Left-sided Predominance Research Articles

Familial arachnoid cysts: a review of 35 families

Arachnoid cysts are commonly considered congenital lesions, but this has not been proven. With the development of neuroimaging and DNA testing technology, more cases of familial arachnoid cysts have been reported. Herein, we review such cases. The PubMed, Embase, and Web of Science databases were searched for case reports of arachnoid cysts published through April 2018. Case reports were included only if two or more related patients were diagnosed with an arachnoid cyst by neuroimaging or intraoperatively. For each report, the following data were extracted: first author name, date of publication, number of families, number of patients, location of the arachnoid cysts, patient age, patient sex, and genetic mutations and associated disease. Our searches identified 33 case reports involving 35 families and 115 patients. The locations of arachnoid cysts were similar in 25 of the 35 families. Spinal extradural arachnoid cysts were reported most often, followed by arachnoid cysts in the middle fossa and posterior fossa. A left-sided predominance was noticed for arachnoid cysts of the middle fossa. Mutation of the FOXC2 gene was reported most often, and arachnoid cysts may be associated with mutations on chromosome 16. Although the origin of arachnoid cysts is believed to have a genetic component by some researchers, the genes associated with arachnoid cysts remain unknown. Unfortunately, the evidence remains insufficient.

White Matter Network Disruption and Cognitive Dysfunction in Neuromyelitis Optica Spectrum Disorder.

Background: In neuromyelitis optica spectrum disorder (NMOSD), brain involvement is common and cognitive dysfunction is frequently found. The study investigated alterations of white matter (WM) connectivity using graph theory and correlations with cognitive dysfunction in patients with NMOSD.Methods: We prospectively enrolled patients with NMOSD (N = 14) and age- and sex-matched healthy controls (N = 21). Structural connections between any pair of the 90 cortical and subcortical regions were established using diffusion tensor imaging and graph theory. Network-based statistics was employed to assess differences in WM connectivity between the NMOSD and healthy control groups. We further investigated the relationship between the topological network characteristics and cognitive test performances.Results: WM network analysis showed decreased total strength of brain networks and two disrupted sub-networks in patients with NMOSD. The first featured six hub nodes in the rectus, hippocampus, calcarine, cuneus, and precuneus with the left-sided predominance. The second had six hub nodes in the orbitomiddle frontal, post-central, superior parietal, superior, and middle temporal, and caudate with the right-sided predominance. Compared to healthy controls, NMOSD patients showed poor performance on tests for attention/working memory and processing speed, visuospatial processing, and executive function, which were associated with significant decreases in nodal clustering coefficient, local efficiency, and regional efficiency in the disrupted sub-networks (all p < 0.05).Conclusions: The data show the overall WM disruption and the relationship between poor cognitive function and sub-network alterations identified by the network analysis in NMOSD patients. We suggest that cognitive dysfunction is related to dysconnectivity of WM network including default mode network in NMOSD.

Does Side Matter: Clinical Characteristics Associated with the Laterality of Endometriosis

Objective: To validate prior findings of retrospective studies that endometriosis presents with left-sided predominance.

Outcomes of left trisectionectomy and right hepatectomy for perihilar cholangiocarcinoma

BackgroundRight hepatectomy (RH) is the standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. Therefore, this study aimed to compare the outcomes of LT and RH for PHC. MethodsConsecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching. ResultsOf 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (37%) underwent LT, and 70 (63%) underwent RH. In a matched cohort (LT: n = 27, RH: n = 27), major complication rates (67% vs. 52%; p = 0.42), 90-day mortality rates (15% vs. 0%; p = 0.11) and R0 resection rates (56% vs. 44%; p = 0.58) were similar in both groups. The 3-year recurrence-free survival rates (27% vs. 47%; p = 0.27) and overall survival rates (45% vs. 60%; p = 0.17) were also similar in both groups. ConclusionsIn patients with PHC, LT could achieve similar surgical and survival outcomes as RH.

