Lesions In Various Locations Research Articles

Emotional Incontinence in a Patient with Neuromyelitis Optica Spectrum Disorder

The pathologic laughing is involuntary and associated with brain damage seen in a variety of disorders, which occurs as a result of lesions in various locations and is often seen associated with prefrontal or brainstem lesions. Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system characterized by severe attacks of optic neuritis and myelitis, and also develops brain lesions involving the bilateral diencephalic regions adjacent to the third ventricles, the brainstem and cerebellum surrounding the fourth ventricles, and the periventricular white matter adjacent to the lateral ventricles. Emotional incontinence refers to episodic laughing or crying, and occurs as a result of brain damage in various locations and is often seen associated with prefrontal or brainstem lesions. Emotional incontinence has been well described in multiple sclerosis, however the emotional incontinence in NMO has not been systemically documented. My report a characteristic patient with NMO showing the pathologic laughing as an initial manifestation, and the plasmapheresis therapy showed remarkable improvement in severity and occurrence of the pathologic laughing.

Emotional Incontinence in a Patient with Neuromyelitis Optica Spectrum Disorder

The pathologic laughing is involuntary and associated with brain damage seen in a variety of disorders, which occurs as a result of lesions in various locations and is often seen associated with prefrontal or brainstem lesions. Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system characterized by severe attacks of optic neuritis and myelitis, and also develops brain lesions involving the bilateral diencephalic regions adjacent to the third ventricles, the brainstem and cerebellum surrounding the fourth ventricles, and the periventricular white matter adjacent to the lateral ventricles. Emotional incontinence refers to episodic laughing or crying, and occurs as a result of brain damage in various locations and is often seen associated with prefrontal or brainstem lesions. Emotional incontinence has been well described in multiple sclerosis, however the emotional incontinence in NMO has not been systemically documented. My report a characteristic patient with NMO showing the pathologic laughing as an initial manifestation, and the plasmapheresis therapy showed remarkable improvement in severity and occurrence of the pathologic laughing.

Human Papillomavirus: Oral Lesions and Vaccination

Human papillomavirus (HPV) is associated with benign and malignant lesions in various locations, such as the skin and oral and genital mucosa [...]

Pineal region teratoma with metastases in uncommon locations: a case report

BackgroundWe report a rare case in medical literature of a patient with pineal gland teratoma and uncommon metastases. Usually, metastases of this kind of tumor are located in several organs such as lung and breast, but here we found metastases to the spinal cord and vertebrae.Case presentationA 35-year-old Asian white man presented with diplopia and acute neural symptoms in the lower limbs such as numbness, tingling, and paralysis. His medical history was notable for pineal teratoma, treated 1 year previously with surgery, radiotherapy, and chemotherapy. Physical examination of the lower limbs showed absent reflexes and sensation with muscle power scale score of 1 in both limbs. Magnetic resonance imaging of brain and spine revealed many lesions in various locations, most compatible with neural, spinal, and vertebral metastases. Unfortunately, the patient died suddenly before any intervention was carried out.ConclusionIt is extremely rare for pineal region teratoma to metastasize to the spinal cord and vertebrae, thus more vigilant observation and examination should be provided to patients with pineal teratoma to detect any new lesions and prevent them from becoming dangerous.

Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques.

Although rare, unintended thermal injury to organs surrounding the ablation zone can lead to severe complications. Over the past 15years, different protective methods have been developed to limit risk of complications, and expand indications to include more challenging lesions in various locations including liver, kidney, lung and bone. The most frequently used techniques include hydrodissection, carbodissection, balloon interposition and probe torqueing. In most cases, tumours can be physically separated from sensitive structures, reducing risk of thermal injury. Endoluminal cooling/warming is an alternative option for complex ablations close to the ureter or major bile ducts. Different techniques may be combined to achieve successful protection in locations with complex anatomy. The purpose of this review is to provide an overview of available protective measures and discuss respective advantages/drawbacks.

