Effect of recombinant human thyroid stimulating hormone on serum thyroxin and thyroid scintigraphy in euthyroid cats.

PubMed

van Hoek, Ingrid M; Peremans, Kathelijne; Vandermeulen, Eva; Duchateau, Luc; Gommeren, Kris; Daminet, Sylvie

2009-04-01

This study investigated the thyroidal response to administration of recombinant human thyroid stimulating hormone (rhTSH) by means of serum total thyroxine (TT(4)) concentration and pertechnetate uptake by the thyroid gland in six healthy euthyroid spayed female cats. A pertechnetate scan was performed on day 1 to calculate thyroid/salivary gland (T/S) uptake ratio. On day 3, 25 microg rhTSH was injected intravenously. Six hours later the thyroid scan was repeated as on day 1. Blood was drawn for serum TT(4) measurement prior to injection of rhTSH and performance of the pertechnetate scan. Statistically significant differences in mean serum TT(4) concentration, T/S uptake ratio before and 6h after rhTSH administration and T/S uptake ratio between left and right lobes were noted. We can conclude that 25 microg rhTSH increases pertechnetate uptake in the thyroid glands of cats, this should be taken into account when thyroid scintigraphy after rhTSH administration is interpreted.

Real-time shear wave elastography may predict autoimmune thyroid disease.

PubMed

Vlad, Mihaela; Golu, Ioana; Bota, Simona; Vlad, Adrian; Timar, Bogdan; Timar, Romulus; Sporea, Ioan

2015-05-01

To evaluate and compare the values of the elasticity index as measured by shear wave elastography in healthy subjects and in patients with autoimmune thyroid disease, in order to establish if this investigation can predict the occurrence of autoimmune thyroid disease. A total of 104 cases were included in the study group: 91 women (87.5%), out of which 52 (50%) with autoimmune thyroid disease diagnosed by specific tests and 52 (50%) healthy volunteers, matched for age and gender. For all the subjects, three measurements were performed on each thyroid lobe and a mean value was calculated. The data were expressed in kPa. The investigation was performed with an Aixplorer system (SuperSonic Imagine, France), using a linear high-resolution 15-4 MHz transducer. The mean value for the elasticity index was similar in the right and the left thyroid lobes, both in normal subjects and in patients with autoimmune thyroid disease: 19.6 ± 6.6 vs. 19.5 ± 6.8 kPa, p = 0.92, and 26.6 ± 10.0 vs. 25.8 ± 11.7 kPa, p = 0.71, respectively. This parameter was significantly higher in patients with autoimmune thyroid disease than in controls (p < 0.001). For a cut-off value of 22.3 kPa, which resulted in the highest sum of sensitivity and specificity, the elasticity index assessed by shear wave elastography had a sensitivity of 59.6% and a specificity of 76.9% (AUROC = 0.71; p < 0.001) for predicting the presence of autoimmune thyroid disease. Quantitative elasticity index measured by shear wave elastography was significantly higher in autoimmune thyroid disease than in normal thyroid parenchyma and may predict the presence of autoimmune thyroid disease.

Prevalence and Characterization of Thyroid Hemiagenesis in Japan: The Fukushima Health Management Survey.

PubMed

Suzuki, Satoru; Midorikawa, Sanae; Matsuzuka, Takashi; Fukushima, Toshihiko; Ito, Yuko; Shimura, Hiroki; Takahashi, Hideto; Ohira, Tetsuya; Ohtsuru, Akira; Abe, Masafumi; Suzuki, Shinichi; Yamashita, Shunichi

2017-08-01

Thyroid hemiagenesis is a rare congenital variant characterized by the lack of development of one thyroid lobe with no clinical manifestations. This study was performed to determine the prevalence and characteristics of thyroid hemiagenesis in a normal Japanese population. This cross-sectional study was performed from October 9, 2011, to April 30, 2015. In total, 299,908 children and young adults in the Fukushima Health Management Survey were examined to determine the presence of thyroid agenesis or hemiagenesis. Thyroid width, thickness, and length were measured in 292,452 of these subjects. Thyroid agenesis was diagnosed in 13 subjects, and hemiagenesis was detected in 67 subjects (0.02%; 22.3/100,000 individuals). Although there was no significant sex-related difference (p = 0.067), the female:male ratio was 1.67:1.00. Females were significantly dominant in right hemiagenesis, while there was no difference in left hemiagenesis between males and females. The thyroid volumes at the 2.5th and 97.5th percentiles for age and body surface area were determined for each sex. Multivariate regression analysis showed that a large hemithyroid volume was independently associated with the presence of contralateral hemiagenesis (p < 0.001). The prevalence of thyroid hemiagenesis in the present study is in agreement with that reported in other countries. The prevalence of right hemiagenesis was higher in females, and the larger contralateral lobe in patients with rather than without hemiagenesis may have been caused by a compensatory feedback mechanism to prevent hypothyroidism. In addition, the prevalence of hemiagenesis, especially right hemiagenesis, may be affected by sex-related factors similar to those in patients with an ectopic thyroid gland.

Prevalence and Characterization of Thyroid Hemiagenesis in Japan: The Fukushima Health Management Survey

PubMed Central

Midorikawa, Sanae; Matsuzuka, Takashi; Fukushima, Toshihiko; Ito, Yuko; Shimura, Hiroki; Takahashi, Hideto; Ohira, Tetsuya; Ohtsuru, Akira; Abe, Masafumi; Suzuki, Shinichi; Yamashita, Shunichi

2017-01-01

Background: Thyroid hemiagenesis is a rare congenital variant characterized by the lack of development of one thyroid lobe with no clinical manifestations. Methods: This study was performed to determine the prevalence and characteristics of thyroid hemiagenesis in a normal Japanese population. This cross-sectional study was performed from October 9, 2011, to April 30, 2015. In total, 299,908 children and young adults in the Fukushima Health Management Survey were examined to determine the presence of thyroid agenesis or hemiagenesis. Thyroid width, thickness, and length were measured in 292,452 of these subjects. Results: Thyroid agenesis was diagnosed in 13 subjects, and hemiagenesis was detected in 67 subjects (0.02%; 22.3/100,000 individuals). Although there was no significant sex-related difference (p = 0.067), the female:male ratio was 1.67:1.00. Females were significantly dominant in right hemiagenesis, while there was no difference in left hemiagenesis between males and females. The thyroid volumes at the 2.5th and 97.5th percentiles for age and body surface area were determined for each sex. Multivariate regression analysis showed that a large hemithyroid volume was independently associated with the presence of contralateral hemiagenesis (p < 0.001). Conclusion: The prevalence of thyroid hemiagenesis in the present study is in agreement with that reported in other countries. The prevalence of right hemiagenesis was higher in females, and the larger contralateral lobe in patients with rather than without hemiagenesis may have been caused by a compensatory feedback mechanism to prevent hypothyroidism. In addition, the prevalence of hemiagenesis, especially right hemiagenesis, may be affected by sex-related factors similar to those in patients with an ectopic thyroid gland. PMID:28657504

Mixed germ cells tumour primarily located in the thyroid -- a case report.

PubMed

Wierzbicka-Chmiel, Joanna; Chrószcz, Małgorzata; Słomian, Grzegorz; Kajdaniuk, Dariusz; Zajęcki, Wojciech; Borgiel-Marek, Halina; Marek, Bogdan

2012-01-01

Germ cells tumours most frequently occur in the gonads. Extragonadal localisation is rare and concerns mainly the mediastinum, retroperitoneum and pineal. We present the first description of a patient with a mixed germ cells tumour located primarily in the thyroid. A 35-year-old man in a good clinical condition was admitted to diagnose metastasis revealed in an X-ray of his lungs. Abnormal laboratory tests showed high concentrations of beta-HCG and LDH. Ultrasound examination revealed: hypoechogenic area 8 × 4 × 5 mm in the left testicle, and enlarged left thyroid lobe with echogenically heterogenous mass. In cytological examination of the thyroid, carcinomatous cells were found, which suggested metastasis. A diagnosis of cancerous spread of testicular cancer to the lungs and thyroid was made. The left testicle, with spermatic cord, was removed, yet in the histopathological examination no carcinomatous cells were found. Rescue chemotherapy, according to the BEP scheme (bleomycin, etoposide, cisplatin) was started, but during its course the patient died. Histopathology disclosed primary mixed germ cells tumour in the thyroid, predominantly with carcinoma embryonale and focuses of choriocarcinoma. Extragonadal germ cells tumours rarely occur in the thyroid. In medical literature, some cases of teratomas and a single case of yolk sac tumour in the thyroid have been described. The presence of choriocarcinoma was responsible for the high serum concentration of beta-HCG. Surgery of germ cells tumours proves insufficient. The conventional chemotherapy is based on cisplatin. In conclusion, extragonadal germ cells tumours are rare, but should be considered while co-existing with elevated markers such as: AFP, beta-HCG and lack of abnormalities in the gonads.

Differentiated thyroid carcinoma with functional autonomy.

PubMed

Yaturu, Subhashini; Fowler, Marjorie R

2002-01-01

To present a case of papillary carcinoma in an autonomously hyperfunctioning thyroid nodule. We chronicle the clinical and laboratory findings in a patient with a painless neck mass, with a particular focus on the pathologic findings after surgical removal of the right thyroid lobe. A 39-year-old woman had an enlarging nodule of the right thyroid lobe. Results of thyroid function tests suggested subclinical hyperthyroidism. Two months later, the patient complained of increasing swelling in the neck (but still had no symptoms suggestive of hyperthyroidism). Thus, resection of the right thyroid lobe was performed. Pathologic analysis disclosed low-grade papillary thyroid carcinoma within the nodule, with a small rim of compressed inactive-appearing thyroid tissue surrounding the nodule. Subsequently, she underwent total thyroidectomy and follow-up care for thyroid carcinoma. Although solitary hyperfunctioning nodules of the thyroid gland are usually considered benign, the current case suggests that the diagnosis of autonomous thyroid nodules does not preclude thyroid carcinoma in a functioning nodule.

Genetic and environmental influence on thyroid gland volume and thickness of thyroid isthmus: a twin study.

PubMed

Tarnoki, Adam Domonkos; Tarnoki, David Laszlo; Speer, Gabor; Littvay, Levente; Bata, Pal; Garami, Zsolt; Berczi, Viktor; Karlinger, Kinga

2015-12-01

Decreased thyroid volume has been related to increased prevalence of thyroid cancer. One hundred and fourteen Hungarian adult twin pairs (69 monozygotic, 45 dizygotic) with or without known thyroid disorders underwent thyroid ultrasound. Thickness of the thyroid isthmus was measured at the thickest portion of the gland in the midline using electronic calipers at the time of scanning. Volume of the thyroid lobe was computed according to the following formula: thyroid height*width*depth*correction factor (0.63). Age-, sex-, body mass index- and smoking-adjusted heritability of the thickness of thyroid isthmus was 50% (95% confidence interval [CI], 35 to 66%). Neither left nor right thyroid volume showed additive genetic effects, but shared environments were 68% (95% CI, 48 to 80%) and 79% (95% CI, 72 to 87%), respectively. Magnitudes of monozygotic and dizygotic co-twin correlations were not substantially impacted by the correction of covariates of body mass index and smoking. Unshared environmental effects showed a moderate influence on dependent parameters (24-50%). Our analysis support that familial factors are important for thyroid measures in a general twin population. A larger sample size is needed to show whether this is because of common environmental (e.g. intrauterine effects, regional nutrition habits, iodine supply) or genetic effects.

Unusual thyroid carcinoma with excessive extracellular hyaline globules: a case of "hyalinizing papillary carcinoma".

PubMed

Kondo, Tetsuo; Nakazawa, Tadao; Terada, Nobuo; Nakazawa, Kumiko; Kawasaki, Tomonori; Mochizuki, Kunio; Yamane, Tetsu; Ohno, Shinichi; Katoh, Ryohei

2012-06-01

We present an unusual case of papillary thyroid carcinoma in a 47-year-old Japanese woman. The tumor, 0.8 cm in diameter, was located in the upper left lobe of the thyroid. Histologically, we observed a microfollicular-like and trabecular arrangement of the tumor cells with marked hyalinized stroma and hyaline globules. Immunohistochemically, tumor cells were positive for thyroglobulin and thyroid transcription factor 1. Hyaline stroma and globular bodies were immunopositive for laminin and type IV collagen. MIB-1 index was approximately 1% without membranous immunoreactivity. Under the electron microscope, hyaline stroma and globules showed electron-dense, complex meshwork structures composed of granular and fibrous elements similar to the structure of the lamina densa. Genetic analysis demonstrated a BRAF(V600E) mutation. Based on these findings, we diagnosed the present tumor as a rare morphological variation of papillary thyroid carcinoma with excessive hyaline globules consisting of basal membrane materials. Copyright © 2012 Elsevier Inc. All rights reserved.

Dual ectopic thyroid associated with thyroid hemiagenesis.

PubMed

Nakamura, Shigenori; Masuda, Teruyuki; Ishimori, Masatoshi

2018-01-01

We report a case of a 15-year-old girl with a midline neck mass that was first noted 2 or 3 years previously. She had been treated with levothyroxine (L-T4) for congenital hypothyroidism until 11 years of age. Ultrasonography revealed an atrophic right thyroid (1.0 × 1.6 × 2.6 cm in size) and a mass (2.3 × 1.0 × 3.5 cm in size) in the upper part of the neck. No left lobe of the thyroid was detected. On further evaluation, Tc-99m pertechnetate thyroid scintigraphy and CT showed ectopic thyroid tissue in the lingual region and infrahyoid region. Thus, she was diagnosed as having dual ectopic thyroid and thyroid hemiagenesis. The atrophic right thyroid was thought be non-functional. Treatment with L-T4 was started to reduce the size of the dual ectopic thyroid tissue. This may be the first reported case of dual ectopic thyroid associated with hemiagenesis detected only by ultrasonography. Ultrasonography can confirm the presence or absence of orthotopic thyroid tissue in patients with ectopic thyroid.The cause of congenital hypothyroidism should be examined.Clinical manifestation of ectopic thyroid may appear when the treatment with L-T4 is discontinued.Annual follow-up is needed in all children when their thyroid hormone replacement is stopped.

Diffuse sclerosing variant of thyroid carcinoma presenting as Hashimoto thyroiditis: a case report.

PubMed

Vukasović, Anamarija; Kuna, Sanja Kusacić; Ostović, Karmen Trutin; Prgomet, Drago; Banek, Tomislav

2012-11-01

The aim of report is to present a case of a rare diffuse sclerosing variant of a papillary thyroid carcinoma. A 15-year old girl referred for ultrasound examination because of painless thyroid swelling lasting 10 days before. An ultrasound of the neck showed diffusely changed thyroid parenchyma, without nodes, looking as lymphocytic thyroiditis Hashimoto at first, but with snow-storm appearance, predominantly in the right lobe. Positive thyroid peroxidase antibodies (TPO-AT) also suggested Hashimoto thyroiditis. Repeated US-FNAB (fine needle-aspiration biopsy) of the right lobe revealed diffuse sclerosing variant of papillary thyroid carcinoma and patient underwent total thyreoidectomy. Patohistologic finding confirmed diffuse sclerosing variant of a papillary thyroid carcinoma in the both thyroid lobes and several metastatic lymph nodes. Two months later patient recived radioablative therapy with 3700 MBq (100 mCi) of 1-131 followed by levothyroxine replacement. At the moment, patient is without evidence of local or distant metastases and next regular control is scheduled in 6 months. In conclusion, a diffuse sclerosing variant is rare form of papillary thyroid carcinoma that echographically looks similar to Hashimoto thyroiditis and sometimes could be easily overlooked.

Mixed primary squamous cell carcinoma, follicular carcinoma, and micropapillary carcinoma of the thyroid gland: A case report.

PubMed

Dong, Su; Song, Xue-Song; Chen, Guang; Liu, Jia

2016-08-01

Primary squamous cell carcinoma of the thyroid gland is rare, and mixed squamous cell and follicular carcinoma is even rarer still, with only a few cases reported in the literature. The simultaneous presentation of three primary cancers of the thyroid has not been reported previously. Here we report a case of primary squamous cell carcinoma of the thyroid, follicular thyroid carcinoma, and micropapillary thyroid carcinoma. A 62-year-old female patient presented with complaints of pain and a 2-month history of progressively increased swelling in the anterior region of the neck. Fine-needle-aspiration cytology of both lobes indicated the possibility of the presence of a follicular neoplasm. Total thyroidectomy with left-sided modified radical neck dissection was performed. Postoperative pathological examination confirmed the diagnosis of thyroid follicular carcinoma with squamous cell carcinoma and micropapillary carcinoma of the thyroid. Thyroid-stimulating hormone suppressive therapy with l-thyroxine was administered. Radioiodine and radiotherapy also were recommended, but the patient did not complete treatment as scheduled. The patient remained alive more than 9 months after operation. The present case report provides an example of the coexistence of multiple distinct malignancies in the thyroid. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

PubMed Central

Cesareo, Roberto; Naciu, Anda Mihaela; Pasqualini, Valerio; Pelle, Giuseppe; Manfrini, Silvia; Tabacco, Gaia; Lauria Pantano, Angelo; Casini, Alessandro; Cianni, Roberto

2017-01-01

Percutaneous ethanol injection (PEI) is a technique used only for benign thyroid nodules, cystic or mixed cystic-solid with a large fluid component. It is a quite low-cost, safe, and outpatient method of treatment. Rare and severe complications have been described after PEI: jugular vein thrombosis and severe ethanol toxic necrosis of the larynx combined with necrotic dermatitis. Moreover, only four thyrotoxicosis cases due to Graves' disease have been reported. We report a case of 58-year-old female with a voluminous thyroid cystic nodule, occupying almost the entire left thyroid lobe. Our patient had already performed surgical visit and intervention of thyroidectomy had been proposed to her, which she refused. At baseline, our patient has a normal thyroid function with negative autoantibodies. According to the nodular structure, intervention of PEI has been performed with a significant improvement of compressive symptoms and cosmetic disorders. About 30 days after treatment, there was a significant volume reduction, but patient developed an acclaimed symptomatic thyrotoxicosis. After ruling out several causes of hyperthyroidism and according to the thyroid scintigraphy findings, we made the diagnosis of Plummer adenoma. To our knowledge, our patient is the first case of Plummer adenoma following PEI treatment of nontoxic thyroid nodule. PMID:28465846

Thyroid Ultrasound Pitfalls: Esophageal Fibrovascular Polyp Mimicking Thyroid Nodule

PubMed Central

Brigante, G.; Madeo, B.

2016-01-01

Background. Ultrasound (US) is the most accurate tool in the diagnosis of thyroid nodules if performed by expert physician. Misdiagnosis due to extrathyroidal lesions mimicking thyroid nodules is reported in literature. We describe the first case of an esophageal fibrovascular polyp misdiagnosed as a thyroid nodule on US examination. Patient Findings. A 54-year-old woman presented to emergency department for headache and underwent carotid Doppler extended to neck ultrasound with incidental finding of a nodule in the posterior side of the left thyroid lobe. A following thyroid US performed by an endocrinologist allowed the characterization of the lesion as an esophageal pathology, considering the extrathyroidal position, the typical peripheral hyperechoic spots and hypoechoic rim, the connection to the esophagus, and the swallowing connected movement. The patient was addressed to further investigations and finally to anterior pharyngotomy with histological diagnosis of esophageal fibrovascular polyp. Summary. Differential diagnosis between thyroid nodules and other neck lesions is important to prevent an unnecessary fine needle aspiration biopsy and to treat the extrathyroidal pathology. In this case, an US performed by an expert endocrinologist allowed detecting an esophageal fibrovascular polyp requiring surgical removal. In conclusion, the possibility of an esophageal pathology, and even fibrovascular polyp, should be considered during US thyroid examination. PMID:27022492

[A Case of Metachronous Multiple Thyroid Papillary Carcinoma with FAP].

PubMed

Tajima, Yusuke; Kumamoto, Kensuke; Yamamoto, Azusa; Chika, Noriyasu; Watanabe, Yuichiro; Matsuzawa, Takeaki; Ishibashi, Keiichiro; Mochiki, Erito; Iwama, Takeo; Akagi, Kiwamu; Ishida, Hideyuki

2015-11-01

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, the result of a germ line mutation in the adenomatous polyposis coli (APC) gene. FAP can be associated with various extracolonic lesions, including thyroid cancer, which frequently occurs in women. We report the case of a 36-year-old woman diagnosed as having FAP with multiple metachronous thyroid papillary carcinomas. She underwent left thyroidectomy at the age of 19 years without a diagnosis of FAP. Multiple polyps in her stomach were detected by medical examination and more than 100 polyps in the colon were found by colonoscopy. She was referred to our hospital after a diagnosis of non-profuse FAP. Multiple tumors with a maximum diameter of 10mm were detected in the right lobe of the thyroid gland during the preoperative examination. Papillary carcinoma was suspected based on fine-needle aspiration cytology. We performed a right thyroidectomy after prophylactic colectomy. Pathological findings revealed a cribriform-morula variant of papillary thyroid carcinoma. The patient remains well after 2 year 6 months with no recurrence.

Management of the Patient with Aggressive and Resistant Papillary Thyroid Carcinoma

PubMed Central

Miftari, Rame; Topçiu, Valdete; Nura, Adem; Haxhibeqiri, Valdete

2016-01-01

Purpose: Papillary carcinoma is the most frequent type of thyroid cancer and was considered the most benign of all thyroid carcinomas, with a low risk of distant metastases. However, there are some variants of papillary thyroid carcinoma that have affinity to spread in many organs, such as: lymph nodes, lungs and bones. Aim: The aim of this study was presentation of a case with papillary carcinoma of the thyroid gland, very persistent and resistant in treatment with I 131. Material and results: A man 56 years old were diagnosed with papillary carcinoma of thyroid gland. He underwent a surgical removal of the tumor and right lobe of thyroid gland. With histopathology examination, were confirmed follicular variant of papillary carcinoma pT4. Two weeks later he underwent total thyroidectomy and was treated with 100 mCi of J 131. Six months later, the value of thyroglobulin was found elevated above upper measured limits (more than 500 ng/ml). Patient underwent surgical removal of 10 metastatic lymph nodes in the left side of the neck and has been treated with 145 mCi of radioiodine I 131. The examination after 5 months shows elevation of thyroglobulin, more than 20000 ng/ml and focally uptake of J 131 in the left lung. Patient was treated once again with 150 mCi radioiodine J 131. Whole body scintigraphy was registered focal uptake of radioiodine in the middle of the left collarbone. After a month, patient refers the enlargement of the lymph node in the right side of the neck. Currently patient is being treated with kinase inhibitor drug sorafenib and ibandronate. We have identified first positive response in treatment. Enlarged lymph node in the neck was reduced and the patient began feeling better. Conclusion: This study suggests that some subtypes of papillary thyroid carcinoma appear to have more aggressive biological course. Subtypes of papillary thyroid carcinoma such as diffuse sclerosing carcinoma, tall cell or columnar cell and insular variants, appears to have more aggressive biological course and need early detection and other kind of treatment. PMID:27703298

Activating thyrotropin receptor mutations in histologically heterogeneous hyperfunctioning nodules of multinodular goiter.

PubMed

Tonacchera, M; Vitti, P; Agretti, P; Giulianetti, B; Mazzi, B; Cavaliere, R; Ceccarini, G; Fiore, E; Viacava, P; Naccarato, A; Pinchera, A; Chiovato, L

1998-07-01

Activating thyrotropin (TSH) receptor mutations have been found in toxic adenomas and in hot nodules contained in toxic multinodular goiter. The typical feature of multinodular goiter is the heterogeneity in morphology and function of different follicles within the same enlarged gland. In this report we describe a patient with a huge multinodular goiter, normal free triiodothyronine (FT3) and free thyroxine (FT4) serum values, and subnormal TSH serum concentration. Thyroid scintiscan showed two hot areas corresponding to the basal and apical nodules of the left lobe. The right lobe was poorly visualized by the radioisotope. The patient underwent thyroidectomy, and histological examination of the tissue was performed. Genomic DNA was extracted from the tissue specimen and direct sequencing of the TSH receptor and Gs alpha genes was done. At histology, one hyperfunctioning nodule had the typical microscopic structure of thyroid adenomas, and the other contained multiple macrofollicular areas not confined by a capsule. In spite of this histological difference, both hyperfunctioning nodules harbored a mutation of the thyrotropin receptor (TSHr) gene: an isoleucine instead of a threonine in position 632 (T632I) in the first nodule and a methionine instead of an isoleucine in position 486 (I486M) in the second nodule. In conclusion, our findings show for the first time that gain-of-function TSHr mutations are not only present in hyperfunctioning thyroid nodules with the histological features of the true thyroid adenomas, but also in hyperfunctioning hyperplastic nodules contained in the same multinodular goiter.

Intraoperative gamma probe guidance with 99mTc-pertechnetate in the completion thyroidectomy.

PubMed

Aras, Gülseren; Gültekin, Salih Sinan; Küçük, Nuriye Ozlem; Demirer, Seher; Tuğ, Tuğbay

2009-07-01

Intraoperative gamma probe (GP) guidance with (99m)Tc-pertechnetate in the completion total thyroidectomy after a first thyroidectomy was investigated in this prospective study. The study group comprises of fourteen consecutive patients (14 females, age mean 50.2 +/- 12.0 years, age range 29-73 years). All patients underwent a second thyroidectomy due to inadequate (5/14 patients) and complementary (9/14 patients) interventions. Serum-free three iodothyronine, free thyroxin and thyroid stimulating hormone measurements, a neck ultrasonography (USG) and thyroid scintigraphy (TS) were performed in the preoperative and postoperative period. After a 185 MBq (5 mCi) injection of (99m)Tc-pertechnetate, background (BG), left thyroid lobe (LTL), right thyroid lobe (RTL) and pyramidal tyroid lobe (PTL) regions were counted in time before and after resection of thyroid remnants by intraoperative GP. All resection materials were evaluated by histopathologic examination. Preoperative TSH was less than 30 mIU/mL (mean 21 +/- 7) in all patients. Functioning thyroid remnants were shown in 13/14 patients on the preoperative TS and USG, which were diagnosed by USG in one but by TS in other one. We calculated that percentage median (minimum-maximum) values were 220.90% (56.00-411.11%) in LTL, 80.43% (11.54-471.05%) in RTL and 66.60% (-3.33 to 158.33%) in PTL for counts before resection, on the other hand, 15.96% (-20.55 to 47.62%) in LTL, 17.59% (-15.07 to 38.46%) in RTL and 17.59% (-1.96 to 57.14%) in PTL regions for counts after resection. There were statistically significant differences between these values belonging to before and after resection for LTL (p = 0.001), RTL (p = 0.001) and PTL (p = 0.008). Bilateral small foci in a patient and unilateral focus in other patient were observed in postoperative TS. Unilateral focus was detected on the RTL by GP, but not bilateral foci. Postoperative TSH levels increased to 30 mIU/mL (mean 69 +/- 26) at least. There was a statistically significant difference between preoperative and postoperative TSH values (p < 0.001). Histopathologic confirmation revealed that all removed materials were the thyroid tissues. Gamma probe guidance with (99m)Tc-pertechnetate seemed to be a good option and easy available method in patients undergoing the completion total thyroidectomy.

Unilateral occurrence of five different thyroid arteries-a need of terminological systematization: a case report.

PubMed

Lovasova, Kvetuse; Kachlik, David; Santa, Marian; Kluchova, Darina

2017-08-01

This article highlights an unusual and unilateral variation in the blood supply to the inferior portion of the thyroid gland observed on the right lobe during anatomy dissection course. The rare variation of the occurrence of two anomalous arteries: the middle thyroid artery and the aberrant accessory inferior thyroid artery, and one uncommon variant, the thyroid ima artery, was detected in an adult female cadaver. The two generally constant arteries, the superior thyroid artery and the inferior thyroid artery, have been found in their usual anatomical location. Both the middle thyroid artery and aberrant accessory inferior thyroid artery arose from the right common carotid artery. The middle thyroid artery coursed as a very short branch ventromedially to enter the inferior lateral portion of the right lobe of the thyroid gland. It was at the same level, in which the inferior thyroid artery reached the lateral border of the thyroid gland. The aberrant accessory inferior thyroid artery originated similarly, from the ventromedial surface of the right common carotid artery and passed to supply the inferior pole of the right lobe. The thyroid ima artery was found to arise from the brachiocephalic trunk, entering the isthmus of the thyroid gland. Information about the embryological background might be helpful to clarify why such a type of variation occurs. It is necessary to understand the possible existence of this anomaly, to carry out successful radical neck dissection and to minimize the risk of postoperative complications in patients.

Postotic and preotic cranial neural crest cells differently contribute to thyroid development.

PubMed

Maeda, Kazuhiro; Asai, Rieko; Maruyama, Kazuaki; Kurihara, Yukiko; Nakanishi, Toshio; Kurihara, Hiroki; Miyagawa-Tomita, Sachiko

2016-01-01

Thyroid development and formation vary among species, but in most species the thyroid morphogenesis consists of five stages: specification, budding, descent, bilobation and folliculogenesis. The detailed mechanisms of these stages have not been fully clarified. During early development, the cranial neural crest (CNC) contributes to the thyroid gland. The removal of the postotic CNC (corresponding to rhombomeres 6, 7 and 8, also known as the cardiac neural crest) results in abnormalities of the cardiovascular system, thymus, parathyroid glands, and thyroid gland. To investigate the influence of the CNC on thyroid bilobation process, we divided the CNC into two regions, the postotic CNC and the preotic CNC (from the mesencephalon to rhombomere 5) regions and examined. We found that preotic CNC-ablated embryos had a unilateral thyroid lobe, and confirmed the presence of a single lobe or the absence of lobes in postotic CNC-ablated chick embryos. The thyroid anlage in each region-ablated embryos was of a normal size at the descent stage, but at a later stage, the thyroid in preotic CNC-ablated embryos was of a normal size, conflicting with a previous report in which the thyroid was reduced in size in the postotic CNC-ablated embryos. The postotic CNC cells differentiated into connective tissues of the thyroid in quail-to-chick chimeras. In contrast, the preotic CNC cells did not differentiate into connective tissues of the thyroid. We found that preotic CNC cells encompassed the thyroid anlage from the specification stage to the descent stage. Finally, we found that endothelin-1 and endothelin type A receptor-knockout mice and bosentan (endothelin receptor antagonist)-treated chick embryos showed bilobation anomalies that included single-lobe formation. Therefore, not only the postotic CNC, but also the preotic CNC plays an important role in thyroid morphogenesis. Copyright © 2015 Elsevier Inc. All rights reserved.

Frequency of thyroid incidentalomas in Karachi population.

PubMed

Kamran, Mahrukh; Hassan, Nuzhat; Ali, Muhammad; Ahmad, Farah; Shahzad, Sikandar; Zehra, Nosheen

2014-07-01

The aim of this study was to determine frequency of thyroid incidentalomas (TI) through ultrasound (US) and its association with age, gender and ethnicities. It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. Frequency of TI found was 21%. TI was detected in 25% of females and 16% males (P= 0.078). 61% had thyroid nodules (TNs) in one lobe (right, left or isthmus) and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities (P= 0.758). Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it's status as an iodine sufficient state.

Frequency of thyroid incidentalomas in Karachi population

PubMed Central

Kamran, Mahrukh; Hassan, Nuzhat; Ali, Muhammad; Ahmad, Farah; Shahzad, Sikandar; Zehra, Nosheen

2014-01-01

Objectives: The aim of this study was to determine frequency of thyroid incidentalomas (TI) through ultrasound (US) and its association with age, gender and ethnicities. Methods: It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. Results: Frequency of TI found was 21%. TI was detected in 25% of females and 16% males (P= 0.078). 61% had thyroid nodules (TNs) in one lobe (right, left or isthmus) and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities (P= 0.758). Conclusion: Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it’s status as an iodine sufficient state. PMID:25097519

[Apathetic hyperthyroidism with heart failure in an elderly patient with Plummer's disease].

PubMed

Narisawa, Manabu; Okada, Yosuke; Arao, Tadashi; Kuno, Fumi; Tanaka, Yoshiya

2014-12-01

We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of age, and one year later was found to have asymptomatic hyperthyroidism. Anti-thyroid autoantibodies were negative, but thyroid echography showed a 32-mm tumor devoid of internal blood flow in the left lower lobe. Free thyroxine 4 (FT4) decreased from 3.30 to 2.60 ng/dl without treatment. The patient was diagnosed with transient thyroiditis and was followed-up without treatment. However, a repeat thyroid echography showed growth of the tumor to 41 mm in 4 years. Thyroid scintigraphy showed uptake that matched the thyroid mass. Based on these findings, the established diagnosis was Plummer's disease complicated with heart failure. The patient was treated with anti-thyroid drugs, which resulted in improvement of FT4 and reduced the severity of heart failure. In this rare case of an elderly patient, Plummer's disease was associated with a slowly-growing functional thyroid adenoma, apathetic hyperthyroidism, repeated episodes of atrial fibrillation and heart failure. Since symptoms of thyrotoxicosis are likely to be missed in the elderly, it is necessary to include hyperthyroidism in the pathoetiology of heart failure and atrial fibrillation in this population.

A patient presenting with spinal cord compression who had two distinct follicular cell type thyroid carcinomas.

PubMed

Koca, E; Sokmensuer, C; Yildiz, B O; Engin, H; Bozkurt, M F; Aras, T; Barista, I; Gurlek, A

2004-06-01

A 61-yr-old woman presented with complaints of weakness and pain in her legs. A magnetic resonance imaging showed a 3 x 5.6 x 7.8 cm mass lesion destructing the T1 and T2 vertebral bodies and compressing the spinal cord. The mass was excised surgically. It was follicular carcinoma metastasis of the cervicodorsal region. Then, she underwent a total thyroidectomy. Pathological examination showed two different types of carcinomas in two different focuses; follicular carcinoma in the left lobe and follicular variant papillary carcinoma in the isthmic lobe. After the operation she was given 100 mCi 131I. This is the first report of a patient who had both metastatic follicular carcinoma and follicular variant papillary carcinoma together.

Hyperfunctioning papillary thyroid carcinoma: A case report with literature review.

PubMed

Salih, Abdulwahid M; Kakamad, F H; Nihad, Han

2016-01-01

Thyroid malignant tumors are rarely associated with hyperfunctioning thyroid. The incidence of this co-incidence is highly variable. Here we report a rare case of papillary thyroid cancer associated with hyperthyroidism with brief literature review. A 40-year-old male, presented with palpitation, excess sweating and weight loss for one month duration. There was asymmetrical swelling of the neck, more on right side, mobile. Free T3: 11.09pmol/L, free T4: 34.41pmol/L, TFT: less than 0.005mIU/ml, Neck ultrasound showed features of background thyroiditis. Left lobe contained 9×7×5mm nodule with irregular outline and multiple dots of calcification, other nodules are of the same features. Under ultrasound guide, fine needle aspiration cytology showed features of papillary carcinoma. After preparation, total thyrodectomy done and the result of histopathological examination confirmed papillary thyroid carcinoma. The patient was put on 0.2mg thyroxine daily. Literature review has showed an increasing number of papers reporting the association of high level of thyroid function tests and thyroid malignancy. The cause of high level of TH in thyroid malignancy is thought to be due to an active mutation of the gene of TH receptor. Niepomniszcze and colleagues found that a combination of TSH receptor mutations and Ki-RAS was the main etiological factor for hyperfunction of the thyroid malignancy. Although the coexistence of them is rare, thyroid malignancy should be put in the differential diagnosis of hyperthyroid goiter. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Thyroid organotypic rat and human cultures used to investigate drug effects on thyroid function, hormone synthesis and release pathways.

PubMed

Vickers, Alison E M; Heale, Jason; Sinclair, John R; Morris, Stephen; Rowe, Josh M; Fisher, Robyn L

2012-04-01

Drug induced thyroid effects were evaluated in organotypic models utilizing either a rat thyroid lobe or human thyroid slices to compare rodent and human response. An inhibition of thyroid peroxidase (TPO) function led to a perturbation in the expression of key genes in thyroid hormone synthesis and release pathways. The clinically used thiourea drugs, methimazole (MMI) and 6-n-propyl-2-thioruacil (PTU), were used to evaluate thyroid drug response in these models. Inhibition of TPO occurred early as shown in rat thyroid lobes (2 h) and was sustained in both rat (24-48 h) and human (24 h) with ≥ 10 μM MMI. Thyroid from rats treated with single doses of MMI (30-1000 mg/kg) exhibited sustained TPO inhibition at 48 h. The MMI in vivo thyroid concentrations were comparable to the culture concentrations (~15-84 μM), thus demonstrating a close correlation between in vivo and ex vivo thyroid effects. A compensatory response to TPO inhibition was demonstrated in the rat thyroid lobe with significant up-regulation of genes involved in the pathway of thyroid hormone synthesis (Tpo, Dio1, Slc5a5, Tg, Tshr) and the megalin release pathway (Lrp2) by 24h with MMI (≥ 10 μM) and PTU (100 μM). Similarly, thyroid from the rat in vivo study exhibited an up-regulation of Dio1, Slc5a5, Lrp2, and Tshr. In human thyroid slices, there were few gene expression changes (Slc5a5, ~2-fold) and only at higher MMI concentrations (≥ 1500 μM, 24h). Extended exposure (48 h) resulted in up-regulation of Tpo, Dio1 and Lrp2, along with Slc5a5 and Tshr. In summary, TPO was inhibited by similar MMI concentrations in rat and human tissue, however an increased sensitivity to drug treatment in rat is indicated by the up-regulation of thyroid hormone synthesis and release gene pathways at concentrations found not to affect human tissue. Copyright © 2012 Elsevier Inc. All rights reserved.

[Prediction of occult carcinoma in contralateral nodules based on the ultrasonic features of unilateral papillary thyroid carcinoma].

PubMed

Yang, L M; Li, Q; Zhao, B W; Lyu, J G; Xu, H S; Xu, L L; Li, S Y; Gao, L; Zhu, J

2017-04-07

Objective: To investigate the occurrence of occult carcinoma in contralateral lobes based on the ultrasonic features of unilateral papillary thyroid carcinoma. Methods: The study included 202 consecutives cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from June 2014 to December 2015. All patients received total thyroidectomies, and with postoperative pathological examination they were divided into two groups, one including 60 cases with positive occult cancer and another one consisting of 142 cases with negative occult cancer. Univariate and multivariate analyses were performed to analyze the sonographic features of unilateral papillary thyroid carcinoma relevant to the occurrence of occult carcinoma in the contralateral nodules. Results: Univariate analysis indicated occult carcinoma in the contralateral lobes was associated with Hashimoto's thyroiditis(χ(2)=3.955, P =0.047), unclear border (χ(2)=4.375, P =0.036)and multifocality in the ipsilateral(χ(2)=7.375, P =0.007), but not with tumors maximum size, location, A/T, shape, internal structure, internal echo, acoustic halo, calcification, capsular invasion and blood flow signal in the lobe with carcinoma on another side. Multivariate analysis showed unclear border ( OR =2.727, P =0.010) and multifocality in the ipsilateral( OR =2.807, P =0.005)of carcinoma were independent predictive factor for contralateral occult PTC. Conclusions: Unclear border and multifocality of PTC in the ipsilateral were closely relevant to the occurrence of occult carcinoma in the contralateral nodules.

Thyroid organotypic rat and human cultures used to investigate drug effects on thyroid function, hormone synthesis and release pathways

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vickers, Alison E.M., E-mail: vickers_alison@allergan.com; Heale, Jason; Sinclair, John R.

Drug induced thyroid effects were evaluated in organotypic models utilizing either a rat thyroid lobe or human thyroid slices to compare rodent and human response. An inhibition of thyroid peroxidase (TPO) function led to a perturbation in the expression of key genes in thyroid hormone synthesis and release pathways. The clinically used thiourea drugs, methimazole (MMI) and 6-n-propyl-2-thioruacil (PTU), were used to evaluate thyroid drug response in these models. Inhibition of TPO occurred early as shown in rat thyroid lobes (2 h) and was sustained in both rat (24–48 h) and human (24 h) with ≥ 10 μM MMI. Thyroidmore » from rats treated with single doses of MMI (30–1000 mg/kg) exhibited sustained TPO inhibition at 48 h. The MMI in vivo thyroid concentrations were comparable to the culture concentrations (∼ 15–84 μM), thus demonstrating a close correlation between in vivo and ex vivo thyroid effects. A compensatory response to TPO inhibition was demonstrated in the rat thyroid lobe with significant up-regulation of genes involved in the pathway of thyroid hormone synthesis (Tpo, Dio1, Slc5a5, Tg, Tshr) and the megalin release pathway (Lrp2) by 24 h with MMI (≥ 10 μM) and PTU (100 μM). Similarly, thyroid from the rat in vivo study exhibited an up-regulation of Dio1, Slc5a5, Lrp2, and Tshr. In human thyroid slices, there were few gene expression changes (Slc5a5, ∼ 2-fold) and only at higher MMI concentrations (≥ 1500 μM, 24 h). Extended exposure (48 h) resulted in up-regulation of Tpo, Dio1 and Lrp2, along with Slc5a5 and Tshr. In summary, TPO was inhibited by similar MMI concentrations in rat and human tissue, however an increased sensitivity to drug treatment in rat is indicated by the up-regulation of thyroid hormone synthesis and release gene pathways at concentrations found not to affect human tissue. -- Highlights: ► Novel model of rat thyroid or human thyroid slices to evaluate pathways of injury. ► TPO inhibition by MMI or PTU altered hormone synthesis and release genes. ► Rat thyroid was more sensitive to the drug effects than human tissue.« less

Influence of short-term selenium supplementation on the natural course of Hashimoto's thyroiditis: clinical results of a blinded placebo-controlled randomized prospective trial.

PubMed

Esposito, D; Rotondi, M; Accardo, G; Vallone, G; Conzo, G; Docimo, G; Selvaggi, F; Cappelli, C; Chiovato, L; Giugliano, D; Pasquali, D

2017-01-01

The real efficacy of selenium supplementation in Hashimoto's thyroiditis (HT) is still an unresolved issue. We studied the short-term effect of L-selenomethionine on the thyroid function in euthyroid patients with HT. Our primary outcome measures were TSH, thyroid hormones, thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) levels and thyroid echogenicity after 6 months of L-selenomethionine treatment. The secondary outcome measure was serum CXCL10 levels. In a placebo-controlled randomized prospective study, we have enrolled untreated euthyroid patients with HT. Seventy-six patients were randomly assigned to receive L-selenomethionine 166 µg/die (SE n = 38) or placebo (controls n = 38) for 6 months. TSH, free T 4 (FT 4 ), free T 3 (FT 3 ), TPOAb and CXCL10 serum levels were assayed at time 0, after 3 and 6 months. An ultrasound examination of the left and right thyroid lobe in transverse and longitudinal sections was performed. A rectangular region, the region of interest, was selected for analysis. TSH, FT4, FT3, TPOAb, thyroid echogenicity and CXCL10 were not statistically different between SE and control groups at time 0, after 3 and 6 months. In the SE group, FT 4 levels were significantly decreased (P < 0.03) after 3 months, while FT 3 increased (P < 0.04) after 3 and 6 months versus baseline values. In the control group, the FT 3 decreased after 3 and 6 months (P < 0.02) compared to baseline. The short-term L-selenomethionine supplementation has a limited impact on the natural course in euthyroid HT. Our results tip the balance toward the ineffectiveness of short-term L-selenomethionine supplementation in HT.

Working memory network plasticity after anterior temporal lobe resection: a longitudinal functional magnetic resonance imaging study

PubMed Central

Stretton, Jason; Sidhu, Meneka K.; Winston, Gavin P.; Bartlett, Philippa; McEvoy, Andrew W.; Symms, Mark R.; Koepp, Matthias J.; Thompson, Pamela J.

2014-01-01

Working memory is a crucial cognitive function that is disrupted in temporal lobe epilepsy. It is unclear whether this impairment is a consequence of temporal lobe involvement in working memory processes or due to seizure spread to extratemporal eloquent cortex. Anterior temporal lobe resection controls seizures in 50–80% of patients with drug-resistant temporal lobe epilepsy and the effect of surgery on working memory are poorly understood both at a behavioural and neural level. We investigated the impact of temporal lobe resection on the efficiency and functional anatomy of working memory networks. We studied 33 patients with unilateral medial temporal lobe epilepsy (16 left) before, 3 and 12 months after anterior temporal lobe resection. Fifteen healthy control subjects were also assessed in parallel. All subjects had neuropsychological testing and performed a visuospatial working memory functional magnetic resonance imaging paradigm on these three separate occasions. Changes in activation and deactivation patterns were modelled individually and compared between groups. Changes in task performance were included as regressors of interest to assess the efficiency of changes in the networks. Left and right temporal lobe epilepsy patients were impaired on preoperative measures of working memory compared to controls. Working memory performance did not decline following left or right temporal lobe resection, but improved at 3 and 12 months following left and, to a lesser extent, following right anterior temporal lobe resection. After left anterior temporal lobe resection, improved performance correlated with greater deactivation of the left hippocampal remnant and the contralateral right hippocampus. There was a failure of increased deactivation of the left hippocampal remnant at 3 months after left temporal lobe resection compared to control subjects, which had normalized 12 months after surgery. Following right anterior temporal lobe resection there was a progressive increase of activation in the right superior parietal lobe at 3 and 12 months after surgery. There was greater deactivation of the right hippocampal remnant compared to controls between 3 and 12 months after right anterior temporal lobe resection that was associated with lesser improvement in task performance. Working memory improved after anterior temporal lobe resection, particularly following left-sided resections. Postoperative working memory was reliant on the functional capacity of the hippocampal remnant and, following left resections, the functional reserve of the right hippocampus. These data suggest that working memory following temporal lobe resection is dependent on the engagement of the posterior medial temporal lobes and eloquent cortex. PMID:24691395

Clinical versus ultrasound examination of the thyroid gland in common clinical practice.

PubMed

Brander, A; Viikinkoski, P; Tuuhea, J; Voutilainen, L; Kivisaari, L

1992-01-01

In a prospective series of 72 patients, clinical and ultrasonographic examination of the thyroid gland were compared in detail. Normal-sized lobes were differentiated from enlarged ones both by inspection and by palpation. When lobar size was assessed by palpation, the estimate was most clearly influenced by increase in width. The correlation between two examiners in lobe size assessment was significant. In the classification of thyroid disease as diffuse, solitary, or multinodular, clinical examination and ultrasonography correlated significantly. However, only one third of the clinically solitary nodules proved to be solitary by ultrasound examination. Of 77 separate nodules, 43 escaped detection on clinical examination. Of these 43, 14 nodules exceeded 2 cm in diameter. It is concluded that the use of ultrasonography frequently alters the primary evaluation of thyroid nodularity based on palpation.

Localized Ablation of Thyroid Tissue by High-Intensity Focused Ultrasound: an Alternative to Surgery?

NASA Astrophysics Data System (ADS)

Esnault, Olivier; Franc, Brigitte; Chapelon, Jean-Yves; Lacoste, Francois

2006-05-01

PURPOSE: The aim of this study was to evaluate the feasibility of using a High-intensity focused ultrasound (HIFU) device to obtain a localised destruction of the thyroid with no damage to adjacent tissues. MATERIALS AND METHODS: The ewe model was used because its thyroid gland is easily accessible with ultrasound. The animals were anaesthetised with 10 mg / kg IV injection of Penthothal. The HIFU pulses were generated by a 3-MHz spherical transducer under ultrasound guidance. Macroscopic and microscopic tissue lesions were identified after formalin fixation of the anterior part of the ewe's neck. RESULTS: After determining the optimal instrument settings to obtain localized thyroid ablation, the repeatability of the method was evaluated using a HIFU prototype designed specifically for human use: in 13 ewes (26 treated lobes), an average of 20 (range: 14-27) ultrasound pulses (pulse duration: 3 s) per lobe covering a mean volume of 0.5 cm3 (range: 0.3-0.7 cm3) were delivered. The ewes were sacrificed 2-5 weeks after treatment delivery. No damage to the nerves, trachea, esophagus or muscle was observed. Only 3 ewes suffered superficial skin burns. The desired thyroid lesions were obtained in 25/26 treated lobes, as demonstrated by fibrotic tissues, which replaced necrotic areas. CONCLUSION: These results obtained in the ewe model show that thyroid lesions of defined volume can be induced safely and suggest that the HIFU device is now ready for human trials.

Verbal memory after temporal lobe epilepsy surgery in children: Do only mesial structures matter?

PubMed

Law, Nicole; Benifla, Mony; Rutka, James; Smith, Mary Lou

2017-02-01

Previous findings have been mixed regarding verbal memory outcome after left temporal lobectomy in children, and there are few studies comparing verbal memory change after lateral versus mesial temporal lobe resections. We compared verbal memory outcome associated with sparing or including the mesial structures in children who underwent left or right temporal lobe resection. We also investigated predictors of postsurgical verbal memory change. We retrospectively assessed verbal memory change approximately 1 year after unilateral temporal lobe epilepsy surgery using a list learning task. Participants included 23 children who underwent temporal lobe surgery with sparing of the mesial structures (13 left), and 40 children who had a temporal lobectomy that included resection of mesial structures (22 left). Children who underwent resection from the left lateral and mesial temporal lobe were the only group to show decline in verbal memory. Furthermore, when we considered language representation in the left temporal resection group, patients with left language representation and spared mesial structures showed essentially no change in verbal memory from preoperative to follow-up, whereas those with left language representation and excised mesial structures showed a decline. Postoperative seizure status had no effect on verbal memory change in children after left temporal lobe surgery. Finally, we found that patients with intact preoperative verbal memory experienced a significant decline compared to those with below average preoperative verbal memory. Our findings provide evidence of significant risk factors for verbal memory decline in children, specific to left mesial temporal lobe epilepsy. Children who undergo left temporal lobe surgery that includes mesial structures may be most vulnerable for verbal memory decline, especially when language representation is localized to the left hemisphere and when preoperative verbal memory is intact. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Agenesis of the left hepatic lobe undergoing laparoscopic hepatectomy for hepatocellular carcinoma: a case report.

PubMed

Matsushita, Katsunori; Gotoh, Kunihito; Eguchi, Hidetoshi; Iwagami, Yoshihumi; Yamada, Daisaku; Asaoka, Tadafumi; Noda, Takehiro; Wada, Hiroshi; Kawamoto, Koichi; Doki, Yuichiro; Mori, Masaki

2017-12-01

Agenesis of the left hepatic lobe is a rare anomaly. It is defined as the absence of liver tissue to the left of the gallbladder fossa. Additionally, agenesis of the left hepatic lobe accompanied by hepatocellular carcinoma is quite rare. We experienced the case of a patient with agenesis of the left hepatic lobe, undergoing laparoscopic hepatectomy for HCC. A 79-year-old man was referred to our department with epigastralgia. Abdominal computed tomography revealed agenesis of the left hepatic lobe, accompanied by hepatocellular carcinoma in segments 7 and 8. He underwent laparoscopic partial hepatectomy of segments 7 and 8. The operative findings revealed complete agenesis of the liver to the left of the falciform ligament. The patient had a favorable clinical course without liver dysfunction or any complications. We experienced a case with agenesis of the left hepatic lobe undergoing laparoscopic hepatectomy for HCC. Awareness of such anomaly is important for surgeons to avoid postoperative complications.

Memory reorganization following anterior temporal lobe resection: a longitudinal functional MRI study

PubMed Central

Bonelli, Silvia B.; Thompson, Pamela J.; Yogarajah, Mahinda; Powell, Robert H. W.; Samson, Rebecca S.; McEvoy, Andrew W.; Symms, Mark R.; Koepp, Matthias J.

2013-01-01

Anterior temporal lobe resection controls seizures in 50–60% of patients with intractable temporal lobe epilepsy but may impair memory function, typically verbal memory following left, and visual memory following right anterior temporal lobe resection. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated the reorganization of memory function in patients with temporal lobe epilepsy before and after left or right anterior temporal lobe resection and the efficiency of postoperative memory networks. We studied 46 patients with unilateral medial temporal lobe epilepsy (25/26 left hippocampal sclerosis, 16/20 right hippocampal sclerosis) before and after anterior temporal lobe resection on a 3 T General Electric magnetic resonance imaging scanner. All subjects had neuropsychological testing and performed a functional magnetic resonance imaging memory encoding paradigm for words, pictures and faces, testing verbal and visual memory in a single scanning session, preoperatively and again 4 months after surgery. Event-related analysis revealed that patients with left temporal lobe epilepsy had greater activation in the left posterior medial temporal lobe when successfully encoding words postoperatively than preoperatively. Greater pre- than postoperative activation in the ipsilateral posterior medial temporal lobe for encoding words correlated with better verbal memory outcome after left anterior temporal lobe resection. In contrast, greater postoperative than preoperative activation in the ipsilateral posterior medial temporal lobe correlated with worse postoperative verbal memory performance. These postoperative effects were not observed for visual memory function after right anterior temporal lobe resection. Our findings provide evidence for effective preoperative reorganization of verbal memory function to the ipsilateral posterior medial temporal lobe due to the underlying disease, suggesting that it is the capacity of the posterior remnant of the ipsilateral hippocampus rather than the functional reserve of the contralateral hippocampus that is important for maintaining verbal memory function after anterior temporal lobe resection. Early postoperative reorganization to ipsilateral posterior or contralateral medial temporal lobe structures does not underpin better performance. Additionally our results suggest that visual memory function in right temporal lobe epilepsy is affected differently by right anterior temporal lobe resection than verbal memory in left temporal lobe epilepsy. PMID:23715092

Thyroid gland rupture caused by blunt trauma to the neck.

PubMed

Hara, Hirotaka; Hirose, Yoshinobu; Yamashita, Hiroshi

2016-02-19

Thyroid rupture following blunt trauma is extremely rare, and neck pain without swelling may be the only presenting symptom. However, hemorrhage and hematoma subsequently causes severe tracheal compression and respiratory distress. A 71-year-old Japanese woman visited our emergency room with a complaint of increasing right-sided neck pain at the thyroid cartilage level after she tripped and accidentally hit her neck against a pole 3 h back. On admission, her vital signs were stable. There was no swelling or subcutaneous emphysema. Laryngeal endoscopy revealed mild laryngeal edema, although there was no impairment in vocal fold mobility on either side. Contrast-enhanced computed tomography (CT) revealed rupture of the right lobe of the thyroid gland accompanied by a large hematoma extending from the neck to the mediastinum. Under general anesthesia, the right lobe was resected and the hematoma was evacuated. Only a few isolated cases of thyroid rupture caused by blunt neck trauma have been reported in patients with normal thyroid glands and neck pain without swelling may be the only presenting symptom. When suspected, CT should be performed to confirm the diagnosis determine the optimal treatment.

Cervical dedifferentiated liposarcoma with meningothelial-like whorling.

PubMed

Blumberg, Jeffrey M; Jedrych, Jaroslaw; Costa, Jose; Judson, Benjamin

2012-12-01

Liposarcomas are the most common soft-tissue sarcoma of adults, but rare in the head and neck. Recently, a subtype of dedifferentiated liposarcoma with meningiothelial-like whorls was reported and we present the first description of such a tumor in the head and neck. A 65 year old male underwent a resection of a calcified retroesophageal mass that was in close relation to the left hemithyroid and recurrent laryngeal nerve. It was resected en bloc with the left thyroid lobe. Initial pathologic evaluation suggested the mass was a schwanomma of the recurrent laryngeal nerve, but positive staining for MDM2 and CDK4 indicated the tumor was a dedifferentiated liposarcoma. Further evaluation elucidated the unique meningothelial-like whorls within the tumor. This case demonstrates dedifferentiated liposarcomas do appear in the head and neck. Furthermore, this is the first report in the head and neck of the mengiothelial-like whorling pattern type of dedifferentiated liposarcoma.

Inverted Lobes Have Satisfactory Functions Compared With Noninverted Lobes in Lung Transplantation.

PubMed

Kayawake, Hidenao; Chen-Yoshikawa, Toyofumi F; Motoyama, Hideki; Hamaji, Masatsugu; Hijiya, Kyoko; Aoyama, Akihiro; Goda, Yasufumi; Oda, Hiromi; Ueda, Satoshi; Date, Hiroshi

2018-04-01

To overcome the problem of small-for-size grafts in standard living-donor lobar lung transplantation (LDLLT), we developed inverted LDLLT, in which a right lower lobe from 1 donor is implanted as a right graft and another right lower lobe from another donor is implanted as a left graft. We retrospectively analyzed the functions of inverted grafts vs noninverted grafts. Between 2008 and 2015, 64 LDLLTs were performed. Included were 35 LDLLTs whose recipients were adults and monitored for more than 6 months without developing chronic lung allograft dysfunction. Among them, 65 implanted lobes were eligible for this analysis. There were 31 right lower lobes implanted as right grafts (right-to-right group), 7 right lower lobes as inverted left grafts (right-to-left group), and 27 left lower lobes as left grafts (left-to-left group). We evaluated the graft forced vital capacity (G-FVC) and graft volume of the 65 lobes before and 6 months after LDLLT and compared them among the three groups. Preoperatively, G-FVC in the right-to-left group (1,050 mL) was comparable to that in the right-to-right group (1,177 mL) and better than that in the left-to-left group (791 mL, p < 0.01). Six months after LDLLT, G-FVC in the right-to-left group (1,015 mL) remained comparable to that in the right-to-right group (1,001 mL) and better than that in the left-to-left group (713 mL, p = 0.047). The ratio of graft volume 6 months after LDLLT to the preoperative value was comparable. The functions of inverted grafts in inverted LDLLTs were satisfactory compared with those of noninverted grafts. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Intra- and interoperator variability of lobar pulmonary volumes and emphysema scores in patients with chronic obstructive pulmonary disease and emphysema: comparison of manual and semi-automated segmentation techniques.

PubMed

Molinari, Francesco; Pirronti, Tommaso; Sverzellati, Nicola; Diciotti, Stefano; Amato, Michele; Paolantonio, Guglielmo; Gentile, Luigia; Parapatt, George K; D'Argento, Francesco; Kuhnigk, Jan-Martin

2013-01-01

We aimed to compare the intra- and interoperator variability of lobar volumetry and emphysema scores obtained by semi-automated and manual segmentation techniques in lung emphysema patients. In two sessions held three months apart, two operators performed lobar volumetry of unenhanced chest computed tomography examinations of 47 consecutive patients with chronic obstructive pulmonary disease and lung emphysema. Both operators used the manual and semi-automated segmentation techniques. The intra- and interoperator variability of the volumes and emphysema scores obtained by semi-automated segmentation was compared with the variability obtained by manual segmentation of the five pulmonary lobes. The intra- and interoperator variability of the lobar volumes decreased when using semi-automated lobe segmentation (coefficients of repeatability for the first operator: right upper lobe, 147 vs. 96.3; right middle lobe, 137.7 vs. 73.4; right lower lobe, 89.2 vs. 42.4; left upper lobe, 262.2 vs. 54.8; and left lower lobe, 260.5 vs. 56.5; coefficients of repeatability for the second operator: right upper lobe, 61.4 vs. 48.1; right middle lobe, 56 vs. 46.4; right lower lobe, 26.9 vs. 16.7; left upper lobe, 61.4 vs. 27; and left lower lobe, 63.6 vs. 27.5; coefficients of reproducibility in the interoperator analysis: right upper lobe, 191.3 vs. 102.9; right middle lobe, 219.8 vs. 126.5; right lower lobe, 122.6 vs. 90.1; left upper lobe, 166.9 vs. 68.7; and left lower lobe, 168.7 vs. 71.6). The coefficients of repeatability and reproducibility of emphysema scores also decreased when using semi-automated segmentation and had ranges that varied depending on the target lobe and selected threshold of emphysema. Semi-automated segmentation reduces the intra- and interoperator variability of lobar volumetry and provides a more objective tool than manual technique for quantifying lung volumes and severity of emphysema.

Primary mucinous carcinoma of thyroid gland with prominent signet-ring-cell differentiation: a case report and review of the literature.

PubMed

Wang, Jian; Guli, Qie-Re; Ming, Xiao-Cui; Zhou, Hai-Tao; Cui, Yong-Jie; Jiang, Yue-Feng; Zhang, Di; Liu, Yang

2018-01-01

This study reports a case of primary mucinous carcinoma of the thyroid gland with signet-ring-cell differentiation, and reviews the literature to evaluate its real incidence and the prognosis of these patients. A 74-year-old Chinese woman, presenting with a mass in the right lobe of thyroid gland, came to the hospital. Computed tomography revealed a mass in the right lobe of the thyroid gland, accompanied with right neck lymphadenectasis and airway deviation caused by tumor compression. Thyroid imaging suggested a thyroid malignant tumor and suspicious lymph node metastasis. Histologically, the tumor was characterized by the tumor cells arranged in small nests or trabeculae with an abundant extracellular mucoid matrix. The tumor cells formed diffuse invasion among thyroid follicles. In the peripheral regions, prominent signet-ring-cells formed a sheet-like structure and extended into the extrathyroidal fat tissue. The tumor cells were diffusely positive for thyroid transcription factor-1 (TTF-1) and PAX8, while they were focally positive for pan-cytokeratin (AE1/AE3) and weakly expressed thyroglobulin. Based on the histological features and immunohistochemical profile, a diagnosis of primary mucinous carcinoma of the thyroid gland with signet-ring-cell differentiation was rendered. Using a panel of immunohistochemical markers may be helpful for differential diagnosis and for determining whether the tumor is primary or not.

Treating autism by targeting the temporal lobes.

PubMed

Chi, Richard P; Snyder, Allan W

2014-11-01

Compelling new findings suggest that an early core signature of autism is a deficient left anterior temporal lobe response to language and an atypical over-activation of the right anterior temporal lobe. Intriguingly, our recent results from an entirely different line of reasoning and experiments also show that applying cathodal stimulation (suppressing) at the left anterior temporal lobe together with anodal stimulation (facilitating) at the right anterior temporal lobe, by transcranial direct current stimulation (tDCS), can induce some autistic-like cognitive abilities in otherwise normal adults. If we could briefly induce autistic like cognitive abilities in healthy individuals, it follows that we might be able to mitigate some autistic traits by reversing the above stimulation protocol, in an attempt to restore the typical dominance of the left anterior temporal lobe. Accordingly, we hypothesize that at least some autistic traits can be mitigated, by applying anodal stimulation (facilitating) at the left anterior temporal lobe together with cathodal stimulation (suppressing) at the right anterior temporal lobe. Our hypothesis is supported by strong convergent evidence that autistic symptoms can emerge and later reverse due to the onset and subsequent recovery of various temporal lobe (predominantly the left) pathologies. It is also consistent with evidence that the temporal lobes (especially the left) are a conceptual hub, critical for extracting meaning from lower level sensory information to form a coherent representation, and that a deficit in the temporal lobes underlies autistic traits. Copyright © 2014 Elsevier Ltd. All rights reserved.

Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer: an appraisal using (99m)Tc-GSA SPECT/CT fusion imaging.

PubMed

Sumiyoshi, Tatsuaki; Shima, Yasuo; Okabayashi, Takehiro; Noda, Yoshihiro; Hata, Yasuhiro; Murata, Yoriko; Kozuki, Akihito; Tokumaru, Teppei; Nakamura, Toshio; Uka, Kiminori

2014-11-01

To determine the functional discrepancy between the two liver lobes using technetium 99m ((99m)Tc) diethylenetriamine-pentaacetic acid-galactosyl human serum albumin ( GSA diethylenetriamine-pentaacetic acid-galactosyl human serum albumin ) single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging following preoperative biliary drainage and portal vein embolization ( PVE portal vein embolization ) in patients with jaundice who have bile duct cancer ( BDC bile duct cancer ). This retrospective study was approved by the institutional review board, with waiver of informed consent. Preoperative (99m)Tc- GSA diethylenetriamine-pentaacetic acid-galactosyl human serum albumin SPECT/CT fusion images from 32 patients with extrahepatic BDC bile duct cancer were retrospectively reviewed. Patients were classified into four groups according to the extent of biliary drainage and presence of a preoperative right PVE portal vein embolization : right lobe drainage group (right drainage), bilateral lobe drainage group (bilateral drainage), left lobe drainage group (left drainage), and left lobe drainage with right PVE portal vein embolization group (left drainage with right PVE portal vein embolization ). Percentage volume and percentage function were measured in each lobe using fusion imaging. The ratio between percentage function and percentage volume (the function-to-volume ratio) was calculated for each lobe, and the results were compared among the four groups. Statistical analysis was performed with Wilcoxon signed-rank tests and Mann-Whitney U tests. The median values for the function-to-volume ratio in the right drainage, bilateral drainage, left drainage, and left drainage with right PVE portal vein embolization group were 1.12, 1.05, 1.02, and 0.81 in the right lobe; and 0.51, 0.88, 0.96, and 1.17 in the left lobe. Significant differences in the function-to-volume ratio were observed among the four groups (right drainage vs bilateral drainage vs left drainage vs left drainage with right PVE portal vein embolization ; with P < .002, P = .023, and P < .002 for the right lobe and P < .001, P = .023, and P < .002 for the left lobe). Hepatic lobar function significantly differs between the two lobes, depending on the extent of biliary drainage and the presence of portal vein embolization.

Thyroid scintigraphy findings in 2096 cats with hyperthyroidism.

