scholarly journals Trigeminal neurovascular contact in SUNCT and SUNA: a cross-sectional magnetic resonance study

Brain ◽  
2020 ◽  
Author(s):  
Giorgio Lambru ◽  
Khadija Rantell ◽  
Emer O’Connor ◽  
Andrew Levy ◽  
Indran Davagnanam ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Aetiological Factor ◽  
Vascular Compression ◽  
Cross Sectional ◽  
Imaging Protocol ◽  
Cranial Autonomic Symptoms ◽  
Data Points ◽  
Trigeminal Root ◽  
Trigeminal Nerves ◽  
Symptomatic Side

Abstract Emerging data points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84–4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46–7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44–5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.

scholarly journals Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Péter J. Hegyi ◽  
Alexandra Soós ◽  
Emese Tóth ◽  
Attila Ébert ◽  
Viktória Venglovecz ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Chronic Pancreatitis ◽  
Morphological Changes ◽  
International Study ◽  
Study Data ◽  
Cross Sectional ◽  
Clinical Biomarkers ◽  
Stage Disease ◽  
Significant Difference ◽  
End Stage

AbstractChronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.

An investigation into the extent of Lodox imaging usage in South Africa: Radiographer’s perspective

2021 ◽  
Author(s):  
Julius Muchui Thambura ◽  
Jeanette G.E du Plessis ◽  
Cheryl M E McCrindle ◽  
Tanita Cronje
Keyword(s):  
South Africa ◽  
Waiting Times ◽  
Cross Sectional Study ◽  
Trauma Patients ◽  
X Rays ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Imaging Protocol ◽  
X Ray ◽  
X Ray Imaging

Abstract Introduction Anecdotal evidence suggests that medical professionals in trauma units are requesting additional regional images using conventional x-ray systems, even after trauma patients have undergone full-body Lodox scans. Patients are then exposed to additional radiation, additional waiting times and an increased medical bill. This study aimed at investigating the extent to which Lodox systems were used in trauma units (n=28) in South Africa. Method In this descriptive cross-sectional study, the researcher invited one radiographer from the 28 hospitals in South Africa that use Lodox systems. Radiographers who were most experienced in using the Lodox system completed an online questionnaire. Results Twenty (71.43% n=20) out of twenty-eight radiographers responded. Most hospitals (90%, n=18) were referring patients for additional conventional x-ray images. Radiographers indicated that conventional x-rays were requested for the chest (27.80%, 10/36), the abdomen (16.67%, 6/36), the spine (13.89%, 5/36) and the extremities and skull (19.44%, 7/36). Additionally, radiographers reported using Lodox to perform procedures and examinations usually performed on conventional x-ray systems when conventional x-ray systems were not operational. Conclusion Currently, it is not clear if the use of conventional x-ray imaging following Lodox is necessary, but the results suggest that the practice is commonplace, with healthcare workers in most hospitals (90%, n=18) requesting additional x-ray imaging. The researcher thus recommends that an imaging protocol for Lodox imaging systems should be developed to guide the referral of the patients for further imaging.

scholarly journals Characteristics of patients with acute heart failure in North Central Nigeria

2021 ◽  
Vol 9 (3) ◽  
pp. 221-235
Author(s):  
J.A. Ogunmodede ◽  
P.M. Kolo ◽  
M.O. Bojuwoye ◽  
B.F. Dele-Ojo ◽  
A.J. Ogunmodede ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Public Health Education ◽  
Sub Saharan Africa ◽  
Aetiological Factor ◽  
Cross Sectional ◽  
Early Presentation ◽  
North Central ◽  
Sub Saharan

Objectives: Heart failure (HF) is an important cause of hospital admission in Nigeria. HF is increasingly prevalent because the population is aging and HF epidemiology is changing. We aimed at profiling the socio-demographic, clinical and echocardiographic (Echo)  characteristics of patients admitted for acute HF. This is one of the largest cohorts of HF patients profiled in Nigeria so far. Methods: Cross sectional design. Socio-demographic, clinical and Echo data were collected from 455 patients admitted for AHF at University of Ilorin Teaching Hospital, North central, Nigeria. Results: Mean age of patients was 58.9± 15.7years, (men were older than women, P= 0.006). 265(58.2%) were males, most patients were aged >60 years, 4.8% had pre-existing Type2 Diabetes mellitus. 53.2% of patients presented in New York Heart Association Stages III and IV. Median duration of admission was 11days (IQR, 6-17), intrahospital mortality- 11.6%. Hypertension was the commonest aetiological factor (62.4%), followed by dilated cardiomyopathy 17.6%, rheumatic heart disease (6.6%), Peripartum cardiomyopathy (5.3%), and others. Conclusion: AHF patients in our study are older than those in previous studies in Nigeria and sub-Saharan Africa. Hypertension is main driver of AHF, and patients largely present with clinically advanced disease necessitating stronger public health education about risk factors and early presentation.  

