symptoms of their ill sibling. Implications of a familial contribution for ventricular size and negative symptoms are discussed.

Introduction: The number of seniors presenting to emergency departments after a fall is increasing. Head injury concerns in this population often leads to a head CT scan. The CT rate among physicians is variable and the reasons for this are unknown. This study examined the role of patient characteristics and country of practice in the decision to order a CT. Methods: This study used a case-based survey of physicians across multiple countries. Each survey included 9 cases pertaining to an 82-year old man who falls. Each case varied in one aspect compared to a base case (aspirin, warfarin, or rivaroxaban use, occipital hematoma, amnesia, dementia, and fall with no head trauma). For each case, participants indicated how “likely” they were to order a head CT scan, measured on a 100-point scale. A response of 80 or more was defined a priori as ‘likely to order a CT scan’. The survey was piloted among emergency residents for feedback on design and comprehension, and was published in French and English. Recruitment was through the Canadian Association of Emergency Physicians, Twitter and CanadiEM. For each case we compared the proportion of physicians who were ‘likely to scan’ with relative to the base case. We also compared the proportion of participants who were ‘likely to scan’ each case in the USA, UK and Australia, relative to Canada. Results: Data was collected from 484 respondents (Canada-308, USA-64, UK-67, Australia-27, and 18 from other countries). Social media distribution limited our ability to estimate of the response rate. Physicians were most likely to scan in the anticoagulation cases (90% likely to order a scan compared to 36% for the base case (p = <0.001)). Other features associated with increased scans were occipital hematoma (48%), multiple falls (68%), and amnesia (68%) (all p < 0.005). Compared to Canada, US physicians were more likely to order CT scans for all cases (p = <0.05). Compared to Canada, UK physicians were significantly less likely to order CT for patients in every case except in the patient with amnesia. Finally, Australian physicians differed from Canada only for the occipital hematoma case where they were significantly more likely to order CT scan. Conclusion: Anticoagulation, amnesia and a history of multiple falls appear to drive the ordering a head CT scan in elderly patients who had fallen. We observed variations in practice between countries. Future clinical decision rules will likely have variable impact on head CT scan rates depending on baseline practice variation.

Objectives: To assess the reduction of mucosal surface after total sphenoethmoidectomy.

Study design: Prospective study.

Methods: Twelve normal, consecutive computed tomography scans were used. Computed tomography measurements were made at two different levels: the cribriform plate, and the upper level of the maxillary antrum. The length of the lateral wall of the ethmoid sinus and the perimeter of each ethmoid cell were measured at each level and on each side. The whole perimeter of the ethmoid sinus was evaluated for each CT scan level. For each side and each level, the ratio between the ethmoid sinus perimeter and the lateral ethmoid wall length was calculated.

Results: The mean length of the lateral ethmoid sinus wall was 61.7±1.3 mm and 59.9±1.6 mm at the upper and lower parts of the ethmoid sinus, respectively. The mean ethmoid sinus perimeter was 263.2±11.5 mm and 250.4±11.1 mm at the upper and lower parts of the ethmoid sinus, respectively. No significant statistical difference was observed between measurements as a function of side (right or left) or level (upper or lower). The mean ratio between the ethmoid sinus perimeter and the lateral ethmoid wall length was 4.2.

Conclusion: After total sphenoethmoidectomy, the mucosal surface of the ethmoid sinuses is reduced by a factor of 4.2; about 76 per cent of the mucosa is removed during total sphenoethmoidectomy.

Background and Objective: The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer's disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. Methods: The setting of the study was the outpatients facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 ± 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. Results: AD patients without delusions had symmetrical enlargement of both temporal (8.1 ± 3.9 vs. 8.5 ± 4.5) and frontal horns (35.8 ± 4.8 vs. 35.9 ± 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 ± 3.3 vs. 7.7 ± 3.1, p = .06) and the frontal horn to the left (35.7 ± 4.3 vs. 37.5 ± 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model (interaction term between asymmetry and group: F1,38 = 5.5, p = .03). Discussion: AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.