PubMed

Peterson, Mark E; Broome, Michael R

2015-01-01

Thyroid scintigraphy is currently the reference standard for diagnosing and staging cats with hyperthyroidism, but few studies describing the scintigraphic characteristics in a large number of cats have been reported. The objective of this study was to better characterize thyroid scintigraphy findings by evaluating 2096 consecutive cats with hyperthyroidism that were referred over a 3.5-year period. Of these cats, 2068 (98.7%) had a high thyroid-to-salivary ratio (>1.5), whereas 2014 (96.1%) were found to have a high thyroid-to-background ratio (>6.1). When the patterns of the cats' thyroid disease were recorded, 665 (31.7%) had unilateral disease, 1060 (50.6%) had bilateral-asymmetric disease (two thyroid lobes unequal in size), 257 (12.3%) had bilateral-symmetric disease (both lobes similar in size), and 81 (3.9%) had multifocal disease (≥3 areas of increased radionuclide uptake). The number of areas of (99m) TcO(-) 4 uptake in the 2096 cats ranged from 1 to 6 (median, 2), located in the cervical area in 2057 (98.1%), thoracic inlet in 282 (13.5%), and in the thoracic cavity in 115 (5.5%). Ectopic thyroid tissue (e.g. lingual or mediastinal) was diagnosed in 81 (3.9%) cats, whereas thyroid carcinoma was suspected in 35 (1.7%) of the cats. The results of this study support conclusions that most hyperthyroid cats have unilateral or bilateral thyroid nodules, but that multifocal disease will develop in a few cats that have ectopic thyroid disease or thyroid carcinoma. Both ectopic thyroid disease and thyroid carcinoma are relatively uncommon in hyperthyroid cats, with a respective prevalence of ∼4% and ∼2% in this study. © 2014 American College of Veterinary Radiology.

Thyroid-stimulating hormone and adverse left ventricular remodeling following ST-segment elevation myocardial infarction.

PubMed

Reindl, Martin; Feistritzer, Hans-Josef; Reinstadler, Sebastian Johannes; Mueller, Lukas; Tiller, Christina; Brenner, Christoph; Mayr, Agnes; Henninger, Benjamin; Mair, Johannes; Klug, Gert; Metzler, Bernhard

2018-04-01

Adverse left ventricular remodeling is one of the major determinants of heart failure and mortality in patients surviving ST-segment elevation myocardial infarction (STEMI). The hypothalamic-pituitary-thyroid axis is a key cardiovascular regulator; however, the relationship between hypothalamic-pituitary-thyroid status and post-STEMI left ventricular remodeling is unclear. We aimed to investigate the association between thyroid-stimulating hormone concentrations and the development of left ventricular remodeling following reperfused STEMI. In this prospective observational study of 102 consecutive STEMI patients, thyroid-stimulating hormone levels were measured at the first day after infarction and 4 months thereafter. Cardiac magnetic resonance scans were performed within the first week as well as at 4 months follow-up to determine infarct characteristics, myocardial function and as primary endpoint left ventricular remodeling, defined as a 20% or greater increase in left ventricular end-diastolic volume. Patients with left ventricular remodeling ( n=15, 15%) showed significantly lower concentrations of baseline (1.20 [0.92-1.91] vs. 1.73 [1.30-2.60] mU/l; P=0.02) and follow-up (1.11 [0.86-1.28] vs. 1.51 [1.15-2.02] mU/l; P=0.002) thyroid-stimulating hormone. The association between baseline thyroid-stimulating hormone and left ventricular remodeling remained significant after adjustment for major clinical (peak high-sensitivity cardiac troponin T and C-reactive protein, heart rate; odds ratio (OR) 5.33, 95% confidence interval (CI) 1.52-18.63; P=0.01) and cardiac magnetic resonance predictors of left ventricular remodeling (infarct size, microvascular obstruction, ejection fraction; OR 4.59, 95% CI 1.36-15.55; P=0.01). Furthermore, chronic thyroid-stimulating hormone was related to left ventricular remodeling independently of chronic left ventricular remodeling correlates (infarct size, ejection fraction, left ventricular end-diastolic volume, left ventricular end-systolic volume; OR 9.22, 95% CI 1.69-50.22; P=0.01). Baseline and chronic thyroid-stimulating hormone concentrations following STEMI were independently associated with left ventricular remodeling, proposing a novel pathophysiological axis in the development of post-STEMI left ventricular remodeling.

Ga-67 positivity in sarcoidosis of the skin with coincident thyroid uptake of uncertain etiology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moreno, A.J.; Brown, J.M.; Salinas, J.A.

1984-03-01

Gallium-67 citrate scintigraphy of a 26-year-old woman with systemic sarcoidosis demonstrated abnormal radiotracer uptake within multiple biopsy-proven sarcoidal cutaneous lesions and within both lobes of the thyroid gland. The etiology of the thyroidal uptake of the Ga-67 was uncertain but it may represent sarcoidal involvement of the gland.

Selected Case From the Arkadi M. Rywlin International Pathology Slide Seminar: Benign Warthin Tumor of the Thyroid.

PubMed

Peckova, Kvetoslava; Daum, Ondrej; Michal, Michael; Curcikova, Radmila; Michal, Michal

2016-09-01

We report on an exceedingly rare lesion of the thyroid probably of a branchial cleft origin, which was not published in the world literature before. A 58-year-old woman underwent a total thyroidectomy for bilateral goiter. Grossly, there was one yellowish nodule sized 15 mm in the largest dimension found in the right lobe. Microscopically, the thyroid parenchyma showed signs of Hashimoto thyroiditis. The nodule in the right lobe was composed of a part of solid cell nests appearance, another part resembling a branchial cleft cyst, and a part resembling Warthin tumor. This lesion may belong to the histogenetically similar group of entities in the head and neck region which are derived from branchial cleft derivatives and which, under the inflammatory influence, have the ability to a cystic dilatation and proliferation of the epithelial component. The epithelium can afterwards become papillary and may undergo oncocytic transformation, thus gaining features that impart the resemblance of a Warthin tumor. Club members generally agreed with a submitted diagnosis of benign Warthin tumor of the thyroid.

Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma.

PubMed

Mourad, Moustafa; Saman, Masoud; Sawhney, Raja; Ducic, Yadranko

2015-08-01

The goal of the study was to determine the role of routine total thyroidectomy and hemithyroidectomy in patients undergoing total laryngectomy for laryngeal squamous cell carcinoma. The study group consisted of 343 patients who underwent total laryngectomy (98 treated with surgery alone, 136 treated following radiation failure, and 109 following chemoradiation failure). Total thyroidectomy was performed in all obstructing and bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. In all, 262 patients underwent total thyroidectomy during total laryngectomy, six of which demonstrated squamous cell carcinoma evident within the thyroid gland (4 from transglottic lesions, 2 from subglottic lesions). Hemithyroidectomy was performed in 81 patients, with only one patient demonstrating evidence of squamous cell carcinoma within the thyroid gland. Hypothyroidism was observed in 88% (n = 61) of patients who underwent thyroid lobectomy alone, requiring hormone supplementation. Routine surgical management of the thyroid gland should not be performed, except in cases of subglottic primary lesions, lesions with significant subglottic extension, or transglottic lesions. Despite efforts to preserve the contralateral thyroid lobe in cases of selective lobectomy, these patients often have a high rate of hypothyroidism, and a total thyroidectomy should be considered when involvement of the thyroid gland is suspected. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Vascular anatomy of canine hepatic venous system: a basis for liver surgery.

PubMed

Mari, L; Acocella, F

2015-06-01

Detailed knowledge of the vascular anatomy is important for improving surgical approaches to the liver. Twelve canine livers were skeletonized to describe the anatomy of their portal and hepatic veins in details. Our data suggest that the liver can be divided into two sections, three divisions, seven lobes and two to four sub-lobes. This differs from the classic division into four lobes, four sub-lobes and two processes. The right section was perfused by the right portal branch and drained by independent hepatic veins, while most of the left section, perfused by the left portal branch, was drained by the main hepatic vein deriving from the middle and the left hepatic vein confluence. Part of the right medial lobe, and in some cases the papillary process of the caudate lobe, drained directly into the caudal vena cava. A proper right hepatic vein draining blood from more than one lobe was never observed. Portal connections between the quadrate and the left medial lobe were frequently recorded. Two sub-lobes with different portal blood supply and venous drainage could be identified in the right lateral (33.3% of cases) and the left lateral (100% of cases) lobes. From our results, the classic nomenclature of the liver lobes does not reflect their vascularization. Based on similarities between canine lobes and human segments, a new nomenclature is possible and may be less confounding in surgical settings. © 2014 Blackwell Verlag GmbH.

Proportion of various types of thyroid disorders among newborns with congenital hypothyroidism and normally located gland: a regional cohort study.

PubMed

Gaudino, Rossella; Garel, Catherine; Czernichow, Paul; Léger, Juliane

2005-04-01

To determine the proportion of the various types of thyroid disorders among newborns detected by the neonatal TSH screening programme, with a normally located thyroid gland. Patients and methods Of the 882 575 infants screened in our centre between 1981 and 2002, 85 infants with a normally located gland had persistent elevation of serum TSH values (an incidence of 1/10 383). Six of these 85 patients were lost to follow-up and were therefore excluded from the study. During follow-up, patients were classified as having permanent or transient hypothyroidism. Among the 79 patients included in the study, transient (n = 30, 38% of cases) and permanent (n = 49, 62% of cases) congenital hypothyroidism (CH) was demonstrated during the follow-up at the age of 0.7 +/- 0.6 years and 2.6 +/- 1.8 years (P < 0.0001), respectively. The proportion of premature births was significantly higher in the group with transient CH (57%) than in the group with permanent CH (2%) (P < 0.0001). A history of iatrogenic iodine overload was identified during the neonatal period in 69% of transient cases. Among permanent CH cases (n = 49), patients were classified as having a goitre (n = 27, 55% of cases), a normal sized and shaped thyroid gland (n = 14, 29% of cases) or a hypoplastic gland (n = 8, 16% of cases). The latter patients demonstrated global thyroid hypoplasia (n = 3), a right hemithyroid (n = 2), hypoplasia of the left lobe (n = 2), or asymmetry in the location of the two lobes (n = 1). Patients with a normal sized and shaped thyroid gland showed a significantly less severe form of hypothyroidism than those with a goitre or a hypoplastic thyroid gland (P < 0.0002). Among permanent CH cases, those with a goitre (n = 27) had an iodine organification defect (n = 10), Pendred syndrome (n = 1), a defect of thyroglobulin synthesis (n = 8), or a defect of sodium iodine symporter (n = 1), and in seven patients no aetiology could be determined. Among permanent cases with a normal sized and shaped thyroid gland (n = 14), a specific aetiology was found in only one patient (pseudohypoparathyroidism) and two patients had Down's syndrome. Among those with a globally hypoplastic gland, a TSH receptor gene mutation was found in two patients. A precise description of the phenotype can enhance our understanding of various forms of neonatal hypothyroidism as well as their prevalence and management. It also helps to identify cases of congenital hypothyroidism of unknown aetiology, which will need to be investigated in collaboration with molecular biologists.

Using Acoustic Structure Quantification During B-Mode Sonography for Evaluation of Hashimoto Thyroiditis.

PubMed

Rhee, Sun Jung; Hong, Hyun Sook; Kim, Chul-Hee; Lee, Eun Hye; Cha, Jang Gyu; Jeong, Sun Hye

2015-12-01

This study aimed to evaluate the usefulness of Acoustic Structure Quantification (ASQ; Toshiba Medical Systems Corporation, Nasushiobara, Japan) values in the diagnosis of Hashimoto thyroiditis using B-mode sonography and to identify a cutoff ASQ level that differentiates Hashimoto thyroiditis from normal thyroid tissue. A total of 186 thyroid lobes with Hashimoto thyroiditis and normal thyroid glands underwent sonography with ASQ imaging. The quantitative results were reported in an echo amplitude analysis (Cm(2)) histogram with average, mode, ratio, standard deviation, blue mode, and blue average values. Receiver operating characteristic curve analysis was performed to assess the diagnostic ability of the ASQ values in differentiating Hashimoto thyroiditis from normal thyroid tissue. Intraclass correlation coefficients of the ASQ values were obtained between 2 observers. Of the 186 thyroid lobes, 103 (55%) had Hashimoto thyroiditis, and 83 (45%) were normal. There was a significant difference between the ASQ values of Hashimoto thyroiditis glands and those of normal glands (P < .001). The ASQ values in patients with Hashimoto thyroiditis were significantly greater than those in patients with normal thyroid glands. The areas under the receiver operating characteristic curves for the ratio, blue average, average, blue mode, mode, and standard deviation were: 0.936, 0.902, 0.893, 0.855, 0.846, and 0.842, respectively. The ratio cutoff value of 0.27 offered the best diagnostic performance, with sensitivity of 87.38% and specificity of 95.18%. The intraclass correlation coefficients ranged from 0.86 to 0.94, which indicated substantial agreement between the observers. Acoustic Structure Quantification is a useful and promising sonographic method for diagnosing Hashimoto thyroiditis. Not only could it be a helpful tool for quantifying thyroid echogenicity, but it also would be useful for diagnosis of Hashimoto thyroiditis. © 2015 by the American Institute of Ultrasound in Medicine.

The cognitive profile of occipital lobe epilepsy and the selective association of left temporal lobe hypometabolism with verbal memory impairment.

PubMed

Knopman, Alex A; Wong, Chong H; Stevenson, Richard J; Homewood, Judi; Mohamed, Armin; Somerville, Ernest; Eberl, Stefan; Wen, Lingfeng; Fulham, Michael; Bleasel, Andrew F

2014-08-01

We investigated the cognitive profile of structural occipital lobe epilepsy (OLE) and whether verbal memory impairment is selectively associated with left temporal lobe hypometabolism on [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET). Nine patients with OLE, ages 8-29 years, completed presurgical neuropsychological assessment. Composite measures were calculated for intelligence quotient (IQ), speed, attention, verbal memory, nonverbal memory, and executive functioning. In addition, the Wisconsin Card Sorting Test (WCST) was used as a specific measure of frontal lobe functioning. Presurgical FDG-PET was analyzed with statistical parametric mapping in 8 patients relative to 16 healthy volunteers. Mild impairments were evident for IQ, speed, attention, and executive functioning. Four patients demonstrated moderate or severe verbal memory impairment. Temporal lobe hypometabolism was found in seven of eight patients. Poorer verbal memory was associated with left temporal lobe hypometabolism (p = 0.002), which was stronger (p = 0.03 and p = 0.005, respectively) than the association of left temporal lobe hypometabolism with executive functioning or with performance on the WCST. OLE is associated with widespread cognitive comorbidity, suggesting cortical dysfunction beyond the occipital lobe. Verbal memory impairment is selectively associated with left temporal lobe hypometabolism in OLE, supporting a link between neuropsychological dysfunction and remote hypometabolism in focal epilepsy. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

Decreased expression of thyroid receptor-associated protein 220 in temporal lobe tissue of patients with refractory epilepsy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li Jinmei; Wang Xuefeng; Xi Zhiqin

2006-10-06

Purpose: TRAP220 (thyroid hormone receptor-associated protein) functions as a coactivator for nuclear receptors and stimulates transcription by recruiting the TRAP mediator complex to hormone responsive promoter regions. Thus, TRAP220 enhances the function of thyroid/steroid hormone receptors such as thyroid hormone and oestrogen receptors. This study investigated the expression of TRAP220 mRNA and protein level in epileptic brains comparing with human control. Methods: We examined the expression of TRAP220 mRNA and protein levels in temporal lobes from patients with chronic pharmacoresistant epilepsy who have undergone surgery. Results: Expression of TRAP220 mRNA and protein was shown to be decreased significantly in themore » temporal cortex of the patients with epilepsy. Conclusions: Our work showed that a decrease in TRAP220 mRNA and protein levels may be involved in the pathophysiology of epilepsy and may be associated with impairment of the brain caused by frequent seizures.« less

Differentiated thyroid cancer: A retrospective evaluation of the impact of changes to disease management guidelines on patients in South East Scotland.

PubMed

Williamson, A G; Wilmot, V; Ntala, C; Gibb, F W; Conn, B; Nixon, I J

2018-06-05

The British Thyroid Association (BTA) updated guidelines for the management of differentiated thyroid cancer (DTC) in 2014. A key update was that patients with unifocal disease >10-≤40 mm in diameter, aged <45 years and with no other risk factors could be considered for lobectomy alone. The aim of this study was to retrospectively evaluate the potential impact of these changes on the management of DTC in South East Scotland, and to analyse the characteristics of lobes now potentially considered for observation rather than resection. Consecutive patients were identified through prospectively held regional MDT minutes from 2009 to 13. Data included age, pT, pN, M stage, tumour size, vascular invasion and extra-thyroidal extension. From a cohort of 281 patients, 22 (8%) could now be considered for lobectomy alone. Of these, 4 had disease in the contralateral lobe (18%), all of which were low-risk tumours with no influence on recommendation for radioactive remnant ablation (RRA). Analysis of all patients, regardless of age, with pT1-2N0M0 disease (n = 50) revealed 11 (22%) had contralateral disease. The presence of index multifocal disease was predictive of disease in the contralateral lobe. One patient (2%) had a finding in the contralateral lobe which may potentially influence the recommendation for RRA. In no cases did findings in the contralateral lobe elevate a patient to a group where RRA was routinely recommended by BTA guidelines. The updated BTA guidelines are likely to affect only 8% of our cohort. Further analysis questions the role of age in excluding patients from a conservative approach. Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Preserving lung after traumatic transection of left lower lobe bronchus from bullet injury.

PubMed

Hanif, Muhammad Shoaib; Mishwani, A H; Oparka, J; Buchan, K

2015-06-01

A 22-year-old soldier was shot in the left chest by a bullet from close range. He was found to have a left haemothorax and remained shocked despite aggressive resuscitation. Due to difficult terrain and night time movement restrictions, there were limitations to the transfer of patient. So he was attended at a peripheral hospital. At emergency thoracotomy, three segmental arteries to left upper lobe were ligated and haemostasis was secured. The level of transection of left lower lobe bronchus was identified to be below the origin of the apical segmental bronchus. The lower lobe bronchus was successfully re-attached and followed up with a daily bronchoscopic clearance of distal airway. The patient made a full recovery. Anastomosis of left lower lobe bronchus after traumatic transection is a viable option for preserving an amputated lobe, in trauma settings, provided haemostatic control has been adequately achieved. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver.

PubMed

Toshima, Takeo; Shirabe, Ken; Takeishi, Kazuki; Motomura, Takashi; Mano, Youhei; Uchiyama, Hideaki; Yoshizumi, Tomoharu; Soejima, Yuji; Taketomi, Akinobu; Maehara, Yoshihiko

2011-05-01

Virtual touch tissue quantification (VTTQ) based on acoustic radiation force impulse (ARFI) imaging has been developed as a noninvasive bedside method for the assessment of liver stiffness. In this study, we examined the diagnostic performance of ARFI imaging in 103 patients, focusing on the difference in VTTQ values between the right and left liver lobes. We evaluated VTTQ values of the right and left lobes in 79 patients with chronic liver disease who underwent histological examination of liver fibrosis and in 24 healthy volunteers. The diagnostic accuracy of VTTQ was compared with several serum markers, including hyaluronic acid, type 4 collagen, and aspartate transaminase to platelet ratio index. The VTTQ values (meters per second) in the right and left lobes were 1.61 ± 0.51 and 1.90 ± 0.68, respectively, and the difference was statistically significant (P < 0.0001). The VTTQ values in both liver lobes were correlated significantly with histological fibrosis grades (P < 0.001). The standard deviations of the VTTQ values in the right lobe were significantly lower than those in the left lobe (P < 0.001). The area under the receiver-operating characteristic curve for the diagnosis of fibrosis (F ≥ 3) using VTTQ values in both liver lobes was superior to serum markers, especially in the right lobe. VTTQ is an accurate and reliable tool for the assessment of liver fibrosis. VTTQ of the right lobe was more accurate for diagnosing liver fibrosis than in the left lobe.

Spontaneous brain activity in chronic smokers revealed by fractional amplitude of low frequency fluctuation analysis: a resting state functional magnetic resonance imaging study.

PubMed

Chu, Shuilian; Xiao, Dan; Wang, Shuangkun; Peng, Peng; Xie, Teng; He, Yong; Wang, Chen

2014-01-01

Nicotine is primarily rsponsible for the highly addictive properties of cigarettes. Similar to other substances, nicotine dependence is related to many important brain regions, particular in mesolimbic reward circuit. This study was to further reveal the alteration of brain function activity during resting state in chronic smokers by fractional amplitude of low frequency fluctuation (fALFF) based on functional magnetic resonance imaging (fMRI), in order to provide the evidence of neurobiological mechanism of smoking. This case control study involved twenty healthy smokers and nineteen healthy nonsmokers recruited by advertisement. Sociodemographic, smoking related characteristics and fMRI images were collected and the data analyzed. Compared with nonsmokers, smokers showed fALFF increased significantly in the left middle occipital gyrus, left limbic lobe and left cerebellum posterior lobe but decreases in the right middle frontal gyrus, right superior temporal gyrus, right extra nuclear, left postcentral gyrus and left cerebellum anterior lobe (cluster size >100 voxels). Compared with light smokers (pack years ≤ 20), heavy smokers (pack years >20) showed fALFF increased significantly in the right superior temporal gyrus, right precentral gyrus, and right occipital lobe/cuneus but decreased in the right/left limbic lobe/cingulate gyrus, right/left frontal lobe/sub gyral, right/left cerebellum posterior lobe (cluster size >50 voxels). Compared with nonsevere nicotine dependent smokers (Fagerstrőm test for nicotine dependence, score ≤ 6), severe nicotine dependent smokers (score >6) showed fALFF increased significantly in the right/left middle frontal gyrus, right superior frontal gyrus and left inferior parietal lobule but decreased in the left limbic lobe/cingulate gyrus (cluster size >25 voxels). In smokers during rest, the activity of addiction related regions were increased and the activity of smoking feeling, memory, related regions were also changed. The resting state activity changes in many regions were associated with the cumulative amount of nicotine intake and the severity of nicotine dependence.

Clinicopathologic risk factors for right paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma.

PubMed

Yu, Q A; Ma, D K; Liu, K P; Wang, P; Xie, C M; Wu, Y H; Dai, W J; Jiang, H C

2018-03-17

To investigate risk factors associated with right paraesophageal lymph node (RPELN) metastasis in patients with papillary thyroid carcinoma (PTC) and to determine the indications for right lymph node dissection. Clinicopathologic data from 829 patients (104 men and 725 women) with PTC, operated on by the same thyroid surgery team at the First Affiliated Hospital of Harbin Medical University from January 2013 to May 2017, were analyzed. Overall, 309 patients underwent total thyroidectomy with bilateral lymph node dissection, 488 underwent right thyroid lobe and isthmic resection with right central compartment lymph node dissection, and 32 underwent near-total thyroidectomy (ipsilateral thyroid lobectomy with contralateral near-total lobectomy) with bilateral lymph node dissection. The overall rate of central compartment lymph node metastasis was 43.5% (361/829), with right central compartment lymph node and RPELN metastasis rates of 35.5% (294/829) and 19.1% (158/829), respectively. Tumor size, number, invasion, and location, lymph node metastasis, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis were associated with RPELN in the univariate analysis, whereas age and sex were not. Multivariate analysis identified tumors with a diameter ≥ 1 cm, multiple tumors, tumors located in the right lobe, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis as independent risk factors for RPELN metastasis. Lymph node dissection, including RPELN dissection, should be performed for patients with PTC with a tumor diameter ≥ 1 cm, multiple tumors, right-lobe tumors, right central compartment lymph node metastasis, or suspected lateral compartment lymph node metastasis.

Acoustic Radiation Force Impulse Quantification in the Evaluation of Thyroid Elasticity in Pediatric Patients With Hashimoto Thyroiditis.

PubMed

Yucel, Serap; Ceyhan Bilgici, Meltem; Kara, Cengiz; Can Yilmaz, Gulay; Aydin, H Murat; Elmali, Muzaffer; Tomak, Leman; Saglam, Dilek

2018-05-01

To evaluate the parenchymal elasticity of the thyroid gland with acoustic radiation force impulse imaging in pediatric patients with Hashimoto thyroiditis and to compare it with healthy volunteers. Twenty-six patients with Hashimoto thyroiditis and 26 healthy volunteers between 6 and 17 years were included. The shear wave velocity (SWV) values of both thyroid lobes in both groups were evaluated. The age and sex characteristics of the controls and patients with Hashimoto thyroiditis were similar. The SWV of the thyroid gland in patients with Hashimoto thyroiditis (mean ± SD, 1.67 ± 0.63 m/s) was significantly higher than that in the control group (1.30 ± 0.13 m/s; P < .001). There was no significant difference between the thyroid lobes in both groups. A receiver operating characteristic curve analyses showed an optimal cutoff value of 1.41 m/s, with 73.1% sensitivity, 80.8% specificity, a 79.2 % positive predictive value, and a 75.0% negative predictive value (area under the curve, 0.806; P < .001). In patients with Hashimoto thyroiditis, there was a positive correlation between the SWV values versus anti-thyroperoxidase (Pearson r = 0.46; P = .038). There were no correlations between age, body mass index, thyroid function test results, and anti-thyroglobulin values and versus SWV values. Also, no significant differences were seen between the groups for gland size, gland vascularity, and l-thyroxine treatment. Acoustic radiation force impulse elastography showed a significant difference in the stiffness of the thyroid gland between children with Hashimoto thyroiditis and the healthy group. Using acoustic radiation force impulse elastography immediately after a standard ultrasound evaluation may predict chronic autoimmune thyroiditis. © 2017 by the American Institute of Ultrasound in Medicine.

Effect of Thyroid Remnant Volume on the Risk of Hypothyroidism After Hemithyroidectomy: A Prospective Study.

PubMed

Lang, Brian Hung-Hin; Wong, Carlos K H; Wong, Kai Pun; Chu, Kelvin Ka-Wan; Shek, Tony W H

2017-06-01

Hypothyroidism is a common sequel after a hemithyroidectomy. Although various risk factors leading to hypothyroidism have been reported, the effect of the contralateral lobe's volume has been understudied. This study aimed to examine the association between the preoperative contralateral lobe's volume and the risk of postoperative hypothyroidism. During a 2-year period, 150 eligible patients undergoing a hemithyroidectomy were evaluated. The volume of the contralateral nonexcised lobe was estimated preoperatively by independent assessors on ultrasonography using the following formula: width (in cm) × depth (in cm) × length (in cm) × (π/6), adjusted for the body surface area (BSA). Postoperative hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) exceeding 4.78 mIU/L. Any significant characteristics in the univariate analysis were entered into the multivariate analysis to determine independent factors. After a mean follow-up period of 53.5 ± 9.4 months, 44 patients (29.3 %) experienced postoperative hypothyroidism, and 10 of these patients required thyroxine replacement. Hypothyroidism was associated with a higher preoperative TSH level (p < 0.001), a smaller BSA-adjusted volume (p < 0.001), fewer ipsilateral nodules (p = 0.037), and the presence of thyroiditis (p = 0.050). After adjustment for thyroiditis, preoperative TSH (p < 0.001), number of ipsilateral nodules (p = 0.048), and BSA-adjusted volume (p < 0.001) were independent factors for hypothyroidism. Patients with a BSA-adjusted volume smaller than 3.2 ml had a threefold greater hypothyroidism risk than those with a BSA-adjusted volume of 3.2 ml or more (p < 0.001). A significant inverse association between the preoperative contralateral lobe's volume and hypothyroidism risk was observed after hemithyroidectomy. Together with a higher preoperative TSH level and fewer ipsilateral nodules, a smaller BSA-adjusted volume measured by preoperative ultrasonography independently predicted hypothyroidism.

Shear wave elastography diagnosis of the diffuse sclerosing variant of papillary thyroid carcinoma: A case report.

PubMed

Xue, Nianyu; Xu, Youfeng; Huang, Pintong; Zhang, Shengmin; Wang, Hongwei; Yu, Fei

2016-08-01

The present study aimed to report the shear wave elastography (SWE) findings in a patient with the diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Since patients with DSVPTC may present with typical clinicopathological features and initially appear to have Hashimoto's thyroiditis, a thorough clinical evaluation and an early diagnosis are important. A 20-year-old female patient presented with a 1-month history of a neck mass and sore throat. Conventional ultrasound and SWE were performed using an AIXPLORER system with 14-5 MHz linear transducer. The patient had undergone total thyroidectomy and bilateral neck lymph node dissection, and an intraoperative pathology consultation to confirm the malignancy of lymph node metastasis. Pathological diagnosis was DSVPTC in both lobes, with lymph node metastases in the bilateral neck. The clinical presentation and serological findings were all indicative of Hashimoto's thyroiditis. Thyroid ultrasonography revealed diffuse enlargement of the both lobes, heterogenous echogenicity without mass formation, diffuse scattered microcalcifications and poor vascularization. SWE revealed stiff values of the thyroid: The mean stiffness was 99.7 kpa, the minimum stiffness was 59.1 kpa and the maximum stiffness was 180.1 kpa. The maximum stiffness of the DSVPTC (180.1 kpa) was higher compared with the diagnostic criteria of malignant thyroid nodules (65 kPa). SWE may be considered as a novel and valuable method to diagnose DSVPC.

Shear wave elastography diagnosis of the diffuse sclerosing variant of papillary thyroid carcinoma: A case report

PubMed Central

Xue, Nianyu; Xu, Youfeng; Huang, Pintong; Zhang, Shengmin; Wang, Hongwei; Yu, Fei

2016-01-01

The present study aimed to report the shear wave elastography (SWE) findings in a patient with the diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Since patients with DSVPTC may present with typical clinicopathological features and initially appear to have Hashimoto's thyroiditis, a thorough clinical evaluation and an early diagnosis are important. A 20-year-old female patient presented with a 1-month history of a neck mass and sore throat. Conventional ultrasound and SWE were performed using an AIXPLORER system with 14-5 MHz linear transducer. The patient had undergone total thyroidectomy and bilateral neck lymph node dissection, and an intraoperative pathology consultation to confirm the malignancy of lymph node metastasis. Pathological diagnosis was DSVPTC in both lobes, with lymph node metastases in the bilateral neck. The clinical presentation and serological findings were all indicative of Hashimoto's thyroiditis. Thyroid ultrasonography revealed diffuse enlargement of the both lobes, heterogenous echogenicity without mass formation, diffuse scattered microcalcifications and poor vascularization. SWE revealed stiff values of the thyroid: The mean stiffness was 99.7 kpa, the minimum stiffness was 59.1 kpa and the maximum stiffness was 180.1 kpa. The maximum stiffness of the DSVPTC (180.1 kpa) was higher compared with the diagnostic criteria of malignant thyroid nodules (65 kPa). SWE may be considered as a novel and valuable method to diagnose DSVPC. PMID:27446574

Hyperfunctioning thyroid nodules in children.

PubMed

Abe, K; Konno, M; Sato, T; Matsuura, N

1980-10-01

We studied two cases of hyperfunctioning thyroid nodules in children. A 9-year-old girl and an 11-year-old girl had thyroid masses in otherwise nonpalpable thyroid glands. Scintiscan showed hyperfunctioning thyroid nodules. The former patient had elevated values for T4 and T3, and plasma thyrotropin (TSH) level failed to respond to stimulation with thyrotropin releasing hormone (TRH), whereas the latter patient had normal values for T4, and T3 and plasma TSH response to TRH was normal. After the surgical removal of nodules, scintiscan exhibited radioactivity in the contralateral lobe of the thyroid gland in the former and in the ectopic thyroid tissue in the latter. Results of microscopic examinations of thyroid nodules were consistent with adenomatous goiter.

Primary hyperparathyroidism as the first clinical manifestation of multiple endocrine neoplasia type 2A in a 5-year-old child.

PubMed

Magalhães, Patrícia Künzle Ribeiro; Antonini, Sonir Roberto Rauber; de Paula, Francisco José Albuquerque; de Freitas, Luiz Carlos Conti; Maciel, Léa Maria Zanini

2011-05-01

Primary hyperparathyroidism occurs in only 10%-30% of patients with multiple endocrine neoplasia type 2A (MEN2A), rarely as the sole clinical manifestation, and is usually diagnosed after the third decade of life. A 5-year-old girl was referred for prophylactic thyroidectomy as she carried the p.C634R RET mutation. She was clinically asymptomatic, with a normally palpable thyroid and with the cervical region free of lymphadenopathy or other nodules. Preoperative tests revealed hypercalcemia associated with elevation of parathyroid hormone (PTH) (calcium = 11.2 mg/dL, calcium ion = 1.48 mmol/L, phosphorus = 4.0 mg/dL, alkaline phosphatase = 625 U/L, parathyroid hormone (PTH) PTH = 998 pg/mL). A thyroid ultrasound was normal and parathyroid scintigraphy with (99m)Tc-Sestamibi revealed an area of radioconcentration in the upper half of the left thyroid lobe suggesting hyperfunctioning parathyroid tissue. She underwent total thyroidectomy and parathyroidectomy and developed hypocalcemia. The anatomopathological examination showed no histopathological changes in the thyroid tissue and an adenoma of the parathyroid gland, confirming the diagnosis of hyperparathyroidism. Primary hyperparathyroidism can be a precocious manifestation of MEN2A. This case report highlights that asymptomatic hypercalcemia should be scrutinized in children related to patients with MEN2A who carry a mutation in the RET proto-oncogene, especially mutations in the codon 634, before the currently recommended age of 8 years.

Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MR images in young adults.

PubMed

Jack, C R; Twomey, C K; Zinsmeister, A R; Sharbrough, F W; Petersen, R C; Cascino, G D

1989-08-01

Volumes of the right and left anterior temporal lobes and hippocampal formations were measured from magnetic resonance images in 52 healthy volunteers, aged 20-40 years. Subjects were selected by age, sex, and handedness to evaluate possible effect of these variables. Data were normalized for variation in total intracranial volume between individuals. Right-left asymmetry in the volumes of the anterior temporal lobes and hippocampal formations was a normal finding. The anterior temporal lobe of the non-dominant (right) hemisphere was larger than the left by a small (mean right-left difference, 2.3 cm3) but statistically significant amount (P less than .005) in right-handed subjects. No significant effect of age or sex was seen in normalized right or left anterior temporal lobe volume. The right hippocampal formation was larger than the left for all subjects by a small (mean right-left difference, 0.3 cm3) but statistically significant amount (P less than .001). No effect of age, sex, or handedness was seen in normalized hippocampal formation volumes.

Temporal order processing of syllables in the left parietal lobe.

PubMed

Moser, Dana; Baker, Julie M; Sanchez, Carmen E; Rorden, Chris; Fridriksson, Julius

2009-10-07

Speech processing requires the temporal parsing of syllable order. Individuals suffering from posterior left hemisphere brain injury often exhibit temporal processing deficits as well as language deficits. Although the right posterior inferior parietal lobe has been implicated in temporal order judgments (TOJs) of visual information, there is limited evidence to support the role of the left inferior parietal lobe (IPL) in processing syllable order. The purpose of this study was to examine whether the left inferior parietal lobe is recruited during temporal order judgments of speech stimuli. Functional magnetic resonance imaging data were collected on 14 normal participants while they completed the following forced-choice tasks: (1) syllable order of multisyllabic pseudowords, (2) syllable identification of single syllables, and (3) gender identification of both multisyllabic and monosyllabic speech stimuli. Results revealed increased neural recruitment in the left inferior parietal lobe when participants made judgments about syllable order compared with both syllable identification and gender identification. These findings suggest that the left inferior parietal lobe plays an important role in processing syllable order and support the hypothesized role of this region as an interface between auditory speech and the articulatory code. Furthermore, a breakdown in this interface may explain some components of the speech deficits observed after posterior damage to the left hemisphere.

Temporal Order Processing of Syllables in the Left Parietal Lobe

PubMed Central

Baker, Julie M.; Sanchez, Carmen E.; Rorden, Chris; Fridriksson, Julius

2009-01-01

Speech processing requires the temporal parsing of syllable order. Individuals suffering from posterior left hemisphere brain injury often exhibit temporal processing deficits as well as language deficits. Although the right posterior inferior parietal lobe has been implicated in temporal order judgments (TOJs) of visual information, there is limited evidence to support the role of the left inferior parietal lobe (IPL) in processing syllable order. The purpose of this study was to examine whether the left inferior parietal lobe is recruited during temporal order judgments of speech stimuli. Functional magnetic resonance imaging data were collected on 14 normal participants while they completed the following forced-choice tasks: (1) syllable order of multisyllabic pseudowords, (2) syllable identification of single syllables, and (3) gender identification of both multisyllabic and monosyllabic speech stimuli. Results revealed increased neural recruitment in the left inferior parietal lobe when participants made judgments about syllable order compared with both syllable identification and gender identification. These findings suggest that the left inferior parietal lobe plays an important role in processing syllable order and support the hypothesized role of this region as an interface between auditory speech and the articulatory code. Furthermore, a breakdown in this interface may explain some components of the speech deficits observed after posterior damage to the left hemisphere. PMID:19812331

Lung cancer diagnosis on ovary mass: a case report

PubMed Central

2013-01-01

Metastatic neoplasms to the ovary often cause diagnostic problems, in particular those large ovarian masses mimicking primary tumors. Most of these tumors arise from digestive system or breast, while 37-year-old woman diagnosed as right adnexal complex mass, with a subpleural nodule in the apical part of the left lower lobe, at preoperative chest computed tomography scan. The patient underwent total abdominal hysterectomy with right salpingo-oophorectomy (ovarian mass 220 × 200 mm), total omentectomy, left ovarian biopsy, peritoneal random biopsies, and peritoneal washings for cytology. Pathologic and immunohistochemical examination of ovarian specimen suggested morphology and expression of metastatic lung adenocarcinoma with an intense positivity for Thyroid Transcriptional Factor-1 (TTF-1) and Cytokeratin 7 (CK7) staining. Fine needle biopsy of the lung nodule found epithelioid like malignant cells, confirming the diagnosis of an ovarian metastasis from a primary lung cancer. This report focused on the clinical and pathologic diagnostic challenge of distinguishing secondary from primary ovarian neoplasms. Issues on useful immunohistochemical stains are also discussed. PMID:23663245

Bronchovascular anatomy of the upper lobes: evaluation with thin-section CT.

PubMed

Lee, K S; Bae, W K; Lee, B H; Kim, I Y; Choi, E W; Lee, B H

1991-12-01

The anatomy of the bronchovascular trees of the upper lobes was evaluated with thin-section computed tomography (CT) in 50 patients. In all patients, the subsegmental bronchi could be seen, except the right B2b, left B1 + 2c, and left B3c. Regular anatomic relationships were seen between the right A3b and B3b (A3b was seen along the medial aspect of B3b in 45 patients [90%]), right A2a and B2a (A2a was seen along the posteromedial aspect of B2a in 45 patients [90%]), and left A1 + 2c and B1 + 2c (A1 + 2c was seen along the posterior aspect of B1 + 2c in 41 patients [82%]). Four patterns of bronchial branching were seen in the left upper lobe. The lateral branch of the posterior segmental vein of the upper lobes was an anatomic landmark dividing the anterior and posterior segments of the upper lobes. Three kinds of venous drainage patterns were identified in both the right and left upper lobes.

Gene expression profile differences in left and right liver lobes from mid-gestation fetal baboons: a cautionary tale

PubMed Central

Cox, Laura A; Schlabritz-Loutsevitch, Natalia; Hubbard, Gene B; Nijland, Mark J; McDonald, Thomas J; Nathanielsz, Peter W

2006-01-01

Interpretation of gene array data presents many potential pitfalls in adult tissues. Gene array techniques applied to fetal tissues present additional confounding pitfalls. The left lobe of the fetal liver is supplied with blood containing more oxygen than the right lobe. Since synthetic activity and cell function are oxygen dependent, we hypothesized major differences in mRNA expression between the fetal right and left liver lobes. Our aim was to demonstrate the need to evaluate RNA samples from both lobes. We performed whole genome expression profiling on left and right liver lobe RNA from six 90-day gestation baboon fetuses (term 180 days). Comparing right with left, we found 875 differentially expressed genes – 312 genes were up-regulated and 563 down-regulated. Pathways for damaged DNA binding, endonuclease activity, interleukin binding and receptor activity were up-regulated in right lobe; ontological pathways related to cell signalling, cell organization, cell biogenesis, development, intracellular transport, phospholipid metabolism, protein biosynthesis, protein localization, protein metabolism, translational regulation and vesicle mediated transport were down-regulated in right lobe. Molecular pathway analysis showed down-regulation of pathways related to heat shock protein binding, ion channel and transporter activities, oxygen binding and transporter activities, translation initiation and translation regulator activities. Genes involved in amino acid biosynthesis, lipid biosynthesis and oxygen transport were also differentially expressed. This is the first demonstration of RNA differences between the two lobes of the fetal liver. The data support the argument that a complete interpretation of gene expression in the developing liver requires data from both lobes. PMID:16484296

Stressing the recurrent laryngeal nerve during thyroidectomy.

PubMed

Serpell, Jonathan W; Lee, James C; Chiu, Wing K; Edwards, Glenn

2015-12-01

In thyroidectomy, little has been reported on the differential recurrent laryngeal nerve (RLN) palsy rates between the left and right sides. Even less is known about the potential differences causing these differential rates. This study reports the left versus right RLN palsy rates of total thyroidectomy cases in a single institution, relating them to the comparative stiffness of the left and right porcine RLNs. Computed stress modelling was also used to estimate the differential levels of tension within each RLN. For the comparison of the left and right RLN palsy rates, 1926 cases of total thyroidectomy (between 2007 and 2013) from the Monash University Endocrine Surgery Unit were included. Stiffness of porcine RLNs was experimentally determined by measuring nerve extension against incremental increase in load. Additionally, the tension of intraoperatively stretched RLNs was estimated by computer modelling. The left RLN had a palsy rate of 0.9% (18/1926), which was significantly lower (P = 0.025) than the right RLN palsy rate of 1.8% (34/1926). The left porcine RLN was 22% stiffer than the right RLN (P = 0.004). The stress modelling estimated that at the apex of the artificial RLN genu during anteromedial rotation of the thyroid lobe, the right RLN experiences twice the tension experienced by the left RLN. The stiffer left RLN and the higher tension generated in the right RLN during thyroidectomy may jointly contribute to the higher right RLN palsy rate. © 2015 Royal Australasian College of Surgeons.

Urine iodine excretion ın patients with euthyroid noduler disease

PubMed Central

Cakir, Evrim; Eskioglu, Erdal; Aydin, Yusuf; Ozkan, Selma Karaahmetoglu; Guler, Serdar

2011-01-01

BACKGROUND AND OBJECTIVES: Different nutritional and environmental factors are responsible for the pathogenesis of goiter, but iodine deficiency is the most important factor. However, little is known about the natural course of benign thyroid nodules in euthyroid patients over time. Few studies have used ultrasonographic evaluation to address this issue, especially in iodine-deficient areas. In this study, we present the long-term follow-up of benign thyroid nodules in a iodine-deficient area. DESIGN AND SETTING: Cross-sectional study at a tertiary referral center. PATIENTS AND METHODS: This study included 62 randomly selected patients with benign euthyroid nodule. Thyroid volume and nodules were measured with sonography. Iodine intake was estimated by patient diet history and by measuring iodine excretion in spot urine samples. Patients were followed one year. RESULTS: Patients were divided into three groups according to level of urine iodine excretion: Group 1: <50μg/L (severe iodine deficiency group), Group 2: 50-100μg/L (mild iodine deficiency group), Group 3: >100 g/L (iodine sufficient group). The presence of additional disease (hypertension, diabetes mellitus, coronary heart disease, chronic renal failure and a history of any medication for chronic disorder) and smoking rates were significantly higher in first group compared to the second and third group. Among groups, no significant difference was observed in either right or left thyroid lobe volume after one year. A clinically significant increase in nodule volume was observed in the first group, while there was a significant decrease in the second and third group. CONCLUSION: In this study, iodine deficiency was associated with an increase in thyroid nodule volumes. Smoking rates were higher in iodine deficient groups. It is thought that smoking impairs iodine intake or absorption consistent with a previous report. PMID:21422654

Long-term subdural strip electrocorticographic monitoring of ictal déjà vu.

PubMed

Weinand, M E; Hermann, B; Wyler, A R; Carter, L P; Oommen, K J; Labiner, D; Ahern, G; Herring, A

1994-01-01

We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experimental phenomenon appears to lateralize to the hemisphere nondominant for handedness.

Evidence for a left-over-right inhibitory mechanism during figural creative thinking in healthy nonartists.

PubMed

Huang, Peiyu; Qiu, Lihua; Shen, Lin; Zhang, Yong; Song, Zhe; Qi, Zhiguo; Gong, Qiyong; Xie, Peng

2013-10-01

As a complex mental process, creativity requires the coordination of multiple brain regions. Previous pathological research on figural creativity has indicated that there is a mechanism by which the left side of the brain inhibits the activities of the right side of the brain during figural creative thinking, but this mechanism has not been directly demonstrated. In this study, we used functional magnetic resonance imaging (fMRI) to demonstrate the existence of this inhibitory mechanism in young adults (15 women, 11 men, mean age: 22 years) that were not artists. By making comparisons between brain activity during creative and uncreative tasks, we found increased activity in the left middle and inferior frontal lobe and strong decreases in activity in the right middle frontal lobe and the left inferior parietal lobe. As such, these data suggest that the left frontal lobe may inhibit the right hemisphere during figural creative thinking in normal people. Moreover, removal of this inhibition by practicing artistry or through specific damage to the left frontal lobe may facilitate the emergence of artistic creativity. Copyright © 2012 Wiley Periodicals, Inc.

Radioactive iodine therapy in cats with hyperthyroidism

DOE Office of Scientific and Technical Information (OSTI.GOV)

Turrel, J.M.; Feldman, E.C.; Hays, M.

Eleven cats with hyperthyroidism were treated with radioactive iodine (/sup 131/I). Previous unsuccessful treatments for hyperthyroidism included hemithyroidectomy (2 cats) and an antithyroid drug (7 cats). Two cats had no prior treatment. Thyroid scans, using technetium 99m, showed enlargement and increased radionuclide accumulation in 1 thyroid lobe in 5 cats and in both lobes in 6 cats. Serum thyroxine concentrations were high and ranged from 4.7 to 18 micrograms/dl. Radioactive iodine tracer studies were used to determine peak radioactive iodine uptake (RAIU) and effective and biological half-lives. Activity of /sup 131/I administered was calculated from peak RAIU, effective half-life, andmore » estimated thyroid gland weight. Activity of /sup 131/I administered ranged from 1.0 to 5.9 mCi. The treatment goal was to deliver 20,000 rad to hyperactive thyroid tissue. However, retrospective calculations based on peak RAIU and effective half-life obtained during the treatment period showed that radiation doses actually ranged from 7,100 to 64,900 rad. Complete ablation of the hyperfunctioning thyroid tissue and a return to euthyroidism were seen in 7 cats. Partial responses were seen in 2 cats, and 2 cats became hypothyroid. It was concluded that /sup 131/I ablation of thyroid tumors was a reasonable alternative in the treatment of hyperthyroidism in cats. The optimal method of dosimetry remains to be determined.« less

Thyroid Lobe Ablation with Radioactive Iodine as an Alternative to Completion Thyroidectomy After Hemithyroidectomy in Patients with Follicular Thyroid Carcinoma: Long-Term Follow-Up

PubMed Central

Goldfarb, Melanie; Parangi, Sareh; Yang, Jingyun; Ross, Douglas S.; Daniels, Gilbert H.

2012-01-01

Background Radioactive iodine lobe ablation (RAI-L-ABL) is a possible alternative to completion thyroidectomy (C-Tx) for follicular thyroid carcinoma (FTC), but no long-term outcome data are available after lobe ablation. We analyzed the long-term outcome of lobe ablation in a series of patients with FTC. Methods This was a retrospective study of patients who were treated with lobe ablation between 1983 and 2008. Of 134 patients with FTC, 37 (27.6%) had lobe ablation with 131I (30–32 mCi) (RAI-L-ABL), 68 (50.7%) had C-Tx, and 29 (21.6%) had initial total thyroidectomy (T-Tx). The main outcomes analyzed were 131I uptake after lobe ablation, C-Tx or T-Tx, serum thyroglobulin (Tg), serum thyroid-stimulating hormone (TSH), long-term disease-specific mortality, and disease-free survival. Results After lobe ablation, radioiodine uptake was significantly lower for the RAI-L-ABL group (0.6%) than for the C-Tx group (2.0%, p<0.005) or T-Tx group (1.3%, p=0.054). Subsequent remnant ablation was performed in 12 of 37 (32%) patients in the RAI-L-ABL group, in 58 of 68 (85.3%) patients in the C-Tx group, and in 25 of 29 (86.2%) patients in the T-Tx group (p<0.01). With median follow-up of 95 months for the RAI-L-ABL group, 47 months for the C-Tx group, and 53 months for the T-Tx group, there was one death in the RAI-L-ABL group and one death in the T-Tx group. No other RAI-L-ABL patients had detectable disease, whereas patients in the C-Tx group and two patients in the T-Tx group had detectable disease (p=0.18). Long-term stimulated or suppressed Tg of <1 ng/mL were found in 87.5% of the RAI-L-ABL group (n=28), 86.3% of the C-Tx group (n=57), and 77.8% of the T-Tx group (n=21). Tg was detectable in 40.6% of the RAI-L-ABL group compared to 13.8% of C-Tx and 28.6% of T-Tx groups (p<0.05, between groups). Conclusions RAI-L-ABL, C-Tx, and T-Tx are equally effective in achieving serum TSH concentrations of >25 mIU/L and preparing patients for conventional 131I treatment and whole body scanning with similar long-term outcomes. However, persistent measurable Tg (range 0.2–2.2 ng/mL) is more common after RAI-L-ABL. PMID:22385290

Gastric injury from (90)Y to left hepatic lobe tumors adjacent to the stomach: fact or fiction?

PubMed

Gates, Vanessa L; Hickey, Ryan; Marshall, Karen; Williams, Melissa; Salzig, Krystina; Lewandowski, Robert J; Salem, Riad

2015-12-01

Radioembolization with (90)Y microspheres is a locoregional radiation therapy for unresectable hepatic neoplasm. Non-target delivery of (90)Y microspheres resulting in gastrointestinal (GI) symptoms is a recognized complication; there is minimal knowledge regarding the radiation effect to the gastric wall from left hepatic lobe (90)Y treatments. Our aim was to study the incidence of GI complications when the target tissue (hepatic parenchyma ± tumor) is in close proximity to the gastric wall. We hypothesized that liver (tumor) to stomach proximity does not correlate with increased toxicity. Between November 2011 and September 2013, we studied all patients who underwent left lobe radioembolization with (90)Y glass microspheres. With Institutional Review Board (IRB) approval, we retrospectively reviewed MRI/CT images of these patients, identifying a subset of patients with the left hepatic lobe <1 cm from the gastric wall. Patients were seen in clinic 1 month posttreatment and subsequently at 3-month intervals. Short- and long-term gastric adverse events were tabulated. Ninety-seven patients successfully underwent left hepatic lobe (90)Y microsphere radioembolization in which the average distance from the liver to the stomach wall was 1.0 ± 2.8 mm. The average dose for patients who received radioembolization to the left hepatic lobe was 109 ± 57 Gy. Fifty patients had tumor within 1 cm of the gastric wall. The average dose for patients who received radioembolization to the left hepatic lobe with tumor within 1 cm of the gastric wall was 121 ± 41 Gy. There were no reportable or recordable medical events. Of the patients, 34% reported abdominal pain that was grade 1-2; 65% of the patients reported no abdominal pain. None of the 97 patients developed a clinically evident GI ulcer. Patients with left lobe tumors adjacent to or abutting the stomach do not exhibit acute or chronic radiation effects following radioembolization with glass microspheres.

Corrosion cast study of the canine hepatic veins.

PubMed

Uršič, M; Vrecl, M; Fazarinc, G

2014-11-01

This study presents a detailed description of the distribution, diameters and drainage patterns of hepatic veins on the basis of the corrosion cast analysis in 18 dogs. We classified the hepatic veins in three main groups: the right hepatic veins of the caudate process and right lateral liver lobe, the middle hepatic veins of the right medial and quadrate lobes and the left hepatic veins of both left liver lobes and the papillary process. The corrosion cast study showed that the number of the veins in the Nomina Anatomica Veterinaria and most anatomical textbooks is underestimated. The number of various-sized hepatic veins of the right liver division ranged from 3 to 5 and included 1 to 4 veins from the caudate process and 2 to 4 veins from the right lateral liver lobe. Generally, in all corrosion casts, one middle-sized vein from the right part of the right medial lobe, which emptied separately in the caudal vena cava, was established. The other vein was a large-sized vein from the remainder of the central division, which frequently joined the common left hepatic vein from the left liver lobes. The common left hepatic vein was the largest of all the aforementioned hepatic veins.

Partial anomalous left pulmonary artery: report of two cases and review of literature.

PubMed

Sen, Supratim; Winlaw, David S; Sholler, Gary F

2015-06-01

We describe two cases of anomalous origin of the left lower-lobe pulmonary artery from the right pulmonary artery. The primary diagnosis was mitral atresia, hypoplastic left ventricle, aortic arch hypoplasia in the first child, and tetralogy of Fallot in the second. In both cases, the pulmonary trunk gave rise to a left pulmonary artery in the normal position. In addition, a second branch of the left pulmonary artery arose from the right pulmonary artery, and passed posterior and inferior to the left main or upper-lobe bronchus to supply the left lower lobe. In this review, we compare our findings with previously reported examples of this extremely rare cardiac malformation, and discuss possible embryological explanations for the lesion.

Hyperfunctioning solid/trabecular follicular carcinoma of the thyroid gland.

PubMed

Giovanella, Luca; Fasolini, Fabrizio; Suriano, Sergio; Mazzucchelli, Luca

2010-01-01

A 68-year-old woman with solid/trabecular follicular thyroid carcinoma inside of an autonomously functioning thyroid nodule is described in this paper. The patient was referred to our clinic for swelling of the neck and an increased pulse rate. Ultrasonography showed a slightly hypoechoic nodule in the right lobe of the thyroid. Despite suppressed TSH levels, the (99m)Tc-pertechnetate scan showed a hot area corresponding to the nodule with a suppressed uptake in the remaining thyroid tissue. Histopathological examination of the nodule revealed a solid/trabecular follicular thyroid carcinoma. To the best of our knowledge, this is the first case of hyperfunctioning follicular solid/trabecular carcinoma reported in the literature. Even if a hyperfunctioning thyroid carcinoma is an extremely rare malignancy, careful management is recommended so that a malignancy will not be overlooked in the hot thyroid nodules.

[Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: description of a case].

PubMed

Cavazza, A; Toschi, E; Valcavi, R; Piana, S; Scotti, R; Carlinfante, G; Gardini, G

1999-02-01

A case of sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland is described. The patient, a 32 year-old female with Hashimoto's thyroiditis, presented with a 4 cm nodule of the right lobe of the thyroid gland. The tumour was constituted by squamoid cords infiltrating a dense fibro-jaline stroma rich in eosinophils. The patient is alive and well 14 months after surgery. The literature is briefly reviewed and the differential diagnosis is discussed. In the Author's opinion, sclerosing mucoepidermoid carcinoma with eosinophilia of the tyroid is a well defined clinicopathological entity.

Effects of electromagnetic radiation exposure on bone mineral density, thyroid, and oxidative stress index in electrical workers

PubMed Central

Kunt, Halil; Şentürk, İhsan; Gönül, Yücel; Korkmaz, Mehmet; Ahsen, Ahmet; Hazman, Ömer; Bal, Ahmet; Genç, Abdurrahman; Songur, Ahmet

2016-01-01

Background In the literature, some articles report that the incidence of numerous diseases increases among the individuals who live around high-voltage electric transmission lines (HVETL) or are exposed vocationally. However, it was not investigated whether HVETL affect bone metabolism, oxidative stress, and the prevalence of thyroid nodule. Methods Dual-energy X-ray absorptiometry (DEXA) bone density measurements, serum free triiodothyronine (FT3), free thyroxine (FT4), RANK, RANKL, osteoprotegerin (OPG), alkaline phosphatase (ALP), phosphor, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were analyzed to investigate this effect. Results Bone mineral density levels of L1–L4 vertebrae and femur were observed significantly lower in the electrical workers. ALP, phosphor, RANK, RANKL, TOS, OSI, and anteroposterior diameter of the left thyroid lobe levels were significantly higher, and OPG, TAS, and FT4 levels were detected significantly lower in the study group when compared with the control group. Conclusion Consequently, it was observed that the balance between construction and destruction in the bone metabolism of the electrical workers who were employed in HVETL replaced toward destruction and led to a decrease in OPG levels and an increase in RANK and RANKL levels. In line with the previous studies, long-term exposure to an electromagnetic field causes disorders in many organs and systems. Thus, it is considered that long-term exposure to an electromagnetic field affects bone and thyroid metabolism and also increases OSI by increasing the TOS and decreasing the antioxidant status. PMID:26929645

Research on spontaneous activity in adult anisometropic amblyopia with regional homogeneity

NASA Astrophysics Data System (ADS)

Huang, Yufeng; Zhou, Yifeng

2017-06-01

Amblyopia usually occurs in early childhood and results in monocular visual impairment. The functional magnetic resonance imaging (fMRI) studies have reflected functional anomaly in amblyopia. In resting-state fMRI study, spontaneous activity changes abnormally in anisometropic amblyopia could be revealed by the regional homogeneity (ReHo). Twenty two adult anisometropic amblyopes and Twenty one normal controls participated in this fMRI study. Two sample T test was carried out to analysis ReHo within the whole brain for the inter groups. Compare with normal group, our study found that the amblyopia’s ReHo mainly increased in the left frontal lobe, while decreased in the left cerebellum, the temporal lobe (left and right), and the left parietal lobe. And the ReHo values in middle and inferior temporal lobe, the prefrontal lobe, frontal lobe (positive) and parietal lobe and medial frontal gyrus (negative) could be correlated with the acuity deficit of amblyopia. The results increased in ReHo may indicate compensatory plasticity in higher vision information process, while the decreased in ReHo may reflect decreased ability in eye movement, spatial sense and visuo-motor coordination. The correlation revealed that the vision deficit may correspond to the spontaneous in certain brain area.

Gender differences in brain regional homogeneity of healthy subjects after normal sleep and after sleep deprivation: a resting-state fMRI study.

PubMed

Dai, Xi-Jian; Gong, Hong-Han; Wang, Yi-Xiang; Zhou, Fu-Qing; Min, You-Jiang; Zhao, Feng; Wang, Si-Yong; Liu, Bi-Xia; Xiao, Xiang-Zuo

2012-06-01

To explore the gender differences of brain regional homogeneity (ReHo) in healthy subjects during the resting-state, after normal sleep, and after sleep deprivation (SD) using functional magnetic resonance imaging (fMRI) and the ReHo method. Sixteen healthy subjects (eight males and eight females) each underwent the resting-state fMRI exams twice, i.e., once after normal sleep and again after 24h's SD. According to the gender and sleep, 16 subjects were all measured twice and divided into four groups: the male control group (MC), female control group (FC), male SD group (MSD), and female SD group (FSD). The ReHo method was used to calculate and analyze the data, SPM5 software was used to perform a two-sample T-test and a two-pair T-test with a P value <0.001, and cluster volume ≥ 270 mm(3) was used to determine statistical significance. Compared with the MC, the MSD showed significantly higher ReHo in the right paracentral lobule (BA3/6), but in no obviously lower regions. Compared with the FC, the FSD showed significantly higher ReHo in bilateral parietal lobes (BA2/3), bilateral vision-related regions of occipital lobes (BA17/18/19), right frontal lobe (BA4/6), and lower ReHo in the right frontal lobe. Compared with the FC, the MC showed significantly higher ReHo in the left occipital lobe (BA18/19), and left temporal lobe (BA21), left frontal lobe, and lower ReHo in the right insula and in the left parietal lobe. Compared with the FSD, the MSD showed significantly higher ReHo in the left cerebellum posterior lobe (uvula/declive of vermis), left parietal lobe, and bilateral frontal lobes, and lower ReHo in the right occipital lobe (BA17) and right frontal lobe (BA4). The differences of brain activity in the resting state can be widely found not only between the control and SD group in a same gender group, but also between the male group and female group. Thus, we should take the gender differences into consideration in future fMRI studies, especially the treatment of brain-related diseases (e.g., depression). Copyright © 2012 Elsevier B.V. All rights reserved.

[Effects of hypophyseal Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly synthetic peptides on immunity, hemostasis, morphology and functions of the thyroid gland in neonatally hypophysectomized chicken and one-year-old birds].

PubMed

Kuznik, B I; Pateiuk, A V; Rusaeva, N S; Baranchugova, L M; Obydenko, V I

2010-01-01

Neonatal hypophysectomy in chicken produces enlarged follicles of the thyroid gland, accumulation of colloids, impressed follicular epithelium, increased nucleus-cytoplasm ratio in thyrocytes, atrophied inter-follicular epithelium, depressed immunity, development of hypercoagulation and depressed fibrinolysis. When hypophysectomy is performed in one-year-old birds the impairments developing in thyroid morphology, immunity and hemostasis are less pronounced. Peptides of the anterior (Lys-Glu-Asp-Gly) and posterior (Ala-Glu-Asp-Gly) thyroid lobes injected to hypophysectomized birds prevent atrophic changes of the thyroid gland, normalize immune and hemostatic parameters.

Left lower lobe atelectasis and consolidation following cardiac surgery: the effect of topical cooling on the phrenic nerve

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benjamin, J.J.; Cascade, P.N.; Rubenfire, M.

1982-01-01

Retrospective and prospective analyses of chest radiographs of patients following coronary artery bypass surgery were undertaken. Left lower lobe pulmonary infiltrate and/or atelectasis developed in 13 of 40 (32.5%) patients who were operated upon without topical cooling of the heart with ice, and in 77 of 122 (63.1%) patients in one group and 34 of 40 (85.0%) patients in another group who were operated upon with topical cooling of the heart with ice. This difference was highly significant (p<0.001). Of the patients in one group in whom left lower lobe abnormality developed, 69.2% had paralysis or paresis of the leftmore » hemidiaphragm. It is evident that application of ice to the phrenic nerve can lead to temporary paralysis of the left leaf of the diaphragm, with subsequent development of left lower lobe pulmonary infiltrate and/or atelectasis.« less

Complementary Hemispheric Asymmetries in Object Naming and Recognition: A Voxel-Based Correlational Study

ERIC Educational Resources Information Center

Acres, K.; Taylor, K. I.; Moss, H. E.; Stamatakis, E. A.; Tyler, L. K.

2009-01-01

Cognitive neuroscientific research proposes complementary hemispheric asymmetries in naming and recognising visual objects, with a left temporal lobe advantage for object naming and a right temporal lobe advantage for object recognition. Specifically, it has been proposed that the left inferior temporal lobe plays a mediational role linking…

Endometriosis of the lung: report of a case and literature review

PubMed Central

2013-01-01

This paper reports a case of endometriosis of the lung in a 29-year-old woman with long-term periodic catamenial hemoptysis. A chest computed tomography image obtained during menstruation revealed a radiographic opaque lesion in the lingular segment of the left superior lobe. During bronchoscopy, bleeding in the mucosa of the distal bronchus of the lingular segment of the left superior lobe was observed. Histopathology subsequent to an exploratory thoracotomy confirmed the diagnosis of endometriosis of the left lung. The 2-year follow-up after lingular lobectomy of the left superior lobe showed no recurrence or complications. PMID:23634803

The effect of applied transducer force on acoustic radiation force impulse quantification within the left lobe of the liver.

PubMed

Porra, Luke; Swan, Hans; Ho, Chien

2015-08-01

Introduction: Acoustic Radiation Force Impulse (ARFI) Quantification measures shear wave velocities (SWVs) within the liver. It is a reliable method for predicting the severity of liver fibrosis and has the potential to assess fibrosis in any part of the liver, but previous research has found ARFI quantification in the right lobe more accurate than in the left lobe. A lack of standardised applied transducer force when performing ARFI quantification in the left lobe of the liver may account for some of this inaccuracy. The research hypothesis of this present study predicted that an increase in applied transducer force would result in an increase in SWVs measured. Methods: ARFI quantification within the left lobe of the liver was performed within a group of healthy volunteers (n = 28). During each examination, each participant was subjected to ARFI quantification at six different levels of transducer force applied to the epigastric abdominal wall. Results: A repeated measures ANOVA test showed that ARFI quantification was significantly affected by applied transducer force (p = 0.002). Significant pairwise comparisons using Bonferroni correction for multiple comparisons showed that with an increase in applied transducer force, there was a decrease in SWVs. Conclusion: Applied transducer force has a significant effect on SWVs within the left lobe of the liver and it may explain some of the less accurate and less reliable results in previous studies where transducer force was not taken into consideration. Future studies in the left lobe of the liver should take this into account and control for applied transducer force.

Increase in left liver lobe function after preoperative right portal vein embolisation assessed with gadolinium-EOB-DTPA MRI.