Outcomes of left trisectionectomy and right hepatectomy for perihilar cholangiocarcinoma

Background: Right hepatectomy (RH) is a standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. The aim of this study was to compare the outcomes of LT vs. RH for PHC. Methods: Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching. The primary end points of the study were major complications (Clavien-Dindo grades III-IV), 90-day mortality, R0 resection, recurrence-free survival (RFS) and overall survival (OS). Results: Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (36.9%) underwent LT, and 70 (63.1%) underwent RH. In a matched cohort (LT; n=27, RH; n=27), major complication rates (67% vs. 52%; p=0.42), 90-day mortality rates (15% vs. 0%; p=0.11) and R0 resection rates (56% vs. 44%; p=0.58) were similar in both groups. The 3-year RFS rates (27% vs. 47%; p=0.27) and OS rates (45% vs. 60%; p=0.17) were similar in both groups. On multivariate analysis, CA19-9 ≤145 U/mL, initially resectable disease, and a histological tumor grade of G1 were identified as independent predictors of a favorable prognosis in patients who underwent LT and RH for PHC. Conclusions: In patients with PHC, LT could achieve similar surgical and survival outcomes as RH.

Laterality and Left-sidedness in the Nose, Face, and Body: A New Finding.

Background:Asymmetry is a common occurrence in bilaterian animals, particularly human beings. Through examination of patients and their photographs during rhinoplasty, we noted wider left-sided nasal and facial features in most patients. This observation led us to hypothesize that this might be consistent to the whole body.Methods:We conducted a study in 3 parts to test the question above. First, we analyzed operating notes of 50 rhinoplasty patients to determine the wider side of the upper, middle, and lower thirds of the nose. Second, we analyzed the width of the face and chest wall in 31 patients to discern any correlation between facial and bodily asymmetry. Third, computerized tomographic scans of the thorax and body of 48 patients were studied to measure the width of the hemithorax and hemipelvic bone.Results:(1) Upper vault width was wider on left side (78%). Left middle vault width was wider (88%). The lower lateral cartilage, lateral crura convexity was more prominent on left side (48%), and a wider scroll area was found and trimmed in 21 (left) and 0 (right) cases. The alar base was wider on left side (56%). (2) In the body and face analysis, 64.5% had a wider left-sided face and body. (3) In the computed tomographic scan analysis, same-sided thorax and pelvis asymmetry was seen (85.35%), 33 and 7 of which were left- and right-sided, respectively.Conclusion:We observed generalized asymmetry of the face and body with left-sided predominance.

Radial Head Subluxation: Factors Associated with Its Recurrence and Radiographic Evaluation in a Tertiary Pediatric Emergency Department

BackgroundRadial head subluxation (RHS) is a common complaint seen in the pediatric emergency department in children ages 6 months to 4 years. Classically, injury occurs due to axial traction on the arm, but this mechanism is not universal. Some patients will have recurrent RHS; some may undergo x-ray (XR) evaluation for alternative diagnosis. ObjectivesTo determine factors associated with recurrences and radiographic evaluations in RHS. MethodsA retrospective study with inclusion criteria: under 10 years of age with discharge diagnosis “nursemaid,” “radial head,” or “subluxation.” We examined factors associated with RHS recurrences, circumstances when radiographic evaluations performed, physician's training background (pediatric vs. general emergency medicine), mechanisms of injury, and demographic factors including age, gender, and arm involved. ResultsIn 246 visits, median age was 27 months (interquartile range 16.1), with females comprising 55.7% (n = 137), and left-sided predominance (52%, n = 130). Mechanisms of injury were classified as “pull” (65.9%, n = 162), “non-pull” (15.9%, n = 39), and “unknown” (18.3%, n = 45). Eighteen patients with recurring RHS were more likely to be male (p = 0.008). In 61 visits where radiography was performed, patients were older (p = 0.03), with a higher frequency seen in non-pull and unknown mechanism (p = 0.0001). No significant difference was found in frequency of radiographs obtained in regard to physician training (p = 0.4660). ConclusionRHS can result from a myriad of mechanisms. We found that recurrence was more likely in male patients. Factors associated with radiographic evaluation included atypical mechanism, older age, and unclear history, regardless of physician training background.