Wideband Absorbance in Young Infants (0–6 months): A Cross-Sectional Study

2014 ◽  
Vol 25 (05) ◽  
pp. 471-481 ◽  
Author(s):  
Sreedevi Aithal ◽  
Joseph Kei ◽  
Carlie Driscoll
Keyword(s):  
Mixed Model ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Distortion Product Otoacoustic Emission ◽  
Sectional Study ◽  
Cross Sectional ◽  
Distortion Product ◽  
Young Infants ◽  
Developmental Effects ◽  
Data Points

Background: Wideband acoustic immittance (WAI) studies on infants have shown changes in WAI measures with age. These changes are attributed, at least in part, to developmental effects. However, developmental effects in young infants (0–6 mo) on WAI have not been systematically investigated. Purpose: The objective of this study was to compare wideband absorbance (WBA) in healthy neonates and infants aged 1, 2, 4, and 6 mo. Research Design: This was a prospective cross-sectional study. All participants were assessed by using 1-kHz tympanometry, distortion product otoacoustic emission (DPOAE) tests, and WBA tests. Study Sample: Participants included 35 newborns (35 ears), 16 infants aged 1 mo (29 ears), 16 infants aged 2 mo (29 ears), 15 infants aged 4 mo (28 ears), and 14 infants aged 6 mo (27 ears). For each participant, the ears that passed both high-frequency (1-kHz) tympanometry and DPOAE tests were included for analysis. Data Collection and Analysis: WBA was recorded at ambient pressure conditions, and the response consisted of 16 data points at 1/3-octave frequencies from 0.25 to 8 kHz. A mixed-model analysis of variance (ANOVA) was applied to the data in each age group to evaluate the effects of sex, ear, and frequency on WBA. WBA was compared between various age groups. In addition, a separate mixed-model ANOVA was applied to WBA data, and post hoc analyses with the Bonferroni correction were performed at each of the 16 data points at 1/3-octave frequencies across age groups to examine the effect of age on WBA. Results: For all age groups, WBA was highest between 1.5 and 5 kHz and lowest at frequencies of less than 1.5 kHz and greater than 5 kHz. A developmental trend was evident, with both the 0- and 6-mo-old infants being significantly different from other age groups at most frequencies. The WBA results exhibited a multipeaked pattern for infants aged 0 to 2 mo, whereas a single broad peaked pattern for 4- and 6-mo-old infants was observed. The difference in WBA between 0- and 6-mo-old infants was statistically significant across most frequencies. In contrast, the WBA results for 1- and 2-mo-old infants were comparable. There were no significant sex or ear effects on WBA for all age groups. Conclusions: Developmental effects of WBA were evident for infants during the first 6 mo of life. The WBA data can be used as a reference for detecting disorders in the sound-conductive pathways (outer and middle ear) in young infants. Further development of age-specific normative WBA data in young infants is warranted.

Nerve Hypertrophy and Altered Diffusion in Anti-Myelin-Associated Glycoprotein Neuropathy Detected by Brachial Plexus Magnetic Resonance Neurography

2021 ◽  
pp. 1-9
Author(s):  
Kyosuke Koide ◽  
Atsuhiko Sugiyama ◽  
Hajime Yokota ◽  
Hiroki Mukai ◽  
Jiaqi Wang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Diffusion Tensor ◽  
Morphological Changes ◽  
Mean Diffusivity ◽  
Nerve Roots ◽  
Magnetic Resonance Neurography ◽  
Cross Sectional ◽  
3 Dimensional ◽  
Myelin Associated Glycoprotein

<b><i>Introduction:</i></b> This study assessed the morphological changes and diffusion tensor imaging (DTI)-derived parameters of the brachial plexus using magnetic resonance neurography (MRN) in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy. <b><i>Methods:</i></b> Eight patients with anti-MAG neuropathy underwent MRN of the brachial plexus with 3-dimensional (3D) short tau inversion recovery (STIR) and DTI sequences. Two neuroradiologists and a neurologist qualitatively assessed nerve hypertrophy on 3D STIR MRN. The cross-sectional area (CSA) of the nerve roots was measured. Quantitative analyses of fractional anisotropy (FA) and axial, radial, and mean diffusivity (AD, RD, and MD) were obtained after postprocessing on DTI and manual segmentation. <b><i>Results:</i></b> There was nerve hypertrophy in 37.5% of the patients with anti-MAG neuropathy. All patients with anti-MAG neuropathy with nerve hypertrophy were refractory to rituximab therapy. The CSA of the nerve roots was inversely correlated with FA and positively correlated with MD and RD. FA decreased in the nerve roots and inversely correlated with disease duration. <b><i>Conclusions:</i></b> Nerve hypertrophy appears in the proximal portion of peripheral nerves, such as the brachial plexus, in patients with anti-MAG neuropathy. Altered diffusion in the nerve roots might be associated with the loss of myelin integrity due to the demyelination process in anti-MAG neuropathy.