PubMed

Geisel, Dominik; Lüdemann, Lutz; Keuchel, Thomas; Malinowski, Maciej; Seehofer, Daniel; Stockmann, Martin; Hamm, Bernd; Gebauer, Bernhard; Denecke, Timm

2013-09-01

To prospectively evaluate the early development of regional liver function after right portal vein embolisation (PVE) with Gd-EOB-DTPA-enhanced MRI in patients scheduled for extended right hemihepatectomy. Ten patients who received a PVE before an extended hemihepatectomy were examined before and 14 days after PVE using Gd-EOB-DTPA-enhanced MRI of the liver. In these sequences representative region of interest measurements were performed in the embolised right (RLL) and the non-embolised left liver lobe (LLL). The volume as well as hepatic uptake index (HUI) was calculated independently for each lobe. Relative enhancement 14 days after PVE decreased in the RLL and increased significantly in the LLL (P < 0.05). Average hepatic uptake index (HUI) for RLL was significantly lower 14 days after PVE than before PVE (P < 0.05) and significantly higher for LLL (P < 0.05). A significant shift of contrast uptake from the right to the left liver lobe can be depicted as early as 14 days after right PVE by using Gd-EOB-DTPA-enhanced MRI, which could reflect the redirected portal venous blood flow and the rapid utilisation of a hepatic functional reserve. • Preoperative portal vein embolisation (PVE) is widely performed before right-sided hepatic resection. • PVE increases intravenous contrast medium uptake in the left lobe of liver. • The hepatic uptake index for the left liver lobe increases rapidly after PVE. • Left liver lobe function increase may be visualised by Gd-EOB-DTPA-enhanced MRI.

Hyperfunctioning Solid/Trabecular Follicular Carcinoma of the Thyroid Gland

PubMed Central

Giovanella, Luca; Fasolini, Fabrizio; Suriano, Sergio; Mazzucchelli, Luca

2010-01-01

A 68-year-old woman with solid/trabecular follicular thyroid carcinoma inside of an autonomously functioning thyroid nodule is described in this paper. The patient was referred to our clinic for swelling of the neck and an increased pulse rate. Ultrasonography showed a slightly hypoechoic nodule in the right lobe of the thyroid. Despite suppressed TSH levels, the 99mTc-pertechnetate scan showed a hot area corresponding to the nodule with a suppressed uptake in the remaining thyroid tissue. Histopathological examination of the nodule revealed a solid/trabecular follicular thyroid carcinoma. To the best of our knowledge, this is the first case of hyperfunctioning follicular solid/trabecular carcinoma reported in the literature. Even if a hyperfunctioning thyroid carcinoma is an extremely rare malignancy, careful management is recommended so that a malignancy will not be overlooked in the hot thyroid nodules. PMID:20847957

Positron emission tomography as an aid in the diagnosis and follow-up of Riedel's thyroiditis.

PubMed

Kotilainen, Pirkko; Airas, Laura; Kojo, Tiina; Kurki, Timo; Kataja, Kaisa; Minn, Heikki; Nuutila, Pirjo

2004-06-01

We describe the usage of positron emission tomography (PET) as an aid in the initial diagnosis and follow-up of Riedel's thyroiditis. A 41-year-old patient was admitted for an enlarged and tender thyroid gland in association with severe systemic symptoms of inflammation. Imaging with fluorine-18 fluorodeoxyglucose (FDG) and PET demonstrated an intensive uptake of FDG in both lobes of the thyroid gland as an indication of severe inflammation. The diagnosis of Riedel's thyroiditis was confirmed by the histological findings of biopsy specimens taken during a palliative thyroid resection. The inflammatory symptoms and local pain dramatically disappeared after commencement of high-dose corticosteroid therapy. A follow-up PET scan after 2 weeks of corticosteroid treatment showed a 60% decrease in the uptake of FDG in the thyroid. This indicates that FDG metabolic activity can also be used to assess a patient's response to therapy in Riedel's thyroiditis.

Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery.

PubMed

Singh, Priyanka; Sharma, Kalpana; Agarwal, Sunita

2017-09-01

To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy ( p value 0.001). Level of evidence III.

Reduced sensitivity of the N400 and late positive component to semantic congruity and word repetition in left temporal lobe epilepsy.

PubMed

Olichney, John M; Riggins, Brock R; Hillert, Dieter G; Nowacki, Ralph; Tecoma, Evelyn; Kutas, Marta; Iragui, Vicente J

2002-07-01

We studied 14 patients with well-characterized refractory temporal lobe epilepsy (TLE), 7 with right temporal lobe epilepsy (RTE) and 7 with left temporal lobe epilepsy (LTE), on a word repetition ERP experiment. Much prior literature supports the view that patients with left TLE are more likely to develop verbal memory deficits, often attributable to left hippocampal sclerosis. Our main objectives were to test if abnormalities of the N400 or Late Positive Component (LPC, P600) were associated with a left temporal seizure focus, or left temporal lobe dysfunction. A minimum of 19 channels of EEG/EOG data were collected while subjects performed a semantic categorization task. Auditory category statements were followed by a visual target word, which were 50% "congruous" (category exemplars) and 50% "incongruous" (non-category exemplars) with the preceding semantic context. These auditory-visual pairings were repeated pseudo-randomly at time intervals ranging from approximately 10-140 seconds later. The ERP data were submitted to repeated-measures ANOVAs, which showed the RTE group had generally normal effects of word repetition on the LPC and the N400. Also, the N400 component was larger to incongruous than congruous new words, as is normally the case. In contrast, the LTE group did not have statistically significant effects of either word repetition or congruity on their ERPs (N400 or LPC), suggesting that this ERP semantic categorization paradigm is sensitive to left temporal lobe dysfunction. Further studies are ongoing to determine if these ERP abnormalities predict hippocampal sclerosis on histopathology, or outcome after anterior temporal lobectomy.

Ectopic Cushing' syndrome caused by a neuroendocrine carcinoma of the mesentery.

PubMed

Fasshauer, Mathias; Lincke, Thomas; Witzigmann, Helmut; Kluge, Regine; Tannapfel, Andrea; Moche, Michael; Buchfelder, Michael; Petersenn, Stephan; Kratzsch, Juergen; Paschke, Ralf; Koch, Christian A

2006-04-27

ACTH overproduction within the pituitary gland or ectopically leads to hypercortisolism. Here, we report the first case of Cushing' syndrome caused by an ectopic ACTH-secreting neuroendocrine carcinoma of the mesentery. Moreover, diagnostic procedures and pitfalls associated with ectopic ACTH-secreting tumors are demonstrated and discussed. A 41 year-old man presented with clinical features and biochemical tests suggestive of ectopic Cushing's syndrome. First, subtotal thyroidectomy was performed without remission of hypercortisolism, because an octreotide scan showed increased activity in the left thyroid gland and an ultrasound revealed nodules in both thyroid lobes one of which was autonomous. In addition, the patient had a 3 mm hypoenhancing lesion of the neurohypophysis and a 1 cm large adrenal tumor. Surgical removal of the pituitary lesion within the posterior lobe did not improve hypercortisolism and we continued to treat the patient with metyrapone to block cortisol production. At 18-months follow-up from initial presentation, we detected an ACTH-producing neuroendocrine carcinoma of the mesentery by using a combination of octreotide scan, computed tomography scan, and positron emission tomography. Intraoperatively, use of a gamma probe after administration of radiolabeled (111)In-pentetreotide helped identify the mesenteric neuroendocrine tumor. After removal of this carcinoma, the patient improved clinically. Laboratory testing confirmed remission of hypercortisolism. An octreotide scan 7 months after surgery showed normal results. This case underscores the diagnostic challenge in identifying an ectopic ACTH-producing tumor and the pluripotency of cells, in this case of mesenteric cells that can start producing and secreting ACTH. It thereby helps elucidate the pathogenesis of neuroendocrine tumors. This case also suggests that patients with ectopic Cushing's syndrome and an octreotide scan positive in atypical locations may benefit from explorative radioguided surgery using (111)In-pentetreotide and a gamma probe.

Ectopic Cushing' syndrome caused by a neuroendocrine carcinoma of the mesentery

PubMed Central

Fasshauer, Mathias; Lincke, Thomas; Witzigmann, Helmut; Kluge, Regine; Tannapfel, Andrea; Moche, Michael; Buchfelder, Michael; Petersenn, Stephan; Kratzsch, Juergen; Paschke, Ralf; Koch, Christian A

2006-01-01

Background ACTH overproduction within the pituitary gland or ectopically leads to hypercortisolism. Here, we report the first case of Cushing' syndrome caused by an ectopic ACTH-secreting neuroendocrine carcinoma of the mesentery. Moreover, diagnostic procedures and pitfalls associated with ectopic ACTH-secreting tumors are demonstrated and discussed. Case presentation A 41 year-old man presented with clinical features and biochemical tests suggestive of ectopic Cushing's syndrome. First, subtotal thyroidectomy was performed without remission of hypercortisolism, because an octreotide scan showed increased activity in the left thyroid gland and an ultrasound revealed nodules in both thyroid lobes one of which was autonomous. In addition, the patient had a 3 mm hypoenhancing lesion of the neurohypophysis and a 1 cm large adrenal tumor. Surgical removal of the pituitary lesion within the posterior lobe did not improve hypercortisolism and we continued to treat the patient with metyrapone to block cortisol production. At 18-months follow-up from initial presentation, we detected an ACTH-producing neuroendocrine carcinoma of the mesentery by using a combination of octreotide scan, computed tomography scan, and positron emission tomography. Intraoperatively, use of a gamma probe after administration of radiolabeled 111In-pentetreotide helped identify the mesenteric neuroendocrine tumor. After removal of this carcinoma, the patient improved clinically. Laboratory testing confirmed remission of hypercortisolism. An octreotide scan 7 months after surgery showed normal results. Conclusion This case underscores the diagnostic challenge in identifying an ectopic ACTH-producing tumor and the pluripotency of cells, in this case of mesenteric cells that can start producing and secreting ACTH. It thereby helps elucidate the pathogenesis of neuroendocrine tumors. This case also suggests that patients with ectopic Cushing's syndrome and an octreotide scan positive in atypical locations may benefit from explorative radioguided surgery using 111In-pentetreotide and a gamma probe. PMID:16643652

Alteration of Duration Mismatch Negativity Induced by Transcranial Magnetic Stimulation Over the Left Parietal Lobe.

PubMed

Oshima, Hirokazu; Shiga, Tetsuya; Niwa, Shin-Ichi; Enomoto, Hiroyuki; Ugawa, Yoshikazu; Yabe, Hirooki

2017-01-01

Mismatch negativity (MMN) is generated by a comparison between an incoming sound and the memory trace of preceding sounds stored in sensory memory without any attention to the sound. N100 (N1) is associated with the afferent response to sound onset and reflects early analysis of stimulus characteristics. MMN generators are present in the temporal and frontal lobe, and N1 generators are present in the temporal lobe. The parietal lobe is involved in MMN generation elicited by a change in duration. The anatomical network connecting these areas, lateralization, and the effect of the side of ear stimulation on MMN remain unknown. Thus, we studied the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the left parietal lobe on MMN and N1 in 10 healthy subjects. Low-frequency rTMS over the left parietal lobe decreased the amplitude of MMN following right ear sound stimulation, but the amplitude was unaffected with left ear sound stimulation. We observed no significant changes in the amplitude of N1 or the latency of MMN or N1. These results suggest that low-frequency rTMS over the left parietal lobe modulates the detection of early auditory changes in duration in healthy subjects. Stimulation that is contralateral to the side of the ear experiencing sound may affect the generation of duration MMN more than ipsilateral stimulation. © EEG and Clinical Neuroscience Society (ECNS) 2016.

Brain regions underlying word finding difficulties in temporal lobe epilepsy.

PubMed

Trebuchon-Da Fonseca, Agnes; Guedj, Eric; Alario, F-Xavier; Laguitton, Virginie; Mundler, Olivier; Chauvel, Patrick; Liegeois-Chauvel, Catherine

2009-10-01

Word finding difficulties are often reported by epileptic patients with seizures originating from the language dominant cerebral hemisphere, for example, in temporal lobe epilepsy. Evidence regarding the brain regions underlying this deficit comes from studies of peri-operative electro-cortical stimulation, as well as post-surgical performance. This evidence has highlighted a role for the anterior part of the dominant temporal lobe in oral word production. These conclusions contrast with findings from activation studies involving healthy speakers or acute ischaemic stroke patients, where the region most directly related to word retrieval appears to be the posterior part of the left temporal lobe. To clarify the neural basis of word retrieval in temporal lobe epilepsy, we tested forty-three drug-resistant temporal lobe epilepsy patients (28 left, 15 right). Comprehensive neuropsychological and language assessments were performed. Single spoken word production was elicited with picture or definition stimuli. Detailed analysis allowed the distinction of impaired word retrieval from other possible causes of naming failure. Finally, the neural substrate of the deficit was assessed by correlating word retrieval performance and resting-state brain metabolism in 18 fluoro-2-deoxy-d-glucose-Positron Emission Tomography. Naming difficulties often resulted from genuine word retrieval failures (anomic states), both in picture and in definition tasks. Left temporal lobe epilepsy patients showed considerably worse performance than right temporal lobe epilepsy patients. Performance was poorer in the definition than in the picture task. Across patients and the left temporal lobe epilepsy subgroup, frequency of anomic state was negatively correlated with resting-state brain metabolism in left posterior and basal temporal regions (Brodmann's area 20-37-39). These results show the involvement of posterior temporal regions, within a larger antero-posterior-basal temporal network, in the specific process of word retrieval in temporal lobe epilepsy. A tentative explanation for these findings is that epilepsy induces functional deafferentation between anterior temporal structures devoted to semantic processing and neocortical posterior temporal structures devoted to lexical processing.

Familial temporal lobe epilepsy due to focal cortical dysplasia type IIIa.

PubMed

Fabera, Petr; Krijtova, Hana; Tomasek, Martin; Krysl, David; Zamecnik, Josef; Mohapl, Milan; Jiruska, Premysl; Marusic, Petr

2015-09-01

Focal cortical dysplasia (FCD) represents a common cause of refractory epilepsy. It is considered a sporadic disorder, but its occasional familial occurrence suggests the involvement of genetic mechanisms. Siblings with intractable epilepsy were referred for epilepsy surgery evaluation. Both patients were examined using video-EEG monitoring, MRI examination and PET imaging. They underwent left anteromedial temporal lobe resection. Electroclinical features pointed to left temporal lobe epilepsy and MRI examination revealed typical signs of left-sided hippocampal sclerosis and increased white matter signal intensity in the left temporal pole. PET examination confirmed interictal hypometabolism in the left temporal lobe. Histopathological examination of resected tissue demonstrated the presence FCD type IIIa, i.e. hippocampal sclerosis and focal cortical dysplasia in the left temporal pole. We present a unique case of refractory mesial temporal lobe epilepsy in siblings, characterized by an identical clinical profile and histopathology of FCD type IIIa, who were successfully treated by epilepsy surgery. The presence of such a high concordance between the clinical and morphological data, together with the occurrence of epilepsy and febrile seizures in three generations of the family pedigree points towards a possible genetic nature of the observed FCD type IIIa. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system.

PubMed

Zhao, Yandong; Jiao, Wenjie; Ren, Xiaoyang; Zhang, Liangdong; Qiu, Tong; Fu, Bo; Wang, Lei

2016-04-12

Despite the robotic surgery is widely applied, sleeve lobectomy for lung cancer using the Da Vinci surgical system is still less performed. We described a sleeve lobectomy for adenocarcinoma located at the left lower lobe using the Da Vinci surgical system. A case of 57-year old female referred to our hospital. Computed tomography scan showed an occupation located at the left lower lobe and adenocarcinoma project from the lobe bronchus was diagnosed by bronchoscope examination. A sleeve lobectomy was performed using the Da Vinci surgical system and the postoperative recovery was uneventful. Robotic thoracic surgery is feasible to perform sleeve lobectomy inspite of inadequate experience.

Structural MRI research in patients with nasopharyngeal carcinoma following radiotherapy: A DTI and VBM study.

PubMed

Leng, Xi; Fang, Peng; Lin, Huan; An, Jie; Tan, Xin; Zhang, Chi; Wu, Donglin; Shen, Wen; Qiu, Shijun

2017-11-01

The aim of the present study was to investigate the microstructural characteristics of the brain lobes following radiotherapy (RT) for patients with nasopharyngeal carcinoma (NPC) at distinct times. Diffusion tensor imaging (DTI) and 3D-T1-weighted imaging was performed in 70 age- and sex-matched subjects, 24 of whom were pre-treatment patients. The patients were divided into three groups, according to the time following completion of RT. Fractional anisotropy (FA) and gray matter (GM) volume were determined. The DTI data were analyzed using tract-based spatial statistics and the GM volume was analyzed using voxel-based morphometry (VBM). Compared with the pre-RT group, the mean FA values in the left parietal lobe white matter (WM) and right cerebellum decreased significantly in the post-RT 0-6 month group (P<0.05). In addition, the mean FA values in the right parietal lobe WM decreased significantly in the post-RT 6-12 month group (P<0.05), compared with the pre-RT group. The FA level in the right temporal lobe remained significantly decreased, compared with that in the pre-RT group (P<0.05) for 1 year after RT. Furthermore, compared with pre-RT group, the GM volume in the bilateral frontal lobe, right occipital lobe, left parietal lobe, right temporal lobe and left cerebellum decreased significantly in the post-RT 0-6 month group (P<0.05), and in the bilateral temporal lobe, parietal lobe, right frontal lobe and left cerebellum, the GM volume decreased significantly in the post-RT 6-12 month group (P<0.05). The GM volume in the right temporal lobe, bilateral frontal lobe and bilateral cerebellum remained significantly decreased compared with that in the pre-RT group (P<0.05) for 1 year after RT. A combination of DTI and VBM may be used to determine radiation-induced brain injury in patients treated for NPC.

Memory network plasticity after temporal lobe resection: a longitudinal functional imaging study

PubMed Central

Sidhu, Meneka K.; Stretton, Jason; Winston, Gavin P.; McEvoy, Andrew W.; Symms, Mark; Thompson, Pamela J.; Koepp, Matthias J.

2016-01-01

Abstract Anterior temporal lobe resection can control seizures in up to 80% of patients with temporal lobe epilepsy. Memory decrements are the main neurocognitive complication. Preoperative functional reorganization has been described in memory networks, but less is known of postoperative reorganization. We investigated reorganization of memory-encoding networks preoperatively and 3 and 12 months after surgery. We studied 36 patients with unilateral medial temporal lobe epilepsy (19 right) before and 3 and 12 months after anterior temporal lobe resection. Fifteen healthy control subjects were studied at three equivalent time points. All subjects had neuropsychological testing at each of the three time points. A functional magnetic resonance imaging memory-encoding paradigm of words and faces was performed with subsequent out-of-scanner recognition assessments. Changes in activations across the time points in each patient group were compared to changes in the control group in a single flexible factorial analysis. Postoperative change in memory across the time points was correlated with postoperative activations to investigate the efficiency of reorganized networks. Left temporal lobe epilepsy patients showed increased right anterior hippocampal and frontal activation at both 3 and 12 months after surgery relative to preoperatively, for word and face encoding, with a concomitant reduction in left frontal activation 12 months postoperatively. Right anterior hippocampal activation 12 months postoperatively correlated significantly with improved verbal learning in patients with left temporal lobe epilepsy from preoperatively to 12 months postoperatively. Preoperatively, there was significant left posterior hippocampal activation that was sustained 3 months postoperatively at word encoding, and increased at face encoding. For both word and face encoding this was significantly reduced from 3 to 12 months postoperatively. Patients with right temporal lobe epilepsy showed increased left anterior hippocampal activation on word encoding from 3 to 12 months postoperatively compared to preoperatively. On face encoding, left anterior hippocampal activations were present preoperatively and 12 months postoperatively. Left anterior hippocampal and orbitofrontal cortex activations correlated with improvements in both design and verbal learning 12 months postoperatively. On face encoding, there were significantly increased left posterior hippocampal activations that reduced significantly from 3 to 12 months postoperatively. Postoperative changes occur in the memory-encoding network in both left and right temporal lobe epilepsy patients across both verbal and visual domains. Three months after surgery, compensatory posterior hippocampal reorganization that occurs is transient and inefficient. Engagement of the contralateral hippocampus 12 months after surgery represented efficient reorganization in both patient groups, suggesting that the contralateral hippocampus contributes to memory outcome 12 months after surgery. PMID:26754787

Temporal evolution of hepatic anatomy during gestation and growth in the sheep.

PubMed

Douart, C; Briand, L; Betti, E; Bencharif, D; Tainturier, D

2015-02-01

In mammals, the liver undergoes a series of spectacular anatomical changes during development, particularly in domestic ruminants. In all domestic mammals, the liver retracts cranially until it reaches its definitive diaphragmatic position; however, in the sheep, it also withdraws from the entire left side of the diaphragm and seems to rotate through 180°. An anatomical study reveals that the hepatic conformation evolves very little during this topographical change. The latter occurs in two phases: an initial phase of marked regression of the left lobe, which starts from the beginning of the foetal period (44th day of gestation), followed by marked regression of the entire liver, which starts between the 90th and 117th days and ends between the 2nd and 3rd month of life. The path of hepatic regression is dictated by the particular layout of the liver's attachments in the sheep. The left triangular ligament, which holds the L lobe to the left in other species, is almost completely absent in the sheep, whilst the right lobe is fixed to the top of the diaphragm. As the liver regresses, the right lobe therefore draws the left lobe with it to the right-hand side. A statistical study shows constant regression of the hepatic surface area during the topographical evolution of the liver, with a particularly marked and sudden reduction between the end of the 4th month and the middle of the 5th month of gestation. It also shows that the regression of the left lobe is consistently greater than that of the right lobe and that the topographical regression of the liver cannot be predicted by measuring the weight of the liver, which behaves independently to the surface area of the liver. © 2014 Blackwell Verlag GmbH.

Mapping a lateralization gradient within the ventral stream for auditory speech perception.

PubMed

Specht, Karsten

2013-01-01

Recent models on speech perception propose a dual-stream processing network, with a dorsal stream, extending from the posterior temporal lobe of the left hemisphere through inferior parietal areas into the left inferior frontal gyrus, and a ventral stream that is assumed to originate in the primary auditory cortex in the upper posterior part of the temporal lobe and to extend toward the anterior part of the temporal lobe, where it may connect to the ventral part of the inferior frontal gyrus. This article describes and reviews the results from a series of complementary functional magnetic resonance imaging studies that aimed to trace the hierarchical processing network for speech comprehension within the left and right hemisphere with a particular focus on the temporal lobe and the ventral stream. As hypothesized, the results demonstrate a bilateral involvement of the temporal lobes in the processing of speech signals. However, an increasing leftward asymmetry was detected from auditory-phonetic to lexico-semantic processing and along the posterior-anterior axis, thus forming a "lateralization" gradient. This increasing leftward lateralization was particularly evident for the left superior temporal sulcus and more anterior parts of the temporal lobe.

Mapping a lateralization gradient within the ventral stream for auditory speech perception

PubMed Central

Specht, Karsten

2013-01-01

Recent models on speech perception propose a dual-stream processing network, with a dorsal stream, extending from the posterior temporal lobe of the left hemisphere through inferior parietal areas into the left inferior frontal gyrus, and a ventral stream that is assumed to originate in the primary auditory cortex in the upper posterior part of the temporal lobe and to extend toward the anterior part of the temporal lobe, where it may connect to the ventral part of the inferior frontal gyrus. This article describes and reviews the results from a series of complementary functional magnetic resonance imaging studies that aimed to trace the hierarchical processing network for speech comprehension within the left and right hemisphere with a particular focus on the temporal lobe and the ventral stream. As hypothesized, the results demonstrate a bilateral involvement of the temporal lobes in the processing of speech signals. However, an increasing leftward asymmetry was detected from auditory–phonetic to lexico-semantic processing and along the posterior–anterior axis, thus forming a “lateralization” gradient. This increasing leftward lateralization was particularly evident for the left superior temporal sulcus and more anterior parts of the temporal lobe. PMID:24106470

Spatial memory for asymmetrical dot locations predicts lateralization among patients with presurgical mesial temporal lobe epilepsy.

PubMed

Brown, Franklin C; Hirsch, Lawrence J; Spencer, Dennis D

2015-11-01

This study examined the ability of an asymmetrical dot location memory test (Brown Location Test, BLT) and two verbal memory tests (Verbal Selective Reminding Test (VSRT) and California Verbal Learning Test, Second Edition (CVLT-II)) to correctly lateralize left (LTLE) or right (RTLE) mesial temporal lobe epilepsy that was confirmed with video-EEG. Subjects consisted of 16 patients with medically refractory RTLE and 13 patients with medically refractory LTLE who were left hemisphere language dominant. Positive predictive values for lateralizing TLE correctly were 87.5% for the BLT, 72.7% for the VSRT, and 80% for the CVLT-II. Binary logistic regression indicated that the BLT alone correctly classified 76.9% of patients with left temporal lobe epilepsy and 87.5% of patients with right temporal lobe epilepsy. Inclusion of the verbal memory tests improved this to 92.3% of patients with left temporal lobe epilepsy and 100% correct classification of patients with right temporal lobe epilepsy. Though of a limited sample size, this study suggests that the BLT alone provides strong laterality information which improves with the addition of verbal memory tests. Copyright © 2015 Elsevier Inc. All rights reserved.

Low-resolution electromagnetic tomography (LORETA) in children with cochlear implants: a preliminary report.

PubMed

Henkin, Yael; Kishon-Rabin, Liat; Tatin-Schneider, Simona; Urbach, Doron; Hildesheimer, Minka; Kileny, Paul R

2004-12-01

The current preliminary report describes the utilization of low-resolution electromagnetic tomography (LORETA) in a small group of highly performing children using the Nucleus 22 cochlear implant (CI) and in normal-hearing (NH) adults. LORETA current density estimations were performed on an averaged target P3 component that was elicited by non-speech and speech oddball discrimination tasks. The results indicated that, when stimulated with tones, patients with right implants and NH adults (regardless of stimulated ear) showed enhanced activation in the right temporal lobe, whereas patients with left implants showed enhanced activation in the left temporal lobe. When stimulated with speech, patients with right implants showed bilateral activation of the temporal and frontal lobes, whereas patients with left implants showed only left temporal lobe activation. NH adults (regardless of stimulated ear) showed enhanced bilateral activation of the temporal and parietal lobes. The differences in activation patterns between patients with CI and NH subjects may be attributed to the long-term exposure to degraded input conditions which may have resulted in reorganization in terms of functional specialization. The difference between patients with right versus left implants, however, is intriguing and requires further investigation.

Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome

PubMed Central

Hamad, Abdel-Mohsen; Elmistekawy, Elsayed; Elatafy, Elatafy

2012-01-01

OBJECTIVES Middle lobe syndrome is a well-known clinical condition. In this retrospective study, we report our experience with a similar clinicopathological condition affecting the left lower lobe. METHODS The data of 17 patients with atelectasis or bronchiectasis of the left lower lobe who underwent lobectomy during the period from January 2000 to December 2011 were reviewed. Demographic, clinical, radiological and surgical data were collected. RESULTS Seventeen patients were included in this study, only one adult male patient of 52 years and 16 children. The paediatric patients were 10 boys and 6 girls, their age ranged from 2 to 11 years, mean 6.19 ± 2.6 years. Most patients presented with recurrent respiratory infection 15/17 (88.2%). The lag time before referral to surgery ranged from 3 to 48 months, mean 17.59 ± 13.1 months. Radiological signs of bronchiectasis were found in 11 (64.7%) patients. Bronchoscopy showed patent lower lobe bronchus in all patients. The criteria for lobectomy were evidence of bronchiectasis [11 (64.71%) patients], persistent atelectasis of the lobe after bronchoscopy and intensive medical therapy for a maximum of 2 months [6 (35.29%) patients]. Histopathological examination showed bronchiectasis in 11 (64.71%) patients, fibrosing pneumonitis in 4 (23.53%) patients and peribronchial inflammation in 2 (11.76%) patients. Most patients were doing well 1 year after surgery. CONCLUSIONS Chronic atelectasis of the left lower lobe is a clinicopathological condition equivalent to middle lobe syndrome. Impaired collateral ventilation together with airway plugging with secretion is an accepted explanation. Surgical resection is indicated for bronchiectatic lobe or failure of 2-month intensive medical therapy to resolve lobar atelectasis. PMID:22761114

Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome.

PubMed

Hamad, Abdel-Mohsen; Elmistekawy, Elsayed; Elatafy, Elatafy

2012-10-01

Middle lobe syndrome is a well-known clinical condition. In this retrospective study, we report our experience with a similar clinicopathological condition affecting the left lower lobe. The data of 17 patients with atelectasis or bronchiectasis of the left lower lobe who underwent lobectomy during the period from January 2000 to December 2011 were reviewed. Demographic, clinical, radiological and surgical data were collected. Seventeen patients were included in this study, only one adult male patient of 52 years and 16 children. The paediatric patients were 10 boys and 6 girls, their age ranged from 2 to 11 years, mean 6.19 ± 2.6 years. Most patients presented with recurrent respiratory infection 15/17 (88.2%). The lag time before referral to surgery ranged from 3 to 48 months, mean 17.59 ± 13.1 months. Radiological signs of bronchiectasis were found in 11 (64.7%) patients. Bronchoscopy showed patent lower lobe bronchus in all patients. The criteria for lobectomy were evidence of bronchiectasis [11 (64.71%) patients], persistent atelectasis of the lobe after bronchoscopy and intensive medical therapy for a maximum of 2 months [6 (35.29%) patients]. Histopathological examination showed bronchiectasis in 11 (64.71%) patients, fibrosing pneumonitis in 4 (23.53%) patients and peribronchial inflammation in 2 (11.76%) patients. Most patients were doing well 1 year after surgery. Chronic atelectasis of the left lower lobe is a clinicopathological condition equivalent to middle lobe syndrome. Impaired collateral ventilation together with airway plugging with secretion is an accepted explanation. Surgical resection is indicated for bronchiectatic lobe or failure of 2-month intensive medical therapy to resolve lobar atelectasis.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study.

PubMed

Zuhur, Sayid Shafi; Ozel, Alper; Velet, Selvinaz; Buğdacı, Mehmet Sait; Cil, Esra; Altuntas, Yüksel

2012-01-01

To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study

PubMed Central

Zuhur, Sayid Shafi; Özel, Alper; Velet, Selvinaz; Buğdacı, Mehmet Sait; Çil, Esra; Altuntas, Yüksel

2012-01-01

OBJECTIVE: To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. METHODS: The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age- and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. RESULTS: The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. CONCLUSIONS: This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. PMID:22358236

[Local brain activity in different motor subtypes of Parkinson's disease with fMRI].

PubMed

Hou, Ya'nan; Zhang, Jiarong; Chen, Biao; Wu, Tao

2015-02-17

To explore the changes of local brain activity in motor subtypes of Parkinson's disease (PD) with functional magnetic resonance imaging (fMRI). A total of 60 idiopathic PD and 30 age- and gender-matched normal controls were examined with resting-state fMRI from January 2013 to March 2014. All subjects gave their written informed consent for the study. The amplitude of low-frequency fluctuation (ALFF) was calculated to measure local brain activity. The PD patients were divided into two groups of tremor dominant (TD) and postural instability/gait difficulty (PIGD) (n = 30 each). All subjects gave their written in formed consent for the study.One-way ANOVA and post-hoc t-test were performed to detect the differences of local brain activity between PD and normal subjects. And the correlations were examined between ALFF, scores and levodopa dose. Compared with normal subjects, the TD group showed increased activity in bilateral cerebellums (-37, -47, -38), thalamus (-18, -17,0), pons (-3, -23, -37) and left precentral gyrus (-41, -30, 46) versus decreased activity in bilateral frontal lobes (-13, 69, 6), temporal lobes (-42, 18, -21), left insula (-32, 22, 2) and left anterior cingulated (-7, 32, -5). The PIGD group showed increased activity in right postcentral gyrus (63, -18, 39) and decreased activity in bilateral putamens (-24, 12, 3), pre-supplementary motor area (10, 10, 58), frontal lobes (15, -15, 57), temporal lobes (-39, 18, -3) and left insula (-29, 20, 11). Compared with PIGD, the TD group showed increased activity in temporal lobes, but decreased activity in frontal lobes. Additionally, ALFF in bilateral cerebellums and frontal lobes was positively correlated with TD scores while ALFF in left precentral gyrus, bilateral putamens and temporal lobes negatively correlated with TD scores. ALFF in bilateral frontal lobes and left temporal lobe was positively correlated with PIGD scores.However, in right postcentral gyrus and bilateral putamens, ALFF was negatively correlated with PIGD scores. The levodopa dose was positively correlated with frontal lobes and temporal lobe in TD and cerebellums and inferior parietal lobule in PIGD. A specific pattern of intrinsic activity in TD and PIGD may provide insights into neurophysiological mechanisms of PD motor subtypes. The changes of brain activity in TD are caused by the interaction between cerebello-thalamo-cortical circuit and basal ganglia loop while the changes in PIGD result largely from damaged basal ganglia loop.

The BRAFT1799A mutation is not associated with occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma.

PubMed

Wan, Han-Feng; Zhang, Bin; Yan, Dan-Gui; Xu, Zhen-Gang

2015-01-01

The phenomenon of occult carcinoma maybe observed in patients with clinically unilateral papillary thyroid microcarcinoma (PTMC). Although many studies have reported that the BRAFT1799A mutation is associated with aggressive PTMC, the relationship between BRAFT1799A mutation and occult carcinoma is unclear. The aim of this study was to investigate the risk factors, including BRAFT1799A mutation, for occult contralateral carcinoma in clinically unilateral PTMC accompanied by benign nodules in the contralateral lobe. From January 2011 to December 2013,we prospectively enrolled 89 consecutive PTMC patients with clinically unilateral carcinoma accompanied by benign nodules in the contralateral lobe who received a total thyroidectomy and cervical lymph node dissection. BRAFT1799A mutation was tested by pyrosequencing on postoperative paraffin specimens. The frequency and predictive factors for occult contralateral carcinoma were analyzed with respect to the following variables: age, gender, family history, tumor size, presence of Hashimoto thyroiditis, extrathyroidal extension, central lymph node metastasis, multifocality of primary tumor, or BRAFT1799A mutation. A total of 36 patients (40.4%) had occult PTMC in the contralateral lobe. The median diameter of the occult tumors was 0.33±0.21 cm. The BRAFT1799A mutation was found in 38 cases (42.7%). According to the univariate analysis, there were no significant differences between the presence of occult contralateral carcinoma and age, gender, family history, tumor size, presence of Hashimoto thyroiditis, extrathyroidal extension, central lymph node metastasis, multifocality of primary tumor, or BRAFT1799A mutation. Using current methods, it is difficult to preoperatively identify patients with PTMC, and further research is needed to determine predictive factors for the presence of occult contralateral carcinoma in patients with unilateral PTMC.

Pyramidal lobe of the thyroid gland and the thyroglossal duct remnant: a study using human fetal sections.

PubMed

Takanashi, Yoshitaka; Honkura, Yohei; Rodriguez-Vazquez, Jose Francisco; Murakami, Gen; Kawase, Tetsuaki; Katori, Yukio

2015-01-01

To investigate developmental changes in the thyroglossal duct, we observed serial sagittal sections of eight embryos (crown-rump length (CRL) 6-12 mm; approximately 5-6 weeks of gestation) as well as serial horizontal or cross-sections of 70 embryos and fetuses (CRL 15-110 mm; 6-15 weeks). In the sagittal sections, the thyroglossal duct was identified as a small sheet or mass of relatively large cells with vacuolization anterior, superior or inferior to the fourth pharyngeal arch artery. However, we found no continuous duct-like structure that reached the thyroid gland. Thus, previous classical schemes might have overestimated the continuity of the duct. Among cross-sections of 70 specimens, we found the thyroglossal duct remnant in only two specimens (CRL 15 mm and 100 mm), in contrast to the pyramidal lobe, which was seen in one-third of the specimens. The duct remnant ran downward along the lateral edge of the hyoid body to reach the anterior aspect of the thyroid cartilage. However, the connection between the pyramidal lobe and the duct remnant was interrupted by the anterior cervical muscles. Therefore, it was unlikely that the thyroglossal duct remnant would more frequently be evident in fetuses than in adults. The highly tortuous course of the duct along the lingual aspect of the hyoid body, which has been reported previously, appeared to become established near term. Descent of the thyroid gland was not evident after the CRL 20 mm stage (6 weeks): the gland appeared to retain its position at the level of the third-sixth cervical vertebrae. Copyright © 2014 Elsevier GmbH. All rights reserved.

Variations in the origins of the thyroid arteries on CT angiography.

PubMed

Esen, Kaan; Ozgur, Anil; Balci, Yuksel; Tok, Sermin; Kara, Engin

2018-02-01

To investigate the anatomical variations in the origins of the thyroid arteries on CT angiography images. The presence and the origins of the superior thyroid artery, the inferior thyroid artery, and the thyroidea ima artery were retrospectively evaluated based on carotid CT angiography examinations. The bifurcation level of the common carotid artery with respect to the cervical vertebrae and disc spaces was also determined. A total of 640 patients were included in the study. The right and left superior thyroid arteries arose from the external carotid artery in 413 (64.5%) and 254 (39.7%) patients, from the bifurcation of the common carotid artery in 131 (20.5%) and 148 (23.1%) patients, and from the common carotid artery in 90 (14.1%) and 226 (35.3%) patients, respectively. We could not observe the right and the left superior thyroid arteries in 6 (0.9%) and 12 (1.9%) of the patients, respectively. However, the right and left inferior thyroid arteries were not identified in 14 (2.2%) and 45 (7%) of the patients, respectively. The thyroidea ima artery was detected in 2.3% of the patients. The visualization of thyroid arteries on CT angiography images enables the anatomy of the arterial supply system of the thyroid gland to be explored in a noninvasive manner prior to surgery.

Words and Objects at the Tip of the Left Temporal Lobe in Primary Progressive Aphasia

ERIC Educational Resources Information Center

Mesulam, M.-Marsel; Wieneke, Christina; Hurley, Robert; Rademaker, Alfred; Thompson, Cynthia K.; Weintraub, Sandra; Rogalski, Emily J.

2013-01-01

Eleven of 69 prospectively enrolled primary progressive aphasics were selected for this study because of peak atrophy sites located predominantly or exclusively within the anterior left temporal lobe. Cortical volumes in these areas were reduced to less than half of control values, whereas average volume elsewhere in the left hemisphere deviated…

Hippocampal Atrophy Is Associated with Altered Hippocampus-Posterior Cingulate Cortex Connectivity in Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis.

PubMed

Shih, Y C; Tseng, C E; Lin, F-H; Liou, H H; Tseng, W Y I

2017-03-01

Unilateral mesial temporal lobe epilepsy and hippocampal sclerosis have structural and functional abnormalities in the mesial temporal regions. To gain insight into the pathophysiology of the epileptic network in mesial temporal lobe epilepsy with hippocampal sclerosis, we aimed to clarify the relationships between hippocampal atrophy and the altered connection between the hippocampus and the posterior cingulate cortex in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. Fifteen patients with left mesial temporal lobe epilepsy with hippocampal sclerosis and 15 healthy controls were included in the study. Multicontrast MR imaging, including high-resolution T1WI, diffusion spectrum imaging, and resting-state fMRI, was performed to measure the hippocampal volume, structural connectivity of the inferior cingulum bundle, and intrinsic functional connectivity between the hippocampus and the posterior cingulate cortex, respectively. Compared with controls, patients had decreased left hippocampal volume (volume ratio of the hippocampus and controls, 0.366% ± 0.029%; patients, 0.277% ± 0.063%, corrected P = .002), structural connectivity of the bilateral inferior cingulum bundle (generalized fractional anisotropy, left: controls, 0.234 ± 0.020; patients, 0.193 ± 0.022, corrected P = .0001, right: controls, 0.226 ± 0.022; patients, 0.208 ± 0.017, corrected P = .047), and intrinsic functional connectivity between the left hippocampus and the left posterior cingulate cortex (averaged z-value: controls, 0.314 ± 0.152; patients, 0.166 ± 0.062). The left hippocampal volume correlated with structural connectivity positively (standardized β = 0.864, P = .001), but it had little correlation with intrinsic functional connectivity (standardized β = -0.329, P = .113). On the contralesional side, the hippocampal volume did not show any significant correlation with structural connectivity or intrinsic functional connectivity ( F 2,12 = 0.284, P = .757, R 2 = 0.045). In left mesial temporal lobe epilepsy with hippocampal sclerosis, the left inferior cingulum bundle undergoes degeneration in tandem with the left hippocampal volume, whereas intrinsic functional connectivity seems to react by compensating the loss of connectivity. Such insight might be helpful in understanding the development of the epileptic network in left mesial temporal lobe epilepsy with hippocampal sclerosis. © 2017 by American Journal of Neuroradiology.

Typical and atypical (silent) subacute thyroiditis in a wife and husband

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morrison, J.; Caplan, R.H.

1978-01-01

Typical subacute thyroiditis was diagnosed in a woman. Three weeks later, signs and symptoms of hyperthyroidism developed in her husband. Although the right lobe of his thyroid gland was slightly enlarged, pain and tenderness were absent throughout the course of his illness. The free thyroxine equivalent (FTE) value and the sedimentation rate were elevated; the low uptake of radioactive iodine by the thyroid gland was consistent with ''silent'' subacute thyroiditis. We postulate that a common etiology, probably viral, was operative in both cases. Nine additional cases of hyperthyroidism with low levels of thyroidal uptake of radioactive iodine are described. Themore » thyroid glands of these patients were normal or slightly enlarged. Antithyroglobulin antibody levels determined in seven patients were not substantially elevated. The clinical course of these patients was characteristic of ''silent'' subacute thyroiditis. Although the origin of the syndrome remains unclear, the disease is self-limited and therapy, if any, is supportive.« less

A primary cavernous hemangioma of the thyroid gland: A case report and literature review.

PubMed

Miao, Jie; Chen, Shubo; Li, Yongcai; Fu, Lin; Li, Hui

2017-12-01

Thyroid hemangioma is benign and associated with fine-needle aspiration (FNA) biopsy or trauma in most cases. Its differential diagnosis is very difficult. We presented the case of a 48-year-old man complained of slowly progressed swelling in the anterior neck for 20 years. Ultrasound and CT scan revealed a hypoechogenic and heterogeneous mass measuring 4 × 3.5 cm located in the right lobe of thyroid gland. Postoperative pathological and immunohistochemical examinations of the surgical specimen revealed a primary hemangioma of the thyroid gland. The patient received a right lobectomy of the thyroid. The patient had been followed up for 10 months after surgery without complications and remained asymptomatic. Primary thyroid hemangioma should be considered when there is a well-circumscribed capsule mass on medical imaging without history of FNA or any other cervical procedures or trauma.

Hypothyroidism, new nodule formation and increase in nodule size in patients who have undergone hemithyroidectomy

PubMed Central

Ersoy, Reyhan Ünlü; Anıl, Cüneyd; Demir, Özgür; Erdoğan, Murat Faik; Güllü, Sevim; Berker, Dilek; Gül, Kamile; Ünlütürk, Uğur; Erdoğan, Gürbüz

2012-01-01

Introduction The current medical literature has conflicting results about factors related to hypothyroidism and nodular recurrences during follow-up of hemithyroidectomized patients. We aimed to evaluate factors that may have a role in new nodule formation, hypothyroidism, increase in thyroid lobe and increase in nodule volumes in these patients with and without Hashimoto's thyroiditis (HT), and with and without levothyroxine (LT4) use. Material and methods We enrolled 140 patients from five different hospitals in Ankara and evaluated their thyroid tests, autoantibody titre results and ultrasonographic findings longitudinally between two visits with a minimum 6-month interval. Results In patients with HT there was no significant difference between the two visits but in patients without HT, thyroid stimulating hormone (TSH) levels and nodule volume were higher, and free T4 levels were lower in the second visit. Similarly, in patients with LT4 treatment there was no difference in TSH, free T4 levels, or lobe or nodule size between the two visits, but the patients without LT4 had free T4 levels lower in the second visit. Regression analysis revealed a relationship between first visit TSH levels and hypothyroidism during follow-up. Conclusions Patients who have undergone hemithyroidectomy without LT4 treatment and without HT diagnosis should be followed up more carefully for thyroid tests, new nodule formation and increase in nodule size. The TSH levels at the beginning of the follow-up may be helpful to estimate hypothyroidism in hemithyroidectomized patients. PMID:22661999

A 4-Week Preoperative Ketogenic Micronutrient-Enriched Diet Is Effective in Reducing Body Weight, Left Hepatic Lobe Volume, and Micronutrient Deficiencies in Patients Undergoing Bariatric Surgery: a Prospective Pilot Study.

PubMed

Schiavo, Luigi; Pilone, Vincenzo; Rossetti, Gianluca; Barbarisi, Alfonso; Cesaretti, Manuela; Iannelli, Antonio

2018-03-03

Before bariatric surgery (BS), moderate weight loss, left hepatic lobe volume reduction, and micronutrient deficiency (MD) identification and correction are desirable. The objective of this study was to assess the safety and the effectiveness of a 4-week preoperative ketogenic micronutrient-enriched diet (KMED) in reducing body weight (BW), left hepatic lobe volume, and correcting MD in patients scheduled for BS. In this prospective pilot study, a cohort of morbidly obese patients (n = 27, 17 females, 10 males) with a mean body mass index (BMI) of 45.2 kg/m 2 scheduled for BS underwent a 4-week preoperative KMED. Their BW, BMI, fat mass (FM), fat-free mass (FFM), resting metabolic rate (RMR), left hepatic lobe volume, micronutrient status, and biochemical and metabolic patterns were measured before and after the 4-week KMED. Patient compliance was assessed by validated questionnaires (3-day estimated food records and 72-h recall). Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects. All patients completed the study. We observed highly significant decreases in BW (- 10.3%, p < 0.001, in males; - 8.2%, p < 0.001, in females), left hepatic lobe volume (- 19.8%, p < 0.001), and an amelioration of patient micronutrient status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effect was reported. This study demonstrates that a 4-week preoperative KMED is safe and effective in reducing BW, left hepatic lobe volume, and correcting MD in obese patients scheduled for BS.

Vasovagal reflex emergency caused by Riedel's thyroiditis: A case report and review of the literature.

PubMed

Cai, Wei; Kang, Hua; Hai, Tao

2016-01-01

Riedel's thyroiditis is a rare type of chronic thyroiditis, associated with fibroinflammatory process and invasion into surrounding tissues, leading to compressive symptoms. A 45-year-old man had a left thyroid mass, presenting with hypotension and bradycardia many times. He was diagnosed with vasovagal reflex caused by cervical vessel compression due to a thyroid lesion. We performed the emergency operation, and most of the left thyroid was removed to relieve the compression on cervical vessels. The result of pathology proved to be Riedel's thyroiditis. The vasovagal reflex did not occur any more during the 28-month follow up, except on the 3(rd) day after the surgery. Six months after the thyroidectomy, the patient was found to have retroperitoneal fibrosis, diagnosed by biopsy during a laparotomy for biliary disease. Riedel's thyroiditis can lead to a vasovagal episode and might not be a primary thyroid disease but rather a manifestation of the systemic disorder, multifocal fibrosclerosis. Copyright © 2013. Published by Elsevier Taiwan.

[The importance of bisoprolol in prevention of heart left ventricular hypertrophy in patients with long term L-thyroxin suppressive therapy, after the operation of differentiated thyroid carcinoma].

PubMed

Matuszewska, Gabriela; Marek, Bogdan; Kajdaniuk, Dariusz; Przywara-Chowaniec, Brygida; Jarzab, Jerzy; Jarzab, Barbara

2007-01-01

Patients with differentiated thyroid carcinoma have to undergo radical surgical treatment, which includes total thyreoidectomy, radioiodine therapy and a life-time suppressive therapy with L-thyroxine. The aim of this study was a prospective evaluation of left ventricular hypertrophy during L suppressive-thyroxine treatment in patients treated for differentiated thyroid carcinoma. The examined group comprised 50 patients with differentiated thyroid carcinoma, treated by total thyroidectomy and 131I therapy. Echocardiographic measurements were needed for estimation of left ventricular mass and its index, according to recommendations of American Echocardiography Society. During two-years long suppressive therapy we observed a significant rise in left ventricular mass. In woman group left ventricular mass was increased from 168+/-39 g to 204+/-45 g (p<0.001) and in men from 205+/-60 to 320+/-21 g. Likewise, left ventricular mass index was increased in women group from 96+/-18 g/m(2) to 116+/-25 g/m(2) (p<0.001) and in men group from 107+/-37 g/m(2) to 158+/-28 g/m(2). Simultaneous treatment with bisoprolol caused a regression of left myocardial hypertrophy. Already after 6 months of simultaneous treatment with L-thyroxin and bisoprolol, for left ventricular mass was reduced to normal: in woman 165+/-35 g, and in men to 178+/-38 g. Analogous results were obtained left ventricular mass index. After 6 months it was reduced to 94+/-12 g/m(2) in woman and in men to 132+/-32 g/m(2). 1. In differentiated thyroid cancer patients, treated postoperatively with L-thyroxine suppressive therapy, left ventricular hypertrophy is observed already during the first year of suppressive therapy and progresses during the next year of treatment. 2 Addition of a beta-adrenergic antagonist to suppressive doses of L-thyroxine causes a regression of left ventricular hypertrophy, thus, beta-adrenergic antagonists should be administered in this group of patients.

Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome

PubMed Central

Skirrow, Caroline; Cross, J. Helen; Harrison, Sue; Cormack, Francesca; Harkness, William; Coleman, Rosie; Meierotto, Ellen; Gaiottino, Johanna; Vargha-Khadem, Faraneh

2015-01-01

The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5–15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection volumes and greater temporal pole integrity after left temporal surgery. Results were independent of post-surgical intellectual function and language lateralization. Our findings indicate post-surgical, hemisphere-dependent material-specific improvement in memory functions in the intact temporal lobe. However, outcome was linked to the anatomical integrity of the temporal lobe memory system, indicating that compensatory mechanisms are constrained by the amount of tissue which remains in the operated temporal lobe. Careful tailoring of resections for children undergoing epilepsy surgery may enhance long-term memory outcome. PMID:25392199

Selective hypertrophy of the lobus caudatus as a novel approach enabling extended right hepatectomy in the presence of a non-perfused left lateral liver lobe.

PubMed

Atanasov, Georgi; Schmelzle, Moritz; Thelen, Armin; Wiltberger, Georg; Hau, Hans-Michael; Krenzien, Felix; Petersen, Tim-Ole; Moche, Michael; Jonas, Sven

2014-08-01

Portal vein embolization (PVE) is a well-established technique to enhance functional hepatic reserves of segments II and III before curative extended right hepatectomy for tumors of the right liver lobe. However, an adequate hepatopetal flow of the left lateral portal vein branches is required for a sufficient PVE-associated hypertrophy. Here, we report a 65-year old patient suffering from a locally advanced intrahepatic cholangiocarcinoma in the right liver lobe and segment IV. A curative extended right hepatectomy after preoperative PVE of liver segments IV-VIII was initially impossible because of partial thrombosis of the left lateral portal vein branches resulting in an ischemic-type atrophy of segments II and III. However, due to a massive hypertrophy of the caudate lobe following PVE of liver segments IV-VIII, subsequent extended right hepatectomy with intraoperative thrombectomy of segments II and III was made possible. To our knowledge this is the first case in which an extended right hepatectomy for a liver malignancy, in the presence of atrophic left lateral section, was made possible by a massive PVE-associated hypertrophy of the caudate lobe.

[Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema].

PubMed

Bocquillon, V; Briault, A; Reymond, E; Arbib, F; Jankowski, A; Ferretti, G; Pison, C

2016-11-01

In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

[Effects of Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly peptides on hormonal activity and thyroid morphology in hypophysectomized mature and old birds].

PubMed

Kuznik, B I; Pateiuk, A V; Rusaeva, N S; Baranchugova, L M; Obydenko, V I

2011-01-01

The aim of the paper was to investigate effects of Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly peptides which were designed and synthesized on the basis of amino acid study of the hypophyseal anterior and posterior lobe peptides on the thyroid morphology and hormonal activity in mature chicken and old birds. Hypophysectomy was established to produce atrophic changes in the thyroid gland and development of secondary hypothyrosis. Administration of Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly tetrapeptides significantly prevented these impairments by increasing the levels of the thyroid-stimulating hormone (TSH) as well as T3 and T4. Restoration of the thyroid functions and morphology was registered to be greater in one-year-old chicken as compared to five-year-old ones.

The learning curves in living donor hemiliver graft procurement using small upper midline incision.

PubMed

Ikegami, Toru; Harimoto, Norifumi; Shimokawa, Masahiro; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Itoh, Shinji; Okabe, Norihisa; Sakata, Kazuhito; Nagatsu, Akihisa; Soejima, Yuji; Maehara, Yoshihiko

2016-12-01

The learning curve for performing living donor hemiliver procurement (LDHP) via small upper midline incision (UMI) has not been determined. Living donors (n=101) who underwent LDHP via UMI were included to investigate the learning curve using cumulative sum analysis. The cumulative sum analysis showed that nine cases for right lobe (case #23) and 19 cases for left lobe (case #32 in the whole series) are needed for stable and acceptable surgical outcomes in LDHP via UMI. The established phase (n=69, since case #33) had a significantly shorter operative time, a smaller incision size, and less blood loss than the previous learning phase (n=32, serial case number up to the last 19th left lobe case). Multivariate analysis showed that the learning phase, high body mass index ≥25 kg/m 2 , and left lobe graft procurement are the factors associated with surgical events including operative blood loss ≥400 mL, operative time ≥300 minutes, or surgical complications ≥Clavien-Dindo grade II. There is an obvious learning curve in performing LDHP via UMI, and 32 cases including both 19 cases for left lobe and nine cases for right lobe are needed for having stable and acceptable surgical outcomes. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Declarative long-term memory and the mesial temporal lobe: Insights from a 5-year postsurgery follow-up study on refractory temporal lobe epilepsy.

PubMed

Salvato, Gerardo; Scarpa, Pina; Francione, Stefano; Mai, Roberto; Tassi, Laura; Scarano, Elisa; Lo Russo, Giorgio; Bottini, Gabriella

2016-11-01

It is largely recognized that the mesial temporal lobe and its substructure support declarative long-term memory (LTM). So far, different theories have been suggested, and the organization of declarative verbal LTM in the brain is still a matter of debate. In the current study, we retrospectively selected 151 right-handed patients with temporal lobe epilepsy with and without hippocampal sclerosis, with a homogeneous (seizure-free) clinical outcome. We analyzed verbal memory performance within a normalized scores context, by means of prose recall and word paired-associate learning tasks. Patients were tested at presurgical baseline, 6months, 2 and 5years after anteromesial temporal lobe surgery, using parallel versions of the neuropsychological tests. Our main finding revealed a key involvement of the left temporal lobe and, in particular, of the left hippocampus in prose recall rather than word paired-associate task. We also confirmed that shorter duration of epilepsy, younger age, and withdrawal of antiepileptic drugs would predict a better memory outcome. When individual memory performance was taken into account, data showed that females affected by left temporal lobe epilepsy for longer duration were more at risk of presenting a clinically pathologic LTM at 5years after surgery. Taken together, these findings shed new light on verbal declarative memory in the mesial temporal lobe and on the behavioral signature of the functional reorganization after the surgical treatment of temporal lobe epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

Glucagon Like Peptide-1 Receptor Expression in the Human Thyroid Gland

PubMed Central

Gier, Belinda; Butler, Peter C.; Lai, Chi K.; Kirakossian, David; DeNicola, Matthew M.

2012-01-01

Background: Glucagon like peptide-1 (GLP-1) mimetic therapy induces medullary thyroid neoplasia in rodents. We sought to establish whether C cells in human medullary thyroid carcinoma, C cell hyperplasia, and normal human thyroid express the GLP-1 receptor. Methods: Thyroid tissue samples with medullary thyroid carcinoma (n = 12), C cell hyperplasia (n = 9), papillary thyroid carcinoma (n = 17), and normal human thyroid (n = 15) were evaluated by immunofluorescence for expression of calcitonin and GLP-1 receptors. Results: Coincident immunoreactivity for calcitonin and GLP-1 receptor was consistently observed in both medullary thyroid carcinoma and C cell hyperplasia. GLP-1 receptor immunoreactivity was also detected in 18% of papillary thyroid carcinoma (three of 17 cases). Within normal human thyroid tissue, GLP-1 receptor immunoreactivity was found in five of 15 of the examined cases in about 35% of the total C cells assessed. Conclusions: In humans, neoplastic and hyperplastic lesions of thyroid C cells express the GLP-1 receptor. GLP-1 receptor expression is detected in 18% papillary thyroid carcinomas and in C cells in 33% of control thyroid lobes. The consequence of long-term pharmacologically increased GLP-1 signaling on these GLP-1 receptor-expressing cells in the thyroid gland in humans remains unknown, but appropriately powered prospective studies to exclude an increase in medullary or papillary carcinomas of the thyroid are warranted. PMID:22031513

Unusual congenital pulmonary anomaly with presumed left lung hypoplasia in a young dog.

PubMed

Lee, C M; Kim, J H; Kang, M H; Eom, K D; Park, H M

2014-05-01

A seven-month-old, entire, male miniature schnauzer dog was referred with acute vomiting, inappetence and depression primarily as a result of a gastric foreign body (pine cones). During investigations, thoracic radiographs revealed increased volume of the right lung lobes, deviated cardiomediastinal structures and elevation of the heart from the sternum. Thoracic computed tomography revealed left cranial lung lobe hypoplasia and extension of the right cranial lung parenchyma across the midline to the left hemithorax. Branches of the right pulmonary vessels and bronchi also crossed the midline and extended to the left caudal lung lobe. These findings suggested that the right and left lungs were fused. In humans this finding is consistent with horseshoe lung, which is an uncommon congenital malformation. To the authors' knowledge, this case represents the first report of such a pulmonary anomaly in a dog. © 2014 British Small Animal Veterinary Association.

MEG Evidence for Incremental Sentence Composition in the Anterior Temporal Lobe

ERIC Educational Resources Information Center

Brennan, Jonathan R.; Pylkkänen, Liina

2017-01-01

Research investigating the brain basis of language comprehension has associated the left anterior temporal lobe (ATL) with sentence-level combinatorics. Using magnetoencephalography (MEG), we test the parsing strategy implemented in this brain region. The number of incremental parse steps from a predictive left-corner parsing strategy that is…

Palilalia, echolalia, and echopraxia-palipraxia as ictal manifestations in a patient with left frontal lobe epilepsy.

PubMed

Cho, Yang-Je; Han, Sang-Don; Song, Sook Keun; Lee, Byung In; Heo, Kyoung

2009-06-01

Palilalia is a relatively rare pathologic speech behavior and has been reported in various neurologic and psychiatric disorders. We encountered a case of palilalia, echolalia, and echopraxia-palipraxia as ictal phenomena of left frontal lobe epilepsy. A 55-year-old, right-handed man was admitted because of frequent episodes of rapid reiteration of syllables. Video-electroencephalography monitoring revealed stereotypical episodes of palilalia accompanied by rhythmic head nodding and right-arm posturing with ictal discharges over the left frontocentral area. He also displayed echolalia or echopraxia-palipraxia, partially responding to an examiner's stimulus. Magnetic resonance imaging revealed encephalomalacia on the left superior frontal gyrus and ictal single photon emission computed tomography showed hyperperfusion just above the lesion, corresponding to the left supplementary motor area (SMA), and subcortical nuclei. This result suggests that the neuroanatomic substrate involved in the generation of these behaviors as ictal phenomena might exist in the SMA of the left frontal lobe.

Novel Cause of 'Black Thyroid': Intraoperative Use of Indocyanine Green.

PubMed

Chernock, Rebecca D; Jackson, Ryan S

2017-09-01

The antibiotic minocycline is virtually pathognomonic for brown-black discoloration of the thyroid gland referred to as 'black thyroid'. Black thyroid' is an incidental finding in patients taking the drug who undergo thyroid surgery for another indication and is not of known clinical significance. However, its recognition is important so as not to raise concern for a disease process. Here, we present the first case of 'black thyroid' attributable to the iodine-containing compound indocyanine green. Intraoperative indocyanine green was administered as part of a research protocol transoral robotic-assisted surgery for a base of tongue cancer in a 44-year-old man. Hemithyroidectomy was subsequently performed during the same operation for further evaluation of an indeterminate thyroid nodule. The resected thyroid lobe was dark, nearly black in color, and histologically showed extensive brown pigment deposition in the follicular epithelial cells and colloid, mimicking minocycline-induced 'black thyroid'. In this case, however, the patient was not taking minocycline; instead the 'black thyroid' was attributed to the iodine-containing compound indocyanine green. Indocyanine green is a hereto unreported cause of 'black thyroid' with histopathologic features that are remarkably similar to that induced by minocycline. Indocyanine green should be included the differential diagnosis of 'black thyroid'. Clinical history is important so as not to raise concern for a disease process.

[The wound drainage after operation on thyroid gland].

PubMed

Nechay, A P; Smolyar, V A; Voytenko, V V; Sichinava, R M; Larin, A S; Cherenko, S M

2015-03-01

Efficacy of active draining, promoting the most rapid reconvalescence and rehabilitation of the patients, in comparison to passive wound draining was studied up in various diseases of thyroid gland and operative intervention volume. The autors have had concluded, that suturing of operative wound without draining after hemithyroidectomy conduction is possible, as well as a thyroidectomy for nodular and multinodular goiter, if the excised volume of the lobe/gland do not exceed 15 cm3 and in nonapplication of anticoagulants.

Thyroid lobe ablation with iodine- ¹³¹I in patients with differentiated thyroid carcinoma: a randomized comparison between 1.1 and 3.7 GBq activities.

PubMed

Giovanella, Luca; Piccardo, Arnoldo; Paone, Gaetano; Foppiani, Luca; Treglia, Giorgio; Ceriani, Luca

2013-08-01

The present study was undertaken to evaluate the ablation rate after administration of 1.1 or 3.7 GBq of iodine- (¹³¹I) to patients with low-risk differentiated thyroid carcinoma (DTC) primarily treated by lobectomy. Enrolled were 136 consecutive patients affected by histologically proven low-risk DTC previously treated by lobectomy. Patients were randomized to receive a single dose of 1.1 or 3.7 GBq of ¹³¹I in an equivalence trial. Successful thyroid ablation was defined as a negative diagnostic whole-body scan and stimulated thyroglobulin levels lower than 2 ng/ml in the absence of thyroglobulin antibodies. The patient demographic and clinical data were well balanced at baseline. The ablation rate was significantly (P<0.01) higher in patients treated with 3.7 GBq (75%) than in those treated with 1.1 GBq (54%) of radioiodine. No relevant side effects occurred in either group. Radioiodine lobe ablation with a single administration of 3.7 GBq is a simple and safe mode of treatment, achieving an ablation rate higher than that of 1.1 GBq. This procedure may be offered as an alternative to completion thyroidectomy in highly selected DTC patients who had experienced complications during initial surgery or for whom completion thyroidectomy is contraindicated.

Laparoscopic left hepatectomy in swine: a safe and feasible technique.

PubMed

Zhang, Hua; Liu, Tao; Wang, Yue; Liu, Hai-Feng; Zhang, Jian-Tao; Wu, Yan-Shuang; Lei, Lei; Wang, Hong-Bin

2014-01-01

A purely laparoscopic four-port approach was created for left hepatectomy in pigs. A polyethylene loop was placed on the left two hepatic lobes for traction and lift. Next, penetrating ligation of the lobes using of a double row of silk sutures was performed to control bleeding. A direct hepatic transection was completed using a monopolar hook electrode without meticulous dissection of the left hepatic vein. The raw surface of the liver was coagulated and sealed with fibrin glue. Lobes were retrieved through an enlarged portal. Laparoscopic hepatic lobectomy was completed in all pigs without the use of specialized instruments and with a mean operative time of 179 ± 9 min. No significant perioperative complications were observed. The average weight of each resected lobe was 180 ± 51 g. Complete blood count as well as serum organics and enzyme levels normalized after about 2 weeks. During necropsy, adhesion of the hepatic raw surface to the gastric wall and omentum were observed. No other abnormalities were identified. This minimally invasive left hepatectomy technique in swine could serve as a useful model for investigating liver diseases and regeneration, and offer preclinical information to improve hepatobiliary surgical procedures.

Effects of peptides Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly on hormonal activity and structure of the thyroid gland in hypophysectomized young chickens and old hens.

PubMed

Kuznik, B I; Pateyuk, A V; Rusaeva, N S; Baranchugova, L M; Obydenko, V I

2011-02-01

Hypophysectomy in 5-days chickens and old hens was followed by hormonal disturbances and structural changes in the thyroid gland. Administration of peptides Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly synthesized on the basis the amino acid composition of extracts from the anterior and posterior lobes of the pituitary gland, respectively, to hypophysectomized birds for 40 days significantly reduced the degree of these changes. The normalizing effect of synthetic peptides on the concentration of thyrotrophic hormone and thyroid hormones in old hens was less pronounced than in chickens.

Lateralising value of experiential hallucinations in temporal lobe epilepsy.