Ten-year experience of more than 35,000 orofacial clefts in Africa.

BackgroundSurgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. The present study reviews epidemiological data from a single charitable organization, Smile Train, with a database of surgical cases from 33 African countries from 2001–2011.MethodsDemographic and clinical patient data were collected from questionnaires completed by the participating surgeons. These data were recorded in Excel, analyzed using SPSS and compared with previously reported data.ResultsQuestionnaires were completed for 36,384 patients by 389 African surgeons. The distribution of clefts was: 34.44% clefts of the lip (CL), 58.87% clefts of the lip and palate (CLP), and 6.69% clefts of the palate only (CP). The male to female ratio was 1.46:1, and the unilateral: bilateral ratio 2.93:1, with left-sided predominance 1.69:1. Associated anomalies were found in 4.18% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (68.36%) and bilateral (11.84%). There was seasonal variation in the frequency of oral cleft births with the highest in January and lowest by December. The average age at surgery was 9.34 years and increased in countries with lower gross domestic products. The average hospital stay was 4.5 days. The reported complication rate was 1.92%.ConclusionsWith the exception of cleft palates, results follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns and access to treatment for females. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment. The epidemiology of orofacial clefting in Africa has been difficult to assess due to the diversity of the continent and the considerable variation among study designs. The large sample size of the data collected provides a basis for further study of the epidemiology of orofacial clefting in Africa.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0328-5) contains supplementary material, which is available to authorized users.

A possible relationship between Takotsubo cardiomyopathy and female sex steroid-related modulation of functional cerebral asymmetry

Takotsubo cardiomyopathy (Tc) is a transient left ventricular apical ballooning syndrome, with symptoms and signs of acute myocardial infarction. Tc syndrome, which occurs predominantly in postmenopausal women, is characterized by increase of sympathetic activity.Studies on the gender-specific differences in sympatho-vagal regulation and functional cerebral asymmetry (FCA) imply that female pattern of dominance is characterized by the left hemisphere, which is believed to have parasympathetic predominance, whereas male pattern indicates dominance of the right hemisphere, which is believed to have sympathetic predominance. Fluctuating levels of female sex steroids are supposed to change FCA, modulating transcallosal inter-hemispheric inhibition across the menstrual cycle. The findings suggest that FCA is enhanced during the low steroid phase (menstrual phase), whereas, during high estrogen and/or progesterone phases (follicular and luteal phase) FCA is reduced. This theory is in line with concept of decreased magnitude of inter-hemispheric cortical lateralization in premenopausal women compared to men and postmenopausal women.Therefore, if postmenopausal women are more lateralized for a variety of cerebral functions, they have less balanced equilibrium between the right-sided sympathetic and left-sided parasympathetic predominance. Decrease of endogenous female sex steroid levels in postmenopausal women leads to reduced influence of estrogens to the left hemisphere, which is believed to have parasympathetic predominance. If both of these mechanisms result in sympatho-vagal imbalance, increasing sympathetic system activity in postmenopausal women, it seems reasonable why postmenopausal women became more susceptible to sympathetically-mediated syndromes such as Takotsubo cardiomyopathy.

Hip Disorders in Children

Hip Disorders in ChildrenEvan J. Zucker1,2, Edward Y. Lee3, Ricardo Restrepo4, Ronald L. Eisenberg5Audio Available | Share

Morphology of Mandibular First Molars Analyzed by Cone-beam Computed Tomography in a Korean Population: Variations in the Number of Roots and Canals