Dynamics of the Tracheal Airway and Its Influences on Respiratory Airflows: An Exemplar Study

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Bora Sul ◽  
Talissa Altes ◽  
Kai Ruppert ◽  
Kun Qing ◽  
Daniel S. Hariprasad ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Minute Ventilation ◽  
Correlation Coefficients ◽  
Dynamic Imaging ◽  
Imaging Data ◽  
Cross Sectional ◽  
Mild Conditions ◽  
Large Airways ◽  
Magnetic Resonance Imaging Mri

Respiration is a dynamic process accompanied by morphological changes in the airways. Although deformation of large airways is expected to exacerbate pulmonary disease symptoms by obstructing airflow during increased minute ventilation, its quantitative effects on airflow characteristics remain unclear. Here, we used in vivo dynamic imaging and examined the effects of tracheal deformation on airflow characteristics under different conditions based on imaging data from a single healthy volunteer. First, we measured tracheal deformation profiles of a healthy lung using magnetic resonance imaging (MRI) during forced exhalation, which we simulated to characterize the subject-specific airflow patterns. Subsequently, for both inhalation and exhalation, we compared the airflows when the modeled deformation in tracheal cross-sectional area was 0% (rigid), 33% (mild), 50% (moderate), or 75% (severe). We quantified differences in airflow patterns between deformable and rigid airways by computing the correlation coefficients (R) and the root-mean-square of differences (Drms) between their velocity contours. For both inhalation and exhalation, airflow patterns were similar in all branches between the rigid and mild conditions (R > 0.9; Drms < 32%). However, airflow characteristics in the moderate and severe conditions differed markedly from those in the rigid and mild conditions in all lung branches, particularly for inhalation (moderate: R > 0.1, Drms < 76%; severe: R > 0.2, Drms < 96%). Our exemplar study supports the use of a rigid airway assumption to compute flows for mild deformation. For moderate or severe deformation, however, dynamic contraction should be considered, especially during inhalation, to accurately predict airflow and elucidate the underlying pulmonary pathology.

scholarly journals Morphological changes during early trans-tibial prosthetic fitting

1998 ◽  
Vol 22 (2) ◽  
pp. 115-122 ◽  
Author(s):  
M. Lilja ◽  
P. Hoffmann ◽  
T. Öberg
Keyword(s):  
Morphological Changes ◽  
Muscle Group ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Transtibial Amputation ◽  
Negative Power ◽  
Lateral Muscle ◽  
Amputation Stump ◽  
The Cross

Morphological changes in the amputation stump may have serious implications regarding the suspension and fit of the prosthetic socket. In an earlier study (Lilja and Öberg, 1997) the authors have shown that the volume of the transtibial amputation stump decreases according to a negative power function after amputation, and that the stump volume does not stabilise until four months after the operation. In the present study, Magnetic Resonance Imaging (MRI) technique was used to examine morphological changes in the amputation stump after transtibial amputation in a small number of cases. The authors expected to find a decrease in the cross-sectional area of the stump and of the separate muscles similar to the findings in earlier studies. However, two different patterns were found. The cross-sectional area of the entire stump as well as that of the medial muscle group changed according to the authors' hypothesis, i.e. an initial fast decrease, followed by a more moderate decrease of the area. In the lateral muscle group another pattern was found. After an initial rapid decrease the area increased, sometimes to a magnitude larger than the initial value. After the amputation the lateral muscle group may acquire a new function, contributing to the suspension of the socket. Despite the limited number of patients, this study presents findings which may be important in the clinical fitting of trans-tibial prostheses.