PubMed

Heydrich, Lukas; Marillier, Guillaume; Evans, Nathan; Blanke, Olaf; Seeck, Margitta

2015-11-01

Ever since John Hughlings Jackson first described the so-called 'dreamy state' during temporal lobe epilepsy, that is, the sense of an abnormal familiarity (déjà vu) or vivid memory-like hallucinations from the past (experiential hallucinations), these phenomena have been studied and repeatedly linked to mesial temporal lobe structures. However, little is known about the lateralising value of either déjà vu or experiential hallucinations. We analysed a sample of 28 patients with intractable focal epilepsy suffering from either déjà vu or experiential hallucinations. All the patients underwent thorough presurgical examination, including MRI, positron emission tomography, single-photon emission CT, EEG and neuropsychological examination. While déjà vu was due to right or left mesial temporal lobe epilepsy, experiential hallucinations were strongly lateralised to the left mesial temporal lobe. Moreover, there was a significant effect for interictal language deficits being more frequent in patients suffering from experiential hallucinations. These results suggest a lateralising value for experiential hallucinations to the left temporal lobe. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Submandibular Lateral Ectopic Thyroid Tissue: Ultrasonography, Computed Tomography, and Scintigraphic Findings

PubMed Central

Çeliker, Metin; Beyazal Çeliker, Fatma; Turan, Arzu; Beyazal, Mehmet; Beyazal Polat, Hatice

2015-01-01

Ectopic thyroid can be encountered anywhere between the base of tongue and pretracheal region. The most common form is euthyroid neck mass. Herein, we aimed to present the findings of a female case with ectopic thyroid tissue localized in the left submandibular region. A 44-year-old female patient, who underwent bilateral subtotal thyroidectomy four years ago with the diagnosis of multinodular goiter, was admitted to our hospital due to a mass localized in the left submandibular area that gradually increased in the last six months. Neck ultrasonography, contrast-enhanced computed tomography, and scintigraphic examination were performed on the patient. On thyroid scintigraphy with Tc-99m pertechnetate, thyroid tissue activity uptake showing massive radioactivity was observed in the normal localization of the thyroid gland and in the submandibular localization. The focus in the submandibular region was excised. Pathological examination of the specimen showed normal thyroid follicle cells with no signs of malignancy. The submandibular mass is a rarely encountered lateral ectopic thyroid tissue. Accordingly, ectopic thyroid tissue should also be considered in the differential diagnosis of masses in the submandibular region. PMID:26634164

Altered functional MR imaging language activation in elderly individuals with cerebral leukoaraiosis.

PubMed

Welker, Kirk M; De Jesus, Reordan O; Watson, Robert E; Machulda, Mary M; Jack, Clifford R

2012-10-01

To test the hypothesis that leukoaraiosis alters functional activation during a semantic decision language task. With institutional review board approval and written informed consent, 18 right-handed, cognitively healthy elderly participants with an aggregate leukoaraiosis lesion volume of more than 25 cm(3) and 18 age-matched control participants with less than 5 cm(3) of leukoaraiosis underwent functional MR imaging to allow comparison of activation during semantic decisions with that during visual perceptual decisions. Brain statistical maps were derived from the general linear model. Spatially normalized group t maps were created from individual contrast images. A cluster extent threshold of 215 voxels was used to correct for multiple comparisons. Intergroup random effects analysis was performed. Language laterality indexes were calculated for each participant. In control participants, semantic decisions activated the bilateral visual cortex, left posteroinferior temporal lobe, left posterior cingulate gyrus, left frontal lobe expressive language regions, and left basal ganglia. Visual perceptual decisions activated the right parietal and posterior temporal lobes. Participants with leukoaraiosis showed reduced activation in all regions associated with semantic decisions; however, activation associated with visual perceptual decisions increased in extent. Intergroup analysis showed significant activation decreases in the left anterior occipital lobe (P=.016), right posterior temporal lobe (P=.048), and right basal ganglia (P=.009) in particpants with leukoariosis. Individual participant laterality indexes showed a strong trend (P=.059) toward greater left lateralization in the leukoaraiosis group. Moderate leukoaraiosis is associated with atypical functional activation during semantic decision tasks. Consequently, leukoaraiosis is an important confounding variable in functional MR imaging studies of elderly individuals. © RSNA, 2012.

Solitary liver metastasis from follicular variant papillary thyroid carcinoma: A case report and literature review

PubMed Central

Djenic, Brano; Duick, Daniel; Newell, James O.; Demeure, Michael J.

2014-01-01

Introduction Papillary (PTC) and follicular (FTC) thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Sites of metastases from FTC are usually osseous and those from PTC are in regional nodal basins and the lungs. Visceral metastases are rare and when they do occur, they tend do so in multiple sites. We present the case of a patient with a follicular variant of PTC and a solitary metastasis to the liver then review the relevant literature. Presentation of case An otherwise healthy 68-year-old woman was diagnosed with follicular variant papillary thyroid cancer in 2003 and subsequently underwent thyroidectomy. The patient’s endocrinologist conducted surveillance of her thyroid cancer. In 2012, due to rise in thyroglobulin, a whole body radioiodine scan was obtained which revealed an iodine-avid left liver lobe mass. Three cycles of radioiodine ablation therapy were unsuccessful and eventually the patient was referred for surgical resection. Metastatic evaluation including a PET scan was negative with the exception of an isolated enhancing 4 cm mass in segment 4B of the liver. Anatomic segmental resection of liver was performed without complications. Intraoperative ultrasonography was used to guide resection of the liver mass. Pathology reports confirmed metastatic follicular variant of PTC. Surgical margins were free of tumor. Patient was discharged home and is doing well one year after surgery. The latest thyroglobulin level was undetectable. Discussion Post-operative surveillance by PCP, endocrinologist or surgeon for patients with thyroid carcinoma should be performed routinely. If identified, a solitary liver metastasis from primary thyroid carcinoma should be considered for surgical resection. Due to sparse data available in literature, collecting more data to establish algorithms for treatment of such rare metastatic cancers may be able to aid physicians to achieve better outcomes. Conclusion Rare distant sites of metastases from DTC include eyes, pharynx, skin, muscle, ovaries, adrenal glands, kidneys, esophagus, pancreas and liver. Isolated, resectable liver metastases from PTC are exceedingly rare. Literature review revealed only 10 reported cases of liver metastases from DTC. As in our patient, solitary liver metastasis from PTC should be considered for surgical resection which offers the best chance for prolonged survival. PMID:25536153

Transoral videolaryngoscopic surgery for papillary carcinoma arising in lingual thyroid.

PubMed

Mogi, Chisato; Shinomiya, Hirotaka; Fujii, Natsumi; Tsuruta, Tomoyuki; Morita, Naruhiko; Furukawa, Tatsuya; Teshima, Masanori; Kanzawa, Maki; Hirokawa, Mitsuyoshi; Otsuki, Naoki; Nibu, Ken-Ichi

2018-05-15

Carcinoma arising in lingual thyroid is an extremely rare entity accounting for only 1% of all reported ectopic thyroids. Here, we report a case of carcinoma arising in lingual thyroid, which has been successfully managed by transoral resection and bilateral neck dissections. A lingual mass 4-cm in diameter with calcification was incidentally detected by computed tomography at medical check-up. No thyroid tissue was observed in normal position. Ultrasound examination showed bilateral multiple lymphadenopathies. Fine needle aspiration biopsy from lymph node in his right neck was diagnosed as Class III and thyroglobulin level of the specimen was 459ng/ml. Due to the difficulty in performing FNA of the lingual masses, right neck dissection was performed in advance for diagnostic purpose. Pathological examination showed existence of large and small follicular thyroid tissues in several lymph nodes, suggesting lymph node metastasis from thyroid carcinoma. Two months after the initial surgery, video-assisted transoral resection of lingual thyroid with simultaneous left neck dissection was performed. Postoperative course was uneventful. Papillary carcinoma was found in the lingual thyroid and thyroid tissues were also found in left cervical lymph nodes. Video-assisted transoral resection was useful for the treatment of thyroid cancer arising in lingual thyroid. Copyright © 2018 Elsevier B.V. All rights reserved.

A branching morphogenesis program governs embryonic growth of the thyroid gland

PubMed Central

Liang, Shawn; Johansson, Ellen; Barila, Guillermo; Altschuler, Daniel L.; Fagman, Henrik

2018-01-01

ABSTRACT The developmental program that regulates thyroid progenitor cell proliferation is largely unknown. Here, we show that branching-like morphogenesis is a driving force to attain final size of the embryonic thyroid gland in mice. Sox9, a key factor in branching organ development, distinguishes Nkx2-1+ cells in the thyroid bud from the progenitors that originally form the thyroid placode in anterior endoderm. As lobes develop the thyroid primordial tissue branches several generations. Sox9 and Fgfr2b are co-expressed distally in the branching epithelium prior to folliculogenesis. The thyroid in Fgf10 null mutants has a normal shape but is severely hypoplastic. Absence of Fgf10 leads to defective branching and disorganized angiofollicular units although Sox9/Fgfr2b expression and the ability of cells to differentiate and form nascent follicles are not impaired. These findings demonstrate a novel mechanism of thyroid development reminiscent of the Fgf10-Sox9 program that characterizes organogenesis in classical branching organs, and provide clues to aid understanding of how the endocrine thyroid gland once evolved from an exocrine ancestor present in the invertebrate endostyle. PMID:29361553

A branching morphogenesis program governs embryonic growth of the thyroid gland.

PubMed

Liang, Shawn; Johansson, Ellen; Barila, Guillermo; Altschuler, Daniel L; Fagman, Henrik; Nilsson, Mikael

2018-01-25

The developmental program that regulates thyroid progenitor cell proliferation is largely unknown. Here, we show that branching-like morphogenesis is a driving force to attain final size of the embryonic thyroid gland in mice. Sox9, a key factor in branching organ development, distinguishes Nkx2-1 + cells in the thyroid bud from the progenitors that originally form the thyroid placode in anterior endoderm. As lobes develop the thyroid primordial tissue branches several generations. Sox9 and Fgfr2b are co-expressed distally in the branching epithelium prior to folliculogenesis. The thyroid in Fgf10 null mutants has a normal shape but is severely hypoplastic. Absence of Fgf10 leads to defective branching and disorganized angiofollicular units although Sox9/Fgfr2b expression and the ability of cells to differentiate and form nascent follicles are not impaired. These findings demonstrate a novel mechanism of thyroid development reminiscent of the Fgf10-Sox9 program that characterizes organogenesis in classical branching organs, and provide clues to aid understanding of how the endocrine thyroid gland once evolved from an exocrine ancestor present in the invertebrate endostyle. © 2018. Published by The Company of Biologists Ltd.

Association of Hippocampal Substructure Resting-State Functional Connectivity with Memory Performance in Older Adults.

PubMed

Smagula, Stephen F; Karim, Helmet T; Rangarajan, Anusha; Santos, Fernando Pasquini; Wood, Sossena C; Santini, Tales; Jakicic, John M; Reynolds, Charles F; Cameron, Judy L; Vallejo, Abbe N; Butters, Meryl A; Rosano, Caterina; Ibrahim, Tamer S; Erickson, Kirk I; Aizenstein, Howard J

2018-06-01

Hippocampal hyperactivation marks preclinical dementia pathophysiology, potentially due to differences in the connectivity of specific medial temporal lobe structures. Our aims were to characterize the resting-state functional connectivity of medial temporal lobe sub-structures in older adults, and evaluate whether specific substructural (rather than global) functional connectivity relates to memory function. In 15 adults (mean age: 69 years), we evaluated the resting state functional connectivity of medial temporal lobe substructures: dentate/Cornu Ammonis (CA) 4, CA1, CA2/3, subiculum, the molecular layer, entorhinal cortex, and parahippocampus. We used 7-Tesla susceptibility weighted imaging and magnetization-prepared rapid gradient echo sequences to segment substructures of the hippocampus, which were used as structural seeds for examining functional connectivity in a resting BOLD sequence. We then assessed correlations between functional connectivity with memory performance (short and long delay free recall on the California Verbal Learning Test [CVLT]). All the seed regions had significant connectivity within the temporal lobe (including the fusiform, temporal, and lingual gyri). The left CA1 was the only seed with significant functional connectivity to the amygdala. The left entorhinal cortex was the only seed to have significant functional connectivity with frontal cortex (anterior cingulate and superior frontal gyrus). Only higher left dentate-left lingual connectivity was associated with poorer CVLT performance (Spearman r = -0.81, p = 0.0003, Benjamini-Hochberg false discovery rate: 0.01) after multiple comparison correction. Rather than global hyper-connectivity of the medial temporal lobe, left dentate-lingual connectivity may provide a specific assay of medial temporal lobe hyper-connectivity relevant to memory in aging. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Outcomes of various transplant procedures (single, sparing, inverted) in living-donor lobar lung transplantation.

PubMed

Date, Hiroshi; Aoyama, Akihiro; Hijiya, Kyoko; Motoyama, Hideki; Handa, Tomohiro; Kinoshita, Hideyuki; Baba, Shiro; Mizota, Toshiyuki; Minakata, Kenji; Chen-Yoshikawa, Toyofumi F

2017-02-01

In standard living-donor lobar lung transplantation (LDLLT), the right and left lower lobes from 2 healthy donors are implanted. Because of the difficulty encountered in finding 2 donors with ideal size matching, various transplant procedures have been developed in our institution. The purpose of this retrospective study was to compare outcomes of nonstandard LDLLT with standard LDLLT. Between June 2008 and January 2016, we performed 65 LDLLTs for critically ill patients. Functional size matching was performed by estimating graft forced vital capacity based on the donor's measured forced vital capacity and the number of pulmonary segments implanted. For anatomical size matching, 3-dimensional computed tomography volumetry was performed. In cases of oversize mismatch, single-lobe transplant or downsizing transplant was performed. In cases of undersize mismatch, native upper lobe sparing transplant or right-left inverted transplant was performed. In right-left inverted transplants, the donor's right lower lobe was inverted and implanted into the recipient's left chest cavity. Twenty-nine patients (44.6%) received nonstandard LDLLT, including 12 single-lobe transplants, 7 native upper lobe sparing transplants, 6 right-left inverted transplants, 2 sparing + inverted transplants, and 2 others. Thirty-six patients (57.4%) received standard LDLLT. Three- and five-year survival rates were similar between the 2 groups (89.1% and 76.6% after nonstandard LDLLT vs 78.0% and 71.1% after standard LDLLT, P = .712). Various transplant procedures such as single, sparing and inverted transplants are valuable options when 2 donors with ideal size matching are not available for LDLLT. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Leaning to the Left: Increasing the Donor Pool by Using the Left Lobe, Outcomes of the Largest Single-center North American Experience of Left Lobe Adult-to-adult Living Donor Liver Transplantation.

PubMed

Halazun, Karim J; Przybyszewski, Eric M; Griesemer, Adam D; Cherqui, Daniel; Michelassi, Fabrizio; Guarrera, James V; Kato, Tomoaki; Brown, Robert S; Emond, Jean C; Samstein, Benjamin

2016-09-01

Centers offering adult living donor liver transplantation (LDLT) mostly use right lobe grafts due to fears of providing recipients with insufficient hepatic volume, and the technical challenges presented by using left lobe grafts (LLGs). LLGs therefore represent approximately 5% of adult LDLTs performed in the United States. Here we present the largest North American experience with the use of LLG for adult LDLT. Analysis of a prospectively maintained database of LDLTs performed from 1998 to 2015 at our institution. A total of 214 adult LDLTs were studied. Fifty-six patients (26%) received LLG. LLG recipients were more likely to be women, had significantly lower BMI, graft weight, and graft-weight-recipient-weight ratios (P < 0.05 for all). There were no significant differences in vascular or biliary complication between the groups. No significant differences existed in patient or graft survival at 1, 3, and 5 years (P = 0.747 and P = 0.398 respectively). Despite significantly increased risk of small-for-size syndrome in LLG, there was no increased risk of retransplant within 90-days or perioperative mortality in LLG recipients (P = 0.308 and P = 0.932 respectively). Graft type did not predict patient or graft outcomes on regression analysis (P = 0.857 and 0.399 respectively). Despite smaller graft sizes, outcomes of adult LDLT using LLG are comparable to right lobe grafts transplants. Left lobes can provide an important resource in an era of severe organ shortages, and these data should serve to allay the concerns of the transplant community in the United States.

Dichotic Listening and School Performance in Dyslexia

ERIC Educational Resources Information Center

Helland, Turid; Asbjornsen, Arve E.; Hushovd, Aud Ellen; Hugdahl, Kenneth

2008-01-01

This study focused on the relationship between school performance and performance on a dichotic listening (DL) task in dyslexic children. Dyslexia is associated with impaired phonological processing, related to functions in the left temporal lobe. DL is a frequently used task to assess functions of the left temporal lobe. Due to the predominance…

Bilateral Capacity for Speech Sound Processing in Auditory Comprehension: Evidence from Wada Procedures

ERIC Educational Resources Information Center

Hickok, G.; Okada, K.; Barr, W.; Pa, J.; Rogalsky, C.; Donnelly, K.; Barde, L.; Grant, A.

2008-01-01

Data from lesion studies suggest that the ability to perceive speech sounds, as measured by auditory comprehension tasks, is supported by temporal lobe systems in both the left and right hemisphere. For example, patients with left temporal lobe damage and auditory comprehension deficits (i.e., Wernicke's aphasics), nonetheless comprehend isolated…

Recognition and identification of famous faces in patients with unilateral temporal lobe epilepsy.

PubMed

Seidenberg, Michael; Griffith, Randall; Sabsevitz, David; Moran, Maria; Haltiner, Alan; Bell, Brian; Swanson, Sara; Hammeke, Thomas; Hermann, Bruce

2002-01-01

We examined the performance of 21 patients with unilateral temporal lobe epilepsy (TLE) and hippocampal damage (10 lefts, and 11 rights) and 10 age-matched controls on the recognition and identification (name and occupation) of well-known faces. Famous face stimuli were selected from four time periods; 1970s, 1980s, 1990-1994, and 1995-1996. Differential patterns of performance were observed for the left and right TLE group across distinct face processing components. The left TLE group showed a selective impairment in naming famous faces while they performed similar to the controls in face recognition and semantic identification (i.e. occupation). In contrast, the right TLE group was impaired across all components of face memory; face recognition, semantic identification, and face naming. Face naming impairment in the left TLE group was characterized by a temporal gradient with better naming performance for famous faces from more distant time periods. Findings are discussed in terms of the role of the temporal lobe system for the acquisition, retention, and retrieval of face semantic networks, and the differential effects of lateralized temporal lobe lesions in this process.

A functional magnetic resonance imaging study mapping the episodic memory encoding network in temporal lobe epilepsy

PubMed Central

Sidhu, Meneka K.; Stretton, Jason; Winston, Gavin P.; Bonelli, Silvia; Centeno, Maria; Vollmar, Christian; Symms, Mark; Thompson, Pamela J.; Koepp, Matthias J.

2013-01-01

Functional magnetic resonance imaging has demonstrated reorganization of memory encoding networks within the temporal lobe in temporal lobe epilepsy, but little is known of the extra-temporal networks in these patients. We investigated the temporal and extra-temporal reorganization of memory encoding networks in refractory temporal lobe epilepsy and the neural correlates of successful subsequent memory formation. We studied 44 patients with unilateral temporal lobe epilepsy and hippocampal sclerosis (24 left) and 26 healthy control subjects. All participants performed a functional magnetic resonance imaging memory encoding paradigm of faces and words with subsequent out-of-scanner recognition assessments. A blocked analysis was used to investigate activations during encoding and neural correlates of subsequent memory were investigated using an event-related analysis. Event-related activations were then correlated with out-of-scanner verbal and visual memory scores. During word encoding, control subjects activated the left prefrontal cortex and left hippocampus whereas patients with left hippocampal sclerosis showed significant additional right temporal and extra-temporal activations. Control subjects displayed subsequent verbal memory effects within left parahippocampal gyrus, left orbitofrontal cortex and fusiform gyrus whereas patients with left hippocampal sclerosis activated only right posterior hippocampus, parahippocampus and fusiform gyrus. Correlational analysis showed that patients with left hippocampal sclerosis with better verbal memory additionally activated left orbitofrontal cortex, anterior cingulate cortex and left posterior hippocampus. During face encoding, control subjects showed right lateralized prefrontal cortex and bilateral hippocampal activations. Patients with right hippocampal sclerosis showed increased temporal activations within the superior temporal gyri bilaterally and no increased extra-temporal areas of activation compared with control subjects. Control subjects showed subsequent visual memory effects within right amygdala, hippocampus, fusiform gyrus and orbitofrontal cortex. Patients with right hippocampal sclerosis showed subsequent visual memory effects within right posterior hippocampus, parahippocampal and fusiform gyri, and predominantly left hemisphere extra-temporal activations within the insula and orbitofrontal cortex. Correlational analysis showed that patients with right hippocampal sclerosis with better visual memory activated the amygdala bilaterally, right anterior parahippocampal gyrus and left insula. Right sided extra-temporal areas of reorganization observed in patients with left hippocampal sclerosis during word encoding and bilateral lateral temporal reorganization in patients with right hippocampal sclerosis during face encoding were not associated with subsequent memory formation. Reorganization within the medial temporal lobe, however, is an efficient process. The orbitofrontal cortex is critical to subsequent memory formation in control subjects and patients. Activations within anterior cingulum and insula correlated with better verbal and visual subsequent memory in patients with left and right hippocampal sclerosis, respectively, representing effective extra-temporal recruitment. PMID:23674488

Struma Ovarii with Papillary Thyroid Carcinoma

PubMed Central

Alvarez, Daniel M.; Lee, Victor; Bhatt, Shweta; Dogra, Vikram S.

2011-01-01

Struma ovarii is an uncommon condition, in which thyroid tissue is the predominant or exclusive element in an ovarian teratoma. Thyroid tissue may demonstrate the same spectrum of pathological features as in the normal thyroid including benign and malignant changes. We present a case of papillary thyroid carcinoma arising in a struma ovarii of the left ovary in a 21-year-old female. PMID:22315711

Usefulness of free-breathing readout-segmented echo-planar imaging (RESOLVE) for detection of malignant liver tumors: comparison with single-shot echo-planar imaging (SS-EPI).

PubMed

Tokoro, Hirokazu; Fujinaga, Yasunari; Ohya, Ayumi; Ueda, Kazuhiko; Shiobara, Aya; Kitou, Yoshihiro; Ueda, Hitoshi; Kadoya, Masumi

2014-10-01

We aimed to clarify the usefulness of free-breathing readout-segmented echo-planar imaging (RESOLVE), which is multi-shot echo-planar imaging based on a 2D-navigator-based reacquisition technique, for detecting malignant liver tumor. In 77 patients with malignant liver tumors, free-breathing RESOLVE and respiratory-triggered single-shot echo-planar imaging (SS-EPI) at 3-T MR unit were performed. We set a scan time up to approximately 5 min (300s) before examination, measured actual scan time and assessed (1) susceptibility and (2) motion artifacts in the right and left liver lobes (3, no artifact; 1, marked), and (3) detectability of malignant liver tumors (3, good; 1, poor) using a 3-point scale. The median actual scan time of RESOLVE/SS-EPI was 365/423s. The median scores of each factor in RESOLVE/SS-EPI were as following in this order: (1) 3/2 (right lobe); 3/3 (left lobe), (2) 2/3 (right lobe); 1/2 (left lobe), and (3) 3/3, respectively. Significant differences were noted between RESOLVE and SS-EPI in all evaluated factors (P<0.05) except for susceptibility of left lobe and detectability of the lesions. Despite the effect of motion artifacts, RESOLVE provides a comparable detectability of the lesion and the advantage of reducing scanning time compared with SS-EPI. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Verbal memory outcome in patients with normal preoperative verbal memory and left mesial temporal sclerosis.

PubMed

LoGalbo, Anthony; Sawrie, Stephen; Roth, David L; Kuzniecky, Ruben; Knowlton, Robert; Faught, Edward; Martin, Roy

2005-05-01

Previous studies have shown that structural integrity (i.e., presence/absence of mesial temporal sclerosis (MTS)) of the left mesial temporal lobe is associated with verbal memory outcome following left anterior temporal lobectomy (ATL). However, the functional integrity of the left temporal lobe, as exemplified by preoperative verbal memory performance, has also been associated with verbal memory outcome following surgery. We investigated the risk of verbal memory loss in patients with known structural abnormality (i.e., left mesial temporal sclerosis by MRI) and normal preoperative verbal memory performance who undergo left ATL. Seventeen patients with left temporal lobe epilepsy, MRI-based exclusive left MTS, and normal preoperative verbal memory were identified. Normal verbal memory was defined as performance on both Acquisition (learning across trials 1-5) and Retrieval (long delayed free recall) portions of the California Verbal Learning Test (CVLT) above a T score of 40 (>16%ile). Postoperative verbal memory outcome was established by incorporating standardized regression-based (SRB) change scores. Postoperative declines across both CVLT Retrieval T scores and Acquisition T scores (average 20% and average 15% declines from baseline scores, respectively) were measured for the group. The average CVLT Retrieval SRB change score was -2.5, and the average CVLT Acquisition SRB change score was -1.0. A larger proportion of patients demonstrated postoperative declines on Retrieval scores than Acquisition scores (64.7% vs 17.6%, respectively). Even in the presence of left MTS, patients exhibiting normal presurgical verbal memory are at risk for verbal memory declines following ATL. These results suggest that the functional integrity of the left mesial temporal lobe may play an important role in the verbal memory outcome in this patient group.

Auditory aura in nocturnal frontal lobe epilepsy: a red flag to suspect an extra-frontal epileptogenic zone.

PubMed

Ferri, Lorenzo; Bisulli, Francesca; Nobili, Lino; Tassi, Laura; Licchetta, Laura; Mostacci, Barbara; Stipa, Carlotta; Mainieri, Greta; Bernabè, Giorgia; Provini, Federica; Tinuper, Paolo

2014-11-01

To describe the anatomo-electro-clinical findings of patients with nocturnal hypermotor seizures (NHS) preceded by auditory symptoms, to evaluate the localizing value of auditory aura. Our database of 165 patients with nocturnal frontal lobe epilepsy (NFLE) diagnosis confirmed by videopolysomnography (VPSG) was reviewed, selecting those who reported an auditory aura as the initial ictal symptom in at least two NHS during their lifetime. Eleven patients were selected (seven males, four females). According to the anatomo-electro-clinical data, three groups were identified. Group 1 [defined epileptogenic zone (EZ)]: three subjects were studied with stereo-EEG. The EZ lay in the left superior temporal gyrus in two cases, whereas in the third case seizures arose from a dysplastic lesion located in the left temporal lobe. One of these three patients underwent left Heschl's gyrus resection, and is currently seizure-free. Group 2 (presumed EZ): three cases in which a presumed EZ was identified; in the left temporal lobe in two cases and in the left temporal lobe extending to the insula in one subject. Group 3 (uncertain EZ): five cases had anatomo-electro-clinical correlations discordant. This work suggests that auditory aura may be a helpful anamnestic feature suggesting an extra-frontal seizure origin. This finding could guide secondary investigations to improve diagnostic definition and selection of candidates for surgical treatment. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Liver diffusion-weighted MR imaging: reproducibility comparison of ADC measurements obtained with multiple breath-hold, free-breathing, respiratory-triggered, and navigator-triggered techniques.

PubMed

Chen, Xin; Qin, Lei; Pan, Dan; Huang, Yanqi; Yan, Lifen; Wang, Guangyi; Liu, Yubao; Liang, Changhong; Liu, Zaiyi

2014-04-01

To prospectively compare the reproducibility of normal liver apparent diffusion coefficient (ADC) measurements by using different respiratory motion compensation techniques with multiple breath-hold (MBH), free-breathing (FB), respiratory-triggered (RT), and navigator-triggered (NT) diffusion-weighted (DW) imaging and to compare the ADCs at different liver anatomic locations. The study protocol was approved by the institutional review board, and written informed consent was obtained from each participant. Thirty-nine volunteers underwent liver DW imaging twice. Imaging was performed with a 1.5-T MR imager with MBH, FB, RT, and NT techniques (b = 0, 100, and 500 sec/mm(2)). Three representative sections--superior, central, and inferior--were selected on left and right liver lobes, respectively. On each selected section, three regions of interest were drawn, and ADCs were measured. Analysis of variance was used to assess ADCs among the four techniques and various anatomic locations. Reproducibility of ADCs was assessed with the Bland-Altman method. ADCs obtained with MBH (range: right lobe, [1.641-1.662] × 10(-3)mm(2)/sec; left lobe, [2.034-2.054] ×10(-3)mm(2)/sec) were higher than those obtained with FB (right, [1.349-1.391] ×10(-3)mm(2)/sec; left, [1.630-1.700] ×10(-3)mm(2)/sec), RT (right, [1.439-1.455] ×10(-3)mm(2)/sec; left, [1.720-1.755] ×10(-3)mm(2)/sec), or NT (right, [1.387-1.400] ×10(-3)mm(2)/sec; left, [1.661-1.736] ×10(-3)mm(2)/sec) techniques (P < .001); however, no significant difference was observed between ADCs obtained with FB, RT, and NT techniques (P = .130 to P >.99). ADCs showed a trend to decrease moving from left to right. Reproducibility in the left liver lobe was inferior to that in the right, and the central middle segment in the right lobe had the most reproducible ADC. Statistical differences in ADCs were observed in the left-right direction in the right lobe (P < .001), but they were not observed in the superior-inferior direction (P = .144-.450). However, in the left liver lobe, statistical differences existed in both directions (P = .001 to P = .016 in the left-right direction, P < .001 in the superior-inferior direction). Both anatomic location and DW imaging technique influence liver ADC measurements and their reproducibility. FB DW imaging is recommended for liver DW imaging because of its good reproducibility and shorter acquisition time compared with that of MBH, RT, and NT techniques. RSNA, 2014

Activations in temporal areas using visual and auditory naming stimuli: A language fMRI study in temporal lobe epilepsy.

PubMed

Gonzálvez, Gloria G; Trimmel, Karin; Haag, Anja; van Graan, Louis A; Koepp, Matthias J; Thompson, Pamela J; Duncan, John S

2016-12-01

Verbal fluency functional MRI (fMRI) is used for predicting language deficits after anterior temporal lobe resection (ATLR) for temporal lobe epilepsy (TLE), but primarily engages frontal lobe areas. In this observational study we investigated fMRI paradigms using visual and auditory stimuli, which predominately involve language areas resected during ATLR. Twenty-three controls and 33 patients (20 left (LTLE), 13 right (RTLE)) were assessed using three fMRI paradigms: verbal fluency, auditory naming with a contrast of auditory reversed speech; picture naming with a contrast of scrambled pictures and blurred faces. Group analysis showed bilateral temporal activations for auditory naming and picture naming. Correcting for auditory and visual input (by subtracting activations resulting from auditory reversed speech and blurred pictures/scrambled faces respectively) resulted in left-lateralised activations for patients and controls, which was more pronounced for LTLE compared to RTLE patients. Individual subject activations at a threshold of T>2.5, extent >10 voxels, showed that verbal fluency activated predominantly the left inferior frontal gyrus (IFG) in 90% of LTLE, 92% of RTLE, and 65% of controls, compared to right IFG activations in only 15% of LTLE and RTLE and 26% of controls. Middle temporal (MTG) or superior temporal gyrus (STG) activations were seen on the left in 30% of LTLE, 23% of RTLE, and 52% of controls, and on the right in 15% of LTLE, 15% of RTLE, and 35% of controls. Auditory naming activated temporal areas more frequently than did verbal fluency (LTLE: 93%/73%; RTLE: 92%/58%; controls: 82%/70% (left/right)). Controlling for auditory input resulted in predominantly left-sided temporal activations. Picture naming resulted in temporal lobe activations less frequently than did auditory naming (LTLE 65%/55%; RTLE 53%/46%; controls 52%/35% (left/right)). Controlling for visual input had left-lateralising effects. Auditory and picture naming activated temporal lobe structures, which are resected during ATLR, more frequently than did verbal fluency. Controlling for auditory and visual input resulted in more left-lateralised activations. We hypothesise that these paradigms may be more predictive of postoperative language decline than verbal fluency fMRI. Copyright © 2016 Elsevier B.V. All rights reserved.

Study on memories of temporal lobes and the principles of lateralization using near infrared spectroscopy

NASA Astrophysics Data System (ADS)

Kamakura, Katsutoshi

2007-01-01

In this study we measured the variation of brain blood quantity (Oxy-Hb, Deoxy-Hb and Total-Hb) in the temporal lobes using near infrared spectroscopy (NIRS) when the tasks of the memories were presented to the subjects. The memories are classified into the short-term memory (STM) and the long-term memory (LTM) including the episodic and semantic memories. The subjects joined in this study are 11 persons who are university students including graduate students. We used the language task of letter-number sequencing, also reverse sequencing to measure STM and the task of the episodic memory to measure LTM. As a result of analysis, concerning the episodic memory, the variation of Oxy-Hb in the left temporal lobe was larger than that of Oxy-Hb in the right temporal lobe. The result might suggest that the episodic memory has a relationship with cerebral dominance concerning language area in the left temporal lobe. It seems that the episodic memory meditated with the function of language used in this study is much stored in the left temporal lobe than in the right temporal lobe. This result coincides with the principles of lateralization. The variation of Oxy-Hb in the language task of letter-number sequencing was smaller than that of Oxy-Hb in the language task of the episodic memory.

Thyroidal abscesses in third and fourth branchial anomalies: not only a paediatric diagnosis.

PubMed

Kruijff, Schelto; Sywak, Mark S; Sidhu, Stan B; Shun, Albert; Novakovic, Daniel; Lee, James C; Delbridge, Leigh W

2015-01-01

Acute suppurative thyroiditis and recurrent abscess formation due to third and fourth branchial anomalies typically present in children. However, thyroid abscesses in branchial anomalies may occur in adulthood as well. Failure to recognize and delayed drainage of a neck abscess may lead to a fulminant life-threatening outcome. This is a retrospective case series. The study group comprised all patients presenting over a 12-month period from January to December 2012 with thyroid abscesses and a branchial cleft anomaly in two centres, one adult and the other paediatric. Patient demographics, clinical presentation, imaging, surgical management, definitive histology and outcomes were documented. Five patients were identified with a history of thyroid abscesses. Only one was a child (aged 9 years) with the other four being adults (aged 20, 34, 37 and 41 years). All patients had third or fourth left branchial cleft anomalies, presenting as suppurative thyroiditis with a left-sided thyroid abscess. Management options ranged from abscess drainage on initial presentation, primary thyroid lobectomy or delayed thyroid lobectomy following abscess drainage. Acute suppurative thyroidits and thyroid abscesses is not just a paediatric diagnosis but may present at any age. In both children and adults, a thyroid abscess almost always arises from branchial cleft anomalies. © 2014 Royal Australasian College of Surgeons.

Verbal Memory Compensation: Application to Left and Right Temporal Lobe Epileptic Patients

ERIC Educational Resources Information Center

Bresson, Christel; Lespinet-Najib, Veronique; Rougier, Alain; Claverie, Bernard; N'Kaoua, Bernard

2007-01-01

This study investigates the compensatory impact of cognitive aids on left and right temporal lobe epileptic patients suffering from verbal memory disorders, who were candidates for surgery. Cognitive aids are defined in the levels-of-processing framework and deal with the depth of encoding, the elaboration of information, and the use of retrieval…

Auditory/visual Duration Bisection in Patients with Left or Right Medial-Temporal Lobe Resection

ERIC Educational Resources Information Center

Melgire, Manuela; Ragot, Richard; Samson, Severine; Penney, Trevor B.; Meck, Warren H.; Pouthas, Viviane

2005-01-01

Patients with unilateral (left or right) medial temporal lobe lesions and normal control (NC) volunteers participated in two experiments, both using a duration bisection procedure. Experiment 1 assessed discrimination of auditory and visual signal durations ranging from 2 to 8 s, in the same test session. Patients and NC participants judged…

A "reverse direction" technique of single-port left upper pulmonary resection.

PubMed

Zhang, Min; Sihoe, Alan D L; Du, Ming

2016-08-01

Single-port video-assisted thoracoscopic surgery (VATS) left upper lobectomy is difficult amongst all the lobes. At the beginning of single-port lobectomies, the upper lobes were believed not to be amenable for single-port approach due to the difficult angulation for staplers. Gonzalez reported the first single-port VATS left upper lobectomy in 2011. We report a new technique of single-port VATS left upper lobectomy with the concept of "reverse direction". We divide the apical-anterior arterial trunk with upper vein in the last. The procedure sequence is described as follows: posterior artery, lingular artery, bronchus and finally upper vein & apical-anterior arterial trunk. This method could overcome the angular limitations frequently encountered in single-port VATS procedures; reduce the risk of injuries to pulmonary artery; broaden the indications of single-port the upper lobe of the left lung (LUL) to include hypoplastic lung fissures. Limitations of this new practice include the enlargement or severe calcifications of hilar and bronchial lymph nodes. A "reverse direction" technique of single-port left upper pulmonary resection is feasible and safe.

The Structural Plasticity of White Matter Networks Following Anterior Temporal Lobe Resection

ERIC Educational Resources Information Center

Yogarajah, Mahinda; Focke, Niels K.; Bonelli, Silvia B.; Thompson, Pamela; Vollmar, Christian; McEvoy, Andrew W.; Alexander, Daniel C.; Symms, Mark R.; Koepp, Matthias J.; Duncan, John S.

2010-01-01

Anterior temporal lobe resection is an effective treatment for refractory temporal lobe epilepsy. The structural consequences of such surgery in the white matter, and how these relate to language function after surgery remain unknown. We carried out a longitudinal study with diffusion tensor imaging in 26 left and 20 right temporal lobe epilepsy…

Loculated pneumothorax due to a rare combination resulting in an interesting chest radiograph.

PubMed

Isaac, Barney Thomas Jesudason; Samuel, Johnson Thamarathu; Mukherjee, Dipak K; Pittman, Marcus

2017-11-01

A 35 years old man presented with acute onset left sided pleuritic chest pain and shortness of breath. On evaluation, he was found to have an interesting chest radiograph which showed a loculated pneumothorax with collapse of the left upper lobe and lingula but fully expanded left lower lobe. He is a known asthmatic who had allergic broncho pulmonary aspergillosis (ABPA) previously with left upper lobe and lingular collapse secondary to mucous plugging. This resolved on treatment with steroids and itraconazole. An interesting combination of events is proposed to explain the current presentation. CT scan chest and blood tests confirmed this sequence of events. He was appropriately treated resulting in complete clinical and radiological recovery. The events leading to the presentation and the likely physiological background for this interesting chest radiograph are discussed. © 2016 John Wiley & Sons Ltd.

Low-Dose Radioactive Iodine Destroys Thyroid Tissue Left after Surgery

Cancer.gov

A low dose of radioactive iodine given after surgery for thyroid cancer destroyed (ablated) residual thyroid tissue as effectively as a higher dose, with fewer side effects and less exposure to radiation, according to two randomized controlled trials.

Quantitative Evaluation of Medial Temporal Lobe Morphology in Children with Febrile Status Epilepticus: Results of the FEBSTAT Study.

PubMed

McClelland, A C; Gomes, W A; Shinnar, S; Hesdorffer, D C; Bagiella, E; Lewis, D V; Bello, J A; Chan, S; MacFall, J; Chen, M; Pellock, J M; Nordli, D R; Frank, L M; Moshé, S L; Shinnar, R C; Sun, S

2016-12-01

The pathogenesis of febrile status epilepticus is poorly understood, but prior studies have suggested an association with temporal lobe abnormalities, including hippocampal malrotation. We used a quantitative morphometric method to assess the association between temporal lobe morphology and febrile status epilepticus. Brain MR imaging was performed in children presenting with febrile status epilepticus and control subjects as part of the Consequences of Prolonged Febrile Seizures in Childhood study. Medial temporal lobe morphologic parameters were measured manually, including the distance of the hippocampus from the midline, hippocampal height:width ratio, hippocampal angle, collateral sulcus angle, and width of the temporal horn. Temporal lobe morphologic parameters were correlated with the presence of visual hippocampal malrotation; the strongest association was with left temporal horn width (P < .001; adjusted OR, 10.59). Multiple morphologic parameters correlated with febrile status epilepticus, encompassing both the right and left sides. This association was statistically strongest in the right temporal lobe, whereas hippocampal malrotation was almost exclusively left-sided in this cohort. The association between temporal lobe measurements and febrile status epilepticus persisted when the analysis was restricted to cases with visually normal imaging findings without hippocampal malrotation or other visually apparent abnormalities. Several component morphologic features of hippocampal malrotation are independently associated with febrile status epilepticus, even when complete hippocampal malrotation is absent. Unexpectedly, this association predominantly involves the right temporal lobe. These findings suggest that a spectrum of bilateral temporal lobe anomalies are associated with febrile status epilepticus in children. Hippocampal malrotation may represent a visually apparent subset of this spectrum. © 2016 by American Journal of Neuroradiology.

Naming and recognizing famous faces in temporal lobe epilepsy.

PubMed

Glosser, G; Salvucci, A E; Chiaravalloti, N D

2003-07-08

To assess naming and recognition of faces of familiar famous people in patients with epilepsy before and after anterior temporal lobectomy (ATL). Color photographs of famous people were presented for naming and description to 63 patients with temporal lobe epilepsy (TLE) either before or after ATL and to 10 healthy age- and education-matched controls. Spontaneous naming of photographed famous people was impaired in all patient groups, but was most abnormal in patients who had undergone left ATL. When allowed to demonstrate knowledge of the famous faces through verbal descriptions, rather than naming, patients with left TLE, left ATL, and right TLE improved to normal levels, but patients with right ATL were still impaired, suggesting a new deficit in identifying famous faces. Naming of famous people was related to naming of other common objects, verbal memory, and perceptual discrimination of faces. Recognition of the identity of pictured famous people was more related to visuospatial perception and memory. Lesions in anterior regions of the right temporal lobe impair recognition of the identities of familiar faces, as well as the learning of new faces. Lesions in the left temporal lobe, especially in anterior regions, disrupt access to the names of known people, but do not affect recognition of the identities of famous faces. Results are consistent with the hypothesized role of lateralized anterior temporal lobe structures in facial recognition and naming of unique entities.

Transcriptional activity of TGFβ1 and its receptors genes in thyroid gland.

PubMed

Kajdaniuk, Dariusz; Marek, Anna; Marek, Bogdan; Mazurek, Urszula; Fila-Daniłow, Anna; Foltyn, Wanda; Morawiec-Szymonik, Elżbieta; Siemińśka, Lucyna; Nowak, Mariusz; Głogowska-Szeląg, Joanna; Niedziołka-Zielonka, Danuta; Seemann, Michał; Kos-Kudła, Beata

2016-01-01

Determination of gene-candidates' profile expression responsible for fibrosis, immunosuppression, angiogenesis, and neoplasia processes in the pathogenesis of thyroid gland disease. Sixty-three patients underwent thyroidectomy: 27 with non-toxic nodular goitre (NG), 22 with toxic nodular goitre (TNG), six with papillary cancer (PTC), and eight with Graves' disease (GD). In thyroid tissues, transcriptional activity of TGFbeta1 and its receptors TGFbetaRI, TGFbetaRII, and TGFbetaRIII genes were assessed using RT-qPCR (Reverse Transcriptase Quantitative Polymerase Chain Reaction). Molecular analysis was performed in tissues derived from GD and from the tumour centre (PTC, NG, TNG) and from peripheral parts of the removed lobe without histopathological lesions (tissue control). Control tissue for analysis performed in GD was an unchanged tissue derived from peripheral parts of the removed lobe of patients surgically treated for a single benign tumour. Strict regulation observed among transcriptional activity of TGFb1 and their receptor TGFbetaRI-III genes in control tissues is disturbed in all pathological tissues - it is completely disturbed in PTC and GD, and partially in NG and TNG. Additionally, higher transcriptional activity of TGFb1 gene in PTC in comparison with benign tissues (NG, GD) and lower expression of mRNA TGFbRII (than in TNG, GD) and mRNA TGFbetaRIII than in all studied benign tissues (NG, TNG, GD) suggests a pathogenetic importance of this cytokine and its receptors in PTC development. In GD tissue, higher transcriptional activity of TGFbetaRII and TGFbetaRIII genes as compared to other pathological tissues was observed, indicating a participation of the receptors in the pathomechanism of autoimmune thyroid disease (AITD). TGFbeta1 blood concentrations do not reflect pathological processes taking place in thyroid gland. (Endokrynol Pol 2016; 67 (4): 375-382).

Multifocality and Bilaterality of Papillary Thyroid Microcarcinoma

PubMed Central

So, Yoon Kyoung; Kim, Myung Woo

2015-01-01

Objectives Papillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors. Methods Two hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis. Results Multifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6±1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32±0.18 cm) than the primary tumors (0.63±0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors. Conclusion In cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up. PMID:26045918

Superficial Temporal Artery-Superior Cerebellar Artery Bypass with Anterior Petrosectomy.

PubMed

Hokari, Masaaki; Asaoka, Katsuyuki; Shimbo, Daisuke; Uchida, Kazuki; Itamoto, Koji

2018-06-01

Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is associated with a relatively high risk of surgical complications, such as hematoma and/or edema caused by temporal lobe retraction. Therefore, the right side is typically used to avoid retraction of the left temporal lobe. In this report, we present a case of left STA-SCA bypass with anterior petrosectomy to avoid retraction of dominant-side temporal lobe and describe the surgical technique in detail. A 69-year-old man presented with gradual worsening of dysarthria and gait disturbance. Magnetic resonance imaging showed no signs of acute infarction, but digital subtraction angiography showed severe stenosis of basilar artery and faint flow in the distal basilar artery. On 3-dimensional computed tomography angiography, posterior communicating arteries were not visualized; we could identify the left SCA, but not the right SCA. Despite dual antiplatelet therapy, a small fresh brainstem infarct was detected 10 days after admission. To avert fatal brainstem infarction and further enlargement of the infarct, we performed left STA-SCA bypass with anterior petrosectomy to avoid retraction of the dominant-side temporal lobe. Postoperative imaging revealed no new lesions, such as infarction or temporal lobe contusional hematoma, and confirmed the patency of the bypass. Postoperative single-photon emission computed tomography demonstrated improved cerebral blood flow in the posterior circulation. The patient was transferred to another hospital for rehabilitation. This method helps minimize the risk of injury to the temporal lobe, especially that of the dominant side. Copyright © 2018. Published by Elsevier Inc.

Severity of pulmonary emphysema and lung cancer: analysis using quantitative lobar emphysema scoring.

PubMed

Bae, Kyungsoo; Jeon, Kyung Nyeo; Lee, Seung Jun; Kim, Ho Cheol; Ha, Ji Young; Park, Sung Eun; Baek, Hye Jin; Choi, Bo Hwa; Cho, Soo Buem; Moon, Jin Il

2016-11-01

The aim of this study was to determine the relationship between lobar severity of emphysema and lung cancer using automated lobe segmentation and emphysema quantification methods.This study included 78 patients (74 males and 4 females; mean age of 72 years) with the following conditions: pathologically proven lung cancer, available chest computed tomographic (CT) scans for lobe segmentation, and quantitative scoring of emphysema. The relationship between emphysema and lung cancer was analyzed using quantitative emphysema scoring of each pulmonary lobe.The most common location of cancer was the left upper lobe (LUL) (n = 28), followed by the right upper lobe (RUL) (n = 27), left lower lobe (LLL) (n = 13), right lower lobe (RLL) (n = 9), and right middle lobe (RML) (n = 1). Emphysema ratio was the highest in LUL, followed by that in RUL, LLL, RML, and RLL. Multivariate logistic regression analysis revealed that upper lobes (odds ratio: 1.77; 95% confidence interval: 1.01-3.11, P = 0.048) and lobes with emphysema ratio ranked the 1st or the 2nd (odds ratio: 2.48; 95% confidence interval: 1.48-4.15, P < 0.001) were significantly and independently associated with lung cancer development.In emphysema patients, lung cancer has a tendency to develop in lobes with more severe emphysema.

Severity of pulmonary emphysema and lung cancer: analysis using quantitative lobar emphysema scoring

PubMed Central

Bae, Kyungsoo; Jeon, Kyung Nyeo; Lee, Seung Jun; Kim, Ho Cheol; Ha, Ji Young; Park, Sung Eun; Baek, Hye Jin; Choi, Bo Hwa; Cho, Soo Buem; Moon, Jin Il

2016-01-01

Abstract The aim of this study was to determine the relationship between lobar severity of emphysema and lung cancer using automated lobe segmentation and emphysema quantification methods. This study included 78 patients (74 males and 4 females; mean age of 72 years) with the following conditions: pathologically proven lung cancer, available chest computed tomographic (CT) scans for lobe segmentation, and quantitative scoring of emphysema. The relationship between emphysema and lung cancer was analyzed using quantitative emphysema scoring of each pulmonary lobe. The most common location of cancer was the left upper lobe (LUL) (n = 28), followed by the right upper lobe (RUL) (n = 27), left lower lobe (LLL) (n = 13), right lower lobe (RLL) (n = 9), and right middle lobe (RML) (n = 1). Emphysema ratio was the highest in LUL, followed by that in RUL, LLL, RML, and RLL. Multivariate logistic regression analysis revealed that upper lobes (odds ratio: 1.77; 95% confidence interval: 1.01–3.11, P = 0.048) and lobes with emphysema ratio ranked the 1st or the 2nd (odds ratio: 2.48; 95% confidence interval: 1.48–4.15, P < 0.001) were significantly and independently associated with lung cancer development. In emphysema patients, lung cancer has a tendency to develop in lobes with more severe emphysema. PMID:27902611

Memory for Faces Dissociates from Memory for Location Following Anterior Temporal Lobectomy

ERIC Educational Resources Information Center

Chiaravalloti, Nancy D.; Glosser, Guila

2004-01-01

It has been suggested that the right and left mesial temporal lobes are specialized for processing different types of information for long-term memory (LTM). Although findings have been consistent in regard to the dominant role of the left mesial temporal lobe (MTL) in verbal memory, the role of the right MTL in non-verbal memory remains…

The Impact of Sex and Language Dominance on Material-Specific Memory Before and After Left Temporal Lobe Surgery

ERIC Educational Resources Information Center

Helmstaedter, C.; Brosch, T.; Kurthen, M.; Elger, C. E.

2004-01-01

Recent findings raised evidence that in early-onset left temporal lobe epilepsy, women show greater functional plasticity for verbal memory than men. In particular, women with lesion- or epilepsy-driven atypical language dominance show an advantage over men. The question asked in this study was whether there is evidence of sex- and language…

Disentangling the cognitive components supporting Austin Maze performance in left versus right temporal lobe epilepsy.

PubMed

Hocking, Julia; Thomas, Hannah J; Dzafic, Ilvana; Williams, Rebecca J; Reutens, David C; Spooner, Donna M

2013-12-01

Neuropsychological tests requiring patients to find a path through a maze can be used to assess visuospatial memory performance in temporal lobe pathology, particularly in the hippocampus. Alternatively, they have been used as a task sensitive to executive function in patients with frontal lobe damage. We measured performance on the Austin Maze in patients with unilateral left and right temporal lobe epilepsy (TLE), with and without hippocampal sclerosis, compared to healthy controls. Performance was correlated with a number of other neuropsychological tests to identify the cognitive components that may be associated with poor Austin Maze performance. Patients with right TLE were significantly impaired on the Austin Maze task relative to patients with left TLE and controls, and error scores correlated with their performance on the Block Design task. The performance of patients with left TLE was also impaired relative to controls; however, errors correlated with performance on tests of executive function and delayed recall. The presence of hippocampal sclerosis did not have an impact on maze performance. A discriminant function analysis indicated that the Austin Maze alone correctly classified 73.5% of patients as having right TLE. In summary, impaired performance on the Austin Maze task is more suggestive of right than left TLE; however, impaired performance on this visuospatial task does not necessarily involve the hippocampus. The relationship of the Austin Maze task with other neuropsychological tests suggests that differential cognitive components may underlie performance decrements in right versus left TLE. © 2013.

Incidental Warthin Tumor on Pertechnetate Scintigraphy.

PubMed

Kulkarni, Mukta; Shetkar, Shubhangi; Joshi, Prathamesh; Kasaliwal, Sanket; Chaudhari, Shrikant

2016-09-01

A 30-year-old woman underwent Tc-pertechnetate scintigraphy for evaluation of thyrotoxicosis. The scintigraphy revealed hypervascular thyroid gland with markedly increased trapping function in both the lobes suggesting diagnosis of Graves disease. Incidentally, a hypervascular and pertechnetate avid focus was seen along the lateral margin of the right parotid gland. Pertechnetate avidity and site of uptake suggested possibility of Warthin tumor. Clinical examination and ultrasonography revealed a well-defined lesion in the superficial lobe of the right parotid gland favoring diagnosis of benign lesion. Postsurgery specimen confirmed diagnosis of Warthin tumor.

Bilateral pheochromocytoma associated with paraganglioma and papillary thyroid carcinoma: report of an unusual case.

PubMed

Yang, Jeong Hoon; Bae, Sung Jin; Park, Sanghui; Park, Hyun-Kyung; Jung, Hye Seung; Chung, Jae Hoon; Min, Yong-Ki; Lee, Myung-Shik; Kim, Kwang-Won; Lee, Moon-Kyu

2007-04-01

A 42-year old woman presented with headache, palpitation and facial flushing. Ultrasonograms and computed tomograms revealed tumors in both of the adrenal glands, anterior aspect of the inferior vena cava, and the right lobe of the thyroid gland. Fine needle aspiration biopsy of the thyroid nodule revealed papillary thyroid carcinoma. Serum calcitonin, CEA, intact PTH and calcium levels were within normal limits. Markedly elevated levels of urinary normetanephrine and vanillylmandelic acid, and the result of 131I-metaiodobenzylguanidine (131I-MIBG) scintigraphy indicated that both adrenal masses were pheochromocytoma. Bilateral adrenalectomy, paracaval mass removal and total thyroidectomy together with central lymph node dissection were performed. The final pathological diagnosis was bilateral adrenal pheochromocytoma, paraganglioma, papillary thyroid carcinoma and either parathyroid adenoma or hyperplasia. Analysis of the RET proto-oncogene mutation, von Hippel Lindau mutation, succinate dehydrogenase subunit B mutation, and succinate dehydrogenase subunit D mutation yielded negative results. The relationship of these lesions could not be determined. This is the first report of a combination of bilateral pheochromocytoma, abdominal paraganglioma, papillary thyroid carcinoma and either parathyroid adenoma or hyperplasia without hyperparathyroidism.

Suppurative thyroiditis due to aspergillosis: a case report.

PubMed

Marui, Suemi; de Lima Pereira, Ariella Cabral; de Araújo Maia, Raquel Maria; Borba, Eduardo Ferreira

2014-11-21

Aspergillus, a nosocomial agent, is the most common fungal cause of suppurative thyroiditis. Most patients with Aspergillus thyroiditis have disseminated infection, primarily with lung compromise. Late diagnosis and treatment, severity of immunosuppressive state and thyroid hormone overload contribute to extremely high mortality rates. We describe a 20-year-old Caucasian man receiving corticosteroid suppression therapy for systemic lupus erythematosus. He presented persistent fever with neck pain and pulmonary infection. Piperacillin/tazobactam was initiated but after 2 days he developed hypoxemia, vascular shock, severe anemia, lymphopenia, and high C-reactive protein. Thyroid ultrasound revealed well-defined hypoechogenic clusters in both lobes and laboratorial thyrotoxicosis but low triiodothyronine concentration. A purulent substance was obtained on fine needle aspiration and drained. Amphotericin B and fluconazole were added but he had unfavorable evolution and died. Aspergillus fumigatus was defined only 2 days after his death. This case serves to alert clinicians to the possibility of infectious thyroiditis and reinforces the high risk of aspergillosis in immunocompromised patients. Therefore, management including voriconazole as first-line treatment or amphotericin B, in association with broad-spectrum antibiotic therapy, should be adopted to improve treatment outcome.

Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis

PubMed Central

Kuroda, Hiroaki; Sakao, Yukinori; Mun, Mingyon; Uehara, Hirofumi; Nakao, Masayuki; Matsuura, Yousuke; Mizuno, Tetsuya; Sakakura, Noriaki; Motoi, Noriko; Ishikawa, Yuichi; Yatabe, Yasushi; Nakagawa, Ken; Okumura, Sakae

2015-01-01

Background Left upper division segmentectomy is one of the major pulmonary procedures; however, it is sometimes difficult to completely dissect interlobar lymph nodes. We attempted to clarify the prognostic importance of hilar and mediastinal nodes, especially of interlobar lymph nodes, in patients with primary non-small cell lung cancer (NSCLC) located in the left upper division. Methods We retrospectively studied patients with primary left upper lobe NSCLC undergoing surgical pulmonary resection (at least lobectomy) with radical lymphadenectomy. The representative evaluation of therapeutic value from the lymph node dissection was determined using Sasako’s method. This analysis was calculated by multiplying the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to the station. Results We enrolled 417 patients (237 men, 180 women). Tumors were located in the lingular lobe and at the upper division of left upper lobe in 69 and 348 patients, respectively. The pathological nodal statuses were pN0 in 263 patients, pN1 in 70 patients, and pN2 in 84 patients. Lymph nodes #11 and #7 were significantly correlated with differences in node involvement in patients with left upper lobe NSCLC. Among those with left upper division NSCLC, the 5-year overall survival in pN1 was 31.5% for #10, 39.3% for #11, and 50.4% for #12U. The involvement of node #11 was 1.89-fold higher in the anterior segment than that in the apicoposterior segment. The therapeutic index of estimated benefit from lymph node dissection for #11 was 3.38, #4L was 1.93, and the aortopulmonary window was 4.86 in primary left upper division NSCLC. Conclusions Interlobar node involvement is not rare in left upper division NSCLC, occurring in >20% cases. Furthermore, dissection of interlobar nodes was found to be beneficial in patients with left upper division NSCLC. PMID:26247881

The Medial Temporal Lobe and the Left Inferior Prefrontal Cortex Jointly Support Interference Resolution in Verbal Working Memory

ERIC Educational Resources Information Center

Oztekin, Ilke; Curtis, Clayton E.; McElree, Brian

2009-01-01

During working memory retrieval, proactive interference (PI) can be induced by semantic similarity and episodic familiarity. Here, we used fMRI to test hypotheses about the role of the left inferior frontal gyrus (LIFG) and the medial temporal lobe (MTL) regions in successful resolution of PI. Participants studied six-word lists and responded to a…

Validation of ultrasonography of the thyroid gland for epidemiological purposes.

PubMed

Knudsen, N; Bols, B; Bülow, I; Jørgensen, T; Perrild, H; Ovesen, L; Laurberg, P

1999-11-01

Ultrasonography of the thyroid is often used in epidemiological surveys, thus thorough characterization of the interobserver variation of the different parameters obtained is important. Various methods have been used for measuring thyroid volume, and different formulas have been used for calculation of thyroid volume from the measured dimensions. In this article, two principles of thyroid volume measurement are described in detail: the wellknown method based on the three axes of each lobe and a new principle based on planimetry in two planes. The interobserver variation of the examination and the measuring procedure in itself were tested on 25 participants in a population study. A comparison of postmortem ultrasonography of the thyroid and results of an autopsy was performed. Good correlation and agreement between observers was found for thyroid volume (r = 0.98) and prevalence of thyroid nodules (kappa = 0.72), whereas echogenecity and echopattern showed little agreement. The correlation of thyroid volume by ultrasonography to autopsy results was satisfactory (r = 0.93), but the volume tended to be slightly underestimated even when using the formula pi/6(= 0.52)*length*width*depth. No major differences were found between the performance of the two principles of volume calculation. We conclude that when the measuring procedure is well defined, results of ultrasonography are comparable between observers for thyroid volume and prevalence of thyroid nodules, but not for echogenecity or echopattern. The formula of length*depth*width*pi/6 is suitable for thyroid volume measurement.

Bilateral temporal lobe volume reduction parallels cognitive impairment in progressive aphasia.

PubMed

Andersen, C; Dahl, C; Almkvist, O; Ostberg, P; Julin, P; Wahlund, L O

1997-10-01

Patients with isolated aphasia in the absence of other cognitive abnormalities have been the focus of several studies during the past decade. It has been called primary progressive aphasia (PPA), and the typical features of this syndrome are marked atrophy of the left temporal lobe according to the radiological examination and a language disorder as the initial symptom. In previous studies of PPA, the selection of the patients was based mainly on linguistic symptoms. Now, when computed tomography or magnetic resonance imaging scans are part of the routine investigation of cognitive impairment and suspected dementia, the patients with lobar atrophy will be found at an earlier stage. In the present study, we used a new approach and defined the study group by selecting patients with obvious left temporal lobe atrophy, assessed by MRI, and we referred to them as patients with temporal lobe atrophy (TLA). To identify the features that distinguish TLA from other primary neurodegenerative disorders. Six patients with TLA were compared with patients with Alzheimer disease (AD), patients with frontal lobe dementia (FLD), and healthy control subjects. The investigations included magnetic resonance imaging volumetry, single photon emission computed tomography, and neuropsychologic and linguistic evaluations. In the TLA group, the mean volume of the left temporal lobe was 35% smaller than the right, while in the AD and FLD groups, the atrophy was symmetrical and bilateral. In the TLA group, the absolute volumes of the temporal lobes were significantly smaller on the left side compared with the AD and FLD groups, whereas there was no difference on the right side. The cerebral blood flow pattern in TLA was asymmetric and differed from that in the other study groups. All patients with TLA had a history of progressive Wernicke-type aphasia, ranging from 2 to 6 years. They showed primary verbal memory impairment but had preserved visuospatial functions. The clinical condition of all patients with TLA deteriorated during the study period; severe aphasia developed, and the patients exhibited signs of frontal lobe dysfunction. Serial volumetric measurements in 4 of 6 patients showed an annual 8% to 9% decrease of both left and right temporal lobes. The initial marked asymmetry in cognitive function found in patients with TLA contrasts with the general decline found in patients with AD. The bilateral degenerative process evident in patients with TLA paralleled the clinical deterioration, indicating TLA to be a non-AD lobar atrophy that develops into generalized cognitive dysfunction and dementia.

Thyroid storm following radioactive iodine (RAI) therapy for pediatric graves disease.

PubMed

Rohrs, Henry J; Silverstein, Janet H; Weinstein, David A; Amdur, Robert J; Haller, Michael J

2014-01-01

Female, 11 FINAL DIAGNOSIS: Thyroid storm Symptoms: Diarrhea • tachycardia • tachypnea • tremor • wheezing - Clinical Procedure: - Specialty: - Rare disease. A growing number of pediatric endocrinologists treat Graves disease with radioactive iodine (RAI) therapy due to the typically definitive nature of I-131 therapy. Given the published benefits and perceived low risks of RAI when compared to surgery or long-term anti-thyroid medication, the trend towards therapy with RAI is likely to continue. Nevertheless, RAI is not without significant risk. An 11-year-old girl with newly diagnosed Graves disease received RAI for definitive treatment of her hyperthyroidism. Within 24 hours of receiving I-131, she developed increasing sleepiness and eventually became unresponsive. Upon arrival at the emergency department she had a tonic-clonic seizure and was diagnosed with thyroid storm. Despite best efforts to manage her hyperthyroidism, she suffered a stroke of the left cerebral hemisphere that left her with persistent neurological deficits. Although thyroid storm after thyroid ablation is rare, the significant morbidity and potential mortality of pediatric thyroid storm warrant further studies to determine if children with markedly elevated thyroid hormone concentrations at diagnosis should receive prolonged pretreatment with anti-thyroid drugs. While such an approach may reduce the efficacy of I-131 ablation, it can also reduce and hopefully eliminate the risk of post-ablative thyroid storm.

Distinctive Structural and Effective Connectivity Changes of Semantic Cognition Network across Left and Right Mesial Temporal Lobe Epilepsy Patients.

PubMed

Fan, Xiaotong; Yan, Hao; Shan, Yi; Shang, Kun; Wang, Xiaocui; Wang, Peipei; Shan, Yongzhi; Lu, Jie; Zhao, Guoguang

2016-01-01

Occurrence of language impairment in mesial temporal lobe epilepsy (mTLE) patients is common and left mTLE patients always exhibit a primary problem with access to names. To explore different neuropsychological profiles between left and right mTLE patients, the study investigated both structural and effective functional connectivity changes within the semantic cognition network between these two groups and those from normal controls. We found that gray matter atrophy of left mTLE patients was more severe than that of right mTLE patients in the whole brain and especially within the semantic cognition network in their contralateral hemisphere. It suggested that seizure attacks were rather targeted than random for patients with hippocampal sclerosis (HS) in the dominant hemisphere. Functional connectivity analysis during resting state fMRI revealed that subregions of the anterior temporal lobe (ATL) in the left HS patients were no longer effectively connected. Further, we found that, unlike in right HS patients, increased causal linking between ipsilateral regions in the left HS epilepsy patients cannot make up for their decreased contralateral interaction. It suggested that weakened contralateral connection and disrupted effective interaction between subregions of the unitary, transmodal hub of the ATL may be the primary cause of anomia in the left HS patients.

Distinctive Structural and Effective Connectivity Changes of Semantic Cognition Network across Left and Right Mesial Temporal Lobe Epilepsy Patients

PubMed Central

Fan, Xiaotong; Shang, Kun; Wang, Xiaocui; Wang, Peipei; Shan, Yongzhi; Lu, Jie

2016-01-01

Occurrence of language impairment in mesial temporal lobe epilepsy (mTLE) patients is common and left mTLE patients always exhibit a primary problem with access to names. To explore different neuropsychological profiles between left and right mTLE patients, the study investigated both structural and effective functional connectivity changes within the semantic cognition network between these two groups and those from normal controls. We found that gray matter atrophy of left mTLE patients was more severe than that of right mTLE patients in the whole brain and especially within the semantic cognition network in their contralateral hemisphere. It suggested that seizure attacks were rather targeted than random for patients with hippocampal sclerosis (HS) in the dominant hemisphere. Functional connectivity analysis during resting state fMRI revealed that subregions of the anterior temporal lobe (ATL) in the left HS patients were no longer effectively connected. Further, we found that, unlike in right HS patients, increased causal linking between ipsilateral regions in the left HS epilepsy patients cannot make up for their decreased contralateral interaction. It suggested that weakened contralateral connection and disrupted effective interaction between subregions of the unitary, transmodal hub of the ATL may be the primary cause of anomia in the left HS patients. PMID:28018680

[Trauma induced left maxillary sinus dislocation of eyeball--a case report].