IntroductionThe aim of this study was to determine the root and canal morphology of the mandibular first molars in a Korean population of Mongolian origin by retrospective analysis of a large number of cone-beam computed tomography (CBCT) images. MethodsA total of 976 subjects with bilateral mandibular first molars were examined by using in vivo CBCT methods. The number and configuration of roots, the number of root canals, and the canal configuration based on Vertucci's classification were determined. ResultsOverall, 25.82% of examined molars had 3 roots, 73.51% had 2 roots, and 0.67% had 1 root. The incidence of fourth canal was 50.36%. A right-sided predominance was noted for extra distal roots (P < .001), whereas a left-sided predominance was observed for extra distal canals (P < .001). No significant sex-related differences were shown for their prevalence. The bilateral prevalence rate was 69.13% for extra distal roots and 78.08% for extra distolingual (DL) canals. In the mesial roots, type IV canal was the most frequent (76.86% for 2-rooted molars and 72.96% for 3-rooted molars). In the distal roots, type l was the most common (66.62% for 2-rooted molars and 99.40%–100% for 3-rooted molars). The incidence of 2 canals in distobuccal roots, first reported in this study, was 0.15%. ConclusionsAmong mandibular first molars, there is a high prevalence of a separate DL root and/or a separate DL canal, and such molars commonly have 4 canals in the Korean population. CBCT is a useful tool for determining root and canal morphology.

Retinotopic and Lateralized Processing of Spatial Frequencies in Human Visual Cortex during Scene Categorization

Using large natural scenes filtered in spatial frequencies, we aimed to demonstrate that spatial frequency processing could not only be retinotopically mapped but could also be lateralized in both hemispheres. For this purpose, participants performed a categorization task using large black and white photographs of natural scenes (indoors vs. outdoors, with a visual angle of 24° × 18°) filtered in low spatial frequencies (LSF), high spatial frequencies (HSF), and nonfiltered scenes, in block-designed fMRI recording sessions. At the group level, the comparison between the spatial frequency content of scenes revealed first that, compared with HSF, LSF scene categorization elicited activation in the anterior half of the calcarine fissures linked to the peripheral visual field, whereas, compared with LSF, HSF scene categorization elicited activation in the posterior part of the occipital lobes, which are linked to the fovea, according to the retinotopic property of visual areas. At the individual level, functional activations projected on retinotopic maps revealed that LSF processing was mapped in the anterior part of V1, whereas HSF processing was mapped in the posterior and ventral part of V2, V3, and V4. Moreover, at the group level, direct interhemispheric comparisons performed on the same fMRI data highlighted a right-sided occipito-temporal predominance for LSF processing and a left-sided temporal cortex predominance for HSF processing, in accordance with hemispheric specialization theories. By using suitable method of analysis on the same data, our results enabled us to demonstrate for the first time that spatial frequencies processing is mapped retinotopically and lateralized in human occipital cortex.

Active Tuberculous Endobronchitis: Computed Tomography Findings and Implications

Objective: To describe the pattern of bronchostenosis revealed by computed tomography and virtual bronchoscopy in patients with active tuberculous endobronchitis and associated pulmonary manifestations. Methods: This retrospective study was conducted in Hong Kong, which is an endemic region for tuberculosis, where tuberculous endobronchitis remains a noteworthy clinical entity, with reported frequency of 10 to 40% in patients with active pulmonary tuberculosis. Medical records of a series of 18 patients with active endobronchial tuberculosis (without acquired immunodeficiency syndrome), having acid-fast bacilli in sputum smears, underwent computed tomography and virtual bronchoscopy in two regional hospitals between January 2007 and October 2009 were reviewed. The location, morphology, length, and percentage of luminal bronchostenotic narrowing were evaluated by such imaging and compared with fibre-optic bronchoscopy findings. Associated parenchymal manifestations, namely tree-in-bud nodules, cavitary lesions, segmental atelectasis and enlarged mediastinal lymph nodes, were assessed. Results: Involvement of tuberculous endobronchitis at a single major lobar bronchus with contiguous spread along ipsilateral bronchial tree was observed in most patients (n = 16, 89%). A mural cause of bronchostenosis remained the most frequent finding (n = 12, 67%), with irregular circumferential thickening predominating (n = 8, 44%). Regarding associated parenchymal manifestations, tree-in-bud nodules occurred in all patients (n = 18, 100%); cavitary lesions (n = 9, 50%) and segmental atelectasis (n = 7, 39%) were less frequent. Mediastinal lymph node enlargement was a rare finding (n = 3, 17%). Fibre-optic bronchoscopy performed during the same admission showed confirmatory results in all available cases (n = 14). Conclusion: Centripetal spread of tuberculous endobronchitis from distal small airways to proximal central airway was observed in the majority of our patients. This could correlate with probable pathogenic mechanisms including the submucosal lymphatic spread of tuberculous bacilli and the implantation of bacilli by infected sputum along the bronchial tree. Relative left-sided predominance of bronchial involvement was observed, possibly related to intrinsic anatomical difference in lymphatic drainage between leftand right-sided bronchi. Irregular circumferential and eccentric mural thickening was the most common morphological pattern of bronchostenosis with mural thickening. Mediastinal lymph node enlargement was rare.