Fine Needle Aspiration Cytology of Cutaneous Metastatic LesionsAClinico-Cytopathological Perspective in A Tertiary Hospital

Background: Cutaneous metastasis refers to growth of cancer cells in skin from an internal malignancy which indicates an adverse prognosis for the cancer patient. Fine needle aspiration cytology (FNAC) plays a major role in early diagnosis of such lesions. The study was undertaken in a tertiary hospital in south India with an objective to analyze the cases diagnosed as having metastatic lesions by FNAC with special reference to cutaneous metastasis. Methods: The study consisted of retrospective analysis of all the cases diagnosed in our hospital as having metastatic lesions in various locations based on FNAC over a period of 7 years of which cases with cutaneous metastatic lesions were studied in detail. FNAC was done following routine protocols, stained smears were examined and opined by experienced pathologists. The result was analyzed. Result: A total number of 579  cases were diagnosed to be having metastatic lesions in various sites based on FNAC findings out of which 61(10.5%; Female-44, Male-17) cases had cutaneous metastasis. Majority, 35/61 (57.2%) cases was in 5th to 6th decade. Fifty eight ( 95.0% ) of cases presented with metastasis in single site whereas 3(5.0%) cases had lesions in multiple sites. The commonest primary malignancy in females and males was carcinoma breast and carcinoma colon or lung respectively. Conclusion: This study depicts the clinical and cytopathological findings of patients with cutaneous metastatic lesions with known or unknown primaries and highlights the utility of FNAC in diagnosing  such lesions which helps the clinicians to take prompt decision for further therapeutic management.&nbsp

Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images.

The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20mm in diameter) lung nodules. A 18-gauge (G) (1.2×40mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3±21.6years. Mean nodule diameter was 14.1±2.2mm. The lesion depth from pleural plane ranged from 0mm to 127mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.

A novel technique for CT-guided transthoracic biopsy of lung lesions: improved biopsy accuracy and safety.

To present the diagnostic accuracy and safety of a novel technique for CT-guided transthoracic needle aspiration biopsy (TNAB) of lung lesions suspected of malignancy. A novel technique for coaxial CT-guided TNAB is reported in this single-centre, retrospective study. A 22-gauge guide wire is used to accurately locate the lesion prior to biopsy. The technique enables penetration of lung lesions in various locations with less risk of harm to adjacent organs. Malignant and benign diagnoses were confirmed by histology or radiologic resolution. Clinical features of 181 patients included 59% men. Mean lesion size was 24 ± 14.9 mm with a mean depth of 13.6 ± 18.3 mm. Among 160 (88.4%) confirmed malignancies, 151 (94.4%) were diagnosed with TNAB. Among the 13 (7.2%) confirmed benign diagnoses, 11 (84.6%) received a specific, benign diagnosis with TNAB. The overall diagnostic accuracy of CT-TNAB was 93.6% among all confirmed diagnoses (173/181). Complications included 48 (26.5%) with pneumothorax, of which 77.8% resolved spontaneously, 20% by aspiration and 2.2% required chest drain insertion. Intrapulmonary haemorrhage was observed in 3.9% and hemoptysis in 6.0% without clinical significance. The guide wire technique provides a novel method for needle biopsy of lung lesions with improved accuracy and safety. Lung cancer screening has increased the detection of lung lesions. The guide wire technique is a novel method to biopsy lung lesions. The guide wire technique for lung biopsy demonstrates improved accuracy and safety. The chest tube insertion rate is reduced with aspiration during the procedure.

Ultrasound-guided transesophageal HIFU exposures for atrial fibrillation treatment: First animal experiment

Atrial fibrillation is the most frequent cardiac arrhythmia. Recently, an ultrasound-guided transesophageal high-intensity focused ultrasound (HIFU) device has been designed to perform minimally invasive pulmonary vein isolation. It was made with a 3MHz 8-ring HIFU transducer including in its center a 5MHz 64-element imaging transducer. The HIFU transducer could focus the ultrasound beam over a broad range of depths from 17 to 55mm to perform lesions in various locations, while preserving intervening tissues. Those characteristics having been demonstrated in vitro, the aim of this study was to perform deep cardiac lesions in pig model under ultrasound guidance. A first ex vivo/in situ experiment gave promising results. Indeed, wide linear lesions were obtained in depth at desired locations. In vivo investigations are ongoing to confirm those preliminary results.

