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23 results

Page 1 of 2

  • 5 - What Are Common Epilepsy Imaging Findings in New Onset and Chronic Epilepsy Care?

  • Patrick Landazuri, University of Kansas Medical Centre, Nuria Lacuey Lecumberri, University of Texas Health Science Center, Houston, Laura Vilella Bertran, University of Texas Health Science Center, Houston, Mark Farrenburg, University of Kansas Medical Centre, Samden Lhatoo, University of Texas Health Science Center, Houston
  • Book:
    Seizure and Epilepsy Care
    Published online:
    28 January 2023
    Print publication:
    09 February 2023, pp 79-101

  • Summary

    The use of imaging in epilepsy care is a powerful tool to show a patient why they have epilepsy. You can use it to correlate your semiology history with an imaging finding. Magnetic resonance imaging (MRI) is the most widely used modality for epilepsy care. Ordering an epilepsy protocol MRI on a 3 Tesla (3T) machine increases the likelihood of finding an epilepsy’s etiology. Common findings include stroke, tumor (i.e., ganglioglioma), hippocampal sclerosis, encephalocele, cortical dysplasia, heterotopia, polymicrogyria, or cavernoma. For MRI-negative epilepsy, additional tests to identify the epileptogenic region include PET (positron emission tomography) and SPECT (single photon emission computed tomography). Functional MRI (fMRI) can delineate brain areas critical for specific functions.Lastly, the use of CT (computed tomography) is limited to identification of acute findings like hemorrhage and tumors in new onset seizures.

  • Radio-induced malignancies of the scalp in adult after depilatory radiotherapy for tinea capitis in childhood: 137 cases

  • Hadhri Asma, Yahyaoui Safia, Zarraa Semia, Noubbigh Ghaiet El Fida, Abidi Rim, Mahjoubi Khalil, Messai Taha, Nasr Chiraz, Maalej Mongi
  • Journal:
    Journal of Radiotherapy in Practice / Volume 22 / 2023
    Published online by Cambridge University Press:
    23 September 2022, e53
    • Article
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  • Introduction:

    Radiation-induced malignancies are the most feared complications of radiotherapy. Depilatory radiotherapy for ringworm of the scalp in childhood was the cause of an increase in the incidence of skin tumours of the scalp in adults. The aim of our study was to describe the epidemiological, clinical and therapeutic characteristics of radiation-induced skin tumours of the scalp in order to highlight the characteristics of these tumours compared to non-radiation-induced tumours.

    Methods:

    This is a bi-centric retrospective study, extending over a period of 41 years, which collected 137 patients with 200 tumours of the scalp. These patients were selected after noting a history of depilatory radiotherapy for ringworm in childhood in the clinical records of all patients with scalp tumours.

    We studied the epidemiological, clinical, therapeutic and evolving characteristics of this population.

    Results:

    The average age of consultation was 56·6 years. The sex ratio M/F was 3. Radiation dermatitis was found in 33% of cases. The average latency between depilatory radiotherapy and the appearance of radiation-induced tumours was 42·6 years. Multiple carcinomas (>2 tumours) were observed in 23·3% of cases. In 73% of cases, ulceration was the most frequent macroscopic aspect. The predominant histological type was basal cell carcinoma in 82% of cases. Radiation therapy has been the main treatment modality in 77·3% of cases, followed by surgery in 43% of cases. The appearance of new tumours on the scalp was observed in six patients.

    Conclusion:

    Radiation-induced tumours of the scalp are comparable in epidemiological and clinical characteristics to non-radiation-induced tumours. However, they may represent a challenge in therapeutic care and require regular monitoring.

  • Chapter 12 - Sacrococcygeal Teratoma

  • from Section 3
  • Edited by Olutoyin A. Olutoye
  • Book:
    Anesthesia for Maternal-Fetal Surgery
    Published online:
    19 November 2021
    Print publication:
    11 November 2021, pp 168-190

  • Summary

    Sacrococcygeal teratoma (SCT) is a common tumor of the neonatal period. Prenatal diagnosis of SCT carries a high mortality rate because of the potential for high output heart failure and hydrops. Tumors can also rupture, leading to severe anemia and death. The mother’s health is also at risk if maternal mirror syndrome develops. Prenatal evaluation includes high resolution ultrasound, fetal echocardiography, and magnetic resonance imaging. Pregnancy management includes frequent assessment of the tumor size, growth, and the effects on the fetal cardiovascular system. Treatment options depend on the tumor characteristics and cardiac function, as well as maternal health and support. Fetal therapy aims to debulk or devascularize the tumor, thereby alleviating high output failure and minimizing the risk of spontaneous rupture and hemorrhage. Decisions regarding a symptomatic fetus with SCT may include prenatal intervention or early delivery. Anesthetic management of fetal treatment for SCT is tailored to the mode of therapy chosen; this may include a minimally invasive approach, in-utero surgery, or an EXIT procedure. The nuances of management of this condition center on understanding of the pathophysiology of a hydropic fetus as a result of the SCT and being prepared for resultant cardiovascular instability and massive hemorrhage.