PubMed

Chen, Yu; Liu, Cuiping; Cui, Liping

2013-01-01

Patient male, 27 year old. Left facial and head trauma for 6 hours, due to motor vehicle accident. Patient state of mind was clear at arrival to hospital. Body temperature: 36C; Pulse: 80 Time/Minute; Breath: 20 Time/Minute; Blood pressure: 120/80 mm Hg. An irregular, horizontal laceration at arch of left eyebrow, approximately 8-10 cm. A laceration on left wing of nose skin, approximately 1 cm. A laceration also under lower eyelid skin of right eye, approximately 2 cm. Left blepharedema and enophthalmos. Orbital and nasal sinuses CT indications:contusion and laceration of the left frontal lobe of brain; fracture of the left orbital frontal, ethmoid, sphenoid bone, left nasal, maxillary sinus and zygoma with soft tissue contusion and laceration; the left eyeball and optic nerve sunk into the maxillary sinus (See figure 1). (1) Multiple orbital fractures; (2) Left maxillary sinus dislocation of eyeball; (3) The left frontal lobe contusion and laceration of brain.

Weighing the value of memory loss in the surgical evaluation of left temporal lobe epilepsy: A decision analysis

PubMed Central

Akama-Garren, Elliot H.; Bianchi, Matt T.; Leveroni, Catherine; Cole, Andrew J.; Cash, Sydney S.; Westover, M. Brandon

2016-01-01

SUMMARY Objectives Anterior temporal lobectomy is curative for many patients with disabling medically refractory temporal lobe epilepsy, but carries an inherent risk of disabling verbal memory loss. Although accurate prediction of iatrogenic memory loss is becoming increasingly possible, it remains unclear how much weight such predictions should have in surgical decision making. Here we aim to create a framework that facilitates a systematic and integrated assessment of the relative risks and benefits of surgery versus medical management for patients with left temporal lobe epilepsy. Methods We constructed a Markov decision model to evaluate the probabilistic outcomes and associated health utilities associated with choosing to undergo a left anterior temporal lobectomy versus continuing with medical management for patients with medically refractory left temporal lobe epilepsy. Three base-cases were considered, representing a spectrum of surgical candidates encountered in practice, with varying degrees of epilepsy-related disability and potential for decreased quality of life in response to post-surgical verbal memory deficits. Results For patients with moderately severe seizures and moderate risk of verbal memory loss, medical management was the preferred decision, with increased quality-adjusted life expectancy. However, the preferred choice was sensitive to clinically meaningful changes in several parameters, including quality of life impact of verbal memory decline, quality of life with seizures, mortality rate with medical management, probability of remission following surgery, and probability of remission with medical management. Significance Our decision model suggests that for patients with left temporal lobe epilepsy, quantitative assessment of risk and benefit should guide recommendation of therapy. In particular, risk for and potential impact of verbal memory decline should be carefully weighed against the degree of disability conferred by continued seizures on a patient-by-patient basis. PMID:25244498

Portal Vein Embolization before Right Hepatectomy: Improved Results Using n-Butyl-Cyanoacrylate Compared to Microparticles Plus Coils

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Bize, Pierre; Gunthern, Daniel

Background: There is currently no consensus in the literature on which embolic agent induces the greatest degree of liver hypertrophy after portal vein embolization (PVE). Only experimental results in a pig model have demonstrated an advantage of n-butyl-cyanoacrylate (NBCA) over 3 other embolic materials (hydrophilic gel, small and large polyvinyl alcohol particles) for PVE. Therefore, the aim of this human study was to retrospectively compare the results of PVE using NBCA with those using spherical microparticles plus coils. Methods: A total of 34 patients underwent PVE using either NBCA (n = 20), or spherical microparticles plus coils (n = 14).more » PVE was decided according to preoperative volumetry on the basis of contrast-enhanced CT. Groups were compared for age, sex, volume of the left lobe before PVE and future remnant liver ratio (FRL) (volume of the left lobe/total liver volume - tumor volume). The primary end point was the increase in left lobe volume 1 month after PVE. Secondary end points were procedure complications and biological tolerance. Results: Both groups were similar in terms of age, sex ratio, left lobe volume, and FRL before PVE. NBCA induced a greater increase in volume after PVE than did microparticles plus coils (respectively, +74 {+-} 69 % and +23 {+-} 14 %, p < 0.05). The amount of contrast medium used for the procedure was significantly larger when microparticles and coils rather than NBCA were used (respectively, 264 {+-} 43 ml and 162 {+-} 34 ml, p < 0.01). The rate of PVE complications as well as the biological tolerance was similar in both groups. Conclusion: NBCA seems more effective than spherical microparticles plus coils to induce left-lobe hypertrophy.« less

Weighing the value of memory loss in the surgical evaluation of left temporal lobe epilepsy: a decision analysis.

PubMed

Akama-Garren, Elliot H; Bianchi, Matt T; Leveroni, Catherine; Cole, Andrew J; Cash, Sydney S; Westover, M Brandon

2014-11-01

Anterior temporal lobectomy is curative for many patients with disabling medically refractory temporal lobe epilepsy, but carries an inherent risk of disabling verbal memory loss. Although accurate prediction of iatrogenic memory loss is becoming increasingly possible, it remains unclear how much weight such predictions should have in surgical decision making. Here we aim to create a framework that facilitates a systematic and integrated assessment of the relative risks and benefits of surgery versus medical management for patients with left temporal lobe epilepsy. We constructed a Markov decision model to evaluate the probabilistic outcomes and associated health utilities associated with choosing to undergo a left anterior temporal lobectomy versus continuing with medical management for patients with medically refractory left temporal lobe epilepsy. Three base-cases were considered, representing a spectrum of surgical candidates encountered in practice, with varying degrees of epilepsy-related disability and potential for decreased quality of life in response to post-surgical verbal memory deficits. For patients with moderately severe seizures and moderate risk of verbal memory loss, medical management was the preferred decision, with increased quality-adjusted life expectancy. However, the preferred choice was sensitive to clinically meaningful changes in several parameters, including quality of life impact of verbal memory decline, quality of life with seizures, mortality rate with medical management, probability of remission following surgery, and probability of remission with medical management. Our decision model suggests that for patients with left temporal lobe epilepsy, quantitative assessment of risk and benefit should guide recommendation of therapy. In particular, risk for and potential impact of verbal memory decline should be carefully weighed against the degree of disability conferred by continued seizures on a patient-by-patient basis. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

[Papillary thyroid carcinoma in a child with congenital dyshormonogenetic hypothyroidism. Case report].

PubMed

Orellana, María José; Fulle, Angelo; Carrillo, Diego; Escobar, Lucía; Ebensperger, Alicia; Martínez, Raúl; Rumié Carmi, Hana

Papillary thyroid carcinoma (PTC) is a rare childhood disease. The development of PTC in dyshormonogenetic congenital hypothyroidism (CH) is infrequent, with very few case reports in literature. To report a case of PTC in a boy with dyshormonogenetic CH without goitre and exposed to ionising radiation. To evaluate relationships between these factors and development of PTC. We present a boy with dyshormonogenetic CH since birth. Early hormonal substitution was initiated, with subsequent normal levels of thyrotropin and thyroid hormones. He has also congenital cardiomyopathy, exposed to interventional treatment with 10 heart catheterisations, and approximately 26 chest X-rays at paediatric doses. A thyroid nodule was found in thyroid echography at the age of 6 years old. Fine needle aspiration biopsy confirmed high probability of thyroid carcinoma (Bethesda 5). The pre-surgical thorax and cerebral scan showed no evidence of metastasis. The patient underwent total thyroidectomy. Pathological examination revealed a 0.5cm papillary thyroid micro-carcinoma in the right lobe, with no evidence of dissemination. Genetic mutations and radiation exposure may play an important role in the development of PTC. There may be common pathways between dyshormonogenetic CH and thyroid carcinoma that need further investigation. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Approach to and Treatment of Thyroid Disorders in the Elderly

PubMed Central

Papaleontiou, Maria

2012-01-01

Synopsis Thyroid gland dysfunction is prevalent in older adults and may be associated with significant morbidity if misdiagnosed and left untreated. Due to a decreased number of symptoms at presentation, an increased susceptibility to adverse events if not treated, and a greater likelihood of harm from treatment, the diagnosis and management of thyroid disorders in older adults can be challenging. This review focuses on the epidemiology, clinical presentation, risks/complications, and management of thyroid disorders (including hyperthyroidism, hypothyroidism, thyroid nodules and thyroid cancer) in older adults. PMID:22443977

Acute and chronic hypothyroidism are associated with similar left ventricular diastolic dysfunction relative to the euthyroid state: results of doppler echocardiographic comparisons.

PubMed

Gauna, A; Messuti, H; Papadopulos, G; Benchuga, G; Viale, F; Marlowe, R J; Silva Croome, M C

2011-10-01

How the duration of hypothyroidism affects left ventricular diastolic function is not well-characterized. We sought to compare left ventricular diastolic function in acutely vs chronically hypothyroid patients vs euthyroid controls, and within individuals while on vs off T4. We prospectively performed such comparisons measuring pulsed-wave and color M-mode Doppler echocardiographic variables: early or late mitral peak velocities (E wave or A wave, respectively), E wave/A wave ratio, E wave deceleration time, isovolumic relaxation time (IVRT), mitral flow propagation velocity (Vp), E wave/Vp ratio. Subjects comprised the acute HYPO group, 10 patients undergoing T4 withdrawal ≥ 6 months post-primary treatment for differentiated thyroid cancer (DTC); the chronic HYPO group, 23 treatment-naïve Hashimoto thyroiditis patients; and 21 healthy euthyroid controls. Subjects were adults aged ≤ 60 yr, predominantly female, with sinus rhythm; exclusion criteria were cardiovascular or thyroid disorder besides DTC (Hashimoto thyroiditis) in acute (chronic) HYPO patients or medication (besides thyroid hormone) affecting cardiac or thyroid function. Mean IVRT was significantly delayed and mean Vp, significantly slowed in both HYPO groups vs controls (p<0.0005), but did not differ between HYPO groups. These variables also were significantly impaired (p<0.05) within individuals when off vs on T4 (no.=8 acute, 10 chronic HYPO patients). Both HYPO groups had elevated mean E wave/Vp ratios vs controls, but the elevation reached significance (p<0.05) only in the larger chronic HYPO group. Left ventricular diastolic dysfunction is largely similar in acutely or chronically hypothyroid patients off T4 vs healthy controls or the same patients on T4.

A 61-year-old man with cough and white sputum

PubMed Central

Yao, Yanwen; Yin, Jie; Xiao, Xinwu; Lv, Tangfeng; Sun, Wenkui

2015-01-01

A 61-year-old man with cough and white sputum had an abnormal pulmonary mass in the left lower lobe in the computed tomography (CT) imaging. According to the lung cancer multidisciplinary team (MDT) discussion, the patient took the left lower lobe resection and lymphadenectomy and finally diagnosed as left lung adenocarcinoma with TNM stage IIIA (pT3N2M0). After four cycles of postoperative chemotherapy with pemetrexed and nedaplatin and 10-month release, a solitary pulmonary nodule (SPN) appeared in the middle lobe of right lung in CT scanning. The patient took a second operation “the right middle lobe resection” and was diagnosed as left lung adenocarcinoma at TNM stage IV (pT3N2M1a, two lungs) with neither EGFR mutation nor ALK-EML4 fusion gene. After operation, the patient took another four cycles of postoperative chemotherapy with Docetaxel and Nedaplatin. During the follow-up, another PET/CT scanning reported that several enlarged mediastinal lymph nodes, a SPN in left upper lobe and lesion in cerebellum and the brain metastasis was also proved in MRI. The patient was now diagnosed as left lung adenocarcinoma at TNM stage IV (pT3N2M1b, brain). In the third-line therapy, the patient took the stereotactic radiotherapy for metastatic mediastinal lymph nodes and took erlotinib once a day after the radiotherapy. However, the number of small lesions on lungs was increased and the brain metastasis was enlarged. The stereotactic radiotherapy for the single brain metastasis and single agent chemotherapy of abraxane were taken. The whole body examination suggested that there was progression-free after two cycles of chemo. The patient is now took five cycles of single agent chemotherapy of abraxane. The latest whole body examination showed disease was stable with no new lesions and metastasis, performance status (PS) score is 0 and the overall survival (OS) time is 34 months. PMID:25806349

Physical and radiological findings specific for medullary carcinoma of the thyroid gland.

PubMed

Fujimoto, Y; Oka, A; Fukumitsu, M; Obara, T; Akisada, M

1975-06-01

Preoperative physical and radiological findings, if specific to a certain extent, are important for detecting patients with sporadic form of medullary thyroid carcinoma and especially for the first patient in the family having a hereditary form of medullary thyroid carcinoma and pheochromocytoma syndrome. To delineate clinical features of medullary thyroid carcinoma, a total of 9 patients with this tumor were reviewed retrospectively. In most patients, the thyroid lesions were located in the upper two thirds of the lobe, which was determined by careful palpation or 131I scintiscanning of the thyroid. The primary lesion in the thyroid could be felt more or less as a round, sharply demarcated nodule with fairly good mobility. These findings suggested rather a benign thyroid nodule when there was no lymph node involvement. However, it could be considered a sign suggesting medullary thyroid carcinoma when accompanied by marked lymph node metastasis. In our recent 2 cases, the diagnosis of medullary thyroid carcinoma was strongly suspected on these clinical bases, one of the cases being presented in detail. In 4 patients, lymph node metastasis in the central neck extended to either submandibular or upper mediastinal regions or both. In about one third of the patients, calcified deposits were shown in the cervical roentgenograms. With the use of soft tissue roentgenography, grossly punctate calcific deposits associated with psammoma-like shadows were recognized and the pattern was a criterion for definitive diagnosis of medullary thyroid carcinoma.

Singing can improve speech function in aphasics associated with intact right basal ganglia and preserve right temporal glucose metabolism: Implications for singing therapy indication.

PubMed

Akanuma, Kyoko; Meguro, Kenichi; Satoh, Masayuki; Tashiro, Manabu; Itoh, Masatoshi

2016-01-01

Clinically, we know that some aphasic patients can sing well despite their speech disturbances. Herein, we report 10 patients with non-fluent aphasia, of which half of the patients improved their speech function after singing training. We studied ten patients with non-fluent aphasia complaining of difficulty finding words. All had lesions in the left basal ganglia or temporal lobe. They selected the melodies they knew well, but which they could not sing. We made a new lyric with a familiar melody using words they could not name. The singing training using these new lyrics was performed for 30 minutes once a week for 10 weeks. Before and after the training, their speech functions were assessed by language tests. At baseline, 6 of them received positron emission tomography to evaluate glucose metabolism. Five patients exhibited improvements after intervention; all but one exhibited intact right basal ganglia and left temporal lobes, but all exhibited left basal ganglia lesions. Among them, three subjects exhibited preserved glucose metabolism in the right temporal lobe. We considered that patients who exhibit intact right basal ganglia and left temporal lobes, together with preserved right hemispheric glucose metabolism, might be an indication of the effectiveness of singing therapy.

Left lobe of the prostate during clinical prostate cancer screening: the dark side of the gland for right-handed examiners.

PubMed

Ploussard, G; Nicolaiew, N; Mongiat-Artus, P; Terry, S; Allory, Y; Vacherot, F; Abbou, C-C; Desgrandchamps, F; Salomon, L; de la Taille, A

2014-06-01

The predictive value of the abnormality side during digital rectal examination (DRE) has never been studied, suggesting that physicians examined the left lobe of the gland as well as the right lobe. We aimed to assess the predictive value of the side of DRE abnormality for prostate cancer (PCa) detection and aggressiveness in right-handed urologists. An analysis of a prospective database was carried out that included all consecutive men undergoing prostate biopsies between 2001 and 2012. The main end point was the predictive value of the abnormality side during DRE for cancer detection in clinically suspicious unilateral T2 disease. The diagnostic performance of left- versus right-sided abnormality was also assessed in terms of sensitivity, specificity and negative/positive predictive values. Overall, 308 patients had a suspicious unilateral clinical disease (detection rate 57.5%). The cancer detection rate was significantly higher in case of left-sided compared with right-sided clinical T2 stage (odds ratio 2.1). In case of left-sided disease, the number of positive cores, the rate of perineural invasion, the rate of primary grade 4 pattern and the percentage of cancer involvement per core were significantly higher compared with those reported for right-sided disease. The predictive value of abnormality laterality for cancer detection and aggressiveness remained statistically independent in multivariate models. The positive predictive value for cancer detection was 64.6 in case of suspicious left-sided disease versus 46.9 in case of right-sided disease. The risks of detecting PCa and aggressive disease on biopsy are significantly higher when DRE reveals a suspicious left-sided clinical disease as compared with right-sided disease. Right-handed physicians should be aware of this variance in diagnostic performance and potential underdetection of left-sided clinical disease, and should improve their examination of the left lobe of the gland by conducting longer exams or changing the patient's position.

Levetiracetam reduces abnormal network activations in temporal lobe epilepsy.

PubMed

Wandschneider, Britta; Stretton, Jason; Sidhu, Meneka; Centeno, Maria; Kozák, Lajos R; Symms, Mark; Thompson, Pamela J; Duncan, John S; Koepp, Matthias J

2014-10-21

We used functional MRI (fMRI) and a left-lateralizing verbal and a right-lateralizing visual-spatial working memory (WM) paradigm to investigate the effects of levetiracetam (LEV) on cognitive network activations in patients with drug-resistant temporal lobe epilepsy (TLE). In a retrospective study, we compared task-related fMRI activations and deactivations in 53 patients with left and 54 patients with right TLE treated with (59) or without (48) LEV. In patients on LEV, activation patterns were correlated with the daily LEV dose. We isolated task- and syndrome-specific effects. Patients on LEV showed normalization of functional network deactivations in the right temporal lobe in right TLE during the right-lateralizing visual-spatial task and in the left temporal lobe in left TLE during the verbal task. In a post hoc analysis, a significant dose-dependent effect was demonstrated in right TLE during the visual-spatial WM task: the lower the LEV dose, the greater the abnormal right hippocampal activation. At a less stringent threshold (p < 0.05, uncorrected for multiple comparisons), a similar dose effect was observed in left TLE during the verbal task: both hippocampi were more abnormally activated in patients with lower doses, but more prominently on the left. Our findings suggest that LEV is associated with restoration of normal activation patterns. Longitudinal studies are necessary to establish whether the neural patterns translate to drug response. This study provides Class III evidence that in patients with drug-resistant TLE, levetiracetam has a dose-dependent facilitation of deactivation of mesial temporal structures. © 2014 American Academy of Neurology.

Ectopic Multinodular Goiter: Multidetector Computed Tomography Findings

PubMed Central

Karakaya, Afak Durur; Kantarci, Mecit; Yalcin, Ahmet; Demir, Berrin

2008-01-01

The thyroid is the first endocrine gland to form during embryogenesis. At this stage, incomplete or anomalous migration of thyroid tissue causes ectopic localization of the gland. In our case, a 55-year-old woman who was evaluated via ultrasonography (USG) and multi-detector computed tomography (MDCT) had no thyroid gland at the normal location, but did have ectopic thyroid tissue in the left submandibular and submental regions. PMID:25610021

[Thin-section computed tomography of the bronchi; 2. Right upper lobe and left upper division].

PubMed

Matsuoka, Y; Ookubo, T; Ohtomo, K; Nishikawa, J; Kojima, K; Oyama, K; Yoshikawa, K; Iio, M

1990-02-01

Thin (2mm) section contiguous computed tomographic (CT) scans were obtained through the bronchi of the right upper lobe and the left upper division in 30 patients. All segmental bronchi were identified. The right subsegmental bronchi were identified in 100%, and the left subsegmental bronchi in 97%. The type of the orifice of the right bronchus was trifurcated (53%), the extension of B1 was apicoanterior (50%), and the size of B2b was equal to B3a (63%). The extension of the left B3 was subapicoanterior (38%), and the size of B1+2c was equal to B3a (62%).

Long-term Outcome of Short Metallic Stents for Lobar Airway Stenosis.

PubMed

Fruchter, Oren; Abed El Raouf, Bayya; Rosengarten, Dror; Kramer, Mordechai R

2017-07-01

Whereas stents are considered an excellent treatment for proximal central major airway stenosis, the value of stenting for distal lobar airway stenosis is still controversial. Our aim was to explore the short-term and long-term outcome of metallic stents placed for benign and malignant lobar airway stenosis. Between July 2007 and July 2014, 14 patients underwent small airway stent insertion. The clinical follow-up included serial semiannual physical examinations, pulmonary function tests, imaging, and bronchoscopy. The etiologies for airway stenosis were: early post-lung transplantation bronchial stenosis (N=5), sarcoidosis (N=1), amyloidosis (N=1), anthracofibrosis (N=1), right middle lobe syndrome due to external lymph node compression (N=1), lung cancer (N=4), and stenosis of the left upper lobe of unknown etiology (N=1). Stents were placed in the right upper lobe bronchus (N=2), right middle lobe bronchus (N=6), left upper lobe bronchus (N=4), linguar bronchus (N=1), and left lower lobe bronchus (N=1). The median follow-up period ranged from 2 to 72 months (median 18 mo). Immediate relief of symptoms was achieved in the vast majority of patients (13/14, 92%). Out of 10 patients with benign etiology for stenosis, 9 (90%) experienced sustained and progressive improvement in pulmonary function tests and clinical condition. We describe our positive experience with small stents for lobar airway stenosis; further prospective trials are required to evaluate the value of this novel modality of treatment.

Cerebral Oximetry as an Auxiliary Diagnostic Tool in the Diagnosis of Brain Death.

PubMed

Tatli, O; Bekar, O; Imamoglu, M; Gonenc Cekic, O; Aygun, A; Eryigit, U; Karaca, Y; Sahin, A; Turkmen, S; Turedi, S

2017-10-01

To investigate the efficacy of cerebral oximetry (CO) as an auxiliary diagnostic tool in brain death (BD). This observational case-control study was performed on patients with suspected BD. Patients with diagnosis of BD confirmed by the brain death committee were enrolled as the BD group and other patients as the non-BD group. CO monitoring was performed at least 6 h, and cerebral tissue oxygen saturation (ScO 2 ) parameters were compared. Mean ScO 2 level in the BD group was lower than non-brain-dead patients: mean difference for right lobe = 6.48 (95% confidence interval [CI] 0.08-12.88) and for left lobe = 6.09 (95% CI -0.22-12.41). Maximum ScO 2 values in the BD group were significantly lower than the non-BD group: mean difference for right lobe = 8.20 (95% CI 1.64-14.77) and for left lobe = 9.54 (95% CI 3.06-16.03). The area under the curve for right lobe maximum ScO 2 was 0.69 (95% CI 0.55-0.81) and for left lobe was 0.72 (95% CI 0.58-0.84). Maximum ScO 2 in brain-dead patients at CO monitoring is significantly low. However, this cannot be used to differentiate brain-dead and non-brain-dead patients. CO monitoring is therefore not an appropriate auxiliary diagnostic tool for confirming BD. Copyright © 2017 Elsevier Inc. All rights reserved.

Genetic and Environmental Influences on Regional Brain Uptake of 18F-FDG: A PET Study on Monozygotic and Dizygotic Twins.

PubMed

Watanabe, Shinichiro; Kato, Hiroki; Shimosegawa, Eku; Hatazawa, Jun

2016-03-01

Genetic or environmental influences on cerebral glucose metabolism are unknown. We attempted to reveal these influences in elderly twins by means of (18)F-FDG PET. (18)F-FDG uptake was studied in 40 monozygotic and 18 dizygotic volunteer twin pairs aged 30 y or over. We also created 18 control pairs by pairing age- and sex-matched genetically unrelated subjects from dizygotic and monozygotic pairs. SUV images of the brain were reconstructed and analyzed by voxel-based statistical analysis with automated region-of-interest setting. The (18)F-FDG uptake in each cerebral lobe was semiquantified by taking a ratio of SUVmean in each region of interest to whole-brain SUVaverage. We calculated an intraclass correlation coefficient of SUV ratio in each region of interest for monozygotic and dizygotic pairs. By comparing differences in coefficients between monozygotic and dizygotic pairs, genetic and environmental contributions were estimated. The intraclass correlation coefficient in monozygotic pairs was significantly higher than that in dizygotic pairs in the parietal lobes bilaterally (P < 0.001) and in the left temporal lobe (P < 0.05) but was not significantly different in other lobes. The present study indicated that in the right and left parietal lobes and left temporal lobe, cerebral glucose metabolism is influenced more by genetics than by environment, whereas in other brain regions the influence of environment is dominant. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Functional correlates of musical and visual ability in frontotemporal dementia.

PubMed

Miller, B L; Boone, K; Cummings, J L; Read, S L; Mishkin, F

2000-05-01

The emergence of new skills in the setting of dementia suggests that loss of function in one brain area can release new functions elsewhere. To characterise 12 patients with frontotemporal dementia (FTD) who acquired, or sustained, new musical or visual abilities despite progression of their dementia. Twelve patients with FTD who acquired or maintained musical or artistic ability were compared with 46 patients with FTD in whom new or sustained ability was absent. The group with musical or visual ability performed better on visual, but worse on verbal tasks than did the other patients with FTD. Nine had asymmetrical left anterior dysfunction. Nine showed the temporal lobe variant of FTD. Loss of function in the left anterior temporal lobe may lead to facilitation of artistic or musical skills. Patients with the left-sided temporal lobe variant of FTD offer an unexpected window into the neurological mediation of visual and musical talents.

Different uptake of 123I-MIBG in the two main liver lobes: A persistant unsolved mistery.

PubMed

Bonacina, M; Albano, D; Steimberg, N; Bosio, G; Camoni, L; Bertagna, F; Giubbini, R; Mazzoleni, G

2018-05-10

After radiopharmaceutical injection, a heightened 123 I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123 I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features. Ninety-four 123 I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24h after radiotracer administration. Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy. 123 I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models. Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.

Perigastric lymph node metastasis from papillary thyroid carcinoma in a patient with early gastric cancer: the first case report.

PubMed

Jeong, Gui-Ae; Kim, Hyung-Chul; Kim, Hee-Kyung; Cho, Gyu-Seok

2014-09-01

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

Evidence for degraded low frequency verbal concepts in left resected temporal lobe epilepsy patients.

PubMed

Visser, M; Forn, C; Lambon Ralph, M A; Hoffman, P; Gómez Ibáñez, A; Sunajuán, Ana; Rosell Negre, P; Villanueva, V; Ávila, C

2018-06-01

According to a large neuropsychological and neuroimaging literature, the bilateral anterior temporal lobe (ATL) is a core region for semantic processing. It seems therefore surprising that semantic memory appears to be preserved in temporal lobe epilepsy (TLE) patients with unilateral ATL resection. However, recent work suggests that the bilateral semantic system is relatively robust against unilateral damage and semantic impairments under these circumstances only become apparent with low frequency specific concepts. In addition, neuroimaging studies have shown that the function of the left and right ATLs differ and therefore left or right ATL resection should lead to a different pattern of impairment. The current study investigated hemispheric differences in the bilateral semantic system by comparing left and right resected TLE patients during verbal semantic processing of low frequency concepts. Picture naming and semantic comprehension tasks with varying word frequencies were included to investigate the pattern of impairment. Left but not right TLE patients showed impaired semantic processing, which was particularly apparent on low frequency items. This indicates that, for verbal information, the bilateral semantic system is more sensitive to damage in the left compared to the right ATL, which is in line with theories that attribute a more prominent role to the left ATL due to connections with pre-semantic verbal regions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Suppurative thyroiditis due to aspergillosis: a case report

PubMed Central

2014-01-01

Introduction Aspergillus, a nosocomial agent, is the most common fungal cause of suppurative thyroiditis. Most patients with Aspergillus thyroiditis have disseminated infection, primarily with lung compromise. Late diagnosis and treatment, severity of immunosuppressive state and thyroid hormone overload contribute to extremely high mortality rates. Case presentation We describe a 20-year-old Caucasian man receiving corticosteroid suppression therapy for systemic lupus erythematosus. He presented persistent fever with neck pain and pulmonary infection. Piperacillin/tazobactam was initiated but after 2 days he developed hypoxemia, vascular shock, severe anemia, lymphopenia, and high C-reactive protein. Thyroid ultrasound revealed well-defined hypoechogenic clusters in both lobes and laboratorial thyrotoxicosis but low triiodothyronine concentration. A purulent substance was obtained on fine needle aspiration and drained. Amphotericin B and fluconazole were added but he had unfavorable evolution and died. Aspergillus fumigatus was defined only 2 days after his death. Conclusions This case serves to alert clinicians to the possibility of infectious thyroiditis and reinforces the high risk of aspergillosis in immunocompromised patients. Therefore, management including voriconazole as first-line treatment or amphotericin B, in association with broad-spectrum antibiotic therapy, should be adopted to improve treatment outcome. PMID:25412755

Disrupted dynamic network reconfiguration of the language system in temporal lobe epilepsy.

PubMed

He, Xiaosong; Bassett, Danielle S; Chaitanya, Ganne; Sperling, Michael R; Kozlowski, Lauren; Tracy, Joseph I

2018-05-01

Temporal lobe epilepsy tends to reshape the language system causing maladaptive reorganization that can be characterized by task-based functional MRI, and eventually can contribute to surgical decision making processes. However, the dynamic interacting nature of the brain as a complex system is often neglected, with many studies treating the language system as a static monolithic structure. Here, we demonstrate that as a specialized and integrated system, the language network is inherently dynamic, characterized by rich patterns of regional interactions, whose transient dynamics are disrupted in patients with temporal lobe epilepsy. Specifically, we applied tools from dynamic network neuroscience to functional MRI data collected from 50 temporal lobe epilepsy patients and 30 matched healthy controls during performance of a verbal fluency task, as well as during rest. By assigning 16 language-related regions into four subsystems (i.e. bilateral frontal and temporal), we observed regional specialization in both the probability of transient interactions and the frequency of such changes, in both healthy controls and patients during task performance but not rest. Furthermore, we found that both left and right temporal lobe epilepsy patients displayed reduced interactions within the left frontal 'core' subsystem compared to the healthy controls, while left temporal lobe epilepsy patients were unique in showing enhanced interactions between the left frontal 'core' and the right temporal subsystems. Also, both patient groups displayed reduced flexibility in the transient interactions of the left temporal and right frontal subsystems, which formed the 'periphery' of the language network. Importantly, such group differences were again evident only during task condition. Lastly, through random forest regression, we showed that dynamic reconfiguration of the language system tracks individual differences in verbal fluency with superior prediction accuracy compared to traditional activation-based static measures. Our results suggest dynamic network measures may be an effective biomarker for detecting the language dysfunction associated with neurological diseases such as temporal lobe epilepsy, specifying both the type of neuronal communications that are missing in these patients and those that are potentially added but maladaptive. Further advancements along these lines, transforming how we characterize and map language networks in the brain, have a high probability of altering clinical decision making in neurosurgical centres.10.1093/brain/awy042_video1awy042media15754656112001.

Postencephalitic focal retrograde amnesia after bilateral anterior temporal lobe damage.

PubMed

Tanaka, Y; Miyazawa, Y; Hashimoto, R; Nakano, I; Obayashi, T

1999-07-22

Marked retrograde amnesia with no or almost no anterograde amnesia is rare. Recently, a combination of ventrolateral prefrontal and temporopolar cortical lesions has been suggested as the cause of such isolated or focal retrograde amnesia. It is also assumed that when the right-sided cortical structures are damaged, autobiographical episodic memories are affected. To search for new anatomic substrates for focal retrograde amnesia. We performed extensive neuropsychological tests and obtained detailed neuroimages on a 43-year-old woman who showed a severe, persistent retrograde amnesia but only a limited anterograde amnesia after probable herpes simplex encephalitis. Tests of autobiographical memory revealed that she had a memory loss extending back to her childhood for both semantics and incidents; however, the ability to recall specific episodes appeared much more severely impaired than the ability to recall factual information about her past. The patient also showed profound impairments in recalling public memories; however, her scores improved nearly to a control level on forced-choice recognition memory tasks, although the recall of memories for a decade just before her illness remained mildly impaired. MRI revealed focal pathologies in the temporal poles and the anterior parts of the inferotemporal lobes on both sides, predominantly on the left, with some extension to the anterior parts of the medial temporal lobes. There was additional damage to the left insular cortex and its surrounding structures but no evidence of frontal lobe damage on MRIs or cognitive tests. A profound retrograde amnesia may be produced by damage to the bilateral temporal poles and anterior inferotemporal lobes in the absence of frontal lobe pathologies, and a dense and persistent episodic old memory loss can arise even with a relatively small lesion in the right anterior temporal lobe if it is combined with extensive damage to the left.

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis.

PubMed

Patel, Keval; Griffing, George T; Hauptman, Paul J; Stolker, Joshua M

2016-04-01

Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction caused by transient wall-motion abnormalities of the left ventricular apex and mid ventricle in the absence of obstructive coronary artery disease. Recurrent episodes are rare but have been reported, and several cases of takotsubo cardiomyopathy have been described in the presence of hyperthyroidism. We report the case of a 55-year-old woman who had recurrent takotsubo cardiomyopathy, documented by repeat coronary angiography and evaluations of left ventricular function, in the presence of recurrent hyperthyroidism related to Graves disease. After both episodes, the patient's left ventricular function returned to normal when her thyroid function normalized. These findings suggest a possible role of thyroid-hormone excess in the pathophysiology of some patients who have takotsubo cardiomyopathy.

[[Is it necessary to perform a central lymphodissection in highly differentiated iviicrocarcinoiva of thyroid gland?].

PubMed

Zavgorodniy, S N; Danilyuk, M B; Rylov, A I; Dolya, O S

2016-08-01

The rate of the highly differentiated thyroid microcarcinoma methastasizing in central (6th) group of cervical lymph nodes was studied. In the clinic in 2013 - 2015 yrs 62 patients were operated for primary thyroid microcarcinoma. In accordance to TNM (UICC, AJCC, 2009) classification, papillary cancer in stage TlaNOMO was diagnosed in 35 (56.5%) patients, T1aN1MO - in 22 (35.5%); follicular cancer stage T1aNOMO - in 2 (3.2%); papillary cancer, follicular variant in stage T1aN1 MO - in 2 (3.2%); follicu- lar cancer, papillary variant in stage T1aNOMO - in 1 (1.6%). In 8 (12.9%) patients intraorgan multifocal metastasizing into contralateral thyroid lobe was revealed. In accordance to morphological investigation date of the excised samples, in 24 (38.7%) patients the metastases into the 6th group lymph nodes were revealed. In 4 (16.7%) patients, to whom lateral cervical lymphodissection was done, metastases in 2 - 5th groups of lymph nodes on the thyroid affection side were revealed.

Flow cytometry in the differential diagnostics of Hashimoto's thyroiditis and MALT lymphoma of the thyroid.

PubMed

Adamczewski, Zbigniew; Stasiołek, Mariusz; Dedecjus, Marek; Smolewski, Piotr; Lewiński, Andrzej

2015-01-01

A combination of traditional cytology methods with fluorescence activated cell sorting (FACS) analysis of fine-needle aspiration biopsy (FNAB) material is considered a powerful diagnostic tool in the differential diagnosis of thyroid lesions suspected of mucosa-associated lymphoid tissue lymphoma (MALT-L). The aim of this study was to demonstrate the FACS-based diagnostic process of thyroid lesions in a clinical situation where ultrasound and cytological examinations did not allow differentiation between Hashimoto's thyroiditis (HT) and MALT-L. The patients analysed in this study presented significantly different clinical courses of thyroid disease: quickly enlarging painless tumour of the thyroid right lobe in the first case, and chronic HT with palpable tumour in the thyroid isthmus in the second patient. Due to the suspicion of MALT-L resulting from indeterminate ultrasound and FNAB-cytology results, FNAB material was obtained from all the previously examined thyroid lesions and directly subjected to FACS assessment, encompassing κ/λ light chain restriction analysis, as well as measurements of B and T cell surface antigens. The FACS analysis of FNAB material obtained from our patients did not show any definite signs of light chain restriction. Although one of the samples showed a borderline value of κ/λ ratio (κ/λ = 0.31), further immunophenotyping confirmed clonal expansion in none of the examined thyroid regions. Histopathological findings documented the diagnosis of HT in both clinical cases. We believe that FACS represents a useful and reliable complementary diagnostic measure in FNAB-based differential diagnosis of lymphoproliferative thyroid disorders.

Computerized tomography-based anatomic description of the porcine liver.

PubMed

Bekheit, Mohamed; Bucur, Petru O; Wartenberg, Mylene; Vibert, Eric

2017-04-01

The knowledge of the anatomic features is imperative for successful modeling of the different surgical situations. This study aims to describe the anatomic features of the porcine using computerized tomography (CT) scan. Thirty large, white, female pigs were included in this study. The CT image acquisition was performed in four-phase contrast study. Subsequently, analysis of the images was performed using syngo.via software (Siemens) to subtract mainly the hepatic artery and its branches. Analysis of the portal and hepatic veins division pattern was performed using the Myrian XP-Liver 1.14.1 software (Intrasense). The mean total liver volume was 915 ± 159 mL. The largest sector in the liver was the right medial one representing around 28 ± 5.7% of the total liver volume. Next in order is the right lateral sector constituting around 24 ± 5%. Its volume is very close to the volume of the left medial sector, which represents around 22 ± 4.7% of the total liver volume. The caudate lobe represents around 8 ± 2% of the total liver volume.The portal vein did not show distinct right and left divisions rather than consecutive branches that come off the main trunk. The hepatic artery frequently trifurcates into left trunk that gives off the right gastric artery and the artery to the left lateral sector, the middle hepatic artery that supplies both the right and the left medial sectors and the right hepatic artery trunk that divides to give anterior branch to the right lateral lobe, branch to the right medial lobe, and at least a branch to the caudate lobe. Frequently, there is a posterior branch that crosses behind the portal vein to the right lateral lobe. The suprahepatic veins join the inferior vena cava in three distinct openings. There are communications between the suprahepatic veins that drain the adjacent sectors. The vein from the right lateral and the right medial sectors drains into a common trunk. The vein from the left lateral and from the left medial sectors drains into a common trunk. A separate opening is usually encountered draining the right medial sector. The caudate lobe drains separately into inferior vena cava caudal to the other veins. Knowledge of the anatomic features of the porcine liver is crucial to the performance of a successful surgical procedure. We herein describe the CT-depicted anatomic features of the porcine liver. Copyright © 2016 Elsevier Inc. All rights reserved.

Levels of processing with free and cued recall and unilateral temporal lobe epilepsy.

PubMed

Lespinet-Najib, Véronique; N'Kaoua, Bernard; Sauzéon, Hélène; Bresson, Christel; Rougier, Alain; Claverie, Bernard

2004-04-01

This study investigates the role of the temporal lobes in levels-of-processing tasks (phonetic and semantic encoding) according to the nature of recall tasks (free and cued recall). These tasks were administered to 48 patients with unilateral temporal epilepsy (right "RTLE"=24; left "LTLE"=24) and a normal group (n=24). The results indicated that LTLE patients were impaired for semantic processing (free and cued recall) and for phonetic processing (free and cued recall), while for RTLE patients deficits appeared in free recall with semantic processing. It is suggested that the left temporal lobe is involved in all aspects of verbal memory, and that the right temporal lobe is specialized in semantic processing. Moreover, our data seem to indicate that RTLE patients present a retrieval processing impairment (semantic condition), whereas the LTLE group is characterized by encoding difficulties in the phonetic and semantic condition.

Altered cortical anatomical networks in temporal lobe epilepsy

NASA Astrophysics Data System (ADS)

Lv, Bin; He, Huiguang; Lu, Jingjing; Li, Wenjing; Dai, Dai; Li, Meng; Jin, Zhengyu

2011-03-01

Temporal lobe epilepsy (TLE) is one of the most common epilepsy syndromes with focal seizures generated in the left or right temporal lobes. With the magnetic resonance imaging (MRI), many evidences have demonstrated that the abnormalities in hippocampal volume and the distributed atrophies in cortical cortex. However, few studies have investigated if TLE patients have the alternation in the structural networks. In the present study, we used the cortical thickness to establish the morphological connectivity networks, and investigated the network properties using the graph theoretical methods. We found that all the morphological networks exhibited the small-world efficiency in left TLE, right TLE and normal groups. And the betweenness centrality analysis revealed that there were statistical inter-group differences in the right uncus region. Since the right uncus located at the right temporal lobe, these preliminary evidences may suggest that there are topological alternations of the cortical anatomical networks in TLE, especially for the right TLE.

Impairments in proverb interpretation following focal frontal lobe lesions☆

PubMed Central

Murphy, Patrick; Shallice, Tim; Robinson, Gail; MacPherson, Sarah E.; Turner, Martha; Woollett, Katherine; Bozzali, Marco; Cipolotti, Lisa

2013-01-01

The proverb interpretation task (PIT) is often used in clinical settings to evaluate frontal “executive” dysfunction. However, only a relatively small number of studies have investigated the relationship between frontal lobe lesions and performance on the PIT. We compared 52 patients with unselected focal frontal lobe lesions with 52 closely matched healthy controls on a proverb interpretation task. Participants also completed a battery of neuropsychological tests, including a fluid intelligence task (Raven’s Advanced Progressive Matrices). Lesions were firstly analysed according to a standard left/right sub-division. Secondly, a finer-grained analysis compared the performance of patients with medial, left lateral and right lateral lesions with healthy controls. Thirdly, a contrast of specific frontal subgroups compared the performance of patients with medial lesions with patients with lateral frontal lesions. The results showed that patients with left frontal lesions were significantly impaired on the PIT, while in patients with right frontal lesions the impairments approached significance. Medial frontal patients were the only frontal subgroup impaired on the PIT, relative to healthy controls and lateral frontal patients. Interestingly, an error analysis indicated that a significantly higher number of concrete responses were found in the left lateral subgroup compared to healthy controls. We found no correlation between scores on the PIT and on the fluid intelligence task. Overall our results suggest that specific regions of the frontal lobes contribute to the performance on the PIT. PMID:23850600

Evaluation of the effects of a VEGFR-2 inhibitor compound on alanine aminotransferase gene expression and enzymatic activity in the rat liver

PubMed Central

2011-01-01

Background Traditional assessment of drug-induced hepatotoxicity includes morphological examination of the liver and evaluation of liver enzyme activity in serum. The objective of the study was to determine the origin of drug-related elevation in serum alanine aminotransferase (ALT) activity in the absence of morphologic changes in the liver by utilizing molecular and immunohistochemical techniques. Methods Sixteen female Sprague-Dawley rats were divided into 2 groups (control and treated, n = 4 per group) and treated rats were dosed orally twice daily (400 mg/kg/day) for 7 days with a VEGFR-2 compound (AG28262), which in a previous study caused ALT elevation without morphological changes. Serum of both treated and control animals were evaluated on day 3 of treatment and at day 8. Three separate liver lobes (caudate, right medial, and left lateral) were examined for determination of ALT tissue activity, ALT gene expression and morphological changes. Results ALT activity was significantly (p < 0.01) elevated on day 3 and further increased on day 8. Histologic changes or increase in TUNEL and caspase3 positive cells were not observed in the liver lobes examined. ALT gene expression in the caudate lobe was significantly up-regulated by 63%. ALT expression in the left lateral lobe was not significantly affected. Statistically significant increased liver ALT enzymatic activity occurred in the caudate (96%) and right medial (41%) lobes but not in the left lateral lobe. Conclusions AG28262, a VEFG-r2 inhibitor, causes an increase in serum ALT, due in part to both gene up-regulation. Differences between liver lobes may be attributable to differential distribution of blood from portal circulation. Incorporation of molecular data, such as gene and protein expression, and sampling multiple liver lobes may shed mechanistic insight to the evaluation of hepatotoxicity. PMID:21846403

Evaluation of the effects of a VEGFR-2 inhibitor compound on alanine aminotransferase gene expression and enzymatic activity in the rat liver.

PubMed

Fuentealba, Carmen; Bera, Monali; Jessen, Bart; Sace, Fred; Stevens, Greg J; Trajkovic, Dusko; Yang, Amy H; Evering, Winston

2011-08-17

Traditional assessment of drug-induced hepatotoxicity includes morphological examination of the liver and evaluation of liver enzyme activity in serum. The objective of the study was to determine the origin of drug-related elevation in serum alanine aminotransferase (ALT) activity in the absence of morphologic changes in the liver by utilizing molecular and immunohistochemical techniques. Sixteen female Sprague-Dawley rats were divided into 2 groups (control and treated, n = 4 per group) and treated rats were dosed orally twice daily (400 mg/kg/day) for 7 days with a VEGFR-2 compound (AG28262), which in a previous study caused ALT elevation without morphological changes. Serum of both treated and control animals were evaluated on day 3 of treatment and at day 8. Three separate liver lobes (caudate, right medial, and left lateral) were examined for determination of ALT tissue activity, ALT gene expression and morphological changes. ALT activity was significantly (p < 0.01) elevated on day 3 and further increased on day 8. Histologic changes or increase in TUNEL and caspase3 positive cells were not observed in the liver lobes examined. ALT gene expression in the caudate lobe was significantly up-regulated by 63%. ALT expression in the left lateral lobe was not significantly affected. Statistically significant increased liver ALT enzymatic activity occurred in the caudate (96%) and right medial (41%) lobes but not in the left lateral lobe. AG28262, a VEFG-r2 inhibitor, causes an increase in serum ALT, due in part to both gene up-regulation. Differences between liver lobes may be attributable to differential distribution of blood from portal circulation. Incorporation of molecular data, such as gene and protein expression, and sampling multiple liver lobes may shed mechanistic insight to the evaluation of hepatotoxicity.

Regulation of LH/FSH expression by secretoglobin 3A2 in the mouse pituitary gland.

PubMed

Miyano, Yuki; Tahara, Shigeyuki; Sakata, Ichiro; Sakai, Takafumi; Abe, Hiroyuki; Kimura, Shioko; Kurotani, Reiko

2014-04-01

Secretoglobin (SCGB) 3A2 was originally identified as a downstream target for the homeodomain transcription factor NKX2-1 in the lung. NKX2-1 plays a role in the genesis and expression of genes in the thyroid, lung and ventral forebrain; Nkx2-1-null mice have no thyroid and pituitary and severely hypoplastic lungs and hypothalamus. To demonstrate whether SCGB3A2 plays any role in pituitary hormone production, NKX2-1 and SCGB3A2 expression in the mouse pituitary gland was examined by immunohistochemical analysis and RT-PCR. NKX2-1 was localized in the posterior pituitary lobe, whereas SCGB3A2 was observed in both anterior and posterior lobes as shown by immunohistochemistry and RT-PCR. Expression of CCAAT-enhancer binding proteins (C/EBPs), which regulate mouse Scgb3a2 transcription, was also examined by RT-PCR. C/EBPβ, γ, δ and ζ were expressed in the adult mouse pituitary gland. SCGB3A2 was expressed in the anterior and posterior lobes from postnatal days 1 and 5, respectively and the areas where SCGB3A2 expression was found coincided with the area where FSH-secreting cells were found. Double-staining for SCGB3A2 and pituitary hormones revealed that SCGB3A2 was mainly localized in gonadotrophs in 49 % of FSH-secreting cells and 47 % of LH-secreting cells. In addition, SCGB3A2 dramatically inhibited LH and FSH mRNA expression in rat pituitary primary cell cultures. These results suggest that SCGB3A2 regulates FSH/LH production in the anterior pituitary lobe and that transcription factors other than NKX2-1 may regulate SCGB3A2 expression.

Branchial cleft-like cysts in Hashimoto's thyroiditis: A case report and literature review.

PubMed

Miyazaki, Masaya; Kiuchi, Shizuka; Fujioka, Yasunori

2016-05-01

We report an extremely rare case of branchial cleft-like cysts in Hashimoto's thyroiditis. The patient was a 77-year-old man with a growing mass in the anterior neck. Ultrasonography and computed tomography revealed a cystic lesion with septum in the left thyroid and multiple small cystic lesions in the right thyroid. Lymph node swelling of the cervical region, supraclavicular fossa and submandibular region was also observed. Left thyroidectomy and lymph node dissection were performed. Histologically, cysts were lined by stratified squamous epithelium and dense lymphoid tissue having conspicuous follicle formation surrounded the epithelial lining. Solid cell nest (SCN)-like aggregations were seen in the thyroid parenchyma adjacent to the cyst walls and a small number of thyroid follicles were observed in the fibrous wall. Immunohistochemically, it is suggested that both the cyst lining and SCN-like aggregations are originally from thyroid follicles. Although, the exact histogenesis of branchial cleft-like cysts remains unclear, there are probably two different processes for its development, one is of branchial cleft origin and the other is mere squamous metaplasia, while in our case the latter is suggested. Herein, we report our new case and update information about branchial cleft-like cysts that appears in the literature. © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

Let's Inhibit Our Excitement: The Relationships Between Stroop, Behavioral Disinhibition, and the Frontal Lobes

PubMed Central

Heflin, Lara H.; Laluz, Victor; Jang, Jung; Ketelle, Robin; Miller, Bruce L.; Kramer, Joel H.

2011-01-01

Objective The Stroop is a frequently used neuropsychological test, with poor performance typically interpreted as indicative of disinhibition and frontal lobe damage. This study tested those interpretations by examining relationships between Stroop performance, behavioral disinhibition, and frontal lobe atrophy. Method Participants were 112 well-characterized patients with mild cognitive impairment or dementia, recruited through UCSF's Memory and Aging Center. Participants received comprehensive dementia evaluations including structural MRI, neuropsychological testing, and informant interviews. Freesurfer, a semi-automated parcellation program, was used to analyze 1.5T MRI scans. Behavioral disinhibition was measured using the Disinhibition scale of the Neuropsychiatric Inventory. The sample (n=112) mean age was 65.40 (SD=8.60) years, education was 16.64 (SD=2.54) years, and MMSE was 26.63 (SD=3.32). Hierarchical linear regressions were used for data analysis. Results Controlling for age, MMSE, and Color Naming performance, Stroop performance was not significantly associated with behavioral disinhibition (β=0.01, ΔR2=0.01, p=0.29). Hierarchical regressions controlling for age, MMSE, Color Naming, intracranial volume, and temporal and parietal lobes, examined whether left hemisphere or right hemisphere regions predict Interference speed. Bilaterally, parietal lobes were the brain region in which atrophy best predicted poorer Stroop (left: β=0.0004, ΔR2=0.02, p=0.002; right: β=0.0004, ΔR2=0.02, p=0.002). Of frontal regions, only dorsolateral prefrontal cortex atrophy predicted poorer Stroop (β=0.001, ΔR2=0.01, p=0.03); left and right anterior cingulate cortex (ACC) atrophy predicted better Stroop (left: β=−0.003, ΔR2=0.01, p=0.02; right: β=−0.004, ΔR2=0.01, p=0.02). Conclusions These findings suggest Stroop performance is a poor measure of behavioral disinhibition and frontal lobe atrophy even among a relatively high-risk population. PMID:21574716

Let's inhibit our excitement: the relationships between Stroop, behavioral disinhibition, and the frontal lobes.

PubMed

Heflin, Lara H; Laluz, Victor; Jang, Jung; Ketelle, Robin; Miller, Bruce L; Kramer, Joel H

2011-09-01

The Stroop (Stroop, 1935) is a frequently used neuropsychological test, with poor performance typically interpreted as indicative of disinhibition and frontal lobe damage. This study tested those interpretations by examining relationships between Stroop performance, behavioral disinhibition, and frontal lobe atrophy. Participants were 112 patients with mild cognitive impairment or dementia, recruited through UCSF's Memory and Aging Center. Participants received comprehensive dementia evaluations including structural MRI, neuropsychological testing, and informant interviews. Freesurfer, a semiautomated parcellation program, was used to analyze 1.5T MRI scans. Behavioral disinhibition was measured using the Neuropsychiatric Inventory (Cummings, 1997; Cummings et al., 1994) Disinhibition Scale. The sample (n = 112) mean age was 65.40 (SD = 8.60) years, education was 16.64 (SD = 2.54) years, and Mini-Mental State Examination (MMSE; Folstein et al., 1975) was 26.63 (SD = 3.32). Hierarchical linear regressions were used for data analysis. Controlling for age, MMSE, and color naming, Stroop performance was not significantly associated with disinhibition (β = 0.01, ΔR² = 0.01, p = .29). Hierarchical regressions controlling for age, MMSE, color naming, intracranial volume, and temporal and parietal lobes, examined whether left or right hemisphere regions predict Stroop performance. Bilaterally, parietal lobe atrophy best predicted poorer Stroop (left: β = 0.0004, ΔR² = 0.02, p = .002; right: β = 0.0004, ΔR² = 0.02, p = .002). Of frontal regions, only dorsolateral prefrontal cortex atrophy predicted poorer Stroop (β = 0.001, ΔR² = 0.01, p = .03); left and right anterior cingulate cortex atrophy predicted better Stroop (left: β = -0.003, ΔR² = 0.01, p = .02; right: β = -0.004, ΔR² = 0.01, p = .02). These findings suggest Stroop performance is a poor measure of behavioral disinhibition and frontal lobe atrophy even among a relatively high-risk population. PsycINFO Database Record (c) 2011 APA, all rights reserved.

Brain structural differences associated with the behavioural phenotype in children with Williams syndrome.

PubMed

Campbell, Linda E; Daly, Eileen; Toal, Fiona; Stevens, Angela; Azuma, Rayna; Karmiloff-Smith, Annette; Murphy, Declan G M; Murphy, Kieran C

2009-03-03

We investigated structural brain morphology of intellectually disabled children with Williams (WS) syndrome and its relationship to the behavioural phenotype. We compared the neuroanatomy of 15 children (mean age:13+/-2) with WS and 15 age/gender-matched healthy children using a manual region-of-interest analysis to measure bulk (white+grey) tissue volumes and unbiased fully-automated voxel-based morphometry to assess differences in grey/white matter throughout the brain. Ratings of abnormal behaviours were correlated with brain structure. Compared to controls, the brains of children with WS had a decreased volume of the right parieto-occipital regions and basal ganglia. We identified reductions of grey matter of the parieto-occipital regions, left putamen/globus pallidus and thalamus; and in white matter of the basal ganglia and right posterior cingulate gyrus. In contrast, significant increases of grey matter were identified in the frontal lobes, anterior cingulate gyrus, left temporal lobe, and of white matter bilaterally in the anterior cingulate. Inattention in WS was correlated with volumetric differences in the frontal lobes, caudate nucleus and cerebellum, and hyperactivity was related to differences in the left temporal and parietal lobes and cerebellum. Finally, ratings of peer problems were related to differences in the temporal lobes, right basal ganglia and frontal lobe. In one of the first studies of brain structure in intellectually disabled children with WS using voxel-based morphometry, our findings suggest that this group has specific differences in grey/white matter morphology. In addition, it was found that structural differences were correlated to ratings of inattention, hyperactivity and peer problems in children with WS.

Liver regeneration in donors and adult recipients after living donor liver transplantation.

PubMed

Haga, Junko; Shimazu, Motohide; Wakabayashi, Go; Tanabe, Minoru; Kawachi, Shigeyuki; Fuchimoto, Yasushi; Hoshino, Ken; Morikawa, Yasuhide; Kitajima, Masaki; Kitagawa, Yuko

2008-12-01

In living donor liver transplantation, the safety of the donor operation is the highest priority. The introduction of the right lobe graft was late because of concerns about donor safety. We investigated donor liver regeneration by the types of resected segments as well as recipients to assess that appropriate regeneration was occurring. Eighty-seven donors were classified into 3 groups: left lateral section donors, left lobe donors, and right lobe donors. Forty-seven adult recipients were classified as either left or right lobe grafted recipients. Volumetry was retrospectively performed at 1 week, 1, 2, 3, and 6 months, and 1 year after the operation. In the right lobe donor group, the remnant liver volume was 45.4%, and it rapidly increased to 68.9% at 1 month and 89.8% at 6 months. At 6 months, the regeneration ratios were almost the same in all donor groups. The recipient liver volume increased rapidly until 2 months, exceeding the standard liver volume, and then gradually decreased to 90% of the standard liver volume. Livers of the right lobe donor group regenerated fastest in the donor groups, and the recipient liver regenerated faster than the donor liver. Analyzing liver regeneration many times with a large number of donors enabled us to understand the normal liver regeneration pattern. Although the donor livers did not reach their initial volume, the donors showed normal liver function at 1 year. The donors have returned to their normal daily activities. Donor hepatectomy, even right hepatectomy, can be safely performed with accurate preoperative volumetry and careful decision-making concerning graft-type selection.

Image formation of brain function in patients suffering from knee osteoarthritis treated with moxibustion.

PubMed

Xie, Hongwu; Xu, Fangming; Chen, Rixin; Luo, Tianyou; Chen, Mingren; Fang, Weidong; Lü, Fajin; Wu, Fei; Song, Yune; Xiong, Jun

2013-04-01

Functional magnetic resonance imaging (fMRI) technology was used to study changes to the resting state blood flow in the brains of patients with knee osteoarthritis (KOA) before and after treatment with moxibustion at the acupoint of the left Dubi (ST 35) and to probe the cerebral mechanism underlying the effect of moxibustion. The resting state brain function of 30 patients with left KOA was scanned with fMRI before and after treatment with moxibustion. The analytic methods of fractional amplitude of low frequency fluctuation (fALFF) and regional homogeneity (ReHo) were used to observe changes in resting state brain function. The fALFF values of the right cerebrum, extra-nucleus, left cerebellum, left cerebrum and white matter of patients after moxibustion treatment were higher than before treatment, and the fALFF values of the precentral gyrus, frontal lobe and occipital lobe were lower than before treatment (P < 0.05, K > or = 85). The ReHo values of the thalamus, extra-nucleus and parietal lobe of patients were much higher than those before moxibustion treatment, and the ReHo values of the right cerebrum, left cerebrum and frontal lobe were lower than before treatment (P < 0.05, K > or = 85). The influence of moxibustion on obvious changes in brain regions basically conforms to the way that pain and warmth is transmitted in the body, and the activation of sensitive systems in the body may be objective evidence of channel transmission. The regulation of brain function by moxibustion is not in a single brain region but rather in a network of many brain regions.

A diffusional kurtosis imaging study of idiopathic generalized epilepsy with unilateral interictal epileptiform discharges in children.

PubMed

Zhang, Yuzhen; Gao, Yu; Zhou, Minxiong; Wu, Jie; Zee, Chishing; Wang, Dengbin

2016-10-01

To investigate brain abnormalities in children with a clinical diagnosis of idiopathic generalized epilepsy (IGE) and unilateral interictal epileptiform discharges (IED) demonstrated on electroencephalography (EEG) by diffusional kurtosis imaging (DKI). DKI images were obtained from 18 patients (n=9 each in the left and right hemispheres). Fractional anisotropy (FA), mean diffusivity (MD), and mean kurtosis (MK) maps were estimated through voxel-based analyses, and compared with 18 normal controls matched for age and sex. In the left side group, the significant differences of FA were in the left fusiform gyrus and occipital lobe of the white matter (WM). The significant differences of MD were in the left pons. The significant differences of MK were in the anterior cingulate gyrus, limbic lobe, gray matter (GM) and WM of the right cerebrum. In the right side group, the significant differences of FA were in the WM of the left cerebrum. MD identified differences in the frontal, temporal, occipital, and parietal lobes of both hemispheres, especially in the limbic system, fusiform gyrus, uncus, and parahippocampal gyrus. The significant differences of MK were in the GM of the right cerebrum, particularly in the rolandic operculum and frontal lobe. DKI is sensitive for the detection of diffusion abnormalities in both WM and GM of IGE in children. Secondary brain abnormalities may exist in regions outside the unilateral epileptogenic zone through the limbic epileptic network, and can be detected by DKI indices FA, MD and MK. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Hypoxic pulmonary vasoconstriction does not affect hydrostatic pulmonary edema formation.

PubMed

Cheney, F W; Bishop, M J; Eisenstein, B L; Artman, L D

1987-02-01

We studied the effects of regional hypoxic pulmonary vasoconstriction (HPV) on lobar flow diversion in the presence of hydrostatic pulmonary edema. Ten anesthetized dogs with the left lower lobe (LLL) suspended in a net for continuous weighing were ventilated with a bronchial divider so the LLL could be ventilated with either 100% O2 or a hypoxic gas mixture (90% N2-5% CO2-5% O2). A balloon was inflated in the left atrium until hydrostatic pulmonary edema occurred, as evidenced by a continuous increase in LLL weight. Left lower lobe flow (QLLL) was measured by electromagnetic flow meter and cardiac output (QT) by thermal dilution. At a left atrial pressure of 30 +/- 5 mmHg, ventilation of the LLL with the hypoxic gas mixture caused QLLL/QT to decrease from 17 +/- 4 to 11 +/- 3% (P less than 0.05), pulmonary arterial pressure to increase from 35 +/- 5 to 37 +/- 6 mmHg (P less than 0.05), and no significant change in rate of LLL weight gain. Gravimetric confirmation of our results was provided by experiments in four animals where the LLL was ventilated with an hypoxic gas mixture for 2 h while the right lung was ventilated with 100% O2. In these animals there was no difference in bloodless lung water between the LLL and right lower lobe. We conclude that in the presence of left atrial pressures high enough to cause hydrostatic pulmonary edema, HPV causes significant flow diversion from an hypoxic lobe but the decrease in flow does not affect edema formation.

Altered gray matter density and disrupted functional connectivity of the amygdala in adults with Internet gaming disorder.

PubMed

Ko, Chih-Hung; Hsieh, Tsyh-Jyi; Wang, Peng-Wei; Lin, Wei-Chen; Yen, Cheng-Fang; Chen, Cheng-Sheng; Yen, Ju-Yu

2015-03-03

The aim of this study was to evaluate the altered brain structure and functional connectivity (FC) among subjects with Internet gaming disorder (IGD). We recruited 30 males with IGD and 30 controls and evaluated their gray matter density (GMD) and FC using resting fMRI. The severities of IGD, gaming urge, and impulsivity were also assessed. The results demonstrated that the subjects with IGD had a higher impulsivity and a greater severity of IGD. The subjects with IGD had a lower GMD over the bilateral amygdala than the controls. Further, the subjects with IGD had lower FC with the left amygdala over the left dorsolateral prefrontal lobe (DLPFC) and with the right amygdala over the left DLPFC and orbital frontal lobe (OFL). They also had higher FC with the bilateral amygdala over the contralateral insula than the controls. The FC between the left amygdala and DLPFC was negatively correlated with impulsivity. The FC of the right amygdala to the left DLPFC and orbital frontal lobe was also negatively correlated with impulsivity. Our results indicated that the altered GMD over the amygdala might represent vulnerability to IGD, such as impulsivity. Further analysis of the amygdala demonstrated impaired FC to the frontal lobe, which represents impulsivity. The results of this study suggested that the amygdala plays a very influential role in the mechanism of IGD. Its detailed role should be further evaluated in future study and should be considered in the treatment of IGD. Copyright © 2014 Elsevier Inc. All rights reserved.

Functional cystic thyroid adenoma in a cat.

PubMed

Hofmeister, E; Kippenes, H; Mealey, K L; Cantor, G H; Löhr, C V

2001-07-15

A 9-year-old cat with hyperthyroidism was referred for radioactive iodine treatment. The cat also had a ventral cervical mass that the owners reported had been present for several years and had increased in size during the past few weeks. On physical examination, the mass was found to have caused lateral displacement of the trachea, esophagus, jugular vein, and common carotid artery. The mass was aspirated and was determined to be cystic in nature. Concentrations of thyroid hormones in the cystic fluid were similar to serum concentrations, and nuclear scintigraphy revealed thyroactive tissue lining the cyst wall. Magnetic resonance imaging suggested that the cyst originated from the right lobe of the thyroid gland. The cat was treated with sodium iodide I 131 but died 4 days later, presumably as a result of aspiration of gastric or esophageal contents. A necropsy was not performed, but histologic examination of a biopsy specimen of the mass indicated that it was a cystic thyroid adenoma.

Effects of mental rotation on acalculia: differences in the direction of mental rotation account for the differing characteristics of acalculia induced by right and left hemispheric brain injury.

PubMed

Asada, Tomohiko; Takayama, Yoshihiro; Oita, Jiro; Fukuyama, Hidenao

2014-04-01

We observed a 59-year-old right-handed man with an infarction in his right-middle cerebral artery that included the parietal lobe, who abnormally manipulated mental images in the horizontal direction, resulting in calculation disturbances. Three years later, the patient suffered an infarction in the left parietal lobe and displayed abnormalities during the creation of mental images; i.e., he rotated them in the vertical direction, which again resulted in calculation disturbances. These mental imagery disturbances might indicate that a common acalculia mechanism exists between the right and left hemispheres.

Anomalous Systemic Artery to the Left Lower Lobe: Literature Review and a New Surgical Technique.

PubMed

Miller, Jacob R; Lancaster, Timothy S; Abarbanell, Aaron M; Manning, Peter B; Eghtesady, Pirooz

2018-05-01

Anomalous systemic arterial supply to the basal segments of the left lower lobe without coexisting pulmonary artery connection is a rare anomaly. Most feel treatment is necessary; however, the ideal strategy is unclear. Treatments described include embolization, pulmonary resection, or anastomosis to the native pulmonary artery. We recently encountered an infant with this anomaly and present a literature review summarizing all recent reports. Additionally, we describe a novel surgical technique to create a tension-free anastomosis utilizing segmental aortic translocation that we employed in our patient due to a large distance between the anomalous vessel and native left pulmonary artery.

A case of thyroid storm with multiple organ failure effectively treated with plasma exchange.