Microanatomy of the Central Myelin-Peripheral Myelin Transition Zone of the Trigeminal Nerve

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 354-359 ◽  
Author(s):  
Selçuk Peker ◽  
Özlem Kurtkaya ◽  
İbrahim Üzün ◽  
M Necmettin Pamir
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Transitional Zone ◽  
Vascular Compression ◽  
Lateral Aspect ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Central Myelin ◽  
Trigeminal Nerves ◽  
Vascular Decompression

Abstract OBJECTIVE: The aim of this study was to evaluate the microanatomy of the central myelin-peripheral myelin transitional zone (TZ) in trigeminal nerves from cadavers. METHODS: One hundred trigeminal nerves from 50 cadaver heads were examined. The cisternal portion of the nerve (from the pons to Meckel's cave) was measured. Horizontal sections were stained and photographed. The photomicrographs were used to measure the extent of central myelin on the medial and lateral aspects of the nerve and to classify TZ shapes. RESULTS: The cisternal portions of the specimens ranged from 8 to 15 mm long (mean, 12.3 mm; median, 11.9 mm). The data from the photomicrographs revealed that the extent of central myelin (distance from pons to TZ) on the medial aspect of the nerve (range, 0.1–2.5 mm; mean, 1.13 mm; median, 1 mm) was shorter than that on the lateral aspect (range, 0.17–6.75 mm; mean, 2.47 mm; median, 2.12 mm). CONCLUSION: The data definitively prove that the root entry zone (REZ, nerve-pons junction) and TZ of the trigeminal nerve are distinct sites and that these terms should never be used interchangeably. The measurements showed that the central myelin occupies only the initial one-fourth of the trigeminal nerve length. If trigeminal neuralgia is caused exclusively by vascular compression of the central myelin, the problem vessel would always have to be located in this region. However, it is well known that pain from trigeminal neuralgia can resolve after vascular decompression at more distal sites. This suggests that the effects of surgical decompression are caused by another mechanism.

Surface Morphological Changes of Polyimide with Oxygen Reactive Ion Beam Etching (RIBE)

1988 ◽  
Vol 129 ◽  
Author(s):  
Kyung W. Paik ◽  
Arthur L. Ruoff
Keyword(s):  
Morphological Changes ◽  
Ion Beam ◽  
X Ray Diffraction ◽  
Cross Sectional ◽  
Ion Beam Etching ◽  
X Ray ◽  
Disordered Phase ◽  
Beam Incidence ◽  
Yield Difference ◽  
Sectional Plane

ABSTRACTAt the beginning of etching, surface asperities appeared on the top plane of the polyimide (PI) film. The formation of surface asperities is due to the ordered phase in PI film. The known dimension of the ordered phase measured by X-ray diffraction is consistant with the size of surface asperities, 100 Å, observed by TEM. Further ion doses made these asperties evolve into smooth bumps which then eroded into cones as a result of etch yield difference as a function of the angle of beam incidence Y(θ)/Y(0) which has a maximum at θ=70. Finally cones led to the development of grass-likestructure on the top plane of the PI film. The formation of platelike structure on the cross-sectional plane of PI indicates that the structural inhomogeniety of the PI film(the ordered and disordered phase) is the main cause for the surface morphological changes of PI.

What happens to the long head of the biceps tendon after arthroscopic rotator cuff repair?

2020 ◽  
Vol 102-B (9) ◽  
pp. 1194-1199
Author(s):  
Hyo-Jin Lee ◽  
Eung-Sic Kim ◽  
Yang-Soo Kim
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Biceps Brachii ◽  
Morphological Changes ◽  
Biceps Tendon ◽  
Cross Sectional ◽  
Postoperative Changes ◽  
Long Head ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Aims The purpose of this study was to identify the changes in untreated long head of the biceps brachii tendon (LHBT) after a rotator cuff tear and to evaluate the factors related to the changes. Methods A cohort of 162 patients who underwent isolated supraspinatus with the preservation of LHBT was enrolled and evaluated. The cross-sectional area (CSA) of the LHBT on MRI was measured in the bicipital groove, and preoperative to postoperative difference was calculated at least 12 months postoperatively. Second, postoperative changes in the LHBT including intratendinous signal change, rupture, dislocation, or superior labral lesions were evaluated with seeking of factors that were correlated with the changes or newly developed lesions after rotator cuff repair. Results The postoperative CSA (12.5 mm2 (SD 8.3) was significantly larger than preoperative CSA (11.5 mm2 (SD 7.5); p = 0.005). In total, 32 patients (19.8%) showed morphological changes in the untreated LHBT 24 months after rotator cuff repair. Univariate regression analysis revealed that the factor chiefly related to the change in LHBT status was an eccentric LHBT position within the groove found on preoperative MRI (p = 0.011). Multivariate analysis using logistic regression also revealed that an eccentric LHBT position was a factor related to postoperative change in untreated LHBTs (p = 0.011). Conclusion The CSA of the LHBT inside the biceps groove increased after rotator cuff repair. The preoperative presence of an eccentrically positioned LHBT was associated with further changes of the tendon itself after rotator cuff repair. Cite this article: Bone Joint J 2020;102-B(9):1194–1199.

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