SU-FF-T-322: On Optimization of Treatment Planning for Intensity Modulated Spinal Radiosurgery

Purpose: The purpose of this study is to optimize the treatment planning parameters for spinal radiosurgery for maximal target coverage and spinal cord sparing. Materials and methods: A total of 5 spinal radiosurgery patients with lesions in various locations were randomly selected for the study. The target volume included the entire vertebral body of the involved spine. The spinal cord at the same level of the target, plus 6 mm superior and inferior to the target border, was delineated as the organ at risk (OAR). The normal tissue 12mm outside the target was automatically considered as an OAR. Dose was prescribed at 90% isodose line. Exactly same DVH pre-setting was used for the inverse treatment planning for each patient and each plan. Treatment planning was compared for different beam setups (posterior or all-direction), beam numbers (5–9), and grid/beamlet sizes. The percentage cord dose at 10% volume (D10), dose coverage (V90), and equivalent uniform doses (EUD) of the target and the cord were calculated from the DVH for each plan. The end points were the ratios of D10 toV90 (D10/V90) and EUDcord to EUDtarget (EUDc/EUDt). Results: The D10/V90 value was 45±4% versus 48±4% for posterior versus all-direction 9-beam setups. The posterior setup was significantly better. The D10/V90 value was 48±4%, 47±4%, 45±4%, 45±4% and 45±4% for 5, 6, 7, 8, and 9 beams respectively. Both the D10/V90 and EUDc/EUDt values tended to improve with increasing number of beams. However, the improvement was minimal when the beam number was more than 7. These values also improved with decreasing grid and beamlet sizes. D10/V90 was 40±4% versus 58±10% for 2mm versus 4mm grid/beamlets. Conclusion: The 7–9 beam plans with posterior setup and smallest grid/beamlet size are associated with the optimal plan for spinal radiosurgery.

Follow up CT Findings of Various Types of Recurrence after Curative Gastric Surgery

Although the detection of recurred lesions following curative gastrectomy in patients with gastric cancer has increased as the use of computed tomography (CT) has grown, early or small tumor recurrence can be difficult to identify or correctly diagnose using CT. Therefore, in this study, we retrospectively reviewed cases in which tumor recurrence was missed upon analysis of the follow up CT after gastrectomy. The characteristics of the lesions in various locations of the abdomen and pelvis are illustrated and discussed.

Median nerve somatosensory evoked potentials in patients with lacunar and other small subcortical strokes

We recorded median nerve somatosensory evoked potentials (SSEPs) in 42 patients with small subcortical strokes associated with lacunar syndromes. Seventeen patients had abnormal SSEPs. The P22 component was most often affected; changes in N20 and N18 were less common. Four patients with pure motor strokes (PMS) had abnormal SSEPs. Abnormalities of P22 correlated best with motor findings; those of N20 with sensory signs and symptoms. Similar SSEP abnormalities were produced by lesions in various locations. P22 and N20 abnormalities occurred independently and together. We conclude: (1) abnormal SSEPs are common in patients with small subcortical strokes associated with lacunar syndromes, including pure motor stroke; (2) P22 and N20 have separate cortical generators; and (3) P22 may be generated within sensory pathways which are adjacent to or influenced by motor pathways.

Lesions of the cervical spine caused by suicidal hanging (author's transl)

In 107 cases of suicidal hanging the CVC was investigated systematically. A frequency of lesions at a rate of 65% was found. There were only soft-tissue-lesions with the maximum in C 5/6. The 2nd maximum was the occipito-atlanto-axis-region (C 0/2). This distribution depends on traction. Particularly in the dorsal part the loss of lordosis results from traction. The lesion of C 0/2 is caused by tension due to the weight of the head or by hyperextension due to submental position of the node. 20% of cases showed additional lesions in various locations, which are thought to be results of terminal convulsions.