  • Chapter 8 - Transchoroidal, Subchoroidal, and Combined Approaches to the Third Ventricle

  • from Section II - Open Combined Approaches
  • Edited by Vijay Agarwal
  • Book:
    Integrated Management of Complex Intracranial Lesions
    Published online:
    05 October 2021
    Print publication:
    21 October 2021, pp 79-94

  • Summary

    Intraventricular lesions are challenging pathologies in neurosurgery. Walter Dandy had a major impact in advancing our understanding of the management of these lesions. Furthermore, the introduction of the microscope and microsurgical techniques have improved the surgical outcomes of these lesions. Several approaches have been described to address ventricular lesions, and can be classified anatomically as anterior, lateral, or posterior. The operative corridor for each of these approaches transgresses unaffected neural tissues. Therefore, tailoring the approach to individual patient lesion characteristics and anatomy is crucial to maximize exposure and minimize morbidity. The majority of open and endoscopic approaches to the third ventricle use the interhemispheric anterior transcallosal, frontal transsulcal, or frontal transcortical corridor to access the lateral ventricle. Once inside the lateral ventricle, the operative corridors to the third ventricle include working through the foramen of Monroe (transforaminal approach) for small lesions located in the anterior superior part of the third ventricle, or through the choroidal fissure (transchoroidal or subchoroidal) which provide access to lesions located in, or extending into, the middle or posterior parts of the roof of the third ventricle. In this chapter, we will discuss the transchoroidal, subchoroidal, and combined transchoroidal and subchoroidal approaches to the third ventricle.

  • An acute psychotic disorder revealing hyperthyroidism by thyroid neoplasia: A case study

  • S. Sellami, N. Halouani, A. Chamseddine, F. Ben Othman, J. Aloulou
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S245
    • Article
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  • Introduction

    Rarely, thyroid cancer can lead to hyperthyroidism. The link between dysthyroidism and psychiatric symptoms is well established, but cases of psychosis associated with hyperthyroidism are rarely reported in the literature.

    Objectives

    Identifying psychosis secondary to hyperthyroidism caused by a secreting tumor through a case and literature review.

    Methods

    We report the case of a patient with thyroid suspect tumor and chronic psychosis. We performed a literature review based on a PubMed search with the following keywords: “dysthyroidism psychosis”.

    Results

    Mr. S,32, with a personal psychiatric history of chronic psychosis evolving since 4 years, without notable pathological history, was hospitalized in psychiatry for psychomotor instability, verbal hetero-aggressiveness, subtotal insomnia and refusal of treatment. The psychiatric examination revealed the presence of a chronic delusional syndrome with a theme of persecution, mysticism,and an interpretive, intuitive and hallucinatory mechanism, without dissociative syndrome. The somatic examination objectified a cachectic patient with a bilateral symmetrical non-impulsive exophthalmos, a goiter with a thrill on palpation, dysphonia and sinus tachycardia.A laboratory workup revealed inflammatory syndrome, collapsed TSH (<0.05 mU / L) and an increased T4 to 37 pmol / L. Cervical ultrasound showed a strongly suspect left lobar heteronodular goiter and poorly structured peripheral lymphadenopathy (TI-RADS 4-B). Sedative diazepam therapy was started with antithyroid therapy and a beta blocker. The evolution was quickly favorable. The patient is referred for surgical treatement.

    Conclusions

    The severity of the hyperthyroidism,neoplastic origin, the improvement in psychotic signs with antithyroid treatment are arguments in favor of the thyroid origin by thyroid neoplasia.

  • The role of frozen section biopsy for parotid gland tumour with benign fine-needle aspiration cytology

  • M Suzuki, Y Nakaegawa, T Kobayashi, T Kawase, T Matsuzuka, S Murono
  • Journal:
    The Journal of Laryngology & Otology / Volume 133 / Issue 3 / March 2019
    Published online by Cambridge University Press:
    21 February 2019, pp. 227-229
    Print publication:
    March 2019
  • Objectives

    This study focused on parotid gland tumours diagnosed as benign by fine-needle aspiration cytology and investigated the necessity of frozen section biopsy.

