Abnormal CT Scan Findings Research Articles

Pulmonary sequestration associated with pulmonary actinomycosis: A case report and literature review.

Pulmonary sequestration (PS), a rare pulmonary disease, arises from congenital pulmonary vascular dysplasia. Meanwhile, pulmonary actinomycosis is a purulent infection of lung lesions triggered by the inhalation of actinomycetes, which is also uncommon. Even rarer is the occurrence of pulmonary actinomycete infection secondary to PS. Herein, we present a case report of such a rare occurrence. The 21-year-old female patient had been erroneously diagnosed with pneumonia and tuberculosis, presenting symptoms of cough, sputum, and hemoptysis; however, the implemented anti-infection and antituberculosis treatments proved to be ineffective. The diagnosis of the sequestration in the right lower lung was confirmed through an enhanced chest CT scan and a 3-dimensional reconstruction of the pulmonary vessels. During the surgical video-assisted thoracoscopic resection of the right lower lobe lesion, it was discovered that the isolated lung tissue's blood supply vessel originated from the thoracic aorta. Additionally, the pathological examination revealed that the lung tissue of the right lower lobe lesion was infected with pulmonary actinomycetes. Following thorough evaluation, the patient received a final diagnosis of pulmonary actinomycete infection that occurred secondary to right lower lung sequestration. Consequently, they underwent treatment consisting of high-dose penicillin administered for a period of 6 months post-operation. Over the course of the subsequent 23-month follow-up, no recurrence of the infection or abnormal CT scan findings were observed. Pulmonary sequestration bears clinical resemblance to pulmonary actinomycetes. In cases where recurrent episodes of pneumonia occur at the same location, and chest imaging indicates persistent lesions in the basal segment of the lower lobe near the spine, the possibility of PS should be considered. Prompt chest-enhanced CT and 3-dimensional reconstruction of pulmonary vessels are crucial for a definitive diagnosis. Imaging findings such as mass-like consolidation, cystic lesions, liquefactive necrosis, and pneumonia-like changes, coupled with typical air suspension signs and sulfur-like particles visible under tracheoscopy, suggest a potential pulmonary actinomycete infection. Timely biopsy is essential to confirm the diagnosis and prevent missed or incorrect diagnoses.

Indicators of abnormal CT Scan findings in clinically mild traumatic brain injury patients

Background & Objective: Various clinical guidelines have been developed to predict intracranial findings and minimize the unnecessary head CT scans in mild traumatic brain injury (MTBI) patients. However, the most appropriate guideline for routine practices might be highly dependent on the emergency department policies, qualifications of medical staff, and the level of infrastructure availability. This study aims to identify various indicators that can predict abnormal CT scan findings in clinically MTBI patients. Methods: Our retrospective analytical study included patients diagnosed with MTBI admitted to the Emergency Department of Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia, from November 2022 to February 2023, age ≥18 years, and having undergone a brain CT scan. Multivariate analyses of several indicators were performed to identify the strongest indicators of abnormal CT scan findings. Results: Among 112 subjects, abnormal CT scan findings were identified in 38 subjects (33.9%). The proportion of men is greater (63.4%), with a median age of 33 (18-88) years. The most common mechanism was traffic accidents (83.0%). Logistic regression analysis revealed that skull fracture (OR 8.144, 95% CI 3.110-21.326) and signs of skull base fracture (OR 7.059, 95% CI 2.217- 22.475) were the two strongest indicators in predicting abnormal CT scan findings. Conclusions: Skull fracture and signs of skull base fracture were the two strongest indicators of abnormal CT scan findings in clinically MTBI patients. Therefore, skull X-rays in the setting of limited CT scans and thorough clinical examination are recommended.