Sexual behaviour of White Leghorn cocks bearing basal hypothalamic lesions in various locations

The sexual behaviour of W. Leghorn cocks bearing basal hypothalamic electrolytic lesions in various locations was studied. Lesions located in the mammillary nuclei resulted in functionally castrated cocks (FC), with completely atrophied combs and testes; this seems to indicate a complete block of FRF and LRF secretion. Those birds did not show any sexual activity and were attacked and defeated by the hens. When the lesions were located in the posterior part of the mammillary nuclei, the cocks became partially functionally castrated carrying atrophied testis and large combs (FCLC). In the latter category of cocks the LRF secretion was not affected severely; these birds also did not show any signs of sexual behaviour, but were not defeated by the hens. Treatment of the FC cocks with daily injections of 1 mg/kg b/wt testosterone propionate resulted in a significant increase of their comb size and hematocrit values and they were not attacked by the hens, but did not restore their sexual behaviour. It is suggested that the hypothalamic mammillary nuclei are directly involved in the mechanism controlling sexual behaviour activities of the male domestic fowl.

THE VALUE OF CEREBRAL VEIN STUDY IN CAROTID ANGIOGRAPHY

The relative constancy of the cerebral veins and their various relationships to important cerebral structures has been discussed. It is believed that visual assessment of the deep veins is of more practical value than any measurements. The venous patterns seen with space occupying lesions in various locations have been described. The venous phase study usually supplements the information gained from the arterial phase, often indicating the true extent of the lesion. With some lesions, such as deep central masses, the venous phase may provide the only localizing information. The value of the venous phase in assessing cerebral atrophy, hydrocephalus, cerebral trauma and transtentorial herniation has been stressed.

Symposium on Right Upper Abdominal Pain

DR. BALFOUR stated that pain in the right upper quadrant might be due to lesions in various locations, viz., in the right upper quadrant, elsewhere in the abdomen, in the chest, and to general disease. The most frequent conditions in the right upper quadrant causing pain are lesions in the gall bladder and the duodenum. The more severe the symptoms attributable to these conditions, the greater relief is obtained from surgery. On the other hand, the less severe the symptoms, the less likely is relief to be obtained from surgery. Among the diseases occurring elsewhere in the abdomen the ones most likely to produce pain in the right upper quadrant are those associated with the appendix. The diseases within the chest with which pain in the right upper quadrant is most frequently associated are coronary thrombosis, pneumonia, and pleurisy, especially of the diaphragmatic type. Among general diseases most frequently associated with pain in the right upper quadrant are tabes and herpes zoster. Discussing the treatment of duodenal ulcer, Dr. Balfour showed a series of lantern slides illustrating the various operations for duodenal ulcer. Dr. Kirklin showed a very fine series of lantern slides, illustrating duodenal and gall-bladder diseases, these being the chief conditions in the right upper quadrant which are demonstrable radiologically. He stated that the radiologist should recognize lesions of the duodenum in 100 per cent of the cases, although he might not be able to identify the lesion in all the cases. Duodenal ulcer is recognizable radiologically in 95 per cent of the cases, the fluoroscope being of prime importance in the diagnosis. In acute perforations of the gastro-intestinal tract a diagnostic sign is the presence of gas above the liver and underneath the diaphragm. Acute duodenitis gives characteristic findings, namely, a recticular network of barium in the duodenum, irritability of the first and second parts of the duodenum, and absence of the characteristic crater of an ulcer. A number of characteristic slides of diverticulum of the duodenum were shown. Hypertrophy of the pyloric muscle was shown in a number of slides. The characteristic appearance was an elongated, slightly irregular area of barium connecting the pyloric end of the stomach and the duodenal cap. It is narrow and definitely distinguishable from ulcer and carcinoma. A very complete analysis was given by Dr. Kirklin of his work in cholecystography, in which he uses the oral method. Lantern slides showed the following findings: normal concentration of the dye, irregularities in size of the gall bladder, deficiency in concentration of the dye, gallstones accentuated by the dye, and papilloma and adenoma. In Dr. Kirklin's hands this method is correct in 97.1 per cent in showing poorly functioning gall bladder, is correct in 96.8 per cent in showing non-functioning gall bladder, and is correct in 89.5 per cent in demonstrating normal gall bladder.