Functional MRI During Memory Recognition in Healthy Adults

Purpose: To localize the functional cortices enrolled during abstract picture recognition task that might be a baseline study to provide Thais standard paradigm for future research.&#x0D; Material and methods: The protocol study was approved by institutional review broad and local ethics committee. Informed written consent was obtained from all participants after character of the experimental study was fully explained. Twenty healthy subjects underwent functional MRI and axial T1 weighted image, the latter was anatomic reference image. Abstract picture recognition task as block paradigm was used. Statistic analysis of fMRI datas were analyzed as a whole group analysis and using sample t test random effect analysis model, RFx (corrected P value &lt;0.01). BOLD activities on brain surface rendering images were displayed as color from red (less activity) to yellow (strong activity). The anatomic reference image was loaded to overlay the colored maps and the anatomy of the cerebral cortical lobes and gyri and hippocampal formation were defined. In addition, BOLD activities are also displayed as color overlays on axial, coronal and sagittal views of T1W reference anatomic images, gradual change from dark blue (less activity) to red (most strong activity).&#x0D; Results: Activation for abstract picture recognition was observed at the both-sided cerebellum, bilateral parietal lobes, left hippocampus, bilateral occipital lobes including calcarine cortices, left motor cortex, bilateral premotor cortices, supplementary motor area and left superior temporal gyrus (Wernickeûs area). There is asymmetry of the activities in both hemispheres with left-sided predominance. Bilateral parietal and occipital lobes showed the most intense activities.&#x0D; Conclusion: Abstract picture recognition task showed activation in multiple areas of cortical brain, which correlates with the human memory processing.

Testicular and paratesticular pathology in the pediatric population: A 20 year experience at Riley hospital for children

The goals of this study are to define the spectrum, incidence, and relative frequency of testicular and paratesticular lesions in a typical North American population of 6 million based on the analysis of pathology specimens. Twenty years of pathology reports from 1990 to 2009 of all testicular and paratesticular specimens were retrieved and analyzed from computerized databases of the single major pediatric hospital in the state of Indiana. We showed that the three most common benign lesions were vanishing testis, atrophy/cryptorchidism, and testis torsion, all showed left-sided predominance. The incidence and trends of the major pathology entities were also studied. Neoplasms represented roughly 10% of the total, with leukemia, rhabdomyosarcoma, teratoma, and mixed germ cell tumor occurring in decreasing frequency. Many of the neoplasms occurred at characteristic narrow age ranges, with overall interesting bimodal distribution or some with unique genetic background.

Sunscreen use while driving

Data regarding patient perceptions and behaviors about sun-protection measures while driving are lacking. This study evaluates patients' awareness of the importance of sun protection while in an automobile, and assesses perceptions about and compliance with sun protection. A secondary objective was to detect any significant laterality in melanoma and nonmelanoma skin cancers. We performed a retrospective survey of patients seen at a Mohs micrographic surgery clinic. Significantly fewer patients reported wearing sunscreen while in an automobile when compared with general daily sunscreen use (52% vs 27%, P < .05). Most respondents did not think they needed to use sunscreen while driving, especially if the windows were closed. Those who believed they were protected from sun damage while in a car were much less likely to use sunscreen (12% vs 46%, P < .05). There was a significant left-sided predominance of nonmelanoma skin cancers, except in patients who used automobiles with tinted windows. This retrospective survey study design is not as ideal as a randomized controlled trial. Additional limitations of this study include small sample size, selection bias, and recall bias. Our results reveal poor patient awareness of and compliance with sun-protection measures while in an automobile. Skin cancer prevention efforts should be modified to specifically address automobile-related sun exposure.