    Methods

    There were 104 cases of parotid gland tumour where fine-needle aspiration cytology was benign and frozen section biopsy was subsequently performed, between April 2006 and June 2016. In this retrospective study, the results of frozen section biopsy were analysed and compared with the final histological diagnosis.

    Results

    Among the 104 cases diagnosed as benign by fine-needle aspiration cytology, 102 cases and 2 cases were diagnosed as benign and malignant, respectively, by frozen section biopsy. The final histological diagnoses showed that 98 cases were benign and 6 cases were malignant. The sensitivity and specificity values of frozen section biopsy in detecting malignant tumours were 33 per cent and 100 per cent, respectively.

    Conclusion

    The necessity of frozen section biopsy in cases with benign fine-needle aspiration cytology may be low in parotid gland surgery.

  • High maternal milk intake in the postnatal life reduces the incidence of breast cancer during adulthood in rats

  • F. E. Santiano, L. E. Zyla, F. Campo Verde-Arboccó, C. V. Sasso, F. A. Bruna, V. Pistone-Creydt, C. M. López-Fontana, R. W. Carón
  • Journal:
    Journal of Developmental Origins of Health and Disease / Volume 10 / Issue 4 / August 2019
    Published online by Cambridge University Press:
    10 January 2019, pp. 479-487

  • Environmental factors during perinatal life can lead to changes in the mammary gland, making it susceptible to cancer in adulthood. Breastfeeding has a special importance since it takes place at a critical period of growth and development of the newborn. We aimed to analyze if an appropriate lactation protects the offspring against mammary carcinogenesis during adult life and explore the mechanisms involved in the protective effect. One-day-old Sprague-Dawley female rats were randomly distributed in litters of three (L3), eight (L8) or 12 (L12) pups per dam, to induce a differential consumption of breast milk. At 55 days of age, the animals were treated with a single dose of dimethylbenzanthracene to study tumor latency, incidence and progression. Histological, immunohistochemical and Western blot studies were performed. We observed lower incidence and higher latency in L3 compared to the other groups. The mitotic index and expression of proliferating cell nuclear antigen (PCNA) was significantly augmented in tumors of L12 rats compared to L3 and L8, while the apoptotic index was augmented in tumors of L3 v. L12. Cleaved caspase 8 was significantly higher in tumors from L3 compared to L12. Tumors developed in L3 have a greater number of apoptotic bodies and a greater expression of caspase 8. These results demonstrate that the animals that maintained a higher intake of maternal milk (L3) presented lower incidence and greater tumor latency. Lower consumption of breast milk (L12) would increase tumor mitosis and the expression of PCNA, explaining the higher tumor incidence observed in this group.

  • Gray-Level Co-Occurrence Matrix Texture Analysis of Breast Tumor Images in Prognosis of Distant Metastasis Risk

  • Tijana Vujasinovic, Jelena Pribic, Ksenija Kanjer, Nebojsa T. Milosevic, Zorica Tomasevic, Zorka Milovanovic, Dragica Nikolic-Vukosavljevic, Marko Radulovic
  • Journal:
    Microscopy and Microanalysis / Volume 21 / Issue 3 / June 2015
    Published online by Cambridge University Press:
    10 April 2015, pp. 646-654
    Print publication:
    June 2015

  • Owing to exceptional heterogeneity in the outcome of invasive breast cancer it is essential to develop highly accurate prognostic tools for effective therapeutic management. Based on this pressing need, we aimed to improve breast cancer prognosis by exploring the prognostic value of tumor histology image analysis. Patient group (n=78) selection was based on invasive breast cancer diagnosis without systemic treatment with a median follow-up of 147 months. Gray-level co-occurrence matrix texture analysis was performed retrospectively on primary tumor tissue section digital images stained either nonspecifically with hematoxylin and eosin or specifically with a pan-cytokeratin antibody cocktail for epithelial malignant cells. Univariate analysis revealed stronger association with metastasis risk by texture analysis when compared with clinicopathological parameters. The combination of individual clinicopathological and texture variables into composite scores resulted in further powerful enhancement of prognostic performance, with an accuracy of up to 90%, discrimination efficiency by the area under the curve [95% confidence interval (CI)] of 0.94 (0.87–0.99) and hazard ratio (95% CI) of 20.1 (7.5–109.4). Internal validation was successfully performed by bootstrap and split-sample cross-validation, suggesting that the models are generalizable. Whereas further validation is needed on an external set of patients, this preliminary study indicates the potential use of primary breast tumor histology texture as a highly accurate, simple, and cost-effective prognostic indicator of distant metastasis risk.