Computed Tomographic Findings in Children with Cerebral Palsy in a Developing Country

Background: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. To know the aetiopathogenesis, severity and prognosis of CP, neuroimaging is an important modality of investigation. Objective: This study was done to observe the findings in CT scan of brain in children with CP. Materials and Methods: This is a cross-sectional descriptive study. One hundred and ten patients who were clinically diagnosed as cerebral palsy were enrolled in the study. After selection of the subjects, demographic and clinical characteristics were recorded. All other comorbidities including visual and hearing impairments were identified. CT scan of brain was done in all children and reporting had been done by a single qualified radiologist. Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Seven types of CP were found in the study group. Among them quadriplegic CP were the most common (39.1%). History of perinatal asphyxia was found in 81.8% children. Cognitive delay was found in 90% children, speech delay was found in 88.2% children, visual impairment was found in 35.5% children and hearing impairment in 31.8% cases. Epilepsy was found in 44.4% among studied subjects. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of study population. Conclusion: This study showed that most common type of CP was quadriplegic CP. Maximum children had abnormal CT scan findings. Most common CT scan finding was cerebral atrophy. J Enam Med Col 2021; 11(1): 18-23

Correlations of CT Scan Findings in Different Types of Cerebral Palsy: A Study in a Tertiary Care Centre in Bangladesh

Introduction: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. CT scan is helpful for identification of structural abnormalities, etiology, categorize the types of brain lesions and planning of intervention in the child with CP.
 Objective: This study was done to find relationship between types of CP and CT scan findings of brain.
 Materials and methods: This cross sectional descriptive study was done among 110 clinically diagnosed CP case from department of Paediatric Neurology & IPNA, BSMMU, during March 2016 to August 2017. Demographic, clinical characteristics & physical examination were done & collected data were recorded. CT scan of brain was done in all cases & all data were analyzed.
 Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Among them quadriplegic CP were the most common (39.1%), followed by 28.2% cases of hemiplegic CP, 16.4% were of mixed type, 7.3% were diplegic. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of studied children. Children with hemiplegic CP had brain atrophy in 87% of cases, calcification was found mostly in quadriplegic CP. Brain malformation was found mostly in mixed type of CP.
 Conclusion: Most common CT scan finding was brain atrophy and commonly found in hemiplegic CP. Encephalomalacia and calcifications were commonly found in quadriplegic CP. Brain malformation were commonly found in mixed type of CP.
 BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 67-73

Comparison of neonatal electroencephalogram changes in three month old neonates with seizure in Bu-Ali Hospital of Ardabil city, Iran 2017

Background: The prevalence of neonatal seizure in term neonates is 3 per 1000 births, but in preterm newborns is 50 per 1000 births. Babies who have seizures are at high risk of death or neurological disabilities. Seizure is often the first sign of neonatal dysfunction and may be effective in long-term prognosis. EEG is the only available method for the diagnosis of seizures in neonates. Therefore, authors compared EEG changes in the first EEG infant seizure with 3 months of age in newborns who referred to the Aristotelian hospital in Bouali Hospital.Methods: The present study is a cross-sectional descriptive analytical method. In this study, neonates referred to Ardabil Booali Hospital, EEG, were screened for seizure and EEG was monitored 3 months later and the results were evaluated. Finally, all the data were entered into the SPSS-24 statistical analysis program and authors analyzed the data according to the type of variables by statistical tests.Results: In this study, 50 neonates with seizure were enrolled in this study, 70% of which had an average age of 14.92 days. 80% of infants were born at the time of term. The average birth weight was 3.208 kg. 6.2% of infants had abnormal CT scan findings, with an IVH infant and one baby showing brain edema. In this study, only 14% of neonates with abnormal brain strain were observed in the neonatal period and near the seizure. However, after 3 months, 40% of infants experienced abnormal brain stroke findings. Among the changes in EEG with age (p=0.173), gestational age (p=0.616), gender (p=0.176), seizure (p=0.145), neonatal hypoglycemia (p=0.594), hypocalcaemia (p=0.607) no statistic was found.Conclusions: The results of this study showed that a small percentage of neonates had abnormal EEG in the neonate, but after 3 months of seizure, the larger percentage of them found abnormal EEG.

A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore.