Left-Sided Predominance of Hypodontia Irrespective of Cleft Sidedness in a French Population

Individuals with oral clefts exhibit considerably more dental anomalies than do individuals without clefts. Our aim was to evaluate the prevalence of tooth agenesis in a sample composed of 124 children (81 boys and 43 girls, mean age 12.5 years) with clefts registered with the Cleft Palate Center in Strasbourg (France). Cleft types and dental agenesis were assessed by clinical and radiographic examination. Cleft types were divided into four groups according to the clinical extent of the cleft (cleft lip only [CL, 12.9%], cleft lip and alveolus [CLA, 4%], cleft lip and palate [CLP, 49.2%], and cleft palate only [CP, 33.9%]). Of the subjects 63% had evidence of hypodontia: maxillary lateral incisors (54%) and upper and lower premolars (32%) were the most common missing teeth. The number of dental ageneses associated with CP (54%) and CLP (79%) was significantly higher than that with CL (33%). All these anomalies were found in proportionately higher frequencies as the severity of the cleft increased, and we found left side predominance for hypodontia (p < .01) irrespective of cleft sidedness. Both right-sided and left-sided clefts were more frequently correlated with left-sided dental agenesis. This left-sided prevalence suggests that common signaling malfunctions might be involved, both in dental development anomalies and cleft genesis.

Clinically concordant variations of Alzheimer pathology in aphasic versus amnestic dementia

Primary progressive aphasia is a neurodegenerative syndrome characterized by gradual dissolution of language but relative sparing of other cognitive domains, especially memory. It is associated with asymmetric atrophy in the language-dominant hemisphere (usually left), and differs from typical Alzheimer-type dementia where amnesia is the primary deficit. Various pathologies have been reported, including the tangles and plaques of Alzheimer's disease. Identification of Alzheimer pathology in these aphasic patients is puzzling since tangles and related neuronal loss in Alzheimer's disease typically emerge in memory-related structures such as entorhinal cortex and spread to language-related neocortex later in the disease. Furthermore, Alzheimer pathology is typically symmetric. How can a predominantly limbic and symmetric pathology cause the primary progressive aphasia phenotype, characterized by relative preservation of memory and asymmetric predilection for the language-dominant hemisphere? Initial investigations into the possibility that Alzheimer pathology displays an atypical distribution in primary progressive aphasia yielded inconclusive results. The current study was based on larger groups of patients with either primary progressive aphasia or a typical amnestic dementia. Alzheimer pathology was the principal diagnosis in all cases. The goal was to determine whether Alzheimer pathology had clinically-concordant, and hence different distributions in these two phenotypes. Stereological counts of tangles and plaques revealed greater leftward asymmetry for tangles in primary progressive aphasia but not in the amnestic Alzheimer-type dementia (P < 0.05). Five of seven aphasics had more leftward tangle asymmetry in all four neocortical regions analysed, whereas this pattern was not seen in any of the predominantly amnestic cases. One aphasic case displayed higher right-hemisphere tangle density despite greater left-hemisphere hypoperfusion and atrophy during life. Although there were more tangles in the memory-related entorhinal cortex than in language-related neocortical areas in both phenotypes (P < 0.0001), the ratio of neocortical-to-entorhinal tangles was significantly higher in the aphasic cases (P = 0.034). Additionally, overall numbers of tangles and plaques were greater in the aphasic than amnestic cases (P < 0.05), especially in neocortical areas. No significant hemispheric asymmetry was found in plaque distribution, reinforcing the conclusion that tangles have greater clinical concordance than plaques in the spectrum of Alzheimer pathologies. The presence of left-sided tangle predominance and higher neocortical-to-entorhinal tangle ratio in primary progressive aphasia establishes clinical concordance of Alzheimer pathology with the aphasic phenotype. The one case with reversed asymmetry, however, suggests that these concordant clinicopathological relationships are not universal and that individual primary progressive aphasia cases with Alzheimer pathology exist where distributions of plaques and tangles do not account for the observed phenotype.