PubMed

Sasaki, Kazuki; Yoshida, Akira; Nakata, Yukiko; Mizote, Isamu; Sakata, Yasushi; Komuro, Issei

2011-01-01

We describe a 48-year-old man with thyroid storm presenting with heart failure. He presented severely impaired left ventricular wall motion and a marked increase in the liver enzymes. He developed disseminated intravascular coagulation on day 2. Due to elevated serum thyroid hormone level, anti-thyroid hormone receptor antibody positivity, and his clinical symptoms, he was diagnosed as thyroid storm due to untreated Graves' disease. His condition did not improve even after 6 days of conventional therapy including steroids. After therapeutic plasma exchange was carried out, his thyroid hormone level decreased markedly. Consequently, his condition recovered gradually, and he was discharged at day 43.

The left-right asymmetry of liver lobation is generated by Pitx2c-mediated asymmetries in the hepatic diverticulum.

PubMed

Womble, Mandy; Amin, Nirav M; Nascone-Yoder, Nanette

2018-07-15

Internal organs exhibit left-right asymmetric sizes, shapes and anatomical positions, but how these different lateralities develop is poorly understood. Here we use the experimentally tractable Xenopus model to uncover the morphogenetic events that drive the left-right asymmetrical lobation of the liver. On the right side of the early hepatic diverticulum, endoderm cells become columnar and apically constricted, forming an expanded epithelial surface and, ultimately, an enlarged right liver lobe. In contrast, the cells on the left side become rounder, and rearrange into a compact, stratified architecture that produces a smaller left lobe. Side-specific gain- and loss-of-function studies reveal that asymmetric expression of the left-right determinant Pitx2c elicits distinct epithelial morphogenesis events in the left side of the diverticulum. Surprisingly, the cellular events induced by Pitx2c during liver development are opposite those induced in other digestive organs, suggesting divergent cellular mechanisms underlie the formation of different lateralities. Copyright © 2018 Elsevier Inc. All rights reserved.

On the right side? A longitudinal study of left- versus right-lateralized semantic dementia.

PubMed

Kumfor, Fiona; Landin-Romero, Ramon; Devenney, Emma; Hutchings, Rosalind; Grasso, Roberto; Hodges, John R; Piguet, Olivier

2016-03-01

The typical presentation of semantic dementia is associated with marked, left predominant anterior temporal lobe atrophy and with changes in language. About 30% of individuals, however, present with predominant right anterior temporal lobe atrophy, usually accompanied by behavioural changes and prosopagnosia. Here, we aimed to establish whether these initially distinct clinical presentations evolve into a similar syndrome at the neural and behavioural level. Thirty-one patients who presented with predominant anterior temporal lobe atrophy were included. Based on imaging, patients were categorized as either predominant left (n = 22) or right (n = 9) semantic dementia. Thirty-three Alzheimer's disease patients and 25 healthy controls were included for comparison. Participants completed the Addenbrooke's Cognitive Examination, a Face and Emotion Processing Battery and the Cambridge Behavioural Inventory, and underwent magnetic resonance imaging annually. Longitudinal neuroimaging analyses showed greater right temporal pole atrophy in left semantic dementia than Alzheimer's disease, whereas right semantic dementia showed greater orbitofrontal and left temporal lobe atrophy than Alzheimer's disease. Importantly, direct comparisons between semantic dementia groups revealed that over time, left semantic dementia showed progressive thinning in the right temporal pole, whereas right semantic dementia showed thinning in the orbitofrontal cortex and anterior cingulate. Behaviourally, longitudinal analyses revealed that general cognition declined in all patients. In contrast, patients with left and right semantic dementia showed greater emotion recognition decline than Alzheimer's disease. In addition, left semantic dementia showed greater motivation loss than Alzheimer's disease. Correlational analyses revealed that emotion recognition was associated with right temporal pole, right medial orbitofrontal and right fusiform integrity, while changes in motivation were associated with right temporal pole cortical thinning. While left and right semantic dementia show distinct profiles at presentation, both phenotypes develop deficits in emotion recognition and behaviour. These findings highlight the pervasive socio-emotional deficits in frontotemporal dementia, even in patients with an initial language presentation. These changes reflect right anterior temporal and orbitofrontal cortex degeneration, underscoring the role of these regions in social cognition and behaviour. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A novel robotic surgical technique for thyroid surgery: bilateral axillary approach (BAA).

PubMed

Woo, Jung-Woo; Kim, Seo Ki; Park, Inhye; Choe, Jun Ho; Kim, Jung-Han; Kim, Jee Soo

2017-02-01

Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT) is proven to be a feasible method for the treatment of well-differentiated thyroid cancers in terms of oncology as well as cosmesis. However, BABA RT causes postoperative sternal discomfort and needs an incision over the nipple areolar area. Here, we suggest a novel robotic surgical technique for thyroid surgery that does not need a breast incision-bilateral axillary approach (BAA). We recruited 51 patients who were willing to undergo the novel BAA robotic thyroid surgery. We performed a propensity score-matched analysis to compare the BAA robotic thyroid surgery group (BAA group) with the conventional open thyroid surgery group (open group). Mean operation time in the BAA group (129.7 min) was significantly longer than that in the open group (103.1 min) (p < 0.001). However, no significant differences in the mean number of metastatic lymph nodes (LNs), mean number of retrieved LNs, vocal cord palsy, hypoparathyroidism, and mean stimulated thyroglobulin level were observed between the two groups. There was no case of postoperative bleeding or chyle leak. Of the 51 patients who had undergone the BAA procedure, 27 patients answered the questionnaire. The mean scale, ranging from 0 to 10, at postoperative 1 day/2 weeks was as follows: voice change score, 3.0/1.6; swallowing difficulty score, 4.0/2.0; anterior neck pain score, 4.6/3.6; anterior neck numbness score, 5.4/4.3; right chest pain score, 3.8/2.1; left chest pain score, 3.6/2.3; right chest numbness score, 3.2/2.8; left chest numbness score, 2.4/2.7; right breast pain score, 0.9/0; left breast pain score, 1.2/0; right breast numbness score, 1.7/0; and left breast numbness score, 2.6/0, respectively. BAA robotic thyroid surgery is a novel, safe, and feasible oncoplastic method, especially for patients who have fear of procedures around the nipple areolar complex.

Infected intraparenchymal bronchogenic cyst mimicking recurrent lung abscess in a young adult.

PubMed

Ramzisham, A R M; Johann, K F; Talal, A R; Joanna, O S M; Zamrin, D M

2007-12-01

A 23 year old female with a past history of a lung abscess diagnosed at the age of 13 years presented with recurrent episodes of productive cough. Chest radiograph and a high resolution CT scan of the thorax led to the diagnosis of a left lower lobe lung abscess. She underwent a successful thoracotomy and a left lower lobe lobectomy. Histopathological examination revealed the diagnosis of an infected congenital bronchogenic cyst. The recent literature on this is reviewed.

Everyday conversation requires cognitive inference: neural bases of comprehending implicated meanings in conversations.

PubMed

Jang, Gijeong; Yoon, Shin-ae; Lee, Sung-Eun; Park, Haeil; Kim, Joohan; Ko, Jeong Hoon; Park, Hae-Jeong

2013-11-01

In ordinary conversations, literal meanings of an utterance are often quite different from implicated meanings and the inference about implicated meanings is essentially required for successful comprehension of the speaker's utterances. Inference of finding implicated meanings is based on the listener's assumption that the conversational partner says only relevant matters according to the maxim of relevance in Grice's theory of conversational implicature. To investigate the neural correlates of comprehending implicated meanings under the maxim of relevance, a total of 23 participants underwent an fMRI task with a series of conversational pairs, each consisting of a question and an answer. The experimental paradigm was composed of three conditions: explicit answers, moderately implicit answers, and highly implicit answers. Participants were asked to decide whether the answer to the Yes/No question meant 'Yes' or 'No'. Longer reaction time was required for the highly implicit answers than for the moderately implicit answers without affecting the accuracy. The fMRI results show that the left anterior temporal lobe, left angular gyrus, and left posterior middle temporal gyrus had stronger activation in both moderately and highly implicit conditions than in the explicit condition. Comprehension of highly implicit answers had increased activations in additional regions including the left inferior frontal gyrus, left medial prefrontal cortex, left posterior cingulate cortex and right anterior temporal lobe. The activation results indicate involvement of these regions in the inference process to build coherence between literally irrelevant but pragmatically associated utterances under the maxim of relevance. Especially, the left anterior temporal lobe showed high sensitivity to the level of implicitness and showed increased activation for highly versus moderately implicit conditions, which imply its central role in inference such as semantic integration. The right hemisphere activation, uniquely found in the anterior temporal lobe for highly implicit utterances, suggests its competence for integrating distant concepts in implied utterances under the relevance principle. Copyright © 2013 Elsevier Inc. All rights reserved.

Polysplenia syndrome with duodenal and pancreatic dysplasia in a Holstein calf: a case report.

PubMed

Kondoh, Daisuke; Kawano, Tomomi; Kikuchi, Tomoaki; Hatate, Kaoru; Watanabe, Kenichi; Sasaki, Motoki; Yamagishi, Norio; Inokuma, Hisashi; Kitamura, Nobuo

2017-09-29

Laterality disorders of the abdominal organs include situs inversus totalis that mirrors the arrangements of all internal organs and heterotaxy syndrome (situs ambiguus) in which the thoracic or abdominal organs are abnormally arranged. Heterotaxy is often accompanied by multiple congenital malformations, and it generally comprises asplenia and polysplenia syndromes. To our knowledge, polysplenia syndrome has been reported in only three cattle, and computerized tomographic (CT) images of these animals were not obtained. A six-month-old Holstein heifer had ruminal tympani and right abdominal distension. CT imaging showed that the rumen occupied the right side of the abdominal cavity, the omasum and abomasum occupied the left ventral side and the liver was positioned on the left. The colon and cecum were located at the left dorsum of the cavity, and the left kidney was located more cranially than the right. Postmortem findings revealed two spleens attached to the rumen. Significantly, the duodenum was too short to be divided into segments, except the cranial and descending parts, or flexures, except the cranial flexure, and the pancreas, which lacked a left lobe, was covered with mesojejunum. The liver comprised a relatively large right lobe and a small left lobe without quadrate and caudate lobes. The caudal vena cava that connected to the left azygous vein passed irregularly through the aortic hiatus of the diaphragm, and the common hepatic vein without the caudal vena cava passed through the caval foramen. Although the lungs and heart were morphologically normal, the right atrium received three major systemic veins. Polysplenia syndrome was diagnosed based on the CT and postmortem findings. We defined the positions of the abdominal organs and morphological abnormalities in various organs of a calf with polysplenia syndrome based on CT and postmortem findings. These findings will improve understanding of the malpositioning and malformations that can occur in the organs of cattle with polysplenia syndrome.

Positive pressure ventilation in a patient with a right upper lobar bronchocutaneous fistula: right upper bronchus occlusion using the cuff of a left-sided double lumen endobronchial tube.

PubMed

Omori, Chieko; Toyama, Hiroaki; Takei, Yusuke; Ejima, Yutaka; Yamauchi, Masanori

2017-08-01

In patients with a bronchocutaneous fistula, positive pressure ventilation leads to air leakage and potential hypoxemia. A male patient with a right upper bronchocutaneous fistula was scheduled for esophageal reconstruction. His preoperative chest computed tomography image revealed aeration in the right middle and lower lobe, a large bulla in the left upper lobe, and pleural effusion and pneumonia in the left lower lobe. Therefore, left one-lung ventilation was considered to result in hypoxemia. Before anesthesia induction, the bronchocutaneous fistula was covered with gauze and film to prevent air leakage. After anesthesia induction, mask ventilation was performed with a peak positive pressure of 10 cmH 2 O. A left-sided double lumen endobronchial tube (DLT) was then inserted into the right main bronchus for occluding only the right superior bronchus, and two-lung ventilation was performed to minimize airway pressure and maintain oxygenation, which did not cause air leakage through the fistula. During anesthesia, no ventilation-related difficulty was faced. The method of inserting a left-sided DLT into the right main bronchus and occluding the right upper bronchus selectively by bronchial cuff is considered to be an option for mechanical ventilation in patients with a right upper bronchial fistula, as demonstrated in the present case.

Left Lobe Auxiliary Liver Transplantation for End-stage Hepatitis B Liver Cirrhosis.

PubMed

Wang, S-F; Chen, X-P; Chen, Z-S; Wei, L; Dong, S-L; Guo, H; Jiang, J-P; Teng, W-H; Huang, Z-Y; Zhang, W-G

2017-06-01

Auxiliary liver transplantation (ALT) for hepatitis B virus (HBV)-related liver cirrhosis previously showed poor results, because the native liver was a significant source of HBV recurrence and the graft could be rapidly destroyed by HBV infection in an immunosuppressive condition. Four patients with HBV-related liver cirrhosis were unable to undergo orthotopic liver transplantation because the only available grafts of left lobe were too small. Under entecavir-based anti-HBV treatment, they underwent ALT in which the recipient left liver was removed and the small left lobe graft was implanted in the corresponding space. The mean graft weight/recipient weight was 0.49% (range, 0.38%-0.55%). One year after transplantation, the graft sizes were increased to 273% and the remnant livers were decreased to 44%. Serum HBV DNA was persistently undetectable. Periodic graft biopsy showed no signs of tissue injury and negative immunostaining for hepatitis B surface antigen and hepatitis B core antigen. After a mean follow-up period of 21 months, all patients live well with normal graft function. Our study suggests that ALT for HBV-related liver cirrhosis is feasible under entecavir-based anti-HBV treatment. Successful application of small left livers in end-stage liver cirrhosis may significantly increase the pool of left liver grafts for adult patients. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Immunohistochemistry of medullary thyroid carcinoma and C-cell hyperplasia by an affinity-purified anti-human calcitonin antiserum.

PubMed

Hayashida, C Y; Alves, V A; Kanamura, C T; Ezabella, M C; Abelin, N M; Nicolau, W; Bisi, H; Toledo, S P

1993-08-15

The diagnosis of medullary thyroid carcinoma (MTC) depends on the calcitonin immunohistochemistry. Familial MTC is associated with C-cell hyperplasia (CCH), whereas sporadic MTC is not. A specific and sensitive calcitonin immunohistochemistry is necessary for the diagnosis of MTC and CCH. An affinity-purified anti-calcitonin antiserum (APxCT) was used for immunohistochemistry of the thyroids of 15 patients with MTC. The thyroids of five patients with familial MTC were studied in detail, with each gland sectioned in 48 areas. Between three and ten independent MTC were found in each thyroid, and CCH was found in all five patients (24.2%, varying from 8.4-56.3% of the 48 areas from each thyroid). MTC and CCH were localized mainly in the middle third and in the central axis of the thyroid lobes. They often were found together in the same area (in a total of 21 areas for the five thyroids sectioned in 48 areas) but ten areas with MTC did not have CCH, and 37 areas with CCH did not have MTC. In ten thyroids partially studied, CCH was indicated in three patients thought to have sporadic MTC. In two thyroids, with follicular and papillary carcinoma, a higher density of C-cells was found around the tumors, but disease was not characterized as CCH. APxCT antiserum increased the immunohistochemical specificity and sensitivity. The distinction of the familial from the sporadic MTC requires a careful and extensive search of CCH. C-cells in high density may be found around follicular cell carcinomas, being a potential source of diagnostic error.

Identifying the Cognitive Decrements Caused By HIV

DTIC Science & Technology

1994-06-10

critical analyses 46 pointed to further assessment of frontal lobe structures. Most of the 15 different tests yielded more than on* dependent variable...is also one of the tests included in the Multicenter AIDS Cohort Study longitudinal research on the progression of HIV infection. Left frontal lobe ...structures underlie verbal fluency performance and the particular sensitivity of frontal lobe structures to perturbations with HIV infection would

Psychological consideration in patients with cerebral gliomas candidates for intra-operative radiation therapy based on tumor location.

PubMed

Seddighi, Afsoun; Akbari, Mohammad Esmaeil; Seddighi, Amir Saied; Nikouei, Amir

2017-01-01

Intra-operative Radiation Therapy (IORT) is gaining popularity as an adjuvant option to surgical resection, in treatment of glioblastoma multiforme (GBM) for increasing survival rate, which a highly aggressive cerebral tumor with poor prognosis. Τhe authors plan to investigate the effects of IORT combined with surgical resection on the psychological status of these patients based on tumor location. From December 2013 to February 2017, we have enrolled 109 patients with high grade cerebral gliomas, documented by Magnetic Resonance Spectroscopy (MRS). Patients with previous history of brain surgery or radiation, altered mental status and psychological content and patients diagnosed with metastases were excluded. Demographic data, tumor volume based on pre-operative Magnetic Resonance Imaging (MRI) and psychological status were recorded based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The remaining 56 patients, were equally randomized into conventional (surgical resection-group A), and trial (surgical resection with IORT-group B) who underwent IORT using the 50kV INTRABEAM® system (Carl Zeiss Meditec AG, Germany). Psychological profiles of both groups were re-evaluated in the 3 rd post-operative month. Group A consisted of 18 males and 10 females with mean age of 54.4 years, while group B consisted of 16 males and 12 females with mean age of 57.8 years. Tumor volumetry revealed mean 81.52cc and 82.8cc for group A and B respectively. (P value 0.14) Patients were classified based on glioma location on pre-operative MRI: a) left parietal lobe (6 in group A, 5 in group B); b) left temporal lobe (7 in group A, 5 in group B); c) right parietal lobe (5 in group A, 6 in group B); d) left fronto-temporal lobe (4 in group A, 6 in group B); e) left parieto-temporal lobe (4 in group A, 5 in group B); and, f) right frontal lobe (2 in group A, 1 in group B). Group B received mean 8.05 Gy radiation for mean 11.2 minutes. Post-operative psychological in the 3 rd month evaluation revealed the following in each class: a) Group A: 1 mild depression, Group B: 1 mild depression and 2 major depression; b) Group A: no disorder, Group B: 1 mild depression; c) no disorders in both groups; d) Group A: no disorder, Group B: 1 mild depression, 1 major depression and 1 Obsessive-Compulsive Disorder (OCD); Conclusion: Utilization of IORT is shown to improve survival rate of patients suffering from GBM. However, the psychological status is a major determinating factor for the quality of life of these patients. Our study showed that IORT increased psychological disorders in patients with gliomas located in left parietal, left fronto-temporal and left parieto-temporal lobes and should be considered in pre-operative strategy selection.

Thyroid Swelling and Thyroiditis in the Setting of Recent hCG Injections and Fine Needle Aspiration

PubMed Central

Lamos, Elizabeth M.; Munir, Kashif M.

2016-01-01

A 60-year-old woman presented with a neck mass and underwent fine needle aspiration of a left thyroid nodule. During this time, she had been injected with hCG for weight loss. Soon after, she developed rapid diffuse thyroid growth with pain. She was ultimately diagnosed with thyrotoxicosis due to postaspiration subacute thyroiditis and subsequently became hypothyroid. This condition is rare in the nonpregnant state in noncystic nodules with a smaller needle gauge approach. The incidence of thyroid nodule discovery and evaluation is increasing. As more procedures are undertaken, understanding of potential complications is important. This case highlights potential complications of thyroid fine needle aspiration including diffuse thyroid swelling and thyroiditis. The role of hCG injections is speculated to have potentially stimulated thyroid follicular epithelium via cross-reactivity with the TSH receptor and contributed to the acute inflammatory response after fine needle aspiration. PMID:26942022

Pathophysiology of language switching and mixing in an early bilingual child with subcortical aphasia.

PubMed

Mariën, Peter; Abutalebi, Jubin; Engelborghs, Sebastiaan; De Deyn, Peter P

2005-12-01

Acquired aphasia after circumscribed vascular subcortical lesions has not been reported in bilingual children. We report clinical and neuroimaging findings in an early bilingual boy who incurred equally severe transcortical sensory aphasia in his first language (L1) and second language (L2) after a posterior left thalamic hemorrhage. Following recurrent bleeding of the lesion the aphasic symptoms substantially aggravated. Spontaneous pathological language switching and mixing were found in both languages. Remission of these phenomena was reflected on brain perfusion SPECT revealing improved perfusion in the left frontal lobe and left caudate nucleus. The parallelism between the evolution of language symptoms and the SPECT findings may demonstrate that a subcortical left frontal lobe circuity is crucially involved in language switching and mixing.

A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: value of scintigraphy with Tc-99m GSA and hepatobiliary scintigraphy for indication of lobectomy.

PubMed

Nishiguchi, S; Shiomi, S; Sasaki, N; Iwata, Y; Tanaka, H; Kubo, S; Hirohashi, K; Ochi, H

2000-10-01

A 39-year-old woman with acute cholecystitis and gallstones underwent laparoscopic cholecystectomy. She suffered from recurrent episodes of cholangitis due to injury of the major bile ducts during laparoscopic cholecystectomy. Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan was performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excretion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe. Cholangiography via the PTBD tube revealed complete obstruction of the left hepatico-jejunal anastomosis and could not enhance the right intrahepatic bile duct. A right hepatic lobectomy was performed because of the atrophy, glissonitis and the absence of an appropriate bile duct for reconstruction. Postoperatively she was active and exhibited no evidence of recurrent cholangitis.

Relationship of Temporal Lobe Volumes to Neuropsychological Test Performance in Healthy Children

PubMed Central

Wells, Carolyn T.; Matson, Melissa A.; Kates, Wendy R.; Hay, Trisha; Horska, Alena

2008-01-01

Ecological validity of neuropsychological assessment includes the ability of tests to predict real-world functioning and/or covary with brain structures. Studies have examined the relationship between adaptive skills and test performance, with less focus on the association between regional brain volumes and neurobehavioral function in healthy children. The present study examined the relationship between temporal lobe gray matter volumes and performance on two neuropsychological tests hypothesized to measure temporal lobe functioning (Visual Perception-VP; Peabody Picture Vocabulary Test, Third Edition-PPVT-III) in 48 healthy children ages 5-18 years. After controlling for age and gender, left and right temporal and left occipital volumes were significant predictors of VP. Left and right frontal and temporal volumes were significant predictors of PPVT-III. Temporal volume emerged as the strongest lobar correlate with both tests. These results provide convergent and discriminant validity supporting VP as a measure of the “what” system; but suggest the PPVT-III as a complex measure of receptive vocabulary, potentially involving executive function demands. PMID:18513844

Automated lobar quantification of emphysema in patients with severe COPD.

PubMed

Revel, Marie-Pierre; Faivre, Jean-Baptiste; Remy-Jardin, Martine; Deken, Valérie; Duhamel, Alain; Marquette, Charles-Hugo; Tacelli, Nunzia; Bakai, Anne-Marie; Remy, Jacques

2008-12-01

Automated lobar quantification of emphysema has not yet been evaluated. Unenhanced 64-slice MDCT was performed in 47 patients evaluated before bronchoscopic lung-volume reduction. CT images reconstructed with a standard (B20) and high-frequency (B50) kernel were analyzed using a dedicated prototype software (MevisPULMO) allowing lobar quantification of emphysema extent. Lobar quantification was obtained following (a) a fully automatic delineation of the lobar limits by the software and (b) a semiautomatic delineation with manual correction of the lobar limits when necessary and was compared with the visual scoring of emphysema severity per lobe. No statistically significant difference existed between automated and semiautomated lobar quantification (p > 0.05 in the five lobes), with differences ranging from 0.4 to 3.9%. The agreement between the two methods (intraclass correlation coefficient, ICC) was excellent for left upper lobe (ICC = 0.94), left lower lobe (ICC = 0.98), and right lower lobe (ICC = 0.80). The agreement was good for right upper lobe (ICC = 0.68) and moderate for middle lobe (IC = 0.53). The Bland and Altman plots confirmed these results. A good agreement was observed between the software and visually assessed lobar predominance of emphysema (kappa 0.78; 95% CI 0.64-0.92). Automated and semiautomated lobar quantifications of emphysema are concordant and show good agreement with visual scoring.

Metastasis of colon cancer to the thyroid gland: a case diagnosed on fine-needle aspirate by a combined cytological, immunocytochemical, and molecular approach.

PubMed

Cozzolino, Immacolata; Malapelle, Umberto; Carlomagno, Chiara; Palombini, Lucio; Troncone, Giancarlo

2010-12-01

Fine-needle aspiration (FNA) with cytological evaluation reliably diagnoses primary and secondary thyroid neoplasms. However, identifying the primary origin of a metastatic process involving the thyroid gland is challenging. In particular, metastasis of colon cancer to the thyroid gland is very rare. In this case report, a right lobe solid thyroid nodule in a 66-year-old male was aspirated. FNA cytology showed necrosis and atypical tall columnar cells; since, the patient at age 60 had undergone surgery for a sigmoid-rectal cancer metastasizing to the liver and subsequently to the lung, a suspicion of metastasis from colon cancer was raised. This was corroborated by cell-block immunocytochemistry showing a cytokeratin (CK) 7 negative/CK20-positive staining pattern; thyreoglobulin and TTF-1 were both negative. Since KRAS codon 12/13 mutations frequently occur in colon cancer, whereas they are extremely uncommon in primary thyroid tumors, DNA was extracted from the aspirated cells, and KRAS mutational analysis was carried out. The codon 12 G12D mutation was found; the same mutation was evident in the primary cancer of the colon and in its liver and lung metastasis. Thus, a combined cytological, immunocytochemical and molecular approach unquestionably correlated metastatic adenocarcinoma cells aspirated from the thyroid to a colo-rectal origin. © 2010 Wiley-Liss, Inc.

A Left-Sided Approach for Resection of Hepatic Caudate Lobe Hemangioma: Two Case Reports and a Literature Review.

PubMed

Feng, Xielin; Hu, Yong; Peng, Junping; Liu, Aixiang; Tian, Lang; Zhang, Hui

2015-06-01

Resection of the hemangioma located in the caudate lobe is a major challenge in current liver surgery. This study aimed to present our surgical technique for this condition. Two consecutive patients with symptomatic hepatic hemangioma undergoing caudate lobectomy were investigated retrospectively. First, all the blood inflow of hemangioma from the portal vein and the hepatic artery at the base of the umbilical fissure was dissected. After the tumors became soft and tender, the short hepatic veins and the ligaments between the secondary porta hepatis were severed. At last the tumors were resected from the right lobe of the liver. The whole process was finished by a left-sided approach. Blood lost in Case 1 was 1650 mL because of ligature failing in one short hepatic vein, and in the other case, 210 mL. Operation time was 236 minutes and 130 minutes, respectively. Postoperative hospital stays were 11 and 5 days, respectively. The diameter of tumors was 9.0 cm and 6.5 cm. Case 1 required blood transfusion during surgery. No complications such as biliary fistula, postoperative bleeding, and liver failure occurred. The left-sided approach produced the best results for caudate lobe resection in our cases. The patients who recovered are living well and asymptomatic. Caudate lobectomy can be performed safely and quickly by a left-sided approach, which is carried out with optimized perioperative management and innovative surgical technique.

Impairments in proverb interpretation following focal frontal lobe lesions.

PubMed

Murphy, Patrick; Shallice, Tim; Robinson, Gail; MacPherson, Sarah E; Turner, Martha; Woollett, Katherine; Bozzali, Marco; Cipolotti, Lisa

2013-09-01

The proverb interpretation task (PIT) is often used in clinical settings to evaluate frontal "executive" dysfunction. However, only a relatively small number of studies have investigated the relationship between frontal lobe lesions and performance on the PIT. We compared 52 patients with unselected focal frontal lobe lesions with 52 closely matched healthy controls on a proverb interpretation task. Participants also completed a battery of neuropsychological tests, including a fluid intelligence task (Raven's Advanced Progressive Matrices). Lesions were firstly analysed according to a standard left/right sub-division. Secondly, a finer-grained analysis compared the performance of patients with medial, left lateral and right lateral lesions with healthy controls. Thirdly, a contrast of specific frontal subgroups compared the performance of patients with medial lesions with patients with lateral frontal lesions. The results showed that patients with left frontal lesions were significantly impaired on the PIT, while in patients with right frontal lesions the impairments approached significance. Medial frontal patients were the only frontal subgroup impaired on the PIT, relative to healthy controls and lateral frontal patients. Interestingly, an error analysis indicated that a significantly higher number of concrete responses were found in the left lateral subgroup compared to healthy controls. We found no correlation between scores on the PIT and on the fluid intelligence task. Overall our results suggest that specific regions of the frontal lobes contribute to the performance on the PIT. © 2013 The Authors. Published by Elsevier Ltd. All rights reserved.

Episodic Memory and Regional Atrophy in Frontotemporal Lobar Degeneration

PubMed Central

Söderlund, Hedvig; Black, Sandra E.; Miller, Bruce L.; Freedman, Morris; Levine, Brian

2008-01-01

It has been unclear to what extent memory is affected in frontotemporal lobar degeneration (FTLD). Since patients usually have atrophy in regions implicated in memory function, the frontal and/or temporal lobes, one would expect some memory impairment, and that the degree of atrophy in these regions would be inversely related to memory function. The purposes of this study were 1) to assess episodic memory function in FTLD, and more specifically patients' ability to episodically re-experience an event, and determine its source; 2) to examine whether memory performance is related to quantified regional brain atrophy. FTLD patients (n=18) and healthy comparison subjects (n=14) were assessed with cued recall, recognition, “remember/know” (self-reported re-experiencing) and source recall, at 30 min and 24 hr after encoding. Regional gray matter volumes were assessed with high resolution structural MRI concurrently to testing. Patients performed worse than comparison subjects on all memory measures. Gray matter volume in the left medial temporal lobe was positively correlated with recognition, re-experiencing, and source recall. Gray matter volume in the left posterior temporal lobe correlated significantly with recognition, at 30 min and 24 hr, and with source recall at 30 min. Estimated familiarity at 30 min was positively correlated with gray matter volume in the left inferior parietal lobe. In summary, episodic memory deficits in FTLD may be more common than previously thought, particularly in patients with left medial and posterior temporal atrophy. PMID:17888461

Open and Endoscopic Management of Fourth Branchial Pouch Sinus – Our Experience

PubMed Central

Arunachalam, Pavai; Vaidyanathan, Venkatraman; Sengottan, Palaninathan

2015-01-01

Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses. Objectives The authors present their experience in treating such cases that were observed exclusively in children. Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy. Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic. Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out. PMID:26491476

Open and Endoscopic Management of Fourth Branchial Pouch Sinus - Our Experience.

PubMed

Arunachalam, Pavai; Vaidyanathan, Venkatraman; Sengottan, Palaninathan

2015-10-01

Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses. Objectives The authors present their experience in treating such cases that were observed exclusively in children. Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy. Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic. Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out.

Memory loss and memory reorganization patterns in temporal lobe epilepsy patients undergoing anterior temporal lobe resection, as demonstrated by pre-versus post-operative functional MRI.

PubMed

Limotai, Chusak; McLachlan, Richard S; Hayman-Abello, Susan; Hayman-Abello, Brent; Brown, Suzan; Bihari, Frank; Mirsattari, Seyed M

2018-06-19

This study was aimed to longitudinally assess memory function and whole-brain memory circuit reorganization in patients with temporal lobe epilepsy (TLE) by comparing activation potentials before versus after anterior temporal lobe (ATL) resection. Nineteen patients with medically-intractable TLE (10 left TLE, 9 right TLE) and 15 healthy controls were enrolled. Group analyses were conducted pre- and post-ATL of a novelty complex scene-encoding paradigm comparing areas of blood oxygen-level-dependent (BOLD) signal activations on functional magnetic resonance imaging (fMRI). None of the pre-operative patient characteristics we studied predicted the extent of pre- to post-operative memory loss. On fMRI, extra-temporal activations were detected pre-operatively in both LTLE and RTLE, particularly in the frontal lobe. Greater activations also were noted in the contralateral hippocampus and parahippocampus in both groups. Performing within-subject comparisons, post-op relative to pre-op, pronounced ipsilateral activations were identified in the left parahippocampal gyrus in LTLE, versus the right middle temporal gyrus in RTLE patients. Memory function was impaired pre-operatively but declined after ATL resection in both RTLE and LTLE patients. Post-operative fMRI results indicate possible functional adaptations to ATL loss, primarily occurring within the left parahippocampal gyrus versus right middle temporal gyrus in LTLE versus RTLE patients, respectively. Copyright © 2018 Elsevier Ltd. All rights reserved.

IMAGING OF BRAIN FUNCTION BASED ON THE ANALYSIS OF FUNCTIONAL CONNECTIVITY - IMAGING ANALYSIS OF BRAIN FUNCTION BY FMRI AFTER ACUPUNCTURE AT LR3 IN HEALTHY INDIVIDUALS.

PubMed

Zheng, Yu; Wang, Yuying; Lan, Yujun; Qu, Xiaodong; Lin, Kelin; Zhang, Jiping; Qu, Shanshan; Wang, Yanjie; Tang, Chunzhi; Huang, Yong

2016-01-01

This Study observed the relevant brain areas activated by acupuncture at the Taichong acupoint (LR3) and analyzed the functional connectivity among brain areas using resting state functional magnetic resonance imaging (fMRI) to explore the acupoint specificity of the Taichong acupoint. A total of 45 healthy subjects were randomly divided into the Taichong (LR3) group, sham acupuncture group and sham acupoint group. Subjects received resting state fMRI before acupuncture, after true (sham) acupuncture in each group. Analysis of changes in connectivity among the brain areas was performed using the brain functional connectivity method. The right cerebrum temporal lobe was selected as the seed point to analyze the functional connectivity. It had a functional connectivity with right cerebrum superior frontal gyrus, limbic lobe cingulate gyrus and left cerebrum inferior temporal gyrus (BA 37), inferior parietal lobule compared by before vs. after acupuncture at LR3, and right cerebrum sub-lobar insula and left cerebrum middle frontal gyrus, medial frontal gyrus compared by true vs. sham acupuncture at LR3, and right cerebrum occipital lobe cuneus, occipital lobe sub-gyral, parietal lobe precuneus and left cerebellum anterior lobe culmen by acupuncture at LR3 vs. sham acupoint. Acupuncture at LR3 mainly specifically activated the brain functional network that participates in visual function, associative function, and emotion cognition, which are similar to the features on LR3 in tradition Chinese medicine. These brain areas constituted a neural network structure with specific functions that had specific reference values for the interpretation of the acupoint specificity of the Taichong acupoint.

Temporal lobe volumes in patients with hippocampal sclerosis with or without cortical dysplasia.

PubMed

Diehl, B; Najm, I; LaPresto, E; Prayson, R; Ruggieri, P; Mohamed, A; Ying, Z; Lieber, M; Babb, T; Bingaman, W; Lüders, H O

2004-05-25

Recent MRI-based volume reconstruction studies in intractable temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) suggested atrophy that extends to the adjacent neocortical areas. To study the extent of temporal lobe volume (TLV) abnormalities in patients with pathologically confirmed HS (with or without cortical dysplasia [CD]) who underwent anterior temporal lobectomy for the treatment of drug-resistant TLE. Fifty patients (right TLE: n = 24; left TLE: n = 26) were found to have HS (hippocampal cell loss of >30%). Associated neocortical CD was seen in 20 patients (43%). MRI-based TLVs and hippocampal and hemispheric volume reconstructions in all patients were compared between pathologic groups and with volumes acquired from 10 age-matched control subjects. TLVs ipsilateral to the epileptogenic zone in patients with TLE were smaller than TLVs in control subjects (p < 0.01). In patients with left TLE, TLVs ipsilateral to the epileptogenic zone were smaller than contralateral TLVs (left: 66.6 +/- 8.3 cm3, right: 74.9 +/- 10.0 cm3; p < 0.001). In patients with right TLE, there were no significant asymmetries. The contralateral TLVs (regardless of the side of surgery) were smaller in the HS + CD group than the HS group (HS + CD group: 74.9 +/- 8.6 cm3, HS group: 79.7 +/- 6.6 cm3; p < 0.05). Patients with HS + CD had a tendency to have less hippocampal atrophy and slightly smaller TLVs ipsilateral to the epileptogenic zone, accounting for significantly smaller TLV/hippocampal volume ratios compared with patients with HS alone. Drug-resistant TLE due to HS is associated with extrahippocampal temporal lobe atrophy. The presence of bilateral temporal lobe atrophy is suggestive of a more widespread (bilateral) temporal lobe involvement in patients with HS and CD.

Massive malignant pleural effusion due to lung adenocarcinoma in 13-year-old boy.

PubMed

Afghani, Reza; Hajimohammadi, Amir; Azarhoush, Ramin; Kazemi-Nejad, Vahideh; Yari, Behrouz; Rezapour Esfahani, Mona

2016-05-01

A 13-year-old boy with no risk factors for lung cancer presented with a massive left-sided pleural effusion and a mediastinal shift on chest radiography and computed tomography. A chest tube drained bloody pleural fluid with an exudative pattern. A pleural biopsy and wedge biopsy of the left lower lobe revealed mucinous adenocarcinoma in the left lower lobe wedge biopsy and metastatic adenocarcinoma in the pleural biopsy. The patient is currently undergoing chemotherapy. Radiotherapy is planned after shrinkage of the tumor. Adenocarcinoma of the lung is very rarely seen in teenagers or children, especially in the absence of risk factors. © The Author(s) 2016.

Lesion evidence for a critical role of left posterior but not frontal areas in alpha-beta power decreases during context-driven word production.

PubMed

Piai, Vitória; Rommers, Joost; Knight, Robert T

2017-09-09

Different frequency bands in the electroencephalogram are postulated to support distinct language functions. Studies have suggested that alpha-beta power decreases may index word-retrieval processes. In context-driven word retrieval, participants hear lead-in sentences that either constrain the final word ('He locked the door with the') or not ('She walked in here with the'). The last word is shown as a picture to be named. Previous studies have consistently found alpha-beta power decreases prior to picture onset for constrained relative to unconstrained sentences, localised to the left lateral-temporal and lateral-frontal lobes. However, the relative contribution of temporal versus frontal areas to alpha-beta power decreases is unknown. We recorded the electroencephalogram from patients with stroke lesions encompassing the left lateral-temporal and inferior-parietal regions or left-lateral frontal lobe and from matched controls. Individual participant analyses revealed a behavioural sentence context facilitation effect in all participants, except for in the two patients with extensive lesions to temporal and inferior parietal lobes. We replicated the alpha-beta power decreases prior to picture onset in all participants, except for in the two same patients with extensive posterior lesions. Thus, whereas posterior lesions eliminated the behavioural and oscillatory context effect, frontal lesions did not. Hierarchical clustering analyses of all patients' lesion profiles, and behavioural and electrophysiological effects identified those two patients as having a unique combination of lesion distribution and context effects. These results indicate a critical role for the left lateral-temporal and inferior parietal lobes, but not frontal cortex, in generating the alpha-beta power decreases underlying context-driven word production. © 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

The function of the left anterior temporal pole: evidence from acute stroke and infarct volume

PubMed Central

Tsapkini, Kyrana; Frangakis, Constantine E.

2011-01-01

The role of the anterior temporal lobes in cognition and language has been much debated in the literature over the last few years. Most prevailing theories argue for an important role of the anterior temporal lobe as a semantic hub or a place for the representation of unique entities such as proper names of peoples and places. Lately, a few studies have investigated the role of the most anterior part of the left anterior temporal lobe, the left temporal pole in particular, and argued that the left anterior temporal pole is the area responsible for mapping meaning on to sound through evidence from tasks such as object naming. However, another recent study indicates that bilateral anterior temporal damage is required to cause a clinically significant semantic impairment. In the present study, we tested these hypotheses by evaluating patients with acute stroke before reorganization of structure–function relationships. We compared a group of 20 patients with acute stroke with anterior temporal pole damage to a group of 28 without anterior temporal pole damage matched for infarct volume. We calculated the average percent error in auditory comprehension and naming tasks as a function of infarct volume using a non-parametric regression method. We found that infarct volume was the only predictive variable in the production of semantic errors in both auditory comprehension and object naming tasks. This finding favours the hypothesis that left unilateral anterior temporal pole lesions, even acutely, are unlikely to cause significant deficits in mapping meaning to sound by themselves, although they contribute to networks underlying both naming and comprehension of objects. Therefore, the anterior temporal lobe may be a semantic hub for object meaning, but its role must be represented bilaterally and perhaps redundantly. PMID:21685458

[Traumatic intracerebral hemorrhage developing in the apparent course].

PubMed

Fujiwara, S; Nishimura, A; Yanagida, Y; Nakagawa, K; Mizoi, Y; Tatsuno, Y

1991-06-01

The victim, 52 year old man, was thrust down and hit his left occiput against the concrete floor. He was hospitalised and his comatose state continued to the death. On admission, blood pressure was 212/110 mmHg and the computed tomography scan of the head showed only an extensive right subdural hematoma. But the intracerebral hemorrhages in the right frontal, temporal and parietal lobes were recognized 10.5 hours after the trauma. A subdural hematoma was evacuated by operation on the second hospital day. The intracerebellar hemorrhage also appeared 16 hours after the trauma. Blood pressure fluctuated between 160/80 and 200/110 mmHg. The photo of CT scan at 38.5 hours after the trauma showed little subdural hematoma and new intracerebral hemorrhage located in the left temporal lobe. On the third hospital day, he was equipped with a respirator and blood pressure was between 132/84 and 242/100 mmHg. The reaction of the pupils to light disappeared on the 8th hospital day. Blood pressure gradually decreased on the 9th and 10th hospital days and he died on the 11th day. Autopsy revealed a bruise in the left occiput, a linear fracture in the frontal and left parietal bones and a small amount of subdural hematoma on the surface of the right cerebral hemisphere. Cortical contusions were found in the right frontal, the both temporal and the left parietal lobes. Intracerebral hemorrhages were found in the right frontal, the both temporal and the right parietal lobes. Intracerebellar hemorrhage was also found. Cardiac hypertrophy and atherosclerosis of the aorta were recognized. We thought that small hemorrhages which were not clearly detectable by CT scan immediately after injury may have developed into massive intracerebral and intracerebellar hemorrhages due to high blood pressure after a hospitalization.

A componential analysis of proverb interpretation in patients with frontal lobe epilepsy and temporal lobe epilepsy: relationships with disease-related factors.

PubMed

McDonald, Carrie R; Delis, Dean C; Kramer, Joel H; Tecoma, Evelyn S; Iragui, Vicente J

2008-05-01

The ability to interpret nonliteral, metaphoric language was explored in patients with frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE), and matched control participants, to determine (1) if patients with FLE were impaired in their interpretations relative to those with TLE and controls, and (2) if disease-related variables (e.g., age of seizure onset) predicted performances in either patient group. A total of 22 patients with FLE, 20 patients with TLE, and 23 controls were administered a test of proverb interpretation to assess their ability to grasp the abstract meaning of nonliteral language. Participants were presented with a series of proverbs and asked to provide an oral interpretation of each. Responses to each proverb were scored according to their accuracy and level of abstractness. Patients with FLE, but not TLE, were impaired relative to controls in their overall interpretation of proverbs. However, a subgroup analysis revealed that only patients with left FLE showed impaired interpretation accuracy relative to the other groups, whereas patients with both left FLE and left TLE showed impaired abstraction. Patients with FLE were also impaired when they were asked to select the best interpretation of the proverb from response alternatives. In patients with FLE, only a left-sided seizure focus was associated with poorer performance. In patients with TLE, both an early age of onset and a left-sided seizure focus predicted poorer performance. Overall, FLE patients exhibit greater impairment than TLE patients in interpreting proverbs. However, the nature and disease-specific correlates of impaired performances in proverb interpretation differ between the groups.

A COMPONENTIAL ANALYSIS OF PROVERB INTERPRETATION IN PATIENTS WITH FRONTAL LOBE EPILEPSY AND TEMPORAL LOBE EPILEPSY: RELATIONSHIPS WITH DISEASE-RELATED FACTORS

PubMed Central

McDonald, Carrie R.; Delis, Dean C.; Kramer, Joel H.; Tecoma, Evelyn S.; Iragui, Vicente J.

2017-01-01

The ability to interpret nonliteral, metaphoric language was explored in patients with frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE), and matched control participants, to determine (1) if patients with FLE were impaired in their interpretations relative to those with TLE and controls, and (2) if disease-related variables (e.g., age of seizure onset) predicted performances in either patient group. A total of 22 patients with FLE, 20 patients with TLE, and 23 controls were administered a test of proverb interpretation to assess their ability to grasp the abstract meaning of nonliteral language. Participants were presented with a series of proverbs and asked to provide an oral interpretation of each. Responses to each proverb were scored according to their accuracy and level of abstractness. Patients with FLE, but not TLE, were impaired relative to controls in their overall interpretation of proverbs. However, a subgroup analysis revealed that only patients with left FLE showed impaired interpretation accuracy relative to the other groups, whereas patients with both left FLE and left TLE showed impaired abstraction. Patients with FLE were also impaired when they were asked to select the best interpretation of the proverb from response alternatives. In patients with FLE, only a left-sided seizure focus was associated with poorer performance. In patients with TLE, both an early age of onset and a left-sided seizure focus predicted poorer performance. Overall, FLE patients exhibit greater impairment than TLE patients in interpreting proverbs. However, the nature and disease-specific correlates of impaired performances in proverb interpretation differ between the groups. PMID:17853125

Atypical handedness in mesial temporal lobe epilepsy.

PubMed

Doležalová, Irena; Schachter, Steven; Chrastina, Jan; Hemza, Jan; Hermanová, Markéta; Rektor, Ivan; Pažourková, Marta; Brázdil, Milan

2017-07-01

The main aim of our study was to investigate the handedness of patients with mesial temporal lobe epilepsy (MTLE). We also sought to identify clinical variables that correlated with left-handedness in this population. Handedness (laterality quotient) was assessed in 73 consecutive patients with MTLE associated with unilateral hippocampal sclerosis (HS) using the Edinburgh Handedness Inventory. Associations between right- and left-handedness and clinical variables were investigated. We found that 54 (74.0%) patients were right-handed, and 19 (26%) patients were left-handed. There were 15 (36.6%) left-handed patients with left-sided seizure onset compared to 4 (12.5%) left-handed patients with right-sided seizure onset (p=0.030). Among patients with left-sided MTLE, age at epilepsy onset was significantly correlated with handedness (8years of age [median; min-max 0.5-17] in left-handers versus 15years of age [median; min-max 3-30] in right-handers (p<0.001). Left-sided MTLE is associated with atypical handedness, especially when seizure onset occurs during an active period of brain development, suggesting a bi-hemispheric neuroplastic process for establishing motor dominance in patients with early-onset left-sided MTLE. Copyright © 2017 Elsevier Inc. All rights reserved.

Thyroiditis de Quervain. Are there predictive factors for long-term hormone-replacement?

PubMed

Schenke, S; Klett, R; Braun, S; Zimny, M

2013-01-01

Subacute thyroiditis is a usually self-limiting disease of the thyroid. However, approximately 0.5-15% of the patients require permanent thyroxine substitution. Aim was to determine predictive factors for the necessity of long-term hormone-replacement (LTH). We retrospectively reviewed the records of 72 patients with subacute thyroiditis. Morphological and serological parameters as well as type of therapy were tested as predictive factors of consecutive hypothyroidism. Mean age was 49 ± 11 years, f/m-ratio was 4.5 : 1. Thyroid pain and signs of hyperthyroidism were leading symptoms. Initial subclinical or overt hyperthyroidism was found in 20% and 37%, respectively. Within six months after onset 15% and 1.3% of the patients developed subclinical or overt hypothyroidism, respectively. At latest follow-up 26% were classified as liable to LTH. At onset the thyroid was enlarged in 64%, and at latest follow-up in 8.3%, with a significant reduction of the thyroid volume after three months. At the endpoint the thyroid volume was less in patients in the LTH group compared with the non-LTH group (41.7% vs. 57.2% of sex-adjusted upper norm, p = 0.041). Characteristic ultrasonographic features occurred in 74% of the patients in both lobes. Serological and morphological parameters as well as type of therapy were not related with the need of LTH. In this study the proportion of patients who received LTH was 26%. At the endpoint these patients had a lower thyroid volume compared with euthyroid patients. No predictive factors for LTH were found.

The role of diffusion weighted MR imaging for differentiation between Graves' disease and Hashimoto thyroiditis.

PubMed

Ozturk, T; Bozgeyik, Z; Ozturk, F; Burakgazi, G; Akyol, M; Coskun, S; Ozkan, Y; Ogur, E

2015-08-01

The aim of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DWMRI) for differentation between Graves' disease and Hashimoto's thyroiditis. Fifty patients (27 Graves diseases and 23 Hashimoto thyroiditis) and twenty healthy volunteers were examined using T1, T2 and DWMRI. The patients were diagnosed on the basis of physical findings and the results of thyroid function tests and serological tests. Circular ROIs were positioned on the bilateral thyroid lobes and isthmus. All measurements were repeated three different b values including 100, 600 and 1000 s/mm2 in all cases. ADC (Apparent diffusion coefficient) maps were calculated automatically with the MR system. Mean ADC values were 2.93 × 10-3, 1.97 × 10-3 and 1.62 × 10-3 mm2/s in the healthy volunteers; 3.47 × 10-3, 2.25 × 10-3 and 1.64 × 10-3 mm2/s in Graves' disease; 2.53 × 10-3, 1.76 × 10-3, 1.28 × 10-3 mm2/s in Hashimoto thyroiditis for b100, b600 and b1000, respectively. The ADC values of the Graves diseases were higher than healty volunteers and Hashimoto thyroiditis. ADC values were statistically significant for differentation between Hashimoto thyroiditis and Graves' disease all b values (p < 0.05). DWMRI is fast sequence and does not require contrast agent. Quantitative assessment of the lesion is possible using ADC map. So, DWMRI may be useful differentiation of the Hashimoto thyroiditis and Graves' disease.

Laparoscopic left lobe liver resection in a porcine model: a study of the efficacy and safety of different surgical techniques.

PubMed

Eiriksson, Kristinn; Kristinn, Eiriksson; Fors, Diddi; Diddi, Fors; Rubertsson, Sten; Sten, Rubertsson; Arvidsson, Dag; Dag, Arvidsson

2009-05-01

Laparoscopic liver surgery is evolving and the best technique for dividing the liver parenchyma is currently under debate. The aim of this study was to study different techniques during a full laparoscopic lobe resection, and determine the efficacy and risks of bleeding and gas embolism. Sixteen pigs were randomized to two groups: group US underwent an operation with Ultracision shears (AutoSonix) and ultrasonic dissector (CUSA) and group VS with a vessel sealing system (Ligasure) and ultrasonic dissector. A left lobe resection was performed. Transesophageal endoscopic echocardiography (TEE) was used to detect gas emboli in the right side of the heart and pulmonary artery. The operations and TEE were recorded for later assessment. Compared with group VS, group US exhibited significantly more intraoperative bleeding (p = 0.02), a trend towards a longer operation time (p = 0.08), and a trend towards more embolization for grade I emboli. In total, 10 of 15 animals had emboli during the operation. This study showed that a laparoscopic left lobe resection can be performed with a combination of AutoSonix and CUSA as well as with Ligasure and CUSA instrumentation. In our hands, less bleeding was incurred with Ligasure than with AutoSonix.

The temporal relation between seizure onset and arousal-awakening in temporal lobe seizures.

PubMed

Gumusyayla, Sadiye; Erdal, Abidin; Tezer, F Irsel; Saygi, Serap

2016-07-01

Our main aim was to determine the time interval between the seizure onsets and arousal-awakening related to these seizures in patients with temporal lobe epilepsy (TLE) and to discuss the role of lateralization on arousal-awakening mechanisms. Thirty-three TLE patients who underwent video-EEG monitoring with simultaneous polysomnography (PSG) and had recorded nocturnal seizures were retrospectively examined. These TLE patients had 64 seizures during sleep. The onsets of seizures and arousal-awakening related to these seizures were marked according to clinical and electrophysiological features. The time interval between the seizure onset and arousal-awakening related to the seizure was compared in patients with right- or left-sided temporal lobe seizures. In our TLE patients nocturnal seizures mostly followed arousal-awakening (64%). The time interval between the seizure onset and arousal-awakening related to the seizure was significantly shorter in patients with left-sided temporal lobe seizures (p=0.01). Video-EEG monitoring and PSG with scalp electrodes in our TLE patients showed that nocturnal seizures mostly followed arousal-awakening, and it was more pronounced in those with left-sided seizures. Arousal-awakening might be a signal for subsequent seizures in patients with TLE. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

What role does the anterior temporal lobe play in sentence-level processing? Neural correlates of syntactic processing in semantic PPA

PubMed Central

Wilson, Stephen M.; DeMarco, Andrew T.; Henry, Maya L.; Gesierich, Benno; Babiak, Miranda; Mandelli, Maria Luisa; Miller, Bruce L.; Gorno-Tempini, Maria Luisa

2014-01-01

Neuroimaging and neuropsychological studies have implicated the anterior temporal lobe (ATL) in sentence-level processing, with syntactic structure-building and/or combinatorial semantic processing suggested as possible roles. A potential challenge to the view that the ATL is involved in syntactic aspects of sentence processing comes from the clinical syndrome of semantic variant primary progressive aphasia (semantic PPA, also known as semantic dementia). In semantic PPA, bilateral neurodegeneration of the anterior temporal lobes is associated with profound lexical semantic deficits, yet syntax is strikingly spared. The goal of this study was to investigate the neural correlates of syntactic processing in semantic PPA, in order to determine which regions normally involved in syntactic processing are damaged in semantic PPA, and whether spared syntactic processing depends on preserved functionality of intact regions, preserved functionality of atrophic regions, or compensatory functional reorganization. We scanned 20 individuals with semantic PPA and 24 age-matched controls using structural and functional MRI. Participants performed a sentence comprehension task that emphasized syntactic processing and minimized lexical semantic demands. We found that in controls, left inferior frontal and left posterior temporal regions were modulated by syntactic processing, while anterior temporal regions were not significantly modulated. In the semantic PPA group, atrophy was most severe in the anterior temporal lobes, but extended to the posterior temporal regions involved in syntactic processing. Functional activity for syntactic processing was broadly similar in patients and controls; in particular, whole-brain analyses revealed no significant differences between patients and controls in the regions modulated by syntactic processing. The atrophic left anterior temporal lobe did show abnormal functionality in semantic PPA patients, however this took the unexpected form of a failure to deactivate. Taken together, our findings indicate that spared syntactic processing in semantic PPA depends on preserved functionality of structurally intact left frontal regions and moderately atrophic left posterior temporal regions, but no functional reorganization was apparent as a consequence of anterior temporal atrophy and dysfunction. These results suggest that the role of the anterior temporal lobe in sentence processing is less likely to relate to syntactic structure-building, and more likely to relate to higher level processes such as combinatorial semantic processing. PMID:24345172

Drosophila pachea asymmetric lobes are part of a grasping device and stabilize one-sided mating.

PubMed

Rhebergen, Flor T; Courtier-Orgogozo, Virginie; Dumont, Julien; Schilthuizen, Menno; Lang, Michael

2016-09-01

Multiple animal species exhibit morphological asymmetries in male genitalia. In insects, left-right genital asymmetries evolved many times independently and have been proposed to appear in response to changes in mating position. However, little is known about the relationship between mating position and the interaction of male and female genitalia during mating, and functional analyses of asymmetric morphologies in genitalia are virtually non-existent. We investigated the relationship between mating position, asymmetric genital morphology and genital coupling in the fruit fly Drosophila pachea, in which males possess an asymmetric pair of external genital lobes and mate in an unusual right-sided position on top of the female. We examined D. pachea copulation by video recording and by scanning electron microscopy of genital complexes. We observed that the interlocking of male and female genital organs in D. pachea is remarkably different from genital coupling in the well-studied D. melanogaster. In D. pachea, the female oviscapt valves are asymmetrically twisted during copulation. The male's asymmetric lobes tightly grasp the female's abdomen in an asymmetric 'locking' position, with the left and right lobes contacting different female structures. The male anal plates, which grasp the female genitalia in D. melanogaster, do not contact the female in D. pachea. Experimental lobe amputation by micro-surgery and laser-ablation of lobe bristles led to aberrant coupling of genitalia and variable mating positions, in which the male was tilted towards the right side of the female. We describe, for the first time, how the mating position depends on coupling of male and female genitalia in a species with asymmetric genitalia and one-sided mating position. Our results show that D. pachea asymmetric epandrial lobes do not act as a compensatory mechanism for the change from symmetric to one-sided mating position that occurred during evolution of D. pachea's ancestors, but as holding devices with distinct specialized functions on the left and right sides.

Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal.

PubMed

Riquet, Marc; Rivera, Caroline; Pricopi, Ciprian; Arame, Alex; Mordant, Pierre; Foucault, Christophe; Dujon, Antoine; Le Pimpec-Barthes, Françoise

2015-03-01

Nowadays, early-stage lung cancers are more frequently encountered. Selective lymph node (LN) dissection based on lobe-specific lymphatic pathway has been proposed. Our aim was to study nodal involvement according to tumour location. We reviewed 1779 lobectomized patients and analysed their pathological characteristics according to tumour location: Group 1 (G1), right upper lobe; Group 2 (G2), right middle lobe; Group 3 (G3), right lower lobe; Group 4 (G4), left upper division; Group 5 (G5), lingula; Group 6 (G6), left lower lobe. The pN status was recorded for each group to analyse the lymphatic spread of non-small-cell lung cancer (NSCLC) according to tumour location. The numbers and proportions of lobectomies in each group were 613 patients in G1 (59.2%), 64 in G2 (6.4%), 359 in G3 (34.6%), 404 in G4 (54.3%), 54 in G5 (7.3%) and 286 in G6 (38.4%). The rates of pN2 involvement were similar, whatever the group was, even when deciphering single- and multistation diseases. on the right side, single-station N2 disease was mainly found in the superior mediastinum (SM) for G1 (95%), and in the inferior for G3 (90%). On the left side, single-station N2 was mainly found in the SM in G4 (94%), and the inferior in G6 (48%). Whatever the side, in case of two-station involvement, both mediastina were concerned in 40% (in G4) to 81% of the case (in G3). Long-term survival rates were different in skip metastasis, single- and multistation involvement, but not between lobes. Tumour location is not a predictor of nodal metastasis pattern. In surgical treatment of NSCLC, complete systematic mediastinal LN dissection remains the only acceptable procedure from an oncological point of view. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Recurrent neck infection with branchial arch fistula in children.

PubMed

Madana, J; Yolmo, Deeke; Kalaiarasi, R; Gopalakrishnan, S; Saxena, S K; Krishnapriya, S

2011-09-01

Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side. A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases. The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence. Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

Investigation of Acoustic Structure Quantification in the Diagnosis of Thyroiditis.

PubMed

Park, Jisang; Hong, Hyun Sook; Kim, Chul-Hee; Lee, Eun Hye; Jeong, Sun Hye; Lee, A Leum; Lee, Heon

2016-03-01

The objective of this study was to evaluate the ability of acoustic structure quantification (ASQ) to diagnose thyroiditis. The echogenicity of 439 thyroid lobes, as determined using ASQ, was quantified and analyzed retrospectively. Thyroiditis was categorized into five subgroups. The results were presented in a modified chi-square histogram as the mode, average, ratio, blue mode, and blue average. We determined the cutoff values of ASQ from ROC analysis to detect and differentiate thyroiditis from a normal thyroid gland. We obtained data on the sensitivity and specificity of the cutoff values to distinguish between euthyroid patients with thyroiditis and patients with a normal thyroid gland. The mean ASQ values for patients with thyroiditis were statistically significantly greater than those for patients with a normal thyroid gland (p < 0.001). The AUCs were as follows: 0.93 for the ratio, 0.91 for the average, 0.90 for the blue average, 0.87 for the mode, and 0.87 for the blue mode. For the diagnosis of thyroiditis, the cutoff values were greater than 0.27 for the ratio, greater than 116.7 for the mean, and greater than 130.7 for the blue average. The sensitivities and specificities were as follows: 84.0% and 96.6% for the ratio, 85.3% and 83.0%, for the average, and 79.1% and 93.2% for the blue average, respectively. The ASQ parameters were successful in distinguishing patients with thyroiditis from patients with a normal thyroid gland, with likelihood ratios of 24.7 for the ratio, 5.0 for the average, and 11.6 for the blue average. With the use of the aforementioned cutoff values, the sensitivities and specificities for distinguishing between patients with thyroiditis and euthyroid patients without thyroiditis were 77.05% and 94.92% for the ratio, 85.25% and 82.20% for the average, and 77.05% and 92.37% for the blue average, respectively. ASQ can provide objective and quantitative analysis of thyroid echogenicity. ASQ parameters were successful in distinguishing between patients with thyroiditis and individuals without thyroiditis, with likelihood ratios of 24.7 for the ratio, 5.0 for the average, and 11.6 for the blue average.

Recurrent laryngeal nerve landmarks during thyroidectomy.

PubMed

Ngo Nyeki, A-R; Njock, L-R; Miloundja, J; Evehe Vokwely, J-E; Bengono, G

2015-11-01

This study was designed to describe the various anatomical relations of the recurrent laryngeal nerve (RLN) during thyroid surgery in a Central African population. A prospective study was conducted between January 2012 and December 2012 in 5 otorhinolaryngology and head and neck surgery departments in Cameroon and Gabon. All patients undergoing total or subtotal thyroidectomy or loboisthmectomy with recurrent laryngeal nerve dissection, with no history of previous thyroid surgery, RLN dissection or tumour infiltration of the RLN, were included. Fifty-six patients were included, corresponding to 36 loboisthmectomies and 20 total or subtotal thyroidectomies. A total of 62 recurrent laryngeal nerves were identified: 32 on the right and 30 on the left. The course of the recurrent laryngeal nerve in relation to branches of the inferior thyroid artery (ITA) was retrovascular in 53.1% of cases on the right and 76.6% of cases on the left; transvascular in 15.6% of cases on the right and 13.4% of cases on the left. The course of the recurrent laryngeal nerve was modified by thyroid disease in 12.9% of cases. Six cases (9.7%) of extralaryngeal division of the recurrent laryngeal nerve were observed. No case of non-recurrent nerve was observed in this series. The anatomical relations of the recurrent laryngeal nerve with the inferior thyroid artery were very inconstant in this series and were predominantly retrovascular or transvascular in relation to the branches of the artery. The presence of extralaryngeal branches and modification of the course of the nerve by thyroid disease also introduced additional difficulties during recurrent laryngeal nerve dissection. The anatomical relations of the right recurrent laryngeal nerve in this African population differ from the classically described prevascular course. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Tuberculous Orbital Abscess Associated with Thyroid Tuberculosis

PubMed Central

Sharma, Kumudini; Kanaujia, Vikas; Jain, Anu; Bains, Sukhdeep; Suman, Suvarna

2011-01-01

Purpose To report an unusual presentation of tuberculosis. Case Report A six-year old boy presented with left upper lid swelling of 15 days’ duration and an asymptomatic midline neck mass from 2 months ago. Imaging studies, and microbiologic tests which demonstrated acid-fast bacilli in the fine needle aspirate of the thyroid mass, both confirmed a diagnosis of cold tuberculous thyroid abscess with presumed hematogenous spread to the orbit. The patient demonstrated marked improvement of both lesions with antitubercular drugs. Conclusion This case illustrates a very rare association of orbital and thyroid tuberculosis. PMID:22454737

Pryce type I sequestration: no mosquito shooting.

PubMed

Barik, Ramachandra; Patnaik, Amar Narayan; Malempati, Amaresh Rao; Nemani, Lalita

2015-06-01

We report a case of a 40-year-old woman with congenital dual arterial supply to an otherwise normal left lower lobe, causing hyperperfusion lung injury. In addition to near normal pulmonary arterial supply, the lower lobe of the left lung received a systemic arterial supply from the descending thoracic aorta. The patient was successfully managed by surgical ligation of the systemic arterial supply without lobectomy. We discuss when to defer lobectomy in Pryce type I sequestration. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Complex outflow anatomy in left lateral lobe graft and modified venous reconstruction in pediatric living donor liver transplantation.

PubMed

Benetatos, Nikolaos; Scalera, Irene; Isaac, John R; Mirza, Darius F; Muiesan, Paolo

2014-10-01

Hepatic venous outflow reconstruction is of critical significance in pediatric patients undergoing living donor liver transplantation. Accurate knowledge of the anatomical variations is important to obtain appropriate size segmental grafts. The diameter of the hepatic veins and the potential risk of complications at the level of the anastomosis require an adequate primary vascular reconstruction. We describe a venous outflow reconstruction technique, in a living related left lateral lobe graft, with unfavorable hepatic venous anatomy. © 2014 Steunstichting ESOT.

A Hormonally Active Malignant Struma Ovarii

PubMed Central

Lara, Carolina; Salame, Latife; Padilla-Longoria, Rafael

2016-01-01

Struma ovarii is a rare monodermal variant of ovarian teratoma that contains at least 50% thyroid tissue. Less than 8% of struma ovarii cases present with clinical and biochemical evidence of thyrotoxicosis due to ectopic production of thyroid hormone and only 5% undergo malignant transformation into a papillary thyroid carcinoma. Only isolated cases of hormonally active papillary thyroid carcinoma developing within a struma ovarii have been reported in the literature. We report the case of a 36-year-old woman who presented with clinical signs and symptoms of hyperthyroidism as well as a left adnexal mass, which proved to be a thyroid hormone-producing, malignant struma ovarii. PMID:27882257

[A surgical case of mesial temporal lobe epilepsy associated with hippocampal sclerosis and traumatic neocortical lesion].