Objectives To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI. Methods This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed. Results A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05 ± 3.17 years (range 1–18 years). Twenty patients (28.57%) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69%) in the group with IEM. Nine out of twenty patients (45.00%) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00%), mean age 8.33 years (range 7–10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00%) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00%) had improvement in speech but continued to receive education in special schools. Four patients (20.00%) had poor progress after surgery. Conclusion The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.

Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications

ObjectivesThe aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre–transcatheter aortic valve implantation (TAVI) work-up and to ascertain the...

Computed tomography Scan Findings among Pediatric Patients with unprovoked Seizures: a Hospital-Based Study

Objective. To describe the radiologic findings in pediatric patients who underwent cranial CT scan for unprovoked seizures at the Philippine General Hospital (PGH) and determine whether there is any association between the demographic characteristics such as age, age at onset, gender, as well as normal or abnormal neurologic examination findings, and the abnormal CT scan findings.
 Methods. Official results of all pediatric patients who underwent cranial CT scan for unprovoked seizures from January 1, 2015 to December 31, 2015 in PGH were reviewed. Data were described and statistically analyzed for differences in CT scan findings between different sexes, age groups, ages at onset, and presence or absence of neurologic findings.
 Results and Conclusion. Of the 88 cases included, 29 (32.95%) had abnormal CT findings. The most common finding was volume loss. No statistically significant difference was noted for the frequency of abnormal CT findings between categories. There was a trend towards more frequent abnormal CT scan findings among males, and among patients exhibiting abnormal neurologic findings.

Repetitive Traumatic Brain Injury in Patients From Kashan, Iran

BackgroundTraumatic brain injury (TBI) is a worldwide problem, especially in countries with high incidence of road traffic accidents such as Iran. Patients with a single occurrence of TBI have been shown to be at increased risk to sustain future TBI.ObjectivesThe aim of this study was to present the incidence and characteristics of repeated TBI (RTBI) in Iranian patients.Patients and MethodsDuring one year, all admitted TBI patients with prior TBI history were enrolled into the study. In each patient, data such as age, gender, past medical history, injury cause, anatomic site of injury, TBI severity, clinical findings and CT scan findings were collected.ResultsRTBI comprised 2.5% of TBI cases (41 of 1629). The incidence of RTBI per 100,000 individuals per years was 9.7. The main cause of RTBI was road traffic accident (68.3%); 9.7 % of cases had preexisting seizure/epilepsy disorder; 36.6% of patients with RTBI had pervious ICU admission due to severe TBI. Ten patients had Glasgow coma scale (GCS) ≤ 13 (24.4%). Seizure was seen in seven patients (17.1%). Thirty-nine percent of patients with RTBI had associated injuries. Eleven patients had abnormal CT scan findings (26.9%).ConclusionsConsidering the high incidence of trauma in developing countries, RTBI may also be more common compared with that of developed countries. This mandates a newer approach to preventive strategies, particularly in those with a previous experience of head injury.

Repetitive traumatic brain injury in kashan, iran

Background: Traumatic brain injury (TBI) is a worldwide problem, especially in countries with high incidences of road traffic accidents such as Iran. Patients with a single occurrence of TBI have been shown to be at increased risk to future TBI. This study presents incidences and characteristics of repeated traumatic brain injury (RTBI) in Iran. Methods: During one year, all admitted TBI patients with prior TBI history were enrolled in the study. For each patient, the following data were collected: age, gender, past medical history, type of injury mechanism, anatomic site of injury, TBI severity, clinical findings, and CT scan findings. Results: RTBI were composed of 2.5 % of TBI (41 of 1629). The incidence of TBI per 100,000 person-years was 9.1. The main mechanism of RTBI was road traffic accidents (68.3%). A total of 9.7 % of cases had preexisting seizure/epilepsy disorder (9.7%). A total of 36.6% of RTBI had previous ICU admission due severe TBI. Ten patients had GCS ≤13 (24.4%). Seizures were seen in 7 patients (17.1%). A total of 39% of RTBI patients had associated injuries. Eleven patients had abnormal CT scan findings (26.3%). Conclusions: Considering the high incidence of trauma in developing countries, RTBI may also be more common than in developed countries. This mandates a newer approach to preventive strategies, particularly in those with a previous experience of head injury.