  • Craniopharyngeoma presenting as psychosis, disinhibition and personality change without neurological signs

  • J. Sinai, A. H. C. Wong
  • Journal:
    Acta Neuropsychiatrica / Volume 15 / Issue 2 / April 2003
    Published online by Cambridge University Press:
    24 June 2014, pp. 94-96

  • Tumors of the pituitary are associated most commonly with visual changes or endocrine abnormalities. Although a significant proportion of such tumors cause cognitive abnormalities, only a small number of cases have been reported in which the presenting symptoms are primarily ‘psychiatric’ in nature. The case described below highlights the importance of ancillary investigations in the evaluation of patients admitted to psychiatric wards. Despite the size and extension of the tumor, the patient showed no clear neurological signs, and screening serology was normal except for an elevated prolactin level. Only diagnostic imaging was able to reveal the presence of a calcified, cystic suprasellar mass that was confirmed to be a craniopharyngeoma by histopathology.

  • Chapter 13 - Care of the patient with a tracheotomy

  • Edited by Peggy A. Seidman, Stony Brook University, State University of New York, Elizabeth H. Sinz, Pennsylvania State University, David Goldenberg, Pennsylvania State University
  • Book:
    Tracheotomy Management
    Published online:
    25 October 2011
    Print publication:
    20 October 2011, pp 165-179

  • Summary

    Defective or incomplete separation by the tracheoesophageal septum is one of the most frequent congenital anomalies producing tracheoesophageal fistula (TEF). Anatomic variations that can influence the planning and success of a tracheotomy may be broadly grouped into extrinsic and intrinsic causes. The etiology of the nasal obstruction may include an anterior congenital nasal pyriform aperture stenosis (which is rare), a tumor, or choanal atresia. The most common congenital malformation of the esophagus is esophageal atresia, with or without TEF. Congenital tracheal stenosis may be associated with congenital heart disease, TEF, and skeletal abnormalities. Treatments include tracheoplasty, resection with reanastomosis and stenting. Direct trauma can result in cartilaginous damage and occlusion of the airway lumen by hemorrhage, edema, granulation tissue, scarring, or structural collapse. Congenital tracheal webs are rare presenting with stridor, wheezing, and recurrent respiratory infections. The most common pediatric tracheobronchial tumors include hemangioma, bronchial carcinoid, and papillomatosis.

  • Chapter 15 - The diagnosis of brain death

  • Edited by S. Andrew Josephson, University of California, San Francisco, W. David Freeman, David J. Likosky
  • Book:
    Neurohospitalist Medicine
    Published online:
    07 October 2011
    Print publication:
    29 September 2011, pp 192-202

  • Summary

    The presenting clinical manifestations of a newly detected brain mass can assist the admitting physician in differentiating between tumor and other etiologies. In a patient with imaging features that are highly suggestive of a malignant primary brain tumor, it is reasonable to proceed directly to brain biopsy or craniotomy after a very limited systemic workup. Glioblastomas (GBM) is the most common primary brain tumor with which hospitalists will be involved. The three components of initial, or upfront, treatment for the patient with GBM are maximal safe debulking surgery, involved field irradiation (RT), and chemotherapy. Systemic cancers usually involve the central and peripheral nervous system through direct metastasis or by compression of neural tissue by metastatic disease in adjacent structures. The abundant vasogenic edema that surrounds many brain tumors may be a significant cause of the symptoms such as headache and focal neurological deficits.

  • Free BoundaryProblems Associated with Multiscale Tumor Models

  • A. Friedman
  • Journal:
    Mathematical Modelling of Natural Phenomena / Volume 4 / Issue 3 / 2009
    Published online by Cambridge University Press:
    05 June 2009, pp. 134-155
    Print publication:
    2009

  • The present paper introduces a tumormodel with two time scales, the time t during which the tumorgrows and the cycle time of individual cells. The model alsoincludes the effects of gene mutations on the population densityof the tumor cells. The model is formulated as a free boundaryproblem for a coupled system of elliptic, parabolic and hyperbolicequations within the tumor region, with nonlinear and nonlocalterms. Existence and uniqueness theorems are proved, andproperties of the free boundary are established.

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