PubMed

Kitazawa, Yu; Jin, Kazutaka; Iwasaki, Masaki; Suzuki, Hiroyoshi; Tanaka, Fumiaki; Nakasato, Nobukazu

2017-11-25

A 26-year-old right-handed woman, with a history of left temporal lobe contusion caused by a fall at the age of 9 months, started to have complex partial seizures with oral automatism at the age of 7 years. The seizures occurred once or twice a month despite combination therapy with several antiepileptic agents. Her history and imaging studies suggested the diagnosis of epilepsy arising from traumatic neocortical temporal lesion. Comprehensive assessment including long-term video EEG monitoring, MRI, FDG-PET, MEG, and neuropsychological evaluation was performed at the age of 26 years. The diagnosis was left mesial temporal lobe epilepsy associated with hippocampal atrophy and traumatic temporal cortical lesion. The patient was readmitted for surgical treatment at the age of 27 years. Intracranial EEG monitoring showed that ictal discharges started in the left hippocampus and spread to the traumatic lesion in the left posterior superior temporal gyrus 10 seconds after the onset. This case could not be classified as dual pathology exactly, because the traumatic left temporal cortical lesion did not show independent epileptogenicity. However, the traumatic lesion was highly likely to be the source of the epileptogenicity, and she had right hemispheric dominance for language and functional deterioration in the whole temporal cortex. Therefore, left amygdalo-hippocampectomy and left temporal lobectomy including the traumatic lesion were performed according to the diagnosis of dual pathology. Subsequently, she remained seizure-free for 3 years. Comprehensive assessment of seizure semiology, neurophysiology, neuroradiology, and neuropsychology is important to determine the optimum therapeutic strategies for drug-resistant epilepsy.

The effect of sex and handedness on white matter anisotropy: a diffusion tensor magnetic resonance imaging study.

PubMed

Powell, J L; Parkes, L; Kemp, G J; Sluming, V; Barrick, T R; García-Fiñana, M

2012-04-05

Diffusion tensor magnetic resonance imaging provides a way of assessing the asymmetry of white matter (WM) connectivity, the degree of anisotropic diffusion within a given voxel being a marker of coherently bundled myelinated fibers. Voxel-based statistical analysis was performed on fractional anisotropy (FA) images of 42 right- and 40 left-handers, to assess differences in underlying WM anisotropy and FA asymmetry across the whole brain. Right-handers show greater anisotropy than left-handers in the uncinate fasciculus (UF) within the limbic lobe, and WM underlying prefrontal cortex, medial and inferior frontal gyri. Significantly greater leftward FA asymmetry in cerebellum posterior lobe is seen in left- than right-handers, and males show significantly greater rightward (right-greater-than-left) FA asymmetry in regions of middle occipital lobe, medial temporal gyrus, and a region of the superior longitudinal fasciculus underlying the supramarginal gyrus. Leftward (left-greater-than-right) anisotropy is found in regions of the arcuate fasciculus (AF), UF, and WM underlying pars triangularis in both handedness groups, with right-handers alone showing additional leftward FA asymmetry along the length of the superior temporal gyrus. Overall results indicate that although both handedness groups show anisotropy in similar WM regions, greater anisotropy is observed in right-handers compared with left-handers. The largest differences in FA asymmetry are found between males and females, suggesting a greater effect of sex than handedness on FA asymmetry. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

Semantic retrieval during overt picture description: Left anterior temporal or the parietal lobe?

PubMed

Geranmayeh, Fatemeh; Leech, Robert; Wise, Richard J S

2015-09-01

Retrieval of semantic representations is a central process during overt speech production. There is an increasing consensus that an amodal semantic 'hub' must exist that draws together modality-specific representations of concepts. Based on the distribution of atrophy and the behavioral deficit of patients with the semantic variant of fronto-temporal lobar degeneration, it has been proposed that this hub is localized within both anterior temporal lobes (ATL), and is functionally connected with verbal 'output' systems via the left ATL. An alternative view, dating from Geschwind's proposal in 1965, is that the angular gyrus (AG) is central to object-based semantic representations. In this fMRI study we examined the connectivity of the left ATL and parietal lobe (PL) with whole brain networks known to be activated during overt picture description. We decomposed each of these two brain volumes into 15 regions of interest (ROIs), using independent component analysis. A dual regression analysis was used to establish the connectivity of each ROI with whole brain-networks. An ROI within the left anterior superior temporal sulcus (antSTS) was functionally connected to other parts of the left ATL, including anterior ventromedial left temporal cortex (partially attenuated by signal loss due to susceptibility artifact), a large left dorsolateral prefrontal region (including 'classic' Broca's area), extensive bilateral sensory-motor cortices, and the length of both superior temporal gyri. The time-course of this functionally connected network was associated with picture description but not with non-semantic baseline tasks. This system has the distribution expected for the production of overt speech with appropriate semantic content, and the auditory monitoring of the overt speech output. In contrast, the only left PL ROI that showed connectivity with brain systems most strongly activated by the picture-description task, was in the superior parietal lobe (supPL). This region showed connectivity with predominantly posterior cortical regions required for the visual processing of the pictorial stimuli, with additional connectivity to the dorsal left AG and a small component of the left inferior frontal gyrus. None of the other PL ROIs that included part of the left AG were activated by Speech alone. The best interpretation of these results is that the left antSTS connects the proposed semantic hub (specifically localized to ventral anterior temporal cortex based on clinical neuropsychological studies) to posterior frontal regions and sensory-motor cortices responsible for the overt production of speech. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Preoperative vocal cord paralysis and its association with malignant thyroid disease and other pathological features.

PubMed

Kay-Rivest, Emily; Mitmaker, Elliot; Payne, Richard J; Hier, Michael P; Mlynarek, Alex M; Young, Jonathan; Forest, Véronique-Isabelle

2015-09-11

Vocal cord paralysis (VCP) is found in both benign and malignant thyroid disease. This study was performed to determine if the presence of preoperative VCP predicts malignancy. A retrospective analysis was performed on a cohort of 1923 consecutive patients undergoing thyroid surgery. The incidence of preoperative VCP was recorded. Patient and nodule characteristics were correlated with final pathology. 1.3% of our cohort was found to have preoperative VCP. Malignant pathology was discovered in 76% of patients with preoperative VCP. Among these patients, 72% had a left sided paralysis. 10.5% of patients with preoperative VCP had perineural invasion (PNI) on final pathology, compared to 1.1% of patients with normal VC function. Preoperative VCP appears to be a strong, though not an absolute, indicator of malignancy. Most VCP were on the left side. Assessing for preoperative VCP is crucial in all patients who need thyroid surgery, as even benign nodules can be accompanied by preoperative vocal cord paralysis.

Role of PTEN in the Tumor Microenvironment

DTIC Science & Technology

2010-06-01

like tumor macro- phages modulate the extracellular microenvironment to pro- mote tumor growth and angiogenesis at both primary and tumor sites. A key...median lobe with a saline-moistened cotton tip. The median and left lateral lobe will be held against the diaphragm/thorax with a moistened cotton

The caudate lobe of the liver: implications of embryology and anatomy for surgery.

PubMed

Abdalla, Eddie K; Vauthey, Jean-Nicolas; Couinaud, Claude

2002-10-01

The anatomy of the caudate lobe has technical and possibly oncologic implications for surgeons. The complex anatomy of the lobe is clarified by embryologic and anatomic analysis. This posterior sector is embryonically and anatomically independent of the right and left liver and the main portal fissure. The caudate lobe represents the only part of the liver that is in contact with the vena cava, except at the entrance of the main hepatic veins into the vena cava, and provides an anastomosis between the hepatic veins and vena cava. The entire caudate lobe is a single anatomic segment that is defined by the presence of portal venous and hepatic arterial branches, which supply the lobe, draining biliary ducts, and hepatic veins. Because no separate veins, arteries, or ducts can be defined for the right paracaval portion of the posterior liver and because pedicles cross the proposed division between the right and left caudate, the concept of segment IX is abandoned. The significance of caudate anatomy is reflected in the increase in the frequency and safety of major hepatic resection for primary and metastatic tumors in the liver. Right hepatic lobectomy routinely involves resection of the right portion of the caudate lobe (C. Couinaud, unpublished data, 1999). In the case of hilar bile duct cancer, which may extend into the dorsal ducts (especially the right lateral duct), partial or total caudate lobectomy is often necessary for complete extirpation of the tumor. Isolated caudate lobectomy can be performed for hepatocellular carcinoma that arises in the caudate lobe or for other tumors that arise in the lobe. The caudate lobe can be resected as part of the donor liver in preparation for a living related donor transplantation. Knowledge of the surgical anatomy of the caudate lobe is an essential part of the repertoire for surgeons who perform liver transplants or treat hepatobiliary cancer.

Magnetic resonance spectroscopy findings in photosensitive idiopathic generalized epilepsy.

PubMed

Aydin-Ozemir, Zeynep; Terzibasioglu, Ege; Altindag, Ebru; Sencer, Serra; Baykan, Betul

2010-01-01

Studies investigating the pathophysiology of epileptic photosensitivity indicate variable involvement of particular brain regions. Our aim was to identify metabolic differences between photosensitive idiopathic generalized epilepsy (IGE) patients and nonphotosensitive IGE patients and normal healthy subjects by using Magnetic Resonance Spectroscopy (MRS). Fourteen patients diagnosed with photosensitive IGE were investigated. The control groups consisted of 14 age- and sex-matched healthy volunteers and 14 IGE patients without photosensitivity. MRS measurements of N-acetylaspartate (NAA), choline-containing compounds (Cho), creatine (Cr) were performed in the frontal and occipital cortex and the thalamus bilaterally using a stimulated echo acquisition mode (STEAM) technique with a voxel size of 20 x 20 x 20 mm. The values of the patients with IGE were compared with those of the normal controls and within subgroups according to the clinical variables by appropriate statistical tests. Photosensitive IGE patients showed significantly decreased concentrations of NAA in the right frontal lobe and left thalamus, decreased NAA/Cr ratio in left thalamus and significantly increased concentrations of Cho/Cr ratio in the right frontal lobe and NAA/Cr in the left occipital lobe when compared to normal controls. Furthermore, left occipital NAA concentration increased and left thalamus NAA/Cr ratios were decreased from the IGE patients without photosensitivity but without reaching statistical significance. Our results support previous MR studies suggesting an asymmetrical neuronal dysfunction in favor of the dominant occipital cortex and thalamus in photosensitive IGE patients.

Creative innovation with temporal lobe epilepsy and lobectomy.

PubMed

Ghacibeh, Georges A; Heilman, Kenneth M

2013-01-15

Some patients with left temporal degeneration develop visual artistic abilities. These new artistic abilities may be due to disinhibition of the visuo-spatially dominant right hemisphere. Many famous artists have had epilepsy and it is possible that some may have had left temporal seizures (LTS) and this left temporal dysfunction disinhibited their right hemisphere. Alternatively, unilateral epilepsy may alter intrahemispheric connectivity and right anterior temporal lobe seizures (RTS) may have increased these artists' right hemisphere mediated visual artistic creativity. To test the disinhibition versus enhanced connectivity hypotheses we studied 9 participants with RTS and 9 with left anterior temporal seizures (LTS) who underwent unilateral lobectomy for the treatment of medically refractory epilepsy. Creativity was tested using the Torrance Test of Creative Thinking (TTCT). There were no between group differences in either the verbal or figural scores of the TTCT, suggesting that unilateral anterior temporal ablation did not enhance visual artistic ability; however, for the RTS participants' figural creativity scores were significantly higher than verbal scores. Whereas these results fail to support the left temporal lobe disinhibition postulate of enhanced figural creativity, the finding that the patients with RTS had better figural than verbal creativity suggests that their recurrent right hemispheric seizures lead to changes in their right hemispheric networks that facilitated visual creativity. To obtain converging evidence, studies on RTS participants who have not undergone lobectomy will need to be performed. Published by Elsevier B.V.

Dual malignancy in a thyroid; papillary thyroid carcinoma and small lymphocytic lymphoma; a report of a case with a cyto-histologic correlation.

PubMed

Ahmed, Omar I; Salih, Ziyan T

2017-09-01

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Simultaneous involvement of the thyroid gland by multiple malignancies, is a rare occurrence. Similarly, primary thyroid lymphomas are also rare. We are reporting a rare case of a dual thyroid malignancy; PTC with secondary thyroid involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diagnosed on cytology and confirmed with flow cytometry, histology and immunohistochemistry. Imaging showed two hypermetabolic nodules, one in left parotid gland, and the other in the thyroid isthmus. Cytology smears showed features of PTC along with an atypical lymphocytic infiltrate, which co-expressed CD5, CD19, and CD23 on flowcytometry analysis. Subsequent thyroidectomy showed the atypical lymphocytic infiltrate involving the PTC papillae themselves. The diagnosis of dual malignancies on thyroid FNA is extremely rare and often unexpected, but is possible using appropriate ancillary studies. © 2017 Wiley Periodicals, Inc.

Surface anatomy of major anatomical landmarks of the neck in an adult population: A Ct Evaluation of Vertebral Level.

PubMed

Badshah, Masroor; Soames, Roger; Ibrahim, Muhammad; Khan, Muhammad Jaffar; Khan, Adnan

2017-09-01

To compare the projectional surface anatomy of healthy individuals in an adult population with those with a thyroid mass, using computed tomography (CT). Sixteen slice CT images of 101 individuals were analyzed using a 32-bit Radiant DICOM viewer to establish the relationships among major anatomical landmarks in the neck and their vertebral levels. The structures investigated included: hard palate (HP), hyoid bone (HB) including body and lesser horns, soft palate (SP), thyroid gland (TG) (both superior and inferior poles), thyroid gland anteroposterior (APD) and superoinferior (SID) diameters, thyroid isthmus (TI) superoinferior dimension, epiglottis, vertebral arteries (right and left), and both right and left parotid glands (superior and inferior extents). The vertebral levels noted most frequently were: body of hyoid bone (C4, 42.71%); lesser horns of hyoid bone (C3, 36.46%); thyroid gland superior pole (C6, 31.25%); and thyroid gland inferior pole (T2, 30.2%). TG-ID, TG-APD, and TG-SID were not significantly different between males and females in the healthy group; however, there was a significant gender difference in thyroid gland inferior diameter in the pathology group [males 2.16(±1.16) vs. females 3.37(±1.30), P = 0.01, paired sample t-test]. Further studies are needed to determine whether neck pathology in those with a thyroid mass affects the dimensions of the thyroid gland. Moreover, the surface anatomy of the neck should be revisited using modern imaging techniques to address inconsistencies in anatomy and clinical reference texts. Clin. Anat. 30:781-787, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Fine needle aspiration of secondary synovial sarcoma of the thyroid gland.

PubMed

Murro, Diana; Slade, Jamie Macagba; Syed, Sahr; Gattuso, Paolo

2015-11-01

Synovial sarcomas (SS) of the head and neck region are extremely rare and arise in only 5% of cases. We present a case of secondary SS of the thyroid originally diagnosed as medullary carcinoma on fine needle aspiration (FNA). A 41-year-old man presented with several weeks of dysphonia and a left thyroid mass. FNA of the thyroid nodule showed a cellular smear composed of loosely cohesive oval to spindle-shaped cells with irregular nuclear borders, finely granular chromatin, and inconspicuous nucleoli. The patient was diagnosed with medullary carcinoma and underwent a total thyroidectomy. Intro-operatively, the mass was found to arise from the tracheoesophageal groove with spread to the left thyroid. Microscopic examination of the thyroid tumor revealed a dense spindle cell proliferation with abundant mitoses, scant cords and nests of epithelial cells and foci of necrosis. The spindle cells were positive for bcl2 and vimentin and the epithelial cells were positive for cytokeratin 8/18 and epithelial membrane antigen (EMA). Both spindle and epithelial cells were negative for thyroglobulin, calcitonin, synaptophysin and chromogranin. Fluorescence in situ hybridization (FISH) demonstrated translocation (X;18)(p11;q11), confirming the diagnosis of SS. The patient underwent a total laryngopharyngoesophagectomy with subsequent adjuvant therapy and is currently disease free. Only 6 cases of histologically confirmed primary SS of the thyroid have been reported. To the best of our knowledge, this is the first case of FISH-confirmed secondary SS of the thyroid and also the first case of SS arising from the tracheoesophageal groove. © 2015 Wiley Periodicals, Inc.

Acute severe hemorrhage secondary to arterial invasion in a dog with thyroid carcinoma.

PubMed

Slensky, Kimberly A; Volk, Susan W; Schwarz, Tobias; Duda, Lili; Mauldin, Elizabeth A; Silverstein, Deborah

2003-09-01

A 7-year-old spayed female Labrador Retriever was referred because of progressive swelling and bruising of the neck, hemothorax, a possible mediastinal mass, and stridor. At the time of admission, the dog was recumbent, mentally dull, tachycardic, and hypothermic. Fluid therapy with hydroxyethyl starch and a balanced electrolyte solution was administered because of presumed hypovolemic shock secondary to hemorrhage; multiple units of packed RBCs and fresh frozen plasma were also administered. On the basis of the computed tomographic images, extensive subcutaneous, subfascial, and cranial mediastinal hemorrhage; hemothorax; prescapular lymphadenopathy; and a contrast-enhancing mass in the left cranioventral aspect of the neck were diagnosed. Exploratory surgery of the neck was performed. All subcutaneous structures were encased in a large blood clot. During dissection of the clot, pulsatile bleeding was observed just caudal to and to the left of the larynx; ligation of the left common carotid artery resulted in immediate cessation of the pulsatile bleeding. Further surgical exploration revealed a 2.5 x 2.5-cm mass adhered to the left common carotid artery at the level of the branching to the left cranial thyroid artery. The mass was removed; the histologic diagnosis was thyroid carcinoma. Three weeks after surgery, treatment with a combination of radiation and chemotherapy (doxorubicin and carboplatin) was begun. Thirteen months after surgery, the dog continued to be free from clinical signs of disease.

Gender Differences in Regional Brain Activity in Patients with Chronic Primary Insomnia: Evidence from a Resting-State fMRI Study.

PubMed

Dai, Xi-Jian; Nie, Xiao; Liu, Xuming; Pei, Li; Jiang, Jian; Peng, De-chang; Gong, Hong-Han; Zeng, Xian-Jun; Wáng, Yì-Xiáng J; Zhan, Yang

2016-03-01

To explore the regional brain activities in patients with chronic primary insomnia (PCPIs) and their sex differences. Forty-two PCPIs (27 females, 15 males) and 42 good sleepers (GSs; 24 females, 18 males) were recruited. Six PCPIs (3 males, 3 females) were scanned twice by MRI to examine the test-retest reliability. Amplitude of low frequency fluctuation (ALFF) method was used to assess the local brain features. The mean signal values of the different ALFF areas were analyzed with a receiver operating characteristic (ROC) curve. Simple linear regression analysis was performed to investigate the relationships between clinical features and different brain areas. Both female and male PCPIs showed higher ALFF in the temporal lobe and occipital lobe, especially in female PCPIs. Female PCPIs had lower ALFF in the bilateral cerebellum posterior lobe, left dorsolateral prefrontal cortex, and bilateral limbic lobe; however, male PCPIs showed lower ALFF in the left occipital gyrus. The mean signal value of the cerebellum in female PCPIs showed negative correlations with negative emotions. Compared with male PCPIs, female PCPIs showed higher ALFF in the bilateral middle temporal gyrus and lower ALFF in the left limbic lobe. The different areas showed high test-retest stability (Clusters of contiguous volumes ≥ 1080 mm(3) with an intraclass correlation coefficient ≥ 0.80) and high degree of sensitivity and specificity. Female PCPIs showed more regional brain differences with higher and lower ALFF responses than male PCPIs. However, they shared analogous excessive hyperarousal mechanism and wide variations in aberrant brain areas. © 2016 American Academy of Sleep Medicine.

Changes in spontaneous brain activity in early Parkinson's disease.

PubMed

Yang, Hong; Zhou, Xiaohong Joe; Zhang, Min-Ming; Zheng, Xu-Ning; Zhao, Yi-Lei; Wang, Jue

2013-08-09

Resting state brain activity can provide valuable insights into the pathophysiology of Parkinson's disease (PD). The purpose of the present study was (a) to investigate abnormal spontaneous neuronal activity in early PD patients using resting-state functional MRI (fMRI) with a regional homogeneity (ReHo) method and (b) to demonstrate the potential of using changes in abnormal spontaneous neuronal activity for monitoring the progression of PD during its early stages. Seventeen early PD patients were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), the Hoehn and Yahr disability scale and the Mini-mental State Examination (MMSE) were compared with seventeen gender- and age-matched healthy controls. All subjects underwent MRI scans using a 1.5T General Electric Signa Excite II scanner. The MRI scan protocol included whole-brain volumetric imaging using a 3D inversion recovery prepared (IR-Prep) fast spoiled gradient-echo pulse sequence and 2D multi-slice (22 axial slices covering the whole brain) resting-state fMRI using an echo planar imaging (EPI) sequence. Images were analyzed in SPM5 together with a ReHo algorithm using the in-house software program REST. A corrected threshold of p<0.05 was determined by AlphaSim and used in statistical analysis. Compared with the healthy controls, the early PD group showed significantly increased ReHo in a number of brain regions, including the left cerebellum, left parietal lobe, right middle temporal lobe, right sub-thalamic nucleus areas, right superior frontal gyrus, middle frontal gyrus (MFG), right inferior parietal lobe (IPL), right precuneus lobe, left MFG and left IPL. Additionally, significantly reduced ReHo was also observed in the early PD patients in the following brain regions: the left putamen, left inferior frontal gyrus, right hippocampus, right anterior cingulum, and bilateral lingual gyrus. Moreover, in PD patients, ReHo in the left putamen was negatively correlated with the UPDRS scores (r=-0.69). These results indicate that the abnormal resting state spontaneous brain activity associated with patients with early PD can be revealed by Reho analysis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Metastases of breast cancer to the thyroid gland in two patients - a case report.

PubMed

Skowrońska-Jóźwiak, Elżbieta; Krawczyk-Rusiecka, Kinga; Adamczewski, Zbigniew; Sporny, Stanisław; Zadrożny, Marek; Dedecjus, Marek; Brzeziński, Jan; Lewiński, Andrzej

2010-01-01

Metastatic cancer is rarely found in the thyroid (only 2-3% of malignant tumours found in that gland); primary sources usually including breast, kidney, and lung tumours. Two cases of advanced breast cancer with thyroid metastases in female patients are presented. The similarities between these two cases included: 1) postmenopausal age; 2) diagnosis based on result of FNAB (numerous groups of cells with epithelial phenotype strongly implying metastatic breast cancer); 3) thyroid function - overt hyperthyroidism in the first woman and subclinical hyperthyroidism in the second one; 4) the presence of nodular goitre in clinical examination, the occurrence of many nodular solid normoechogenic lesions with calcifications in both thyroid lobes in US; and 5) negative antithyroid antibodies. The main difference was the time of establishing diagnosis; in the first woman - before mammectomy, parallel to diagnostics of breast tumour, and in the second woman four years after mammectomy, during cancer dissemination (with right pleural effusion and lung metastasis). In the first case, mammectomy was followed two weeks later by thyroidectomy. The second patient was disqualified from thyroid surgery due to systemic metastatic disease. 1. Fine needle aspiration biopsy of the thyroid gland should obligatorily be performed in patients with breast cancer and nodular goitre, even without any clinical data of metastatic disease. 2. The clinical context of cytological findings is of critical value. 3. In patients with breast cancer accompanied by multinodular goitre, we recommend that more punctures be performed during FNAB than is routinely done. (

Left inferior parietal lobe engagement in social cognition and language

PubMed Central

Bzdok, Danilo; Hartwigsen, Gesa; Reid, Andrew; Laird, Angela R.; Fox, Peter T.; Eickhoff, Simon B.

2017-01-01

Social cognition and language are two core features of the human species. Despite distributed recruitment of brain regions in each mental capacity, the left parietal lobe (LPL) represents a zone of topographical convergence. The present study quantitatively summarizes hundreds of neuroimaging studies on social cognition and language. Using connectivity-based parcellation on a meta-analytically defined volume of interest (VOI), regional coactivation patterns within this VOI allowed identifying distinct subregions. Across parcellation solutions, two clusters emerged consistently in rostro-ventral and caudo-ventral aspects of the parietal VOI. Both clusters were functionally significantly associated with social-cognitive and language processing. In particular, the rostro-ventral cluster was associated with lower-level processing facets, while the caudo-ventral cluster was associated with higher-level processing facets in both mental capacities. Contrarily, in the (less stable) dorsal parietal VOI, all clusters reflected computation of general-purpose processes, such as working memory and matching tasks, that are frequently co-recruited by social or language processes. Our results hence favour a rostro-caudal distinction of lower-versus higher-level processes underlying social cognition and language in the left inferior parietal lobe. PMID:27241201

Hepatic Hemodynamics and Portal Flow Modulation: The A2ALL Experience.

PubMed

Emond, Jean C; Goodrich, Nathan P; Pomposelli, James J; Baker, Talia B; Humar, Abhinav; Grant, David R; Abt, Peter; Friese, Chris E; Fisher, Robert A; Kam, Igal; Sherker, Averell H; Gillespie, Brenda W; Merion, Robert M

2017-10-01

A principal aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study was to study hepatic blood flow and effect of portal flow modulation on graft outcomes in the setting of increasing use of smaller and left lobe grafts. Recipients of 274 living donor liver transplant were enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, including 233 (85.0%) right lobes, 40 (14.6%) left lobes, and 1 (0.5%) left lateral section. Hepatic hemodynamics were recorded after reperfusion. A total of 57 portal flow modulations were performed on 52 subjects. Modulation lowered portal pressure in 68% of subjects with inconsistent effects on hepatic arterial and portal flow. A higher rate of graft dysfunction was observed in modulated vs. unmodulated subjects (31% vs. 18%; P = 0.03); however, graft survival in modulated subjects was not different from unmodulated subjects at 3 years. These results suggest the need for a study using a prespecified portal flow modulation protocol with defined indications to better define the effects of these interventions.

Exploring the roles of spectral detail and intonation contour in speech intelligibility: an FMRI study.

PubMed

Kyong, Jeong S; Scott, Sophie K; Rosen, Stuart; Howe, Timothy B; Agnew, Zarinah K; McGettigan, Carolyn

2014-08-01

The melodic contour of speech forms an important perceptual aspect of tonal and nontonal languages and an important limiting factor on the intelligibility of speech heard through a cochlear implant. Previous work exploring the neural correlates of speech comprehension identified a left-dominant pathway in the temporal lobes supporting the extraction of an intelligible linguistic message, whereas the right anterior temporal lobe showed an overall preference for signals clearly conveying dynamic pitch information [Johnsrude, I. S., Penhune, V. B., & Zatorre, R. J. Functional specificity in the right human auditory cortex for perceiving pitch direction. Brain, 123, 155-163, 2000; Scott, S. K., Blank, C. C., Rosen, S., & Wise, R. J. Identification of a pathway for intelligible speech in the left temporal lobe. Brain, 123, 2400-2406, 2000]. The current study combined modulations of overall intelligibility (through vocoding and spectral inversion) with a manipulation of pitch contour (normal vs. falling) to investigate the processing of spoken sentences in functional MRI. Our overall findings replicate and extend those of Scott et al. [Scott, S. K., Blank, C. C., Rosen, S., & Wise, R. J. Identification of a pathway for intelligible speech in the left temporal lobe. Brain, 123, 2400-2406, 2000], where greater sentence intelligibility was predominately associated with increased activity in the left STS, and the greatest response to normal sentence melody was found in right superior temporal gyrus. These data suggest a spatial distinction between brain areas associated with intelligibility and those involved in the processing of dynamic pitch information in speech. By including a set of complexity-matched unintelligible conditions created by spectral inversion, this is additionally the first study reporting a fully factorial exploration of spectrotemporal complexity and spectral inversion as they relate to the neural processing of speech intelligibility. Perhaps surprisingly, there was little evidence for an interaction between the two factors-we discuss the implications for the processing of sound and speech in the dorsolateral temporal lobes.

The association between hemispheric specialization for language production and for spatial attention depends on left-hand preference strength.

PubMed

Zago, Laure; Petit, Laurent; Mellet, Emmanuel; Jobard, Gaël; Crivello, Fabrice; Joliot, Marc; Mazoyer, Bernard; Tzourio-Mazoyer, Nathalie

2016-12-01

Cerebral lateralization for language production and spatial attention and their relationships with manual preference strength (MPS) were assessed in a sample of 293 healthy volunteers, including 151 left-handers, using fMRI during covert sentence production (PROD) and line bisection judgment (LBJ) tasks, as compared to high- and low-level reference tasks. At the group level, we found the expected complementary hemispheric specialization (HS) with leftward asymmetries for PROD within frontal and temporal regions and rightward asymmetries for LBJ within frontal and posterior occipito-parieto-temporal regions. Individual hemispheric (HLI) and regional (frontal and occipital) lateralization indices (LI) were then calculated on the activation maps for PROD and LBJ. We found a correlation between the degree of rightward cerebral asymmetry and the leftward behavioral attentional bias recorded during LBJ task. This correlation was found when LBJ-LI was computed over the hemispheres, in the frontal lobes, but not in the occipital lobes. We then investigated whether language production and spatial attention cerebral lateralization relate to each other, and whether manual preference was a variable that impacted the complementary HS of these functions. No correlation was found between spatial and language LIs in the majority of our sample of participants, including right-handers with a strong right-hand preference (sRH, n=97) and mixed-handers (MH, n=97), indicating that these functions lateralized independently. By contrast, in the group of left-handers with a strong left-hand preference (sLH, n= 99), a negative correlation was found between language and spatial lateralization. This negative correlation was found when LBJ-LI and PROD-LI were computed over the hemispheres, in the frontal lobes and between the occipital lobes for LBJ and the frontal lobes for PROD. These findings underline the importance to include sLH in the study sample to reveal the underlying mechanisms of complementary HS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Persistent post-traumatic headache vs. migraine: an MRI study demonstrating differences in brain structure.

PubMed

Schwedt, Todd J; Chong, Catherine D; Peplinski, Jacob; Ross, Katherine; Berisha, Visar

2017-08-22

The majority of individuals with post-traumatic headache have symptoms that are indistinguishable from migraine. The overlap in symptoms amongst these individuals raises the question as to whether post-traumatic headache has a unique pathophysiology or if head trauma triggers migraine. The objective of this study was to compare brain structure in individuals with persistent post-traumatic headache (i.e. headache lasting at least 3 months following a traumatic brain injury) attributed to mild traumatic brain injury to that of individuals with migraine. Twenty-eight individuals with persistent post-traumatic headache attributed to mild traumatic brain injury and 28 individuals with migraine underwent brain magnetic resonance imaging on a 3 T scanner. Regional volumes, cortical thickness, surface area and curvature measurements were calculated from T1-weighted sequences and compared between subject groups using ANCOVA. MRI data from 28 healthy control subjects were used to interpret the differences in brain structure between migraine and persistent post-traumatic headache. Differences in regional volumes, cortical thickness, surface area and brain curvature were identified when comparing the group of individuals with persistent post-traumatic headache to the group with migraine. Structure was different between groups for regions within the right lateral orbitofrontal lobe, left caudal middle frontal lobe, left superior frontal lobe, left precuneus and right supramarginal gyrus (p < .05). Considering these regions only, there were differences between individuals with persistent post-traumatic headache and healthy controls within the right lateral orbitofrontal lobe, right supramarginal gyrus, and left superior frontal lobe and no differences when comparing the migraine cohort to healthy controls. In conclusion, persistent post-traumatic headache and migraine are associated with differences in brain structure, perhaps suggesting differences in their underlying pathophysiology. Additional studies are needed to further delineate similarities and differences in brain structure and function that are associated with post-traumatic headache and migraine and to determine their specificity for each of the headache types.

Three-dimensional vasculature of the bovine liver.

PubMed

Shirai, W; Sato, T; Shibuya, H; Naito, K; Tsukise, A

2005-12-01

To clarify anatomical distribution of Fasciola infection, the vascular and ductal architectures of the liver were studied by means of corrosion cast technique using synthetic resin. The arteria hepatica propria (AP) passes as the arteria gastroduodenalis (AG); AP becomes the left trunk after the porta hepatis; AP passes on the right side of vena porta communis (VPC) and projects AG while curving in a U-shape below the portal vein. Hepatic veins located between the vena hepatica media (HM) and vena hepatica dextra (HD) varied widely among specimens and were irregular, including the vena hepatica dorso-lateralis sinistra (Hds), vena hepatica dorso-lateralis dextra (Hdd), vena hepatica lobi caudati (Hlc), venae hepaticae processus caudati (Hpc), venae hepaticae processus papillaris (Hpp), and the hepatic vein to the dorsal intermediate part, which directly or indirectly drained into the vena cava caudalis. The courses of the bovine hepatic veins were markedly diverse, and anastomoses between vena hepatica sinistra (HS) and Hds were observed in about a half of the livers. The portal vein entered the liver as VPC slightly above the centre of the right lobe on the visceral surface. The intermediate or transverse part [pars transversa trunci sinistri (PTS)] of truncus sinister (TS), which extends from the entry of the portal vein into the left lobe of the liver, was slightly arched downward [pars umbilicalis trunci sinistri (PUS)]. The portal vein further arched from the distal end of TS to the umbilical vein and ran towards the inter-lobar incision between the left lobe and quadrate lobe. Based on these branches, hepatic segments were determined as 13 or 14 areas. A total of 15 bile ducts were derived from various lobes. The hepatic duct was about 2.6-6 cm long from the confluence of the right and left hepatic ducts to the division of the cystic duct and the common hepatic duct.

Breast cancer metastases to the thyroid gland - an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature.

PubMed

Plonczak, Agata M; DiMarco, Aimee N; Dina, Roberto; Gujral, Dorothy M; Palazzo, Fausto F

2017-09-22

Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature. A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy. A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally indicates poor prognosis, obviating the need of surgery in an already compromised patient. An empirical thyroidectomy should be considered in select patients for local disease control.

Preoperative assessment of confrontation naming ability and interictal paraphasia production in unilateral temporal lobe epilepsy.

PubMed

Schefft, Bruce K; Testa, S Marc; Dulay, Mario F; Privitera, Michael D; Yeh, Hwa-Shain

2003-04-01

The present study examined the diagnostic utility of confrontation naming tasks and phonemic paraphasia production in lateralizing the epileptogenic region in patients with temporal lobe epilepsy (TLE). Further, the role of intelligence in moderating the diagnostic utility of confrontation naming tasks was assessed. Eighty patients with medically intractable complex partial seizures (40 left TLE, 40 right TLE) received the Boston Naming Test (BNT) and the Visual Naming subtest (VNT) of the Multilingual Aphasia Examination. The BNT was diagnostically more sensitive than the VNT in identifying left TLE (77.5% vs 17.5%, respectively). The utility of BNT performance and paraphasias was maximal in patients with Full Scale IQs >or=90 who were 6.8 times more likely to have left TLE than patients without paraphasias. Preoperative assessment of confrontation naming ability and phonemic paraphasia production using the BNT provided diagnostically useful information in lateralizing the epileptogenic region in left TLE.

[Dynamics of functional MRI and speech function in patients after resection of frontal and temporal lobe tumors].

PubMed

Buklina, S B; Batalov, A I; Smirnov, A S; Poddubskaya, A A; Pitskhelauri, D I; Kobyakov, G L; Zhukov, V Yu; Goryaynov, S A; Kulikov, A S; Ogurtsova, A A; Golanov, A V; Varyukhina, M D; Pronin, I N

There are no studies on application of functional MRI (fMRI) for long-term monitoring of the condition of patients after resection of frontal and temporal lobe tumors. The study purpose was to correlate, using fMRI, reorganization of the speech system and dynamics of speech disorders in patients with left hemisphere gliomas before surgery and in the early and late postoperative periods. A total of 20 patients with left hemisphere gliomas were dynamically monitored using fMRI and comprehensive neuropsychological testing. The tumor was located in the frontal lobe in 12 patients and in the temporal lobe in 8 patients. Fifteen patients underwent primary surgery; 5 patients had repeated surgery. Sixteen patients had WHO Grade II and Grade III gliomas; the others had WHO Grade IV gliomas. Nineteen patients were examined preoperatively; 20 patients were examined at different times after surgery. Speech functions were assessed by a Luria's test; the dominant hand was determined using the Annette questionnaire; a family history of left-handedness was investigated. Functional MRI was performed on an HDtx 3.0 T scanner using BrainWavePA 2.0, Z software for fMRI data processing program for all calculations >7, p<0.001. In patients with extensive tumors and recurrent tumors, activation of right-sided homologues of the speech areas cold be detected even before surgery; but in most patients, the activation was detected 3 months or more after surgery. Therefore, reorganization of the speech system took time. Activation of right-sided homologues of the speech areas remained in all patients for up to a year. Simultaneous activation of right-sided homologues of both speech areas, the Broca's and Wernicke's areas, was detected more often in patients with frontal lobe tumors than in those with temporal lobe tumors. No additional activation foci in the left hemisphere were found at the thresholds used to process fMRI data. Recovery of the speech function, to a certain degree, occurred in all patients, but no clear correlation with fMRI data was found. Complex fMRI and neuropsychological studies in 20 patients after resection of frontal and temporal lobe tumors revealed individual features of speech system reorganization within one year follow-up. Probably, activation of right-sided homologues of the speech areas in the presence of left hemisphere tumors depends not only on the severity of speech disorder but also reflects individual involvement of the right hemisphere in enabling speech function. This is confirmed by right-sided activation, according to the fMRI data, in right-sided patients without aphasia and, conversely, the lack of activation of right-sided homologues of the speech areas in several patients with severe postoperative speech disorders during the entire follow-up period.

Cognitive consequences of coexisting temporal lobe developmental malformations and hippocampal sclerosis.

PubMed

Martin, R; Dowler, R; Gilliam, F; Faught, E; Morawetz, R; Kuzniecky, R

1999-09-11

To characterize patterns of cognitive functioning in a well-defined group of patients with MRI-identified coexisting left temporal lobe developmental malformations (TLDM) and mesial temporal sclerosis (MTS), and to examine neuropsychological outcome in this dual-pathology group following epilepsy surgery. Cognitive functioning in patients with left TLDM and MTS (n = 15) was compared with patients with isolated left MTS (n = 40). TLDM and MTS were identified by high-quality MRI protocol. Patients were administered a battery of neuropsychology tests as part of their presurgical workup for possible epilepsy surgery. Unilateral temporal lobe resection was performed on 10 of the dual-pathology patients and 34 of the isolated MTS patients. Postoperative cognitive performance was also assessed. Both groups displayed impairments in verbal and visual memory, language, and academic achievement. Performance on measures of psychometric intelligence, executive function, and attention were not impaired and were similar between groups. Presence of dual pathology was associated with a significantly less efficient verbal encoding strategy on the word list learning task. Postoperatively, declines were noted for both groups across tasks of verbal memory and language. Groups were not different significantly in terms of neuropsychological outcome after surgery. Patients with coexisting TLDM and MTS have impaired cognitive functioning similar to MTS patients-in particular, with regard to episodic memory and language deficits. Temporal lobe resection produces similar cognitive changes in both groups.

[Iodine 131 joint radio frequency ablation treatment for child with hyperthyroidism goiter: one case report].

PubMed

Chen, Yonghua; Liang, Li; Fang, Yanlan; Wang, Chunlin; Li, Linfa; Jiang, Tian'an

2017-01-25

A 12-year-old girl presented with a history of cervical mass, and one week of throat discomfort and dyspnea. Five years ago, the patient was diagnosed as Hashimoto's thyroiditis and hyperthyroidism; she received antithyroid drug treatment, but the result was not satisfactory. B-ultrasonic showed that the size of thyroid gland was 8.1 cm×3.2 cm in the left and 8.2 cm×4.8 cm in the right. After iodine 131 combined with radiofrequency ablation (RFA) treatment, throat discomfort and recumbent breathing difficulties disappeared, and B-ultrasonic showed that the size of thyroid reduced to 2.3 cm×1.7 cm (left) and 2.8 cm×2.0 cm (right). No recurrence was observed during the two and a half years of follow-up.

Epilepsy surgery in the elderly: an unusual case of a 75-year-old man with recurrent status epilepticus.

PubMed

Tellez-Zenteno, Jose F; Sadanand, Venkatraman; Riesberry, Martha; Robinson, Christopher A; Ogieglo, Lissa; Masiowski, Paul; Vrbancic, Mirna

2009-06-01

Epilepsy surgery is increasingly well-supported as an effective treatment for patients with intractable epilepsy. It is most often performed on younger patients and the safety and efficacy of epilepsy surgery in elderly patients are not frequently described. We report a case of a 75-year-old right-handed man who underwent a left fronto-temporal craniotomy for resection of a suprasellar meningioma in 2002. Immediately following hospital discharge, he began to experience complex partial seizures. He continued to have frequent seizures despite treatment with multiple combinations of antiepileptic medications. He presented with status epilepticus every two or three months, and required long periods of hospitalization on each occasion for post-ictal confusion and aphasia. Scalp EEG showed continuous spikes and polyspikes and persistent slowing in the left temporal area, as well as spikes in the left frontal area. EEG telemetry recorded multiple seizures, all with a clear focus in the left temporal area. MRI scan showed an area of encephalomalacia in the left temporal lobe, as well as post-surgical changes in the left frontal area. Neuropsychological testing showed bilateral memory impairment with no significant cognitive decline expected after unilateral temporal lobe resection. A left anteromesial temporal lobectomy was performed with intraoperative electrocorticography. Since surgery, the patient was not seizure-free (Engel class II-b), but had no further episodes of status epilepticus in one year and two months of follow-up. This is one of the oldest patients reported in the literature with epilepsy surgery and supports the possibility of epilepsy surgery in elderly patients for particular cases. In addition, few cases with such a malignant evolution of temporal lobe epilepsy have been described in this age group.

Impaired cerebral blood flow networks in temporal lobe epilepsy with hippocampal sclerosis: A graph theoretical approach.

PubMed

Sone, Daichi; Matsuda, Hiroshi; Ota, Miho; Maikusa, Norihide; Kimura, Yukio; Sumida, Kaoru; Yokoyama, Kota; Imabayashi, Etsuko; Watanabe, Masako; Watanabe, Yutaka; Okazaki, Mitsutoshi; Sato, Noriko

2016-09-01

Graph theory is an emerging method to investigate brain networks. Altered cerebral blood flow (CBF) has frequently been reported in temporal lobe epilepsy (TLE), but graph theoretical findings of CBF are poorly understood. Here, we explored graph theoretical networks of CBF in TLE using arterial spin labeling imaging. We recruited patients with TLE and unilateral hippocampal sclerosis (HS) (19 patients with left TLE, and 21 with right TLE) and 20 gender- and age-matched healthy control subjects. We obtained all participants' CBF maps using pseudo-continuous arterial spin labeling and analyzed them using the Graph Analysis Toolbox (GAT) software program. As a result, compared to the controls, the patients with left TLE showed a significantly low clustering coefficient (p=0.024), local efficiency (p=0.001), global efficiency (p=0.010), and high transitivity (p=0.015), whereas the patients with right TLE showed significantly high assortativity (p=0.046) and transitivity (p=0.011). The group with right TLE also had high characteristic path length values (p=0.085), low global efficiency (p=0.078), and low resilience to targeted attack (p=0.101) at a trend level. Lower normalized clustering coefficient (p=0.081) in the left TLE and higher normalized characteristic path length (p=0.089) in the right TLE were found also at a trend level. Both the patients with left and right TLE showed significantly decreased clustering in similar areas, i.e., the cingulate gyri, precuneus, and occipital lobe. Our findings revealed differing left-right network metrics in which an inefficient CBF network in left TLE and vulnerability to irritation in right TLE are suggested. The left-right common finding of regional decreased clustering might reflect impaired default-mode networks in TLE. Copyright © 2016 Elsevier Inc. All rights reserved.

Recovery of injured Broca's portion of arcuate fasciculus in the dominant hemisphere in a patient with traumatic brain injury.

PubMed

Jang, Sung Ho; Ha, Ji Wan; Kim, Hyun Young; Seo, You Sung

2017-12-01

Recovery of injured AF in patients with traumatic brain injury (TBI) has not been reported. In this study, we report on a patient with TBI who recovered from an injury to Broca's portion of AF in the dominant hemisphere, diagnosed by diffusion tensor tractography (DTT). A 28-year-old right-handed male patient suffered head trauma resulting from sliding while riding a motorcycle. He was diagnosed with a traumatic contusional hemorrhage in the left frontal lobe, subarachnoid hemorrhage, and subdural hemorrhage in the left fronto-temporal lobe. He underwent craniectomy on the left fronto-temporal area, and hematoma removal for the subdural hemorrhage in the neurosurgery department of a university hospital. Two weeks after the injury, he was transferred to the rehabilitation department of another university hospital. He showed severe aphasia and brain MRI showed leukomalactic lesion in the left frontal lobe. The result WAB for the patient showed severe aphasia, with an aphasia quotient of 45.3 percentile. However, his aphasia improved rapidly by 9 months with an aphasia quotient at the 100.0 percentile. 2-week DTT detected discontinuity in the subcortical white matter at the branch to Broca's area of left AF. By contrast, on 9-month DTT, the discontinued portion of left AF was elongated to the left Broca's area. Recovery of injured Broca's portion of AF in the dominant hemisphere along with excellent improvement of aphasia was demonstrated in a patient with TBI. This study has important implications in brain rehabilitation because the mechanism of recovery from aphasia following TBI has not been elucidated. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Alteration of functional connectivity within visuospatial working memory-related brain network in patients with right temporal lobe epilepsy: a resting-state fMRI study.

PubMed

Lv, Zong-xia; Huang, Dong-Hong; Ye, Wei; Chen, Zi-rong; Huang, Wen-li; Zheng, Jin-ou

2014-06-01

This study aimed to investigate the resting-state brain network related to visuospatial working memory (VSWM) in patients with right temporal lobe epilepsy (rTLE). The functional mechanism underlying the cognitive impairment in VSWM was also determined. Fifteen patients with rTLE and 16 healthy controls matched for age, gender, and handedness underwent a 6-min resting-state functional MRI session and a neuropsychological test using VSWM_Nback. The VSWM-related brain network at rest was extracted using multiple independent component analysis; the spatial distribution and the functional connectivity (FC) parameters of the cerebral network were compared between groups. Behavioral data were subsequently correlated with the mean Z-value in voxels showing significant FC difference during intergroup comparison. The distribution of the VSWM-related resting-state network (RSN) in the group with rTLE was virtually consistent with that in the healthy controls. The distribution involved the dorsolateral prefrontal lobe and parietal lobe in the right hemisphere and the partial inferior parietal lobe and posterior lobe of the cerebellum in the left hemisphere (p<0.05, AlphaSim corrected). Between-group differences suggest that the group with rTLE had a decreased FC within the right superior frontal lobe (BA8), right middle frontal lobe, and right ventromedial prefrontal lobe compared with the controls (p<0.05, AlphaSim corrected). The regions of increased FC in rTLE were localized within the right superior frontal lobe (BA11), right superior parietal lobe, and left posterior lobe of the cerebellum (p<0.05, AlphaSim corrected). Moreover, patients with rTLE performed worse than controls in the VSWM_Nback test, and there were negative correlations between ACCmeanRT (2-back) and the mean Z-value in the voxels showing decreased or increased FC in rTLE (p<0.05). The results suggest that the alteration of the VSWM-related RSN might underpin the VSWM impairment in patients with rTLE and possibly implies a functional compensation by enlarging the FC within the ipsilateral cerebral network. Copyright © 2014 Elsevier Inc. All rights reserved.

Laparoscopic anatomy of the equine abdomen.

PubMed

Galuppo, L D; Snyder, J R; Pascoe, J R

1995-04-01

Laparoscopy was performed on 6 horses (2 mares, 2 geldings, 2 stallions) to determine the normal laparoscopic anatomy of the equine abdomen. After withholding feed for 36 hours, horses were examined from the left and right paralumbar fossae, and the visceral anatomic structures were recorded by videotape and photography. One mare developed emphysema located subcutaneously at the primary laparoscopic portal; otherwise, there were no complications. The anatomic structures of diagnostic importance that were observed in the left half of the abdomen were the hepatic duct; left lateral and quadrate lobes of the liver; stomach; spleen; left kidney with the associated nephrosplenic ligament; segments of jejunum, descending colon, and ascending colon; left side of the male and female reproductive tracts; urinary bladder; vaginal ring; and mesorchium. Important structures observed in the right side of the abdomen were portions of the common hepatic duct; left lateral, quadrate, and right lobes of the liver; caudate process of the liver; stomach; duodenum; right dorsal colon, epiploic foramen; omental bursa; right kidney; base of the cecum; segments of jejunum, descending colon, and ascending colon; urinary bladder; right half of the male and female reproductive tracts; and rectum.

Quantification of incidental mediastinal and hilar irradiation delivered during definitive stereotactic body radiation therapy for peripheral non-small cell lung cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martin, Kate L.; Gomez, Jorge; Nazareth, Daryl P.

2012-07-01

To determine the amount of incidental radiation dose received by the mediastinal and hilar nodes for patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Fifty consecutive patients with NSCLC, treated using an SBRT technique, were identified. Of these patients, 38 had a prescription dose of 60 Gy in 20-Gy fractions and were eligible for analysis. For each patient, ipsilateral upper (level 2) and lower (level 4) paratracheal, and hilar (level 10) nodal regions were contoured on the planning computed tomography (CT) images. Using the clinical treatment plan, dose and volume calculations were performed retrospectivelymore » for each nodal region. SBRT to upper lobe tumors resulted in an average total ipsilateral mean dose of between 5.2 and 7.8 Gy for the most proximal paratracheal nodal stations (2R and 4R for right upper lobe lesions, 2L and 4L for left upper lobe lesions). SBRT to lower lobe tumors resulted in an average total ipsilateral mean dose of between 15.6 and 21.5 Gy for the most proximal hilar nodal stations (10R for right lower lobe lesions, 10 l for left lower lobe lesions). Doses to more distal nodes were substantially lower than 5 Gy. The often substantial incidental irradiation, delivered during SBRT for peripheral NSCLC of the lower lobes to the most proximal hilar lymph nodes may be therapeutic for low-volume, subclinical nodal disease. Treatment of peripheral upper lobe lung tumors delivers less incidental irradiation to the paratracheal lymph nodes with lower likelihood of therapeutic benefit.« less

Decreasing Temporal Lobe Dose With Five-Field Intensity-Modulated Radiotherapy for Treatment of Pituitary Macroadenomas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parhar, Preeti K.; Duckworth, Tamara; Shah, Parinda

2010-10-01

Purpose: To compare temporal lobe dose delivered by three pituitary macroadenoma irradiation techniques: three-field three-dimensional conformal radiotherapy (3D-CRT), three-field intensity-modulated radiotherapy (3F IMRT), and a proposed novel alternative of five-field IMRT (5F IMRT). Methods and Materials: Computed tomography-based external beam radiotherapy planning was performed for 15 pituitary macroadenoma patients treated at New York University between 2002 and 2007 using: 3D-CRT (two lateral, one midline superior anterior oblique [SAO] beams), 3F IMRT (same beam angles), and 5F IMRT (same beam angles with additional right SAO and left SAO beams). Prescription dose was 45 Gy. Target volumes were: gross tumor volume (GTV)more » = macroadenoma, clinical target volume (CTV) = GTV, and planning target volume = CTV + 0.5 cm. Structure contouring was performed by two radiation oncologists guided by an expert neuroradiologist. Results: Five-field IMRT yielded significantly decreased temporal lobe dose delivery compared with 3D-CRT and 3F IMRT. Temporal lobe sparing with 5F IMRT was most pronounced at intermediate doses: mean V25Gy (% of total temporal lobe volume receiving {>=}25 Gy) of 13% vs. 28% vs. 29% for right temporal lobe and 14% vs. 29% vs. 30% for left temporal lobe for 5F IMRT, 3D-CRT, and 3F IMRT, respectively (p < 10{sup -7} for 5F IMRT vs. 3D-CRT and 5F IMRT vs. 3F IMRT). Five-field IMRT plans did not compromise target coverage, exceed normal tissue dose constraints, or increase estimated brain integral dose. Conclusions: Five-field IMRT irradiation technique results in a statistically significant decrease in the dose to the temporal lobes and may thus help prevent neurocognitive sequelae in irradiated pituitary macroadenoma patients.« less

Treatment of Proper Name Retrieval Deficits in an Individual with Temporal Lobe Epilepsy

ERIC Educational Resources Information Center

Minkina, Irene; Ojemann, Jeffrey G.; Grabowski, Thomas J.; Silkes, JoAnn P.; Phatak, Vaishali; Kendall, Diane L.

2013-01-01

Purpose: Studies investigating language deficits in individuals with left temporal-lobe epilepsy have consistently demonstrated impairments in proper name retrieval. The aim of this Phase I rehabilitation study was to investigate the effects of a linguistically distributed word retrieval treatment on proper name retrieval in an individual with…

Magnitude of Cerebral Asymmetry at Rest: Covariation with Baseline Cardiovascular Activity

ERIC Educational Resources Information Center

Foster, Paul S.; Harrison, David W.

2006-01-01

The cerebral regulation of cardiovascular functioning varies along both a lateral and a longitudinal axis. The parasympathetic and sympathetic nervous systems are lateralized to the left and right cerebral hemispheres, respectively. Further, the frontal lobes are known to be inhibitory in nature, whereas the temporal lobes are excitatory. However,…

An unusual case of cerebral penetrating injury by a driven bone fragment secondary to blunt head trauma.

PubMed

Lee, Jae Il; Ko, Jun Kyeung; Cha, Seung Heon; Han, In Ho

2011-12-01

Temple trauma that appears initially localized to the skin might possess intracranial complications. Early diagnosis and management of such complications are important, to avoid neurologic sequelae. Non-penetrating head injuries with intracranial hemorrhage caused by a driven bone fragment are extremely rare. A 53-year-old male was referred to our hospital because of intracerebral hemorrhage. He was a mechanic and one day before admission to a local clinic, tip of metallic rod hit his right temple while cutting the rod. Initial brain computed tomography (CT) and magnetic resonance imaging demonstrated scanty subdural hematoma at right temporal lobe and left falx and intracerebral hematoma at both frontal lobes. Facial CT with 3-D reconstruction images showed a small bony defect at the right sphenoid bone's greater wing and a small bone fragment at the left frontal lobe, crossing the falx. We present the unusual case of a temple trauma patient in whom a sphenoid bone fragment migrated from its origin upward, to the contralateral frontal lobe, producing hematoma along its trajectory.

Cytological Diagnosis of an Uncommon High Grade Malignant Thyroid Tumour: A Case Report.

PubMed

Nagpal, Ruchi; Kaushal, Manju; Kumar, Sawan

2017-07-01

Anaplastic Thyroid Carcinoma (ATC) is a relatively uncommon highly malignant tumour originating from the follicular cells of thyroid gland having poor prognosis. It accounts for 2% to 5% of all thyroid carcinomas and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 53-year-old male presented with diffuse neck swelling measuring 8x6 cm and right cervical lymph node measuring 2x2 cm since one month which was associated with dyspepsia and dyspnoea. Ultrasound and Contrast Enhanced Computed Tomography (CECT) neck revealed enlarged right lobe of thyroid and multiple enlarged cervical lymph nodes with soft tissue density nodules in bilateral lungs. Fine Needle Aspiration (FNA) from the swelling revealed giant cell, spindle cell and squamoid pattern. Focal areas showed follicular epithelial cells arranged in repeated microfollicular pattern suggesting an underlying follicular neoplasm. FNAC smears from the lymph node also revealed similar findings. Based on the cytomorphological and radiological findings, final diagnosis of ATC probably arising from underlying follicular carcinoma with cervical lymph node and lung metastasis was given. FNAC leads to prompt and definitive diagnosis, so that therapy can be initiated as soon as possible for better outcome. Multimodality therapy (surgery, external beam radiation, and chemotherapy) is the mainstay of treatment.

Cytological Diagnosis of an Uncommon High Grade Malignant Thyroid Tumour: A Case Report

PubMed Central

Kaushal, Manju; Kumar, Sawan

2017-01-01

Anaplastic Thyroid Carcinoma (ATC) is a relatively uncommon highly malignant tumour originating from the follicular cells of thyroid gland having poor prognosis. It accounts for 2% to 5% of all thyroid carcinomas and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 53-year-old male presented with diffuse neck swelling measuring 8x6 cm and right cervical lymph node measuring 2x2 cm since one month which was associated with dyspepsia and dyspnoea. Ultrasound and Contrast Enhanced Computed Tomography (CECT) neck revealed enlarged right lobe of thyroid and multiple enlarged cervical lymph nodes with soft tissue density nodules in bilateral lungs. Fine Needle Aspiration (FNA) from the swelling revealed giant cell, spindle cell and squamoid pattern. Focal areas showed follicular epithelial cells arranged in repeated microfollicular pattern suggesting an underlying follicular neoplasm. FNAC smears from the lymph node also revealed similar findings. Based on the cytomorphological and radiological findings, final diagnosis of ATC probably arising from underlying follicular carcinoma with cervical lymph node and lung metastasis was given. FNAC leads to prompt and definitive diagnosis, so that therapy can be initiated as soon as possible for better outcome. Multimodality therapy (surgery, external beam radiation, and chemotherapy) is the mainstay of treatment. PMID:28892908

Thyroid Adenomas After Solid Cancer in Childhood

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haddy, Nadia; El-Fayech, Chiraz; Guibout, Catherine

Purpose: Very few childhood cancer survivor studies have been devoted to thyroid adenomas. We assessed the role of chemotherapy and the radiation dose to the thyroid in the risk of thyroid adenoma after childhood cancer. Methods and Materials: A cohort of 3254 2-year survivors of a solid childhood cancer treated in 5 French centers before 1986 was established. The dose received by the isthmus and the 2 lobes of the thyroid gland during each course of radiation therapy was estimated after reconstruction of the actual radiation therapy conditions in which each child was treated as well as the dose receivedmore » at other anatomical sites of interest. Results: After a median follow-up of 25 years, 71 patients had developed a thyroid adenoma. The risk strongly increased with the radiation dose to the thyroid up to a few Gray, plateaued, and declined for high doses. Chemotherapy slightly increased the risk when administered alone but also lowered the slope of the dose-response curve for the radiation dose to the thyroid. Overall, for doses up to a few Gray, the excess relative risk of thyroid adenoma per Gray was 2.8 (90% CI: 1.2-6.9), but it was 5.5 (90% CI: 1.9-25.9) in patients who had not received chemotherapy or who had received only 1 drug, and 1.1 (90% CI: 0.4-3.4) in the children who had received more than 1 drug (P=.06, for the difference). The excess relative risk per Gray was also higher for younger children at the time of radiation therapy than for their older counterparts and was higher before attaining 40 years of age than subsequently. Conclusions: The overall pattern of thyroid adenoma after radiation therapy for a childhood cancer appears to be similar to that observed for thyroid carcinoma.« less

Struma Ovarii With Hyperthyroidism.

PubMed

Ang, Lynn P; Avram, Anca M; Lieberman, Richard W; Esfandiari, Nazanene H

2017-06-01

We report the case of a 61-year-old woman with persistent thyrotoxicosis for 7 years despite low thyroidal radioiodine uptake and methimazole treatment. Her initial I whole-body scan (WBS) was read as negative. Upon evaluation in our institution, she remained hyperthyroid after discontinuation of methimazole. Repeat WBS with SPECT/CT revealed low 24-hour thyroidal uptake (RAIU = 2%) and intensely focal radioiodine uptake in a large heterogeneous left pelvic mass, consistent with left adnexal struma ovarii. Resection of this mass confirmed benign struma ovarii. This case illustrates the advantage of fusion SPECT/CT imaging with planar I-WBS for diagnosis of extrathyroidal thyrotoxicosis.

[Successful treatment with anti-epileptic-drug of an 83-year-old man with musical hallucinosis].

PubMed

Futamura, Akinori; Katoh, Hirotaka; Kawamura, Mitsuru

2014-05-01

An 83-year-old man with 3 years symptomatic hearing loss suddenly experienced musical hallucinosis. He heard children's songs, folk songs, military songs, and the Japanese national anthem for seven months every day. He sometime had paroxysmal nausea, dull headaches and depressive mood. On examination he had no psychosis or neurological symptoms except sensorineural hearing loss in both ears. MRI brain imaging and electroencephalography showed no significant abnormalities, however ¹²³I-IMP brain SPECT showed decreased activity in the right temporal lobe and increased activity in the left temporal and parietal lobes. Late phase ¹²³I-iomazenil brain SPECT showed decreased accumulation in the right temporal lobe compared to the early phase. This indicates right temporal lobe epilepsy. He was diagnosed with epilepsy because of paroxysmal nausea and headache and the laterality of ¹²³I-IMP brain SPECT and ¹²³I-iomazenil brain SPECT. The musical hallucinosis was much reduced by carbamazepine 200mg per day. Nine months after beginning carbamazepine we detected decreased activity in the right temporal lobe and increased activity in left temporal and parietal lobes was improved. We do not believe he had epileptogenic musical hallucinosis because his musical hallusinosis was neither paroxysmal nor lateral. We diagnosed auditory Charles Bonnet syndrome with onset 3 years after sensorineural hearing loss due to reversible epileptic like discharge in temporal and parietal lobes. There is no established treatment for musical hallucinosis, but anti-epileptic drugs may be of some help.

Risk factors and the preoperative assessment of right para-oesophageal lymph node metastasis in right lobe papillary thyroid carcinoma: A case series.

PubMed

Qu, You; Zhang, Hao; Zhang, Ping; Dong, Wenwu; He, Liang; Sun, Wei; Liu, Jinhao

2017-06-01

Right para-oesophageal lymph nodes (RPELN) are included among the right central compartment lymph nodes (rCLN) and located behind right recurrent laryngeal nerve (rRLN). However, due to the likelihood of increasing postoperative complications, and the extremely difficulties of RPELN dissection, the decision to perform RPELN dissection remains controversial. The aim of this study was to explore the risk factors of RPELN metastasis and evaluate RPELN metastasis by preoperative examination. We reviewed the medical records of 163 consecutive papillary thyroid carcinoma (PTC) patients (125 females and 38 males) who underwent right lobe plus isthmic resection (91 patients) or total thyroidectomy (72 patients) with right or bilateral central compartment lymph node dissection. The RPELN dissections were performed in all patients and were individually dissected and recorded intraoperatively. All patients underwent thyroid ultrasound and enhanced neck computed tomography (CT) routinely during preoperative examination. RPELN metastasis was detected in 20 patients (12.3%), among whom 6 (3.7%) had RPELN metastasis without rCLN metastasis. Total rCLN metastasis and lateral compartment lymph node metastasis were confirmed in 57 (35.0%) and 24 (14.7%) patients, respectively. The tumour diameter, number of metastatic rCLN and lateral compartment lymph nodes, RPELN visible on CT, and enhanced CT value of RPELN were confirmed significantly associated with RPELN metastasis by univariate analysis (P < 0.05). The area under the ROC curve of CT values was 0.77 (95% CI, 0.59-0.95; P = 0.003). The CT value of 132.0 was used as the cut-off point, and the specificity and sensitivity were 84.1% and 71.4%, respectively. PTC patients with a large tumour (>1 cm) in the right lobe or suspected rCLN metastasis were recommended to undergo prophylactic RPELN dissection, particularly in those with a high enhanced CT value (>132) of RPELN or those with the copresence of lateral compartment lymph node metastasis. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Quantification of Hepcidin-related Iron Accumulation in the Rat Liver.

PubMed

Böser, Preethne; Mordashova, Yulia; Maasland, Mark; Trommer, Isabel; Lorenz, Helga; Hafner, Mathias; Seemann, Dietmar; Mueller, Bernhard K; Popp, Andreas

2016-02-01

Hepcidin was originally detected as a liver peptide with antimicrobial activity and it functions as a central regulator in the systemic iron metabolism. Consequently suppression of hepcidin leads to iron accumulation in the liver. AbbVie developed a monoclonal antibody ([mAb]; repulsive guidance molecule [RGMa/c] mAb) that downregulates hepcidin expression by influencing the RGMc/bone morphogenetic protein (BMP)/neogenin receptor complex and causes iron deposition in the liver. In a dose range finding study with RGMa/c mAb, rats were treated with different dose levels for a total of 4 weekly doses. The results of this morphometric analysis in the liver showed that iron accumulation is not homogenous between liver lobes and the left lateral lobe was the most responsive lobe in the rat. Quantitative hepcidin messenger RNA analysis showed that the left lateral lobe was the most responsive lobe showing hepcidin downregulation with increasing antibody dose. In addition, the morphometric analysis had higher sensitivity than the chemical iron extraction and quantification using a colorimetric assay. In conclusion, the Prussian blue stain in combination with semi-quantitative and quantitative morphometric analysis is the most reliable method to demonstrate iron accumulation in the liver compared to direct measurement of iron in unfixed tissue using a colorimetric assay. © The Author(s) 2016.

Tamoxifen-induced non-alcoholic steatohepatitis in patients with breast cancer: determination of a suitable biopsy site for diagnosis.

PubMed

Murata, Yoriko; Ogawa, Yasuhiro; Saibara, Toshiji; Nishioka, Akihito; Takeuchi, Naoko; Kariya, Shinji; Onishi, Saburo; Yoshida, Shoji

2003-01-01

We have evaluated the distribution of fatty infiltration in the liver for determination of a suitable biopsy site for diagnosis of tamoxifen-induced non-alcoholic steatohepatitis (NASH) in patients with breast cancer. Thirty-eight consecutive breast cancer patients undergoing tamoxifen treatment were analyzed by CT to identify hepatic steatosis (HS) via calculation of the liver/spleen CT ratio in Couinaud's 8 areas. We defined hepatic fatty infiltration as a liver/spleen ratio of less than 0.9. The extent and distribution of the fatty infiltration was assessed using the liver/spleen ratio of the patients who had the lowest CT ratio below 0.9 in the 8 areas. Thirteen (34.2%) of the 38 patients had hepatic fatty infiltration. The liver/spleen ratios of each area differed significantly in all patients (p<0.0001). The CT ratio of these 13 patients was significantly lower in the right lobe than the left lobe (p<0.0001), although the ratios did not differ significantly among the 4 areas of the right lobe (p=0.52). Needle biopsy for diagnosis of NASH should be performed at the right lobe, which contains significantly more infiltrated fat than the left lobe in the liver.