Sa1498 Diagnostic Accuracy of CT Scan in Predicting Endoscopic GI Pathology

Incidental CT scan findings, such as bowel wall thickening or mass lesions, are common radiological findings on CT scans performed in the ER. Abnormal findings on CT scan often prompt further evaluation with esophagogastroduodenoscopy (EGD), small bowel enteroscopy (SBE) or colonoscopy. The clinical significance of such findings is debatable with conflicting results. Previous studies have shown a correlation of abnormal CT scan with colonoscopic findings of 55-74%. Currently, there are no evidenced-based guidelines on follow-up of patients with abnormal CT scan findings.

Correlation of Abnormal CT Scan Findings of Upper GI Tract with Upper Endoscopy

Purpose: To ascertain the significance of abnormal findings on CT scan related to upper GI tract with a subsequent endoscopy in an outpatient setting. Methods: All patients that underwent an upper endoscopy for evaluation of abnormal CT findings at an outpatient endoscopy center were reviewed. Findings on endoscopy and biopsies were compared with the original findings on CT scan that necessitated the endoscopy.Table: Table. CT and EGD findings, commonTable: Table. Correlation when “other CT findings” are reportedResults: A total of 70 patients over a ten year period (2004 to 2012) were reviewed. Age of patients ranged from 32-92 years. 39 (56%) were females, 31 (44%) were males. All abnormal endoscopic findings were biopsied and verified with pathology. Common abnormalities reported in CT include esophageal wall thickening in 15 [21%], gastric wall thickening in 39 [56%] and duodenal wall thickening in 7 [10%]. 9 [13%] had other findings including 3 with portal HTN, 4 with gastric mass, and 2 with liver metastasis. The CT findings co-related with abnormal EGD in 59 out of 70 patients [84%]. Conclusion: Majority of patients (84 %) with abnormal findings related to upper GI tract on CT had significant relevant EGD findings. Therefore, all abnormal CT's warrant further investigation with EGD.

Association of Abnormal CT Scan Findings in the Upper GI Tract with an Esophagogastroduodenoscopy

Purpose: Patients with abnormal CT scan findings in the upper GI tract are often referred for further evaluation with an upper endoscopy. Currently there are no guidelines to classify what type of CT scan findings need to be followed with an endoscopy. A literature review shows some studies have assessed the role of gastrointestinal endoscopy in this situation with different conclusions. The goal of our study is to associate the CT scan findings in the upper GI tract with upper GI endoscopy findings. Methods: Retrospective chart review consisted of adult patients who had an upper endoscopy performed because of an abnormal CT scan between September 1, 2001-April 25, 2011. Abnormal CT findings were correlated with endoscopic findings. Results: 179 subjects had abnormal findings in the upper GI tract on CT scan and were investigated with an upper endoscopy. Mean age of our subjects was 60 years (17-107), and 42% were female. The CT scan findings correlated with abnormal upper endoscopy in 73 /179 subjects. 61 patients had wall thickening on CT scan, 4 patients had esophageal mass, 7 patients had a gastric mass seen on CT scan, and 1 patient had a duodenal mass. Of the 61 patients with wall thickenings, 26 (42%) had esophageal wall thickening, 22 (37%) in stomach wall, and 12 (20%) in duodenum wall. Table 1 shows upper endoscopy findings of patients with esophageal wall thickening seen on CT scan. One patient had an esophageal tumor and the biopsy showed invasive adenocarcinoma. Table 2 shows EGD findings of patients with stomach wall thickening seen on CT scan. Of the 22 patients with stomach wall thickening seen on CT, 7 patients had gastric ulcers on EGD, 2 were H. pylori positive. The biopsy of 2 patients with submucosal gastric tumors showed chronic inflammation. Of the 12 patients with duodenal wall thickening; 5 patients had duodenitis, 5 patients had duodenal ulcers; biopsy of one of the ulcers showed poorly differentiated adenocarcinoma of the duodenum. Of the 7 patients with gastric mass seen on CT scan, upper GI endoscopy revealed 3 patients with gastritis, 2 patients had a gastric mass and the biopsies showed malignant neoplasms. EGD of 2 patients showed a gastric diverticulum and multiple small papules. The patient with duodenal mass on CT scan had a mass on EGD. The biopsy showed poorly differentiated adenocarcinoma.Table 1: Upper endoscopy findings of patients with esophageal wall thickening seen on CT scanTable 2: Upper endoscopy findings of patients with stomach wall thickening seen on CT scanConclusion: Majority of the upper GI findings seen on CT scan did have abnormal endoscopy. In our study abnormal CT scan was found to be associated with malignancy in 5 patients. Therefore, all abnormal CT scans should be pursued with an upper endoscopy if no clear etiology is present.