Thyrotoxicosis with Post-Treatment Hypothyroidism in a Patient with Acute Suppurative Thyroiditis Due to Porphyromonas

Acute suppurative thyroiditis (AST) is a rare, life-threatening thyroid infection characterized by a tender neck mass and fever. As these features are shared with self-limited subacute thyroiditis (SAT), it is important to differentiate between the two disorders. We report a case of AST in a 21-year-old woman who presented with steadily worsening throat pain for 3 weeks, a tender left neck mass, and thyrotoxicosis. She was initially given prednisone for treatment of presumed SAT but then it acutely worsened. Fine needle aspiration yielded pus on gross examination, and she required intubation and emergent surgical drainage to maintain her airway. Culture of the abscess isolated Streptococcus F and Porphyromonas, a gram-negative intracellular anaerobe not previously reported to cause AST. She improved quickly after surgery, developed transient hypothyroidism that did not require treatment with thyroid hormone, and is currently euthyroid. An abnormal piriform sinus fistula was identified on the left using an esophagram. AST may be difficult to clinically differentiate from SAT. Fine needle aspiration revealing pus, culture yielding bacteria or fungi, abscess on ultrasonography and computed tomography, and left-sided predominance are important in the diagnosis of AST. AST should be considered in any patient with SAT who does not rapidly improve following institution of steroids. Further, the presence of thyrotoxicosis does not eliminate AST as an initial diagnosis.

Advanced Colonic Adenomas and Colorectal Cancer Share Similar Dynamic Distribution Patterns

Purpose: Due to the greater colorectal cancer (CRC) risks associated with advanced adenomas (AA), it is recommended that patients with AA undergo more frequent endoscopic surveillance. The purpose of this study was to explore the dynamic distribution patterns of AA in a large group of US patients. Methods: This retrospective study was conducted at Caris Life Sciences, a national specialized gastrointestinal (GI) pathology laboratory that receives specimens from ambulatory endoscopy centers across the U.S. Electronic data from the Caris database were analyzed, including patients' demographics, clinical information, endoscopic findings, biopsy sites, and histopathologic findings. We studied all patients with a diagnosis of adenomatous polyp (AP), including: tubular adenoma (TA), tubulovillous adenoma (TVA), and villous adenoma (VA), with or without high-grade dysplasia (HGD), diagnosed by a single Caris GI pathologist between 01/01/09 and 12/31/09. AA was defined as either: polyp size > 10mm, villous component > 25%, or HGD. The size of polyp was based on the endoscopic description or gross specimen measurement. Serrated polyps were excluded from this study. Results: Among 1,341 patients (age 60+10.7 years, range 21-89; 59.3% males) with AP, there were 247 (18.4%) patients (age 60.6 + 11.2, range 24-89, 59.1% males) with AA, including 58 (23.5%) patients with HGD (26, 9.2%), TVA/VA (40, 14.1%) and TA (9, 3.2%) as well as polyps > 10 mm in size;189 (76.5%) patients had only TA with a polyp size > 10 mm. There were more men (59.1%) than women with AA (p=0.024), and the highest prevalence (33.6%) of AA occurred in those aged 50-59 and with left-sided predominance (p=0.011). There was no difference in the distribution of AA between right and left-sided colon, regardless of patient's gender. During the same study period, there were 1,757 patients with CRC, with the highest frequency among patients 60-69 years and predominantly arising in the left colon. Conclusion: In the population described in our study, 18.4% of adenomatous polyps were advanced. AA were more common in men, peaking in ages 50-59 years with a clear left-side predominance. These distribution patterns correlated with those of CRC, but the peak prevalence occurred in patients 10 years younger. Disclosure: One author is employed by Caris Life Sciences.