Brain Computed Tomography evaluation of patients with syncopal episode in the emergency department at King Hussein Medical Center

Objective: The aim of our study is to determine the value of using brain computerized tomography as a routine investigation in patients presenting with syncope to the emergency department at King Hussein Medical Center Amman Jordon.Methods: In the time period between March 2006 and April 2008, a total of 254 patients (134 males and 120 females) with a mean age ± SD of 62 ±27 years (range: 32-73) presented with syncope to the emergency department. All of these patients underwent various investigations toverify the cause of syncope including brain CT scan. Patients were categorized into three groups according to CT scan findings and their neurological examination on presentation.Results: Patients were classified into three groups based on their brain CT findings and their neurological examination on presentation.The first group included 203 (79.9 %) patients, all of which had normal brain CT scan and normal neurological examination. The second group included 10 (3.9%) patients all of which had abnormal brain CT scan findings and abnormal neurological examination. The abnormal neurological findings can be attributed to their syncopal episode and abnormal brain CT findings. The third group included 41 (16.1%) patients who had abnormal brain CT findings and either normal or abnormal neurological examination which is not related and can’t be attributed to theabnormal head CT findings and their syncopal episode.Conclusion: The use of brain CT scan as a routine investigation in the evaluation of patients presented to the Emergency Department at king Hussein Medical Center with syncope is unjustifiable, unless these patients had abnormal neurological examination.Keywords: Syncope, Brain CT scan, Emergency Department, Transient loss of consciousness.

Isolated Jejunal Graft-Versus-Host-Disease Following Peripheral Blood Stem Cell Transplantation

Purpose: Acute graft-versus-host disease (GVHD) of the gastrointestinal tract is a known complication of peripheral blood stem cell transplantation (PBSCT). Acute GVHD occurs more commonly in cases that involve matched unrelated donors (MUD) and in haploidentical related donors than in related donors. Lower gastrointestinal tract-GVHD is more common than the GVHD of the upper GI tract, in particular, the esophagus and the stomach. Here, we are presenting a patient with an isolated acute GVHD of the jejunum after MUD peripheral blood stem cell transplantation. A 41-year-old female with past medical history of myelodysplastic syndrome - refractory anemia with excess blasts (MDS RAEB-2) was admitted to our institution one month after MUD-PBSCT. She had exhibited minimal response to a five-month treatment of Vidaza prior to stem cell transplantation. She was presented with generalized maculopapular rash, pruritus and scaling of the skin. In addition, she complained of gradually worsening anorexia, food intolerance, nausea, and high volume non-bloody diarrhea. The patient was on an intensive prophylaxis regiment for GVHD with immunosuppressants, in addition to daily PPI and Acyclovir. The initial work-up including the assessment for infectious diarrhea was negative. Subsequently, the patient had an EGD and colonoscopy which did not show any mucosal abnormalities. Random biopsy samples obtained during these procedures were not compatible with GVHD. Patient's skin biopsy showed a complex morphologic pattern compatible with chemotherapy side effects, however, GVHD was not excluded based on the skin biopsy result. For further evaluation of the GI related symptoms, the patient had a CT scan of the abdomen which showed nondilated fluid filled loops of small bowel with possible mild bowel wall thickening. In order to evaluate these abnormal CT scan findings, the patient had a small bowel enteroscopy. During the small bowel enteroscopy, the upper GI tract was found to be normal up to the proximal jejunum. The jejunal mucosa was inflamed and friable with multiple aphthous shallow ulcers and white plaques up to the mid jejunum (180 cm from the incisors). The biopsy of these lesions demonstrated active enteritis with focal apoptosis of crypt epithelium and loss of crypts, consistent with graft versus host disease, grade 2-3. After a thorough review of the literature, we were not able to identify any reported cases of isolated acute GVHD of jejunum in the setting of matched unrelated donor peripheral blood stem cell transplantation. To our knowledge, this is the first reported case of a patient with isolated acute GVHD of jejunum that is caused by PBSCT.

Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system

To determine the response rate of Clostridium difficile disease (CDD) to treatment with metronidazole and assess a scoring system to predict response to treatment with metronidazole when applied at the time of CDD diagnosis. Retrospective review of patients with CDD who received primary treatment with metronidazole. We defined success as diarrhea resolution within 6 days of therapy. A CDD score was defined prospectively using variables suggested to correlate with disease severity. Among 102 evaluable patients, 72 had a successful response (70.6%). Twenty-one of the remaining 30 patients eventually responded to metronidazole, but required longer treatment, leaving 9 'true failures'. The mean CDD score was higher among true failures (2.89+/-1.4) than among all metronidazole responders (0.77+/-1.0) (p<.0001). The score was greater than 2 in 67% of true failures and 2 or less in 94% of metronidazole responders. Leukocytosis and abnormal CT scan findings were individual factors associated with a higher risk of metronidazole failure. Only 71% of CDD patients responded to metronidazole within 6 days, but the overall response rate was 91%. A CDD score greater than 2 was associated with metronidazole failure in 6 of 9 true failures. The CDD score will require prospective validation.

The relationship between Glasgow coma/outcome scores and abnormal CT scan findings in chronic subdural hematoma

Objectives Chronic subdural hematoma (CSDH) is one of the most frequent types of intracranial hemorrhage. We evaluated the independent association between abnormal CT findings in CSDH and both Glasgow coma score (GCS) on admission as a measure of consciousness and Glasgow outcome score (GOS) at discharge as a measure of outcome. Patients and methods One hundred and sixteen consecutive patients with CSDH were studied. The variables considered were brain atrophy, hydrocephalus, hematoma location, midline shift, and hematoma density. After univariate analysis and evaluation of the role of age as a confounder in bivariate analysis, variables that had significant association with Glasgow scores were included in the final multivariate model. Results Brain atrophy was the only variable with significant independent association ( p < 0.001; OR = 77.214; 95% CI = 8.336–715.212) with unfavorable outcome as defined by GOS. On the other hand, hydrocephalus ( p = 0.042; OR = 6.503; 95% CI = 1.072–39.449) and higher hematoma densities ( p = 0.027; OR = 2.597; 95% CI = 1.116–6.024) independently and significantly increased the risk of severe consciousness impairment when the group with GCS > 12 was considered as the reference category. Conclusion Brain atrophy independently increases the risk of unfavorable outcome after CSDH. Hydrocephalus and higher hematoma densities independently increase the risk of severe consciousness impairment after CSDH.

Quantitative Detection of Lung Cancer Cells by Fluorescence In Situ Hybridization: Comparison With Conventional Cytology

The aim of this study was to clarify whether fluorescence in situ hybridization (FISH) can diagnose lung cancer in various clinical specimens in comparison with conventional cytology.Prospective study.University hospital in a metropolitan area.Fifty consecutive patients with abnormal chest radiography or CT scan findings were enrolled. The patients included 32 men and 18 women, with an average age of 64 years. The final definitive diagnosis was made by histologic examination, as follows: 38 primary lung cancers (24 adenocarcinomas, 8 squamous cell carcinomas, 2 large cell carcinomas, and 4 small cell carcinomas); 1 metastatic renal cell carcinoma; and 11 benign lesions.Four types of clinical specimens were analyzed. Cells obtained by transbronchial brushing and transbronchial fine-needle aspiration using a fiberoptic bronchoscope under fluoroscopy, CT scan-guided percutaneous needle biopsy, and bronchial washings. On every examination, duplicate slides were made for analyses of conventional cytology and FISH.Classifications according to conventional cytology were as follows: class I, 4 patients; class II, 15 patients; class IIIa, 3 patients; class IIIb, 5 patients; and class V, 23 patients. A classification higher than class IIIb was considered to be positive for cancer. For cytology, we found no false-positive cases and 11 false-negative cases. The specificity was 100%, and the sensitivity was 71.8%. By FISH, 34 cases showed aberrant copy numbers in either chromosome 3 or 17. We found no false-positive cases and five false-negative cases. The specificity was 100%, and the sensitivity was 87.1%.The ability of FISH to detect aneusomic lung cancer cells is superior to conventional cytology for the diagnosis of lung cancer.

Predictive value of electroencephalography and computed tomography in childhood non-traumatic coma

To study value of electroencephalogram (EEG) and computed tomography (CT Scan) in predicting outcome of non-traumatic coma in children. 100 consecutive children, between 2 months to 12 years, with non-traumatic coma, (Glasgow Coma Scale score < 8). Demographic and clinical data was recorded at admission. EEG and CT scan were done within 24 hours of admission. Etiologic diagnosis was assigned on basis of clinical data and relevant laboratory investigations. The outcome was recorded as survived and died. Among survivors it was graded as no disability, or mild, moderate, or severe disability. Odds ratio and/or relative risk (RR) with 95% confidence interval (C I) were calculated. EEG could be done in 60 patients (43 survived; 7 were normal, 8 had mild, 17 moderate and 11 severe disability) CT scan in 93 patients (60 survived; 11 were normal, 14 had mild, 21 moderate and 14 severe disability). A normal/borderline EEG was associated with good outcome (P = 0.001); 11 of 12 survived and of survivors 55% had no or mild disability. Electrocerebral silence on EEG was a predictor of death (OR = 44 -sub .95% Cl - 1.5-7372; P = 0.01). An abnormal EEG was associated with significant increase in risk of disability among survivors (RR = 2.6, 95% Cl = 1.2-5.4, P = 0.03). Among CT abnormalities intracranial bleed suggested increased risk of death (RR = 2.1; 95% Cl - 0.8-5.3; P = 0.058), while, hydrocephalus was associated with better survival (RR = 0.7; 95% CI - 0.5 to 0.96; P = 0.029). However, hydrocephalus when compared with other abnormal CT scan findings, was associated with higher risk of moderate and severe disability among survivors (P = 0.046) A normal CT scan and EEG, and some of the specific findings could be helpful in predicting outcome in children with non-traumatic coma. EEG and CT scan should be done at admission in all patients with non-traumatic coma if feasible.

Motor and cognitive functions in newly diagnosed adult seizure patients before antiepileptic medication.

Motor and cognitive functions in patients with partial or generalized onset of seizures were evaluated prior to the administration of antiepileptic medication. Motor function, attention and memory of 52 consecutive newly diagnosed adult patients with partial or generalized seizures were assessed with neuropsychological tests. Patients with partial onset of seizures did not differ from patients with generalized seizures in tests of motor function or attention, nor in tests of learning and memory. Compared to controls patients with epilepsy performed significantly worse on visual motor tasks, mental flexibility and in delayed visual memory. Within the patient group as a whole lower education, higher age and symptomatic epilepsy with more abnormal CT scan findings tended to associate with worse performance in tests of concentration and mental flexibility and tests of memory. These findings indicate that newly diagnosed adult patients with partial or generalized onset of seizures prior to treatment with antiepileptic medication experience some problems in visual motor tasks, mental flexibility and memory even without the numerous risk factors for cognitive deficits in epilepsy. In newly diagnosed patients with epilepsy as a whole symptomatic etiology was associated with somewhat more pronounced cognitive problems.