Gender effects on age-related changes in brain structure.

PubMed

Xu, J; Kobayashi, S; Yamaguchi, S; Iijima, K; Okada, K; Yamashita, K

2000-01-01

Previous reports have suggested that brain atrophy is associated with aging and that there are gender differences in brain atrophy with aging. These reports, however, neither exclude silent brain lesions in "healthy subjects" nor divide the brain into subregions. The aim of this study is to clarify the effect of gender on age-related changes in brain subregions by MR imaging. A computer-assisted system was used to calculate the brain matter area index (BMAI) of various regions of the brain from MR imaging of 331 subjects without brain lesions. There was significantly more brain atrophy with aging in the posterior parts of the right frontal lobe in male subjects than there was in female subjects. Age-related atrophy in the middle part of the right temporal lobe, the left basal ganglia, the parietal lobe, and the cerebellum also was found in male subjects, but not in female subjects. In the temporal lobe, thalamus, parieto-occipital lobe, and cerebellum, brain volume in the left hemisphere is significantly smaller than in the right hemisphere; sex and age did not affect the hemisphere differences of brain volume in these regions. The effect of gender on brain atrophy with aging varied in different subregions of the brain. There was more brain atrophy with aging in male subjects than in female subjects.

The right hemisphere's contribution to discourse processing: A study in temporal lobe epilepsy.

PubMed

Lomlomdjian, Carolina; Múnera, Claudia P; Low, Daniel M; Terpiluk, Verónica; Solís, Patricia; Abusamra, Valeria; Kochen, Silvia

2017-08-01

Discourse skills - in which the right hemisphere has an important role - enables verbal communication by selecting contextually relevant information and integrating it coherently to infer the correct meaning. However, language research in epilepsy has focused on single word analysis related mainly to left hemisphere processing. The purpose of this study was to investigate discourse abilities in patients with right lateralized medial temporal lobe epilepsy (RTLE) by comparing their performance to that of patients with left temporal lobe epilepsy (LTLE). 74 pharmacoresistant temporal lobe epilepsy (TLE) patients were evaluated: 34 with RTLE and 40 with LTLE. Subjects underwent a battery of tests that measure comprehension and production of conversational and narrative discourse. Disease related variables and general neuropsychological data were evaluated. The RTLE group presented deficits in interictal conversational and narrative discourse, with a disintegrated speech, lack of categorization and misinterpretation of social meaning. LTLE group, on the other hand, showed a tendency to lower performance in logical-temporal sequencing. RTLE patients showed discourse deficits which have been described in right hemisphere damaged patients due to other etiologies. Medial and anterior temporal lobe structures appear to link semantic, world knowledge, and social cognition associated areas to construct a contextually related coherent meaning. Copyright © 2017 Elsevier Inc. All rights reserved.

Auditory temporal processing in patients with temporal lobe epilepsy.

PubMed

Lavasani, Azam Navaei; Mohammadkhani, Ghassem; Motamedi, Mahmoud; Karimi, Leyla Jalilvand; Jalaei, Shohreh; Shojaei, Fereshteh Sadat; Danesh, Ali; Azimi, Hadi

2016-07-01

Auditory temporal processing is the main feature of speech processing ability. Patients with temporal lobe epilepsy, despite their normal hearing sensitivity, may present speech recognition disorders. The present study was carried out to evaluate the auditory temporal processing in patients with unilateral TLE. The present study was carried out on 25 patients with epilepsy: 11 patients with right temporal lobe epilepsy and 14 with left temporal lobe epilepsy with a mean age of 31.1years and 18 control participants with a mean age of 29.4years. The two experimental and control groups were evaluated via gap-in-noise and duration pattern sequence tests. One-way ANOVA was run to analyze the data. The mean of the threshold of the GIN test in the control group was observed to be better than that in participants with LTLE and RTLE. Also, it was observed that the percentage of correct responses on the DPS test in the control group and in participants with RTLE was better than that in participants with LTLE. Patients with TLE have difficulties in temporal processing. Difficulties are more significant in patients with LTLE, likely because the left temporal lobe is specialized for the processing of temporal information. Copyright © 2016 Elsevier Inc. All rights reserved.

Test-retest reliability of diffusion tensor imaging of the liver at 3.0 T.

PubMed

Girometti, Rossano; Maieron, Marta; Lissandrello, Giovanni; Bazzocchi, Massimo; Zuiani, Chiara

2015-06-01

This study was done to evaluate test-retest reliability of liver diffusion tensor imaging (LDTI). Ten healthy volunteers (median age 23 years) underwent two LDTI scans on a 3.0 T magnet during two imaging sessions separated by 2 weeks (session-1/-2, respectively). Fifteen gradient directions and b values of 0-1,000 s/mm(2) were used. Two radiologists in consensus assessed liver apparent diffusion coefficient (ADC) and fraction of anisotropy (FA) values on ADC and FA maps at four reference levels, namely: right upper level (RUL), right lower level (RLL), left upper level (LUL) and left lower level (LLL). We then assessed (a) whether ADC and FA values overlapped when measured on different levels within the same imaging session or between different imaging sessions; (b) the degree of variability on an intra-session and inter-session basis, respectively, using the coefficient of variation (CV). In sessions 1 and 2, the ADC/FA values were significantly larger in the left liver lobe (LUL/LLL) compared to right liver lobe (RUL/RLL) (p < 0.05/6). Intra-session CVs were 9.51 % (session 1) and 9.73 % (session 2) for ADC, and 12.93 % (session 1) and 11.82 % (session 2) for FA, respectively. When comparing RUL, RLL, LUL and LLL on an inter-session basis, CVs were 6.52, 8.20, 6.52 and 11.06 % for ADC, and 15.42, 15.80, 15.42 and 6.80 % for FA, respectively. LDTI provides consistent and repeatable measurements. However, since larger left lobe ADC/FA values can be attributed to artefacts, right lobe values should be considered the most reliable measurements of water diffusivity within the liver.

Bringing memory fMRI to the clinic: comparison of seven memory fMRI protocols in temporal lobe epilepsy.

PubMed

Towgood, Karren; Barker, Gareth J; Caceres, Alejandro; Crum, William R; Elwes, Robert D C; Costafreda, Sergi G; Mehta, Mitul A; Morris, Robin G; von Oertzen, Tim J; Richardson, Mark P

2015-04-01

fMRI is increasingly implemented in the clinic to assess memory function. There are multiple approaches to memory fMRI, but limited data on advantages and reliability of different methods. Here, we compared effect size, activation lateralisation, and between-sessions reliability of seven memory fMRI protocols: Hometown Walking (block design), Scene encoding (block design and event-related design), Picture encoding (block and event-related), and Word encoding (block and event-related). All protocols were performed on three occasions in 16 patients with temporal lobe epilepsy (TLE). Group T-maps showed activity bilaterally in medial temporal lobe for all protocols. Using ANOVA, there was an interaction between hemisphere and seizure-onset lateralisation (P = 0.009) and between hemisphere, protocol and seizure-onset lateralisation (P = 0.002), showing that the distribution of memory-related activity between left and right temporal lobes differed between protocols and between patients with left-onset and right-onset seizures. Using voxelwise intraclass Correlation Coefficient, between-sessions reliability was best for Hometown and Scenes (block and event). The between-sessions spatial overlap of activated voxels was also greatest for Hometown and Scenes. Lateralisation of activity between hemispheres was most reliable for Scenes (block and event) and Words (event). Using receiver operating characteristic analysis to explore the ability of each fMRI protocol to classify patients as left-onset or right-onset TLE, only the Words (event) protocol achieved a significantly above-chance classification of patients at all three sessions. We conclude that Words (event) protocol shows the best combination of between-sessions reliability of the distribution of activity between hemispheres and reliable ability to distinguish between left-onset and right-onset patients. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Statistical parametric mapping for analyzing interictal magnetoencephalography in patients with left frontal lobe epilepsy.

PubMed

Zhu, Haitao; Zhu, Jinlong; Bao, Forrest Sheng; Liu, Hongyi; Zhu, Xuchuang; Wu, Ting; Yang, Lu; Zou, Yuanjie; Zhang, Rui; Zheng, Gang

2016-01-01

Frontal lobe epilepsy is a common epileptic disorder and is characterized by recurring seizures that arise in the frontal lobes. The purpose of this study is to identify the epileptogenic regions and other abnormal regions in patients with left frontal lobe epilepsy (LFLE) based on the magnetoencephalogram (MEG), and to understand the effects of clinical variables on brain activities in patients with LFLE. Fifteen patients with LFLE (23.20 ± 8.68 years, 6 female and 9 male) and 16 healthy controls (23.13 ± 7.66 years, 6 female and 10 male) were included in resting-stage MEG examinations. Epileptogenic regions of LFLE patients were confirmed by surgery. Regional brain activations were quantified using statistical parametric mapping (SPM). The correlation between the activations of the abnormal brain regions and the clinical seizure parameters were computed for LFLE patients. Brain activations of LFLE patients were significantly elevated in left superior/middle/inferior frontal gyri, postcentral gyrus, inferior temporal gyrus, insula, parahippocampal gyrus and amygdala, including the epileptogenic regions. Remarkable decreased activations were found mainly in the left parietal gyrus and precuneus. There is a positive correlation between the duration of the epilepsy (in month) and activations of the abnormal regions, while no relation was found between age of seizure onset (year), seizure frequency and the regions of the abnormal activity of the epileptic patients. Our findings suggest that the aberrant brain activities of LFLE patients were not restricted to the epileptogenic zones. Long duration of epilepsy might induce further functional damage in patients with LFLE. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Voxel-Based Morphometry and fMRI Revealed Differences in Brain Gray Matter in Breastfed and Milk Formula-Fed Children.

PubMed

Ou, X; Andres, A; Pivik, R T; Cleves, M A; Snow, J H; Ding, Z; Badger, T M

2016-04-01

Infant diets may have significant impact on brain development in children. The aim of this study was to evaluate brain gray matter structure and function in 8-year-old children who were predominantly breastfed or fed cow's milk formula as infants. Forty-two healthy children (breastfed: n = 22, 10 boys and 12 girls; cow's milk formula: n = 20, 10 boys and 10 girls) were studied by using structural MR imaging (3D T1-weighted imaging) and blood oxygen level-dependent fMRI (while performing tasks involving visual perception and language functions). They were also administered standardized tests evaluating intelligence (Reynolds Intellectual Assessment Scales) and language skills (Clinical Evaluation of Language Fundamentals). Total brain gray matter volume did not differ between the breastfed and cow's milk formula groups. However, breastfed children had significantly higher (P < .05, corrected) regional gray matter volume measured by voxel-based morphometry in the left inferior temporal lobe and left superior parietal lobe compared with cow's milk formula-fed children. Breastfed children showed significantly more brain activation in the right frontal and left/right temporal lobes on fMRI when processing the perception task and in the left temporal/occipital lobe when processing the visual language task than cow's milk formula-fed children. The imaging findings were associated with significantly better performance for breastfed than cow's milk formula-fed children on both tasks. Our findings indicated greater regional gray matter development and better regional gray matter function in breastfed than cow's milk formula-fed children at 8 years of age and suggested that infant diets may have long-term influences on brain development in children. © 2016 by American Journal of Neuroradiology.

Visual cortex activation in kinesthetic guidance of reaching.

PubMed

Darling, W G; Seitz, R J; Peltier, S; Tellmann, L; Butler, A J

2007-06-01

The purpose of this research was to determine the cortical circuit involved in encoding and controlling kinesthetically guided reaching movements. We used (15)O-butanol positron emission tomography in ten blindfolded able-bodied volunteers in a factorial experiment in which arm (left/right) used to encode target location and to reach back to the remembered location and hemispace of target location (left/right side of midsagittal plane) varied systematically. During encoding of a target the experimenter guided the hand to touch the index fingertip to an external target and then returned the hand to the start location. After a short delay the subject voluntarily moved the same hand back to the remembered target location. SPM99 analysis of the PET data contrasting left versus right hand reaching showed increased (P < 0.05, corrected) neural activity in the sensorimotor cortex, premotor cortex and posterior parietal lobule (PPL) contralateral to the moving hand. Additional neural activation was observed in prefrontal cortex and visual association areas of occipital and parietal lobes contralateral and ipsilateral to the reaching hand. There was no statistically significant effect of target location in left versus right hemispace nor was there an interaction of hand and hemispace effects. Structural equation modeling showed that parietal lobe visual association areas contributed to kinesthetic processing by both hands but occipital lobe visual areas contributed only during dominant hand kinesthetic processing. This visual processing may also involve visualization of kinesthetically guided target location and use of the same network employed to guide reaches to visual targets when reaching to kinesthetic targets. The present work clearly demonstrates a network for kinesthetic processing that includes higher visual processing areas in the PPL for both upper limbs and processing in occipital lobe visual areas for the dominant limb.

Evaluation of the rabbit liver by direct portography and contrast-enhanced computed tomography: anatomical variations of the portal system and hepatic volume quantification.

PubMed

Páramo, María; García-Barquin, Paula; Santa María, Eva; Madrid, José Miguel; Caballeros, Meylin; Benito, Alberto; Sangro, Bruno; Iñarrairaegui, Mercedes; Bilbao, José Ignacio

2017-01-01

The study was aimed at: (1) describing the incidence of anatomic variations of the portal system in the rabbit using direct portography; and (2) estimating the liver volume and caudate lobe volume by using contrast-enhanced computed tomography (CECT) in the same animal model. Forty-six New Zealand white rabbits were included. All of them underwent direct portography and unenhanced CECT. Conventional liver rabbit portal system anatomy (type 1) consisted of the bifurcation of the main portal vein (MPV) into the right portal vein (RPV) and left portal vein (LPV), which subsequently divided into medial left portal vein and lateral left portal vein. Trifurcation of the LPV was considered type 2. The LPV that divides into four smaller branches was classified as type 3. Other configurations of the portal system, including particular cases of MPV branching, were grouped as type 4. Liver lobes were manually segmented. The incidence of each type of portal system anatomy was: type 1, 67.4%; type 2, 15.2%; type 3, 13.0%); and type 4, 4.3%. The mean volume of the caudate lobe was 19.1 ml ± 5.7 ml and of the cranial lobes it was 66.7 ml ± 13.7 ml, and the total liver volume was 85.7 ml ± 16.7 ml. In New Zealand white rabbits, type 1 is the prevalent type of portal system, liver volume is about 86 ml, and the caudate and cranial lobes are separated. This information could be important when planning experimental rabbit liver procedures.

Altered Brain Network in Amyotrophic Lateral Sclerosis: A Resting Graph Theory-Based Network Study at Voxel-Wise Level.

PubMed

Zhou, Chaoyang; Hu, Xiaofei; Hu, Jun; Liang, Minglong; Yin, Xuntao; Chen, Lin; Zhang, Jiuquan; Wang, Jian

2016-01-01

Amyotrophic lateral sclerosis (ALS) is a rare degenerative disorder characterized by loss of upper and lower motor neurons. Neuroimaging has provided noticeable evidence that ALS is a complex disease, and shown that anatomical and functional lesions extend beyond precentral cortices and corticospinal tracts, to include the corpus callosum; frontal, sensory, and premotor cortices; thalamus; and midbrain. The aim of this study is to investigate graph theory-based functional network abnormalities at voxel-wise level in ALS patients on a whole brain scale. Forty-three ALS patients and 44 age- and sex-matched healthy volunteers were enrolled. The voxel-wise network degree centrality (DC), a commonly employed graph-based measure of network organization, was used to characterize the alteration of whole brain functional network. Compared with the controls, the ALS patients showed significant increase of DC in the left cerebellum posterior lobes, bilateral cerebellum crus, bilateral occipital poles, right orbital frontal lobe, and bilateral prefrontal lobes; significant decrease of DC in the bilateral primary motor cortex, bilateral sensory motor region, right prefrontal lobe, left bilateral precuneus, bilateral lateral temporal lobes, left cingulate cortex, and bilateral visual processing cortex. The DC's z-scores of right inferior occipital gyrus were significant negative correlated with the ALSFRS-r scores. Our findings confirm that the regions with abnormal network DC in ALS patients were located in multiple brain regions including primary motor, somatosensory and extra-motor areas, supporting the concept that ALS is a multisystem disorder. Specifically, our study found that DC in the visual areas was altered and ALS patients with higher DC in right inferior occipital gyrus have more severity of disease. The result demonstrated that the altered DC value in this region can probably be used to assess severity of ALS.

Structural correlates of impaired working memory in hippocampal sclerosis.

PubMed

Winston, Gavin P; Stretton, Jason; Sidhu, Meneka K; Symms, Mark R; Thompson, Pamela J; Duncan, John S

2013-07-01

Temporal lobe epilepsy (TLE) has been considered to impair long-term memory, whilst not affecting working memory, but recent evidence suggests that working memory is compromised. Functional MRI (fMRI) studies demonstrate that working memory involves a bilateral frontoparietal network the activation of which is disrupted in hippocampal sclerosis (HS). A specific role of the hippocampus to deactivate during working memory has been proposed with this mechanism faulty in patients with HS. Structural correlates of disrupted working memory in HS have not been explored. We studied 54 individuals with medically refractory TLE and unilateral HS (29 left) and 28 healthy controls. Subjects underwent 3T structural MRI, a visuospatial n-back fMRI paradigm and diffusion tensor imaging (DTI). Working memory capacity assessed by three span tasks (digit span backwards, gesture span, motor sequences) was combined with performance in the visuospatial paradigm to give a global working memory measure. Gray and white matter changes were investigated using voxel-based morphometry and voxel-based analysis of DTI, respectively. Individuals with left or right HS performed less well than healthy controls on all measures of working memory. fMRI demonstrated a bilateral frontoparietal network during the working memory task with reduced activation of the right parietal lobe in both patient groups. In left HS, gray matter loss was seen in the ipsilateral hippocampus and parietal lobe, with maintenance of the gray matter volume of the contralateral parietal lobe associated with better performance. White matter integrity within the frontoparietal network, in particular the superior longitudinal fasciculus and cingulum, and the contralateral temporal lobe, was associated with working memory performance. In right HS, gray matter loss was also seen in the ipsilateral hippocampus and parietal lobe. Working memory performance correlated with the gray matter volume of both frontal lobes and white matter integrity within the frontoparietal network and contralateral temporal lobe. Our data provide further evidence that working memory is disrupted in HS and impaired integrity of both gray and white matter is seen in functionally relevant areas. We suggest this forms the structural basis of the impairment of working memory, indicating widespread and functionally significant structural changes in patients with apparently isolated HS. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Structural correlates of impaired working memory in hippocampal sclerosis

PubMed Central

Winston, Gavin P; Stretton, Jason; Sidhu, Meneka K; Symms, Mark R; Thompson, Pamela J; Duncan, John S

2013-01-01

Purpose: Temporal lobe epilepsy (TLE) has been considered to impair long-term memory, whilst not affecting working memory, but recent evidence suggests that working memory is compromised. Functional MRI (fMRI) studies demonstrate that working memory involves a bilateral frontoparietal network the activation of which is disrupted in hippocampal sclerosis (HS). A specific role of the hippocampus to deactivate during working memory has been proposed with this mechanism faulty in patients with HS. Structural correlates of disrupted working memory in HS have not been explored. Methods: We studied 54 individuals with medically refractory TLE and unilateral HS (29 left) and 28 healthy controls. Subjects underwent 3T structural MRI, a visuospatial n-back fMRI paradigm and diffusion tensor imaging (DTI). Working memory capacity assessed by three span tasks (digit span backwards, gesture span, motor sequences) was combined with performance in the visuospatial paradigm to give a global working memory measure. Gray and white matter changes were investigated using voxel-based morphometry and voxel-based analysis of DTI, respectively. Key Findings: Individuals with left or right HS performed less well than healthy controls on all measures of working memory. fMRI demonstrated a bilateral frontoparietal network during the working memory task with reduced activation of the right parietal lobe in both patient groups. In left HS, gray matter loss was seen in the ipsilateral hippocampus and parietal lobe, with maintenance of the gray matter volume of the contralateral parietal lobe associated with better performance. White matter integrity within the frontoparietal network, in particular the superior longitudinal fasciculus and cingulum, and the contralateral temporal lobe, was associated with working memory performance. In right HS, gray matter loss was also seen in the ipsilateral hippocampus and parietal lobe. Working memory performance correlated with the gray matter volume of both frontal lobes and white matter integrity within the frontoparietal network and contralateral temporal lobe. Significance: Our data provide further evidence that working memory is disrupted in HS and impaired integrity of both gray and white matter is seen in functionally relevant areas. We suggest this forms the structural basis of the impairment of working memory, indicating widespread and functionally significant structural changes in patients with apparently isolated HS. PMID:23614459

Necessary Contributions of Human Frontal Lobe Subregions to Reward Learning in a Dynamic, Multidimensional Environment.

PubMed

Vaidya, Avinash R; Fellows, Lesley K

2016-09-21

Real-world decisions are typically made between options that vary along multiple dimensions, requiring prioritization of the important dimensions to support optimal choice. Learning in this setting depends on attributing decision outcomes to the dimensions with predictive relevance rather than to dimensions that are irrelevant and nonpredictive. This attribution problem is computationally challenging, and likely requires an interplay between selective attention and reward learning. Both these processes have been separately linked to the prefrontal cortex, but little is known about how they combine to support learning the reward value of multidimensional stimuli. Here, we examined the necessary contributions of frontal lobe subregions in attributing feedback to relevant and irrelevant dimensions on a trial-by-trial basis in humans. Patients with focal frontal lobe damage completed a demanding reward learning task where options varied on three dimensions, only one of which predicted reward. Participants with left lateral frontal lobe damage attributed rewards to irrelevant dimensions, rather than the relevant dimension. Damage to the ventromedial frontal lobe also impaired learning about the relevant dimension, but did not increase reward attribution to irrelevant dimensions. The results argue for distinct roles for these two regions in learning the value of multidimensional decision options under dynamic conditions, with the lateral frontal lobe required for selecting the relevant dimension to associate with reward, and the ventromedial frontal lobe required to learn the reward association itself. The real world is complex and multidimensional; how do we attribute rewards to predictive features when surrounded by competing cues? Here, we tested the critical involvement of human frontal lobe subregions in a probabilistic, multidimensional learning environment, asking whether focal lesions affected trial-by-trial attribution of feedback to relevant and irrelevant dimensions. The left lateral frontal lobe was required for filtering option dimensions to allow appropriate feedback attribution, while the ventromedial frontal lobe was necessary for learning the value of features in the relevant dimension. These findings argue that selective attention and associative learning processes mediated by anatomically distinct frontal lobe subregions are both critical for adaptive choice in more complex, ecologically valid settings. Copyright © 2016 the authors 0270-6474/16/369843-16$15.00/0.

Partial resection and reconstruction of the sternum for treatment of metachronous sternal metastasis of thyroid carcinoma: A case report.

PubMed

Lan, Hong-Jing; Wu, Zhi-Qiang; Gong, Dong-Ge; Zheng, Wang-Yong; Jin, Yun

2017-11-01

Metachronous sternal metastasis of thyroid carcinoma was a rare disease. There was no consensus in the treatment for bone metastasis after the initial thyroid carcinoma surgery. A 53-year-old female patient was hospitalized due to recurrent dull chest pains, with a history of radical right side thyroid carcinoma 4 years ago. On examination, there was an irregular mass on the lower left half of the sternum. Computerized tomography scan showed sternal bone destruction with a soft tissue mass. Metachronous sternal metastasis of thyroid carcinoma. Partial resection of the sternum and reconstruction with a titanium alloy mesh were performed. After a 3-year follow-up, the patient had no recurrence. Surgical resection may be a sufficient treatment for metachronous sternal metastasis of thyroid carcinoma. Biosynthesis material mesh is preferred to be used.

Correlation between white matter damage and gray matter lesions in multiple sclerosis patients.

PubMed

Han, Xue-Mei; Tian, Hong-Ji; Han, Zheng; Zhang, Ce; Liu, Ying; Gu, Jie-Bing; Bakshi, Rohit; Cao, Xia

2017-05-01

We observed the characteristics of white matter fibers and gray matter in multiple sclerosis patients, to identify changes in diffusion tensor imaging fractional anisotropy values following white matter fiber injury. We analyzed the correlation between fractional anisotropy values and changes in whole-brain gray matter volume. The participants included 20 patients with relapsing-remitting multiple sclerosis and 20 healthy volunteers as controls. All subjects underwent head magnetic resonance imaging and diffusion tensor imaging. Our results revealed that fractional anisotropy values decreased and gray matter volumes were reduced in the genu and splenium of corpus callosum, left anterior thalamic radiation, hippocampus, uncinate fasciculus, right corticospinal tract, bilateral cingulate gyri, and inferior longitudinal fasciculus in multiple sclerosis patients. Gray matter volumes were significantly different between the two groups in the right frontal lobe (superior frontal, middle frontal, precentral, and orbital gyri), right parietal lobe (postcentral and inferior parietal gyri), right temporal lobe (caudate nucleus), right occipital lobe (middle occipital gyrus), right insula, right parahippocampal gyrus, and left cingulate gyrus. The voxel sizes of atrophic gray matter positively correlated with fractional anisotropy values in white matter association fibers in the patient group. These findings suggest that white matter fiber bundles are extensively injured in multiple sclerosis patients. The main areas of gray matter atrophy in multiple sclerosis are the frontal lobe, parietal lobe, caudate nucleus, parahippocampal gyrus, and cingulate gyrus. Gray matter atrophy is strongly associated with white matter injury in multiple sclerosis patients, particularly with injury to association fibers.

Cortical thickness and folding deficits in conduct-disordered adolescents

PubMed Central

Hyatt, Christopher J.; Haney-Caron, Emily; Stevens, Michael C.

2012-01-01

Background Studies of pediatric conduct disorder (CD) have described frontal and temporal lobe structural abnormalities that parallel findings in antisocial adults. The purpose of this study was to examine previously unexplored cortical thickness and folding as markers for brain abnormalities in “pure CD”-diagnosed adolescents. Based on current fronto-temporal theories, we hypothesized that CD youth would have thinner cortex or less cortical folding in temporal and frontal lobes than control subjects. Methods We obtained T1-weighted brain structure images from n=24 control and n=19 CD participants aged 12–18 years, matched by overall gender and age. We measured group differences in cortical thickness and local gyrification index (regional cortical folding measure) using surface-based morphometry with clusterwise correction for multiple comparisons. Results CD participants, when compared with controls, showed both reduced cortical thickness and folding. Thinner cortex was located primarily in posterior brain regions, including left superior temporal and parietal lobes, temporoparietal junction and paracentral lobule, right superior temporal and parietal lobes, temporoparietal junction and precuneus. Folding deficits were located mainly in anterior brain regions and included left insula, ventro- and dorsomedial prefrontal, anterior cingulate and orbitofrontal cortices, temporal lobe, right superior frontal and parietal lobes and paracentral lobule. Conclusions Our findings generally agree with previous CD volumetric studies, but here show the unique contributions of cortical thickness and folding to gray matter reductions in pure CD in different brain regions. PMID:22209639

Mesenchymal stem cells and nanofibers as scaffolds for the regeneration of thyroid cartilage.

PubMed

Jotz, Geraldo P; da Luz Soster, Paula R; Kunrath, Seno O; Steffens, Daniela; Braghirolli, Daikelly I; Zettler, Claudio Galleano; Beck, Carlos A; Muccillo, Marcelo; Lopes, Rui F F; Mastella, Bernardo; Pranke, Patricia

2014-12-01

The aim of this study has been to establish an alternative approach in the form of regeneration of the thyroid cartilage. Four 1-month old pigs (Sus scrofa) were used (divided into 3 groups) and submitted to general anesthetic to perform cervictomy with exposure of the thyroid cartilage in a total of 12 (twelve) samples. A resection of 4.0 cm(2) of cartilage was carried out in the right upper region and in the left upper and lower left region of the cartilage, where a scaffold with or without stem cells was implanted. In the left lower region, no biomaterial was implanted and the defect was left open (lesion control [L]). The average extension of the cartilaginous neoformation of L group was 136.3 μm (± 9.6) and 387.7 μm (± 43.2) in the scaffold (SCA) group, presenting a significant statistical difference (P < 0.01). The analysis carried out on the lesion site sections of the cartilage of the larynx of the animals from the SCA group + mesenchymal stem cells (SCA+MSC) showed an average of the extension of neocartilage of 825.4 μm (± 122.1), showing a more extensive area of neocartilage when compared to the other groups. These results demonstrated a high significantly statistical difference (P < 0.001) when compared with the L and SCA groups. In 100% of the cases for which SCA+MSCs were used, a significant success in the cartilage growth and closing of the lesion in the thyroid cartilage was obtained compared to the other two groups for which MSCs were not used. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Local reactions to radioiodine in the treatment of thyroid cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burmeister, L.A.; du Cret, R.P.; Mariash, C.N.

1991-02-01

The purpose of this study is to compare the rate of local complications resulting from radioiodine ablation of thyroid cancer in patients with a residual intact thyroid lobe to that in patients who had more extensive surgical treatment prior to radioiodine administration. We retrospectively studied 59 patients who had received 131I between 1979 and 1989. The patients were divided into two groups, depending on the extent of their previous surgical thyroid excision. Group 1 comprised 10 patients with a lobectomy or hemithyroidectomy before the ablative radioiodine dose, and Group 2 comprised 49 patients with more extensive thyroid excision (near-total ormore » subtotal thyroidectomy) before the radioiodine treatment. Sixty percent of the 10 patients in Group 1 experienced some degree of neck pain or tenderness following radioiodine ablation of their residual thyroid. In one case, the local reaction was very severe and accompanied by the development of transient hyperthyroidism. There was only a 6% local complication rate in the patients who had undergone more extensive thyroid excision before ablative therapy (p less than 0.001), and none had a severe reaction. Patients with only unilateral surgical excision before radioiodine therapy have a higher rate of local complications than do patients treated with more extensive surgery prior to radioiodine ablation. If radioiodine is to be employed in such patients, they should be informed of this possible complication. Since evidence supports a dose effect in the pathogenesis of the complications, we recommend using a dose of less than 30 mCi for the initial ablation in these patients even though it may be necessary to repeat this dose to complete thyroid ablation.« less

FOLLICULAR CELL CARCINOMA OF THE THYROID GLAND IN THREE CAPTIVE AGED RACCOON DOGS (NYCTEREUTES PROCYONOIDES).

PubMed

Kido, Nobuhide; Itagaki, Iori; Ono, Kaori; Omiya, Tomoko; Matsumoto, Rei

2015-12-01

The clinical and histologic features of thyroid carcinoma in raccoon dogs have not been previously reported. Three of four raccoon dogs (Nyctereutes procyonoides) over 8 yr of age at the Nogeyama Zoological Gardens developed thyroid follicular cell carcinomas that were detected at necropsy. The affected raccoon dogs were rescued from the wild and were housed at the Nogeyama Zoological Gardens for 8 yr 8 mo, 8 yr 10 mo, and 10 yr 3 mo, respectively. Although all of them appeared lethargic and developed partial alopecia or desquamation of their skin, they did not display any other specific clinical signs associated with a thyroid lesion. Serum thyroid hormone values were examined in two of the affected raccoon dogs and the average and standard deviation values (free-thyroxin [FT4]: 0.078 ± 0.077 pM/L and 0.062 ± 0.0039 pM/L; free-triiodothyronine [FT3]: 3.261 ± 0.765 pM/L and 3.407 ± 0.919 pM/L) were lower than the reference range (FT4: 0.141 ± 0.117 pM/L; FT3: 5.139 ± 2.412 pM/L) derived from a clinically normal raccoon dog. On necropsy, the thyroid lobes were markedly enlarged bilaterally. Histopathologically, the neoplastic cells in the thyroid gland appeared round or oval and columnar or cuboidal with minimal heteromorphism. Moreover, mostly small (but occasionally large) follicles were identified, and the neoplastic cells had infiltrated into the surrounding capsule and blood vessels. The histopathologic features of the thyroid tumors in the raccoon dogs revealed that the tumors were derived from follicular cells.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leonard, C.M.; Hauser, P.; Weintraub, B.D.

Resistance to thyroid hormone (RTH) is an autosomal dominant disease caused by mutations in the human thyroid receptor beta gene on chromosome 3. Individuals with RTH have an increased incidence of attention deficit hyperactivity disorder (ADHD). The purpose of this study was to search for developmental brain malformations associated with RTH. Forty-three subjects (20 affected males [AM], 23 affected females [AF]) with resistance to thyroid hormone and 32 unaffected first degree relatives (18 unaffected males [UM], 14 unaffected females [UF]) underwent MRI brain scans with a volumetric acquisition that provided 90 contiguous 2 mm thick sagittal images. Films of sixmore » contiguous images beginning at a standard sagittal position lateral to the insula were analyzed by an investigator who was blind with respect to subject characteristics. The presence of extra or missing gyri in the parietal bank of the Sylvian fissure (multimodal association cortex) and multiple Heschl`s transverse gyri (primary auditory cortex) were noted. There was a significantly increased frequency of anomalous Sylvian fissures in the left hemisphere in males with RTH (AM: 70%; AF: 30%; UM: 28% UF: 28%). Also, there was an increased frequency of anomalous Sylvian fissures on the left combined with multiple Heschl`s gyri in either hemisphere in males with RTH (AM: 50%; AF: 9%; UM: 6%; UF: 0%). However, RTH subjects with anomalies did not have an increased frequency of ADHD as compared with RTH subjects with no anomalies. Abnormal thyroid hormone action in the male fetus early during brain development may be associated with grossly observable cerebral anomalies of the left hemisphere. The effects of mutations in the thyroid receptor beta gene provide a model system for studying the complex interaction of genetic and non-genetic factors on brain and behavioral development. 19 refs., 2 figs., 2 tabs.« less

Selective Familiarity Deficits after Left Anterior Temporal-Lobe Removal with Hippocampal Sparing Are Material Specific

ERIC Educational Resources Information Center

Martin, Chris B.; Bowles, Ben; Mirsattari, Seyed M.; Kohler, Stefan

2011-01-01

Research has firmly established a link between recognition memory and the functional integrity of the medial temporal lobes (MTL). Dual-process models of MTL organization maintain that there is a division of labour within the MTL, with the hippocampus (HC) supporting recollective processes and perirhinal cortex (PRc) supporting familiarity…

Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring

PubMed Central

Peterson, Mark E

2015-01-01

Case summary Primary goitrous hypothyroidism was diagnosed in a 12-month-old cat examined because of small stature, mental dullness, severe lethargy, generalized weakness and gait abnormalities. Radiographs of the long bones and spine revealed delayed epiphyseal ossification and epiphyseal dysgenesis. Diagnosis of primary hypothyroidism was confirmed by low serum concentrations of total and free thyroxine (T4) with high thyroid-stimulating hormone (TSH) concentrations. Thyroid scintigraphy revealed severe enlargement of both thyroid lobes, as evidenced by a seven-fold increase in calculated thyroid volume above the reference interval. In addition, this bilateral goiter had an extremely high radionuclide uptake, about 10-fold higher than the normal feline thyroid gland. Treatment with twice-daily levothyroxine (L-T4), administered on an empty stomach, resulted in increased alertness, playfulness, strength and improvement in gait, as well as an increase in body length and weight. L-T4 replacement also led to normalization of serum thyroid hormone and TSH concentrations, and complete resolution of goiter. Relevance and novel information Spontaneous hypothyroidism is rarely reported in cats, with congenital hypothyroidism in kittens diagnosed most frequently. Despite the fact that this cat was a young adult, it likely had a form of congenital hypothyroidism caused by dyshormonogenesis (defect in thyroid hormone synthesis) that led to compensatory development of goiter. In hypothyroid cats, treatment with L-T4 is best given twice daily on an empty stomach to ensure adequate absorption. Normalization of serum TSH and shrinkage of goiter, as well as improvement in clinical signs, is the goal of treatment for cats with goitrous hypothyroidism. PMID:28491394

Hashimoto's encephalitis associated with AMPAR2 antibodies: a case report.

PubMed

Zhu, Mingqin; Yu, Xuefan; Liu, Caiyun; Duan, Chenchen; Li, Chunxiao; Zhu, Jie; Zhang, Ying

2017-02-21

Hashimoto's encephalitis (HE) is a rare neurological complication of Hashimoto's thyroiditis (HT), while limbic encephalitis (LE) is an autoimmune inflammatory disorder frequently associated with anti-neuronal antibodies. The glutamate receptor α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor (AMPAR) is important for synaptic transmission, memory, and learning. The etiology of HE remains unclear. We present a case of HE with antibodies to AMPAR2 both in the serum and cerebrospinal fluid. The patient presented with progressive memory loss and subsequently went into a coma. Magnetic resonance imaging revealed temporal lobe and hippocampal lesions, while the electrocardiogram showed paroxysmal delta waves. Elevated serum levels of antibodies against thyroid globulin, thyroid peroxidase, and thyroid stimulating receptor were also noted. Ultrasonography showed enlargement of the thyroid gland. Therefore, the diagnosis was established as HE. Both the CSF and serum samples of the patient tested positive for antibodies to the cell-surface antigen AMPAR2. Intravenous injection of immunoglobulin followed by dexamethasone treatment resulted in recovery from the coma. Follow-up examination three months later showed some improvement of memory. To our knowledge, this is the first report on the detection of AMPAR2 antibodies in HE. Our findings suggest that antibodies to AMPAR2 may be involved in the pathogenesis of HE. Elevated levels of thyroid antibodies possibly cause immune dysfunction, leading to the production of anti-AMPAR2 antibodies that are detrimental to the neurons. We believe that encephalitis patients with thyroid abnormalities should undergo screening for anti-neuronal antibodies, and early immune therapy may improve prognosis.

Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring.

PubMed

Peterson, Mark E

2015-01-01

Primary goitrous hypothyroidism was diagnosed in a 12-month-old cat examined because of small stature, mental dullness, severe lethargy, generalized weakness and gait abnormalities. Radiographs of the long bones and spine revealed delayed epiphyseal ossification and epiphyseal dysgenesis. Diagnosis of primary hypothyroidism was confirmed by low serum concentrations of total and free thyroxine (T4) with high thyroid-stimulating hormone (TSH) concentrations. Thyroid scintigraphy revealed severe enlargement of both thyroid lobes, as evidenced by a seven-fold increase in calculated thyroid volume above the reference interval. In addition, this bilateral goiter had an extremely high radionuclide uptake, about 10-fold higher than the normal feline thyroid gland. Treatment with twice-daily levothyroxine (L-T4), administered on an empty stomach, resulted in increased alertness, playfulness, strength and improvement in gait, as well as an increase in body length and weight. L-T4 replacement also led to normalization of serum thyroid hormone and TSH concentrations, and complete resolution of goiter. Spontaneous hypothyroidism is rarely reported in cats, with congenital hypothyroidism in kittens diagnosed most frequently. Despite the fact that this cat was a young adult, it likely had a form of congenital hypothyroidism caused by dyshormonogenesis (defect in thyroid hormone synthesis) that led to compensatory development of goiter. In hypothyroid cats, treatment with L-T4 is best given twice daily on an empty stomach to ensure adequate absorption. Normalization of serum TSH and shrinkage of goiter, as well as improvement in clinical signs, is the goal of treatment for cats with goitrous hypothyroidism.

The impact of sex and language dominance on material-specific memory before and after left temporal lobe surgery.

PubMed

Helmstaedter, C; Brosch, T; Kurthen, M; Elger, C E

2004-07-01

Recent findings raised evidence that in early-onset left temporal lobe epilepsy, women show greater functional plasticity for verbal memory than men. In particular, women with lesion- or epilepsy-driven atypical language dominance show an advantage over men. The question asked in this study was whether there is evidence of sex- and language dominance-dependent late, i.e. adult age, plasticity for verbal memory when epilepsy surgery is performed in these patients. Pre- and 1-year postoperative memory performance was evaluated in 169 patients (94 males and 75 females) who underwent left temporal lobe surgery and who had WADA testing of hemispheric language dominance prior to surgery. Verbal memory and figural memory were assessed by list-learning paradigms. According to the Bonn intracarotid amobarbital test (IAT) protocol, patients were categorized into left dominant or atypically dominant (right, incomplete left or right, and bilateral dominant) groups. Results were controlled for the hypothesized sex differences. Thirty-four percent of men and 47% of women displayed patterns of atypical language dominance. Atypical dominance was related to an early onset of epilepsy. Men showed a larger time window for development of atypical dominance but, differently from women, the pattern of atypical dominance was more strictly determined by the age at onset of epilepsy. Atypically dominant women showed better verbal memory than typically dominant women or men. After surgery, right dominant patients had better verbal memory outcome than patients with bilateral or left language dominance who showed significant memory loss. No effect of sex on verbal memory change was found. Figural memory deteriorated in men and improved in women, when they were not left dominant. Seizure outcome had no effect on performance changes. It was concluded that better preserved verbal memory in atypically dominant women before surgery indicates greater benefit from atypical dominance in women than men with regard to the initial damage associated with left hemisphere epilepsy. Later in life, when epilepsy surgery causes additional damage, no such sex difference is observed, indicating that the women's advantage over men is fixed to an early time window in life. Postoperative changes in figural memory suggest dynamics in crowding and suppression patterns. Whether this reflects late plasticity and compensation needs further demonstration. For clinical practice, it is important to note that incomplete right hemisphere and bilateral language dominance do not protect against verbal memory loss after left-sided temporal lobe surgery. Copyright 2004 Guarantors of Brain

Differences in graph theory functional connectivity in left and right temporal lobe epilepsy.

PubMed

Chiang, Sharon; Stern, John M; Engel, Jerome; Levin, Harvey S; Haneef, Zulfi

2014-12-01

To investigate lateralized differences in limbic system functional connectivity between left and right temporal lobe epilepsy (TLE) using graph theory. Interictal resting state fMRI was performed in 14 left TLE patients, 11 right TLE patients, and 12 controls. Graph theory analysis of 10 bilateral limbic regions of interest was conducted. Changes in edgewise functional connectivity, network topology, and regional topology were quantified, and then left and right TLE were compared. Limbic edgewise functional connectivity was predominantly reduced in both left and right TLE. More regional connections were reduced in right TLE, most prominently involving reduced interhemispheric connectivity between the bilateral insula and bilateral hippocampi. A smaller number of limbic connections were increased in TLE, more so in left than in right TLE. Topologically, the most pronounced change was a reduction in average network betweenness centrality and concurrent increase in left hippocampal betweenness centrality in right TLE. In contrast, left TLE exhibited a weak trend toward increased right hippocampal betweenness centrality, with no change in average network betweenness centrality. Limbic functional connectivity is predominantly reduced in both left and right TLE, with more pronounced reductions in right TLE. In contrast, left TLE exhibits both edgewise and topological changes that suggest a tendency toward reorganization. Network changes in TLE and lateralized differences thereof may have important diagnostic and prognostic implications. Published by Elsevier B.V.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karunanithy, Narayan; Gordon, Fabiana, E-mail: fabiana.gordon@imperial.ac.uk; Hodolic, Marina

Purpose: In the presence of variant hepatic arterial anatomy, obtaining whole-liver coverage with yttrium 90 (Y90) radioembolization may be challenging. The purpose of this study was to determine whether a technique whereby variant hepatic arterial branches are embolized and then Y90 is administered selectively into one remaining hepatic arterial branch results in whole-liver coverage and effective therapy. A retrospective comparison of treatment response was made between a group of patients who underwent this technique before Y90 administration and a group of patients who received standard Y90 administration as a single dose into the proper hepatic artery or in divided dosesmore » into the immediate hepatic artery branches. The rest of the workup and treatment were identical in both groups, including routine embolization of potential nonhepatic, nontarget vessels (e.g., the gastroduodenal artery). Methods: A total of 32 patients (mean age 56.9 years, range 39-77 years) treated with Y90 between June 2004 and March 2008 were analyzed. The primary malignancy was colorectal in 29, breast in 2, and cholangiocarcinoma in 1. Group 1 comprised 20 patients who had no alterations to their hepatic arterial supply. Group 2 comprised 12 cases who had undergone prior embolization of hepatic arterial branches before administration of Y90. The response to treatment was assessed by comparing standardized uptake value (SUV) on the pre- and postprocedure fludeoxyglucose positron emission tomographic studies of representative lesions within the right and left lobes of the liver. Results: In group 1, significant response (P < 0.001) was seen among right lobe lesions but not among left lobe lesions (P = 0.549). In group 2, there was a significant response among both right (P = 0.028) and left (P = 0.014) lobe lesions. No difference was found in the response of right lobe lesions (P = 0.726) between groups 1 and 2; a significantly greater response was found in group 2 compared to group 1 (P = 0.004) for left lobe lesions. Conclusion: Selective Y90 radioembolization after manipulation of hepatic arterial blood supply leads to an even distribution within the entire liver. When variations in hepatic arterial anatomy exist, this technique allows effective whole-liver radioembolization therapy from a single selective arterial injection.« less

SU-F-T-222: Dose of Fetus and Infant Following Accidental Intakes of I-131 by the Mother

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Y; Hu, P

Purpose: To estimate the calculation of absorbed dose to the fetus and infants from intakes of I-131 by the mother. Thus provide some advice to the radioprotection of radioactive accident. Methods: In this clinical case, a staff of nuclear medicine accidently intake I-131 during (10–12 weeks) and after pregnancy. The infant was born at full term, but both lobes of the thyroid gland were found to be absent (bilobar thyroid agenesis). It was suspected that the fetal thyroid agenesis may be related with mother’s contamination of I-131 during pregnancy. Urine samples for 24h were collected at different times after administeredmore » and radioactivity were measured to calculate the dose of intake I-131. Calculate the intake I-131 by the results of personal TLD dosimeter. We adopted the mean of two calculated results as the I-131 intake. According to the dose of intake I-131 by the mother, effective dose and absorbed dose of thyroid for mother, fetus and infant were calculated. Results: The intake of I-131 was estimated for 8.18 mCi. I-131 intake was calculated for 7.9 mCi based on data of TLD dosimeter. We adopted the mean of two results as the I-131 intake. The final result was 8.0 mCi. Effective dose and absorbed dose of thyroid for mother were 7.3Sv and 164 Gy, effective dose and absorbed dose of thyroid for fetus were 2.035 Sv and 40.7 Gy, effective dose and absorbed dose of thyroid for infant were 16.25 Sv and 355Gy. Conclusion: The intake during pregnancy was about 1mCi. The absorbed dose of thyroid of the mother was 19.5Gy, whereas the effective of infant was estimated for 40.7Gy. The function of the mother’s thyroid was normal after diagnosis. But the infant was diagnosed as bilobar thyroid agenesis.« less

Diffusion tensor imaging of hemispheric asymmetries in the developing brain.

PubMed

Wilde, Elisabeth A; McCauley, Stephen R; Chu, Zili; Hunter, Jill V; Bigler, Erin D; Yallampalli, Ragini; Wang, Zhiyue J; Hanten, Gerri; Li, Xiaoqi; Ramos, Marco A; Sabir, Sharjeel H; Vasquez, Ana C; Menefee, Deleene; Levin, Harvey S

2009-02-01

Diffusion tensor imaging (DTI) was performed in 39 right-handed children to examine structural hemispheric differences and the impact of age, socioeconomic status, and sex on these differences. Apparent diffusion coefficient (ADC) values were smaller in the left than in the right temporal, prefrontal, anterior internal capsular and the thalamic regions, and fractional anisotropy (FA) values were larger in the left than in the right internal capsule, thalamus, and cingulate. Significant region-by-sex interactions disclosed that the relation of DTI asymmetries to performance depended on sex including the relation of temporal lobes to reading comprehension and the relation of frontal lobes to solving applied mathematical problems.

Revival of Historical Kana Orthography in a Patient with Allographic Agraphia.

PubMed

Maeda, Kengo; Shiraishi, Tomoyuki

2018-01-01

Japanese people born before World War II learned Japanese kana (Japanese syllabograms) writing in a style that is not currently used. These individuals had to learn the current style of kana orthography after the war. An 85-year-old man was taken to our hospital by his family who were surprised by his diary. It was written with kanji (Japanese ideograms) and katakana using the prewar style. A neuropsychological examination revealed impaired recall of hiragana. Neuroimaging studies revealed atrophy of the left fronto-parietal lobe and hypoperfusion of the left frontal lobe. His allographic agraphia might have resulted from the disturbance of the current style of kana orthography.

Sharp Curvature of Frontal Lobe White Matter Pathways in Children with Autism Spectrum Disorder: Tract-Based Morphometry Analysis

PubMed Central

Jeong, Jeong-Won; Kumar, Ajay; Sundaram, Senthil K.; Chugani, Harry T.; Chugani, Diane C.

2013-01-01

Background and Purpose As we had previously observed geometrical changes of frontal lobe association pathways in children with autism spectrum disorder (ASD), in the present study we analyzed the curvature of these white matter pathways using an objective tract based morphometry (TBM) analysis. Materials and Methods Diffusion tensor imaging (DTI) was performed in 32 children with ASD and 14 children with typical development. Curvature, fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) of bilateral arcuate fasciculus (AF), uncinate fasciculus (UF), and genu of corpus callosum (gCC) were investigated using the TBM group analysis assessed by False Discovery Rate p-value (PFDR) for multiple comparisons. Results Significantly higher curvatures were found in children with ASD especially at the parieto-temporal junction for AF (left: PFDR < 0.001; right: PFDR < 0.01), at the fronto-temporal junction for UF (left: PFDR < 0.005; right: PFDR < 0.03), and at the midline of the gCC (PFDR < 0.0001). RD was significantly higher in children with ASD at the same bending regions of AF (left: PFDR < 0.03, right: PFDR < 0.02), UF (left: PFDR < 0.04), and gCC (PFDR < 0.01). Conclusion Higher curvature and curvature dependent RD changes in children with ASD may be the result of higher density of thinner axons in these frontal lobe tracts. PMID:21757519

Left inferior parietal lobe engagement in social cognition and language.

PubMed

Bzdok, Danilo; Hartwigsen, Gesa; Reid, Andrew; Laird, Angela R; Fox, Peter T; Eickhoff, Simon B

2016-09-01

Social cognition and language are two core features of the human species. Despite distributed recruitment of brain regions in each mental capacity, the left parietal lobe (LPL) represents a zone of topographical convergence. The present study quantitatively summarizes hundreds of neuroimaging studies on social cognition and language. Using connectivity-based parcellation on a meta-analytically defined volume of interest (VOI), regional coactivation patterns within this VOI allowed identifying distinct subregions. Across parcellation solutions, two clusters emerged consistently in rostro-ventral and caudo-ventral aspects of the parietal VOI. Both clusters were functionally significantly associated with social-cognitive and language processing. In particular, the rostro-ventral cluster was associated with lower-level processing facets, while the caudo-ventral cluster was associated with higher-level processing facets in both mental capacities. Contrarily, in the (less stable) dorsal parietal VOI, all clusters reflected computation of general-purpose processes, such as working memory and matching tasks, that are frequently co-recruited by social or language processes. Our results hence favour a rostro-caudal distinction of lower- versus higher-level processes underlying social cognition and language in the left inferior parietal lobe. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Contribution of the Parietal Lobes to Speaking and Writing

PubMed Central

Wise, Richard J. S.

2010-01-01

The left parietal lobe has been proposed as a major language area. However, parietal cortical function is more usually considered in terms of the control of actions, contributing both to attention and cross-modal integration of external and reafferent sensory cues. We used positron emission tomography to study normal subjects while they overtly generated narratives, both spoken and written. The purpose was to identify the parietal contribution to the modality-specific sensorimotor control of communication, separate from amodal linguistic and memory processes involved in generating a narrative. The majority of left and right parietal activity was associated with the execution of writing under visual and somatosensory control irrespective of whether the output was a narrative or repetitive reproduction of a single grapheme. In contrast, action-related parietal activity during speech production was confined to primary somatosensory cortex. The only parietal area with a pattern of activity compatible with an amodal central role in communication was the ventral part of the left angular gyrus (AG). The results of this study indicate that the cognitive processing of language within the parietal lobe is confined to the AG and that the major contribution of parietal cortex to communication is in the sensorimotor control of writing. PMID:19531538

Incomplete Hippocampal Inversion: A Comprehensive MRI Study of Over 2000 Subjects.

PubMed

Cury, Claire; Toro, Roberto; Cohen, Fanny; Fischer, Clara; Mhaya, Amel; Samper-González, Jorge; Hasboun, Dominique; Mangin, Jean-François; Banaschewski, Tobias; Bokde, Arun L W; Bromberg, Uli; Buechel, Christian; Cattrell, Anna; Conrod, Patricia; Flor, Herta; Gallinat, Juergen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Ittermann, Bernd; Lemaitre, Hervé; Martinot, Jean-Luc; Nees, Frauke; Paillère Martinot, Marie-Laure; Orfanos, Dimitri P; Paus, Tomas; Poustka, Luise; Smolka, Michael N; Walter, Henrik; Whelan, Robert; Frouin, Vincent; Schumann, Gunter; Glaunès, Joan A; Colliot, Olivier

2015-01-01

The incomplete-hippocampal-inversion (IHI), also known as malrotation, is an atypical anatomical pattern of the hippocampus, which has been reported in healthy subjects in different studies. However, extensive characterization of IHI in a large sample has not yet been performed. Furthermore, it is unclear whether IHI are restricted to the medial-temporal lobe or are associated with more extensive anatomical changes. Here, we studied the characteristics of IHI in a community-based sample of 2008 subjects of the IMAGEN database and their association with extra-hippocampal anatomical variations. The presence of IHI was assessed on T1-weighted anatomical magnetic resonance imaging (MRI) using visual criteria. We assessed the association of IHI with other anatomical changes throughout the brain using automatic morphometry of cortical sulci. We found that IHI were much more frequent in the left hippocampus (left: 17%, right: 6%, χ(2)-test, p < 10(-28)). Compared to subjects without IHI, subjects with IHI displayed morphological changes in several sulci located mainly in the limbic lobe. Our results demonstrate that IHI are a common left-sided phenomenon in normal subjects and that they are associated with morphological changes outside the medial temporal lobe.

Incomplete Hippocampal Inversion: A Comprehensive MRI Study of Over 2000 Subjects

PubMed Central

Cury, Claire; Toro, Roberto; Cohen, Fanny; Fischer, Clara; Mhaya, Amel; Samper-González, Jorge; Hasboun, Dominique; Mangin, Jean-François; Banaschewski, Tobias; Bokde, Arun L. W.; Bromberg, Uli; Buechel, Christian; Cattrell, Anna; Conrod, Patricia; Flor, Herta; Gallinat, Juergen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Ittermann, Bernd; Lemaitre, Hervé; Martinot, Jean-Luc; Nees, Frauke; Paillère Martinot, Marie-Laure; Orfanos, Dimitri P.; Paus, Tomas; Poustka, Luise; Smolka, Michael N.; Walter, Henrik; Whelan, Robert; Frouin, Vincent; Schumann, Gunter; Glaunès, Joan A.; Colliot, Olivier

2015-01-01

The incomplete-hippocampal-inversion (IHI), also known as malrotation, is an atypical anatomical pattern of the hippocampus, which has been reported in healthy subjects in different studies. However, extensive characterization of IHI in a large sample has not yet been performed. Furthermore, it is unclear whether IHI are restricted to the medial-temporal lobe or are associated with more extensive anatomical changes. Here, we studied the characteristics of IHI in a community-based sample of 2008 subjects of the IMAGEN database and their association with extra-hippocampal anatomical variations. The presence of IHI was assessed on T1-weighted anatomical magnetic resonance imaging (MRI) using visual criteria. We assessed the association of IHI with other anatomical changes throughout the brain using automatic morphometry of cortical sulci. We found that IHI were much more frequent in the left hippocampus (left: 17%, right: 6%, χ2−test, p < 10−28). Compared to subjects without IHI, subjects with IHI displayed morphological changes in several sulci located mainly in the limbic lobe. Our results demonstrate that IHI are a common left-sided phenomenon in normal subjects and that they are associated with morphological changes outside the medial temporal lobe. PMID:26733822

Prevalence of ectopic intrathyroidal thymus in Japan: the Fukushima health management survey.

PubMed

Fukushima, Toshihiko; Suzuki, Satoru; Ohira, Tetsuya; Shimura, Hiroki; Midorikawa, Sanae; Ohtsuru, Akira; Sakai, Akira; Abe, Masafumi; Yamashita, Shunichi; Suzuki, Shinichi

2015-05-01

Ectopic intrathyroidal thymus is thought to be a rare entity, often discovered incidentally, and is due to aberrant thymic migration during embryogenesis. The aim of this study was to determine the prevalence of ectopic intrathyroidal thymus in children using ultrasound screening. This study was cross-sectional and was conducted with the initial preliminary survey of the Fukushima Health Management Survey between October 9, 2011, and March 31, 2012, after the Fukushima Daiichi Nuclear Power Plant accident. A total of 37,816 children were examined in the survey. Diagnostic criteria are based on the ultrasonographic appearance of ectopic intrathyroidal thymus, which were round, oval, or polygonal hypoechoic or hyperechoic areas, with multiple granular and punctate echogenic foci. A total of 375 (0.99%) cases (164 girls) with ectopic intrathyroidal thymus were observed. The mean age was 7.0 years (range 0-18 years). Ectopic intrathyroidal thymus was located in the right (n=180), left (n=178), or bilateral (n=17) thyroid lobes. The incidence of ectopic intrathyroidal thymus was inversely correlated with age and body mass index. The results reflect the prevalence of ectopic intrathyroidal thymus using ultrasonography in the general population. Further examination will be needed by way of longitudinal follow-up.

Near-death experiences and the temporal lobe.

PubMed

Britton, Willoughby B; Bootzin, Richard R

2004-04-01

Many studies in humans suggest that altered temporal lobe functioning, especially functioning in the right temporal lobe, is involved in mystical and religious experiences. We investigated temporal lobe functioning in individuals who reported having transcendental "near-death experiences" during life-threatening events. These individuals were found to have more temporal lobe epileptiform electroencephalographic activity than control subjects and also reported significantly more temporal lobe epileptic symptoms. Contrary to predictions, epileptiform activity was nearly completely lateralized to the left hemisphere. The near-death experience was not associated with dysfunctional stress reactions such as dissociation, posttraumatic stress disorder, and substance abuse, but rather was associated with positive coping styles. Additional analyses revealed that near-death experiencers had altered sleep patterns, specifically, a shorter duration of sleep and delayed REM sleep relative to the control group. These results suggest that altered temporal lobe functioning may be involved in the near-death experience and that individuals who have had such experiences are physiologically distinct from the general population.

Dosimetric evaluation of the feasibility of stereotactic body radiotherapy for primary lung cancer with lobe-specific selective elective nodal irradiation

PubMed Central

Komatsu, Tetsuya; Kunieda, Etsuo; Kitahara, Tadashi; Akiba, Takeshi; Nagao, Ryuta; Fukuzawa, Tsuyoshi

2016-01-01

More than 10% of all patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer develop regional lymph node recurrence. We evaluated the dosimetric feasibility of SBRT with lobe-specific selective elective nodal irradiation (ENI) on dose–volume histograms. A total of 21 patients were treated with SBRT for Stage I primary lung cancer between January 2010 and June 2012 at our institution. The extents of lobe-specific selective ENI fields were determined with reference to prior surgical reports. The ENI fields included lymph node stations (LNS) 3 + 4 + 11 for the right upper lobe tumors, LNS 7 + 11 for the right middle or lower lobe tumors, LNS 5 + 11 for the left upper lobe tumors, and LNS 7 + 11 for the left lower lobe tumors. A composite plan was generated by combining the ENI plan and the SBRT plan and recalculating for biologically equivalent doses of 2 Gy per fraction, using a linear quadratic model. The V20 of the lung, D1cm3 of the spinal cord, D1cm3 and D10cm3 of the esophagus and D10cm3 of the tracheobronchial wall were evaluated. Of the 21 patients, nine patients (43%) could not fulfill the dose constraints. In all these patients, the distance between the planning target volume (PTV) of ENI (PTVeni) and the PTV of SBRT (PTVsrt) was ≤2.0 cm. Of the three patients who developed regional metastasis, two patients had isolated lymph node failure, and the lymph node metastasis was included within the ENI field. When the distance between the PTVeni and PTVsrt is >2.0 cm, SBRT with selective ENI may therefore dosimetrically feasible. PMID:26566656

Congenital lobar emphysema: a case report

PubMed Central

2009-01-01

Congenital lobar emphysema is a rare variety of congenital malformation of lung characterized by over distension of a lobe of a lung due to partial obstruction of the bronchus. We are reporting a neonate admitted in the pediatric emergency ward with the respiratory distress since 16th day of life. Investigation revealed the overexpansion of the left upper lobe with mediastinal herniation, shifting of the mediastinum to the opposite side and collapse of the ipsilateral lower lobe. The baby was treated with conservative treatment and the condition of the baby was improved. PMID:19154591

Glomus Tumor of the Neck Detected With 99mTc EDDA HYNIC-TOC.

PubMed

Girotto, Neva; Bogović-Crnčić, Tatjana; Grbac-Ivanković, Svjetlana; Valković-Zujić, Petra

2017-10-01

A 54-year-old woman was referred to thyroid evaluation because of a lump on the left side of the neck. Ultrasound exam did not show any thyroid abnormality, but highly perfused nodule at the left common carotid artery bifurcation was found. Because of the specific location, somatostatin receptor scintigraphy with Tc EDDA HYNIC-TOC was performed, starting with perfusion images and followed with SPECT/CT imaging at 2 and 4 hours. Well-perfused nodule with intensive accumulation and no other visible pathology in the body raised suspicion of a glomus tumor, consistent with MR exam performed later. Subsequent surgical removal confirmed carotid paraganglioma.

Effect of thyroxine on brain microstructure in extremely premature babies: magnetic resonance imaging findings in the TIPIT study.

PubMed

Ng, Sze May; Turner, Mark A; Gamble, Carrol; Didi, Mohammed; Victor, Suresh; Atkinson, Jessica; Sluming, Vanessa; Parkes, Laura M; Tietze, Anna; Abernethy, Laurence J; Weindling, Alan Michael

2014-08-01

In order to assess relationships between thyroid hormone status and findings on brain MRI, a subset of babies was recruited to a multi-centre randomised, placebo-controlled trial of levothyroxine (LT4) supplementation for babies born before 28 weeks' gestation (known as the TIPIT study, for Thyroxine supplementation In Preterm InfanTs). These infants were imaged at term-equivalence. Forty-five TIPIT participants had brain MRI using diffusion tensor imaging (DTI) to estimate white matter development by apparent diffusion coefficient (ADC), fractional anisotropy (FA) and tractography metrics of number and length of streamlines. We made comparisons between babies with the lowest and highest plasma FT4 concentrations during the initial 4 weeks after birth. There were no differences in DTI metrics between babies who had received LT4 supplementation and those who had received a placebo. Among recipients of a placebo, babies in the lowest quartile of plasma-free thyroxine (FT4) concentrations had significantly higher apparent diffusion coefficient measurements in the posterior corpus callosum and streamlines that were shorter and less numerous in the right internal capsule. Among LT4-supplemented babies, those who had plasma FT4 concentrations in the highest quartile had significantly lower apparent diffusion coefficient values in the left occipital lobe, higher fractional anisotropy in the anterior corpus callosum and longer and more numerous streamlines in the anterior corpus callosum. DTI variables were not associated with allocation of placebo or thyroid supplementation. Markers of poorly organised brain microstructure were associated with low plasma FT4 concentrations after birth. The findings suggest that plasma FT4 concentrations affect brain development in very immature infants and that the effect of LT4 supplementation for immature babies with low FT4 plasma concentrations warrants further study.

Differences in sleep architecture between left and right temporal lobe epilepsy.

PubMed

Nakamura, Miki; Jin, Kazutaka; Kato, Kazuhiro; Itabashi, Hisashi; Iwasaki, Masaki; Kakisaka, Yosuke; Nakasato, Nobukazu

2017-01-01

To investigate whether seizure lateralization affects sleep macrostructure in patients with left and right temporal lobe epilepsy (TLE), as rapid eye movement (REM) sleep is shorter in patients with right hemispheric cerebral infarction than with left. We retrospectively analyzed data from 16 patients with TLE (6 men and 10 women aged 34.9 ± 11.4 years) who underwent polysomnography as well as long-term video electroencephalography. Ten patients were diagnosed with left TLE and six patients with right TLE. Sleep stages and respiratory events were scored based on the American Academy of Sleep Medicine criteria. Sleep and respiratory parameters were compared between the patient groups. Percentage of REM stage sleep was significantly (p < 0.05) lower in patients with left TLE (median 8.8 %, interquartile range 5.5-13.8 %) than in patients with right TLE (median 17.0 %, interquartile range 14.1-18.3 %). The other parameters showed no significant differences. Shorter REM sleep in patients with left TLE sharply contrasts with the previous report of shorter REM sleep in patients with right cerebral infarction. Laterality of the irritative epileptic focus versus destructive lesion may have different effects on the sleep macrostructures.

Absence of gender effect on amygdala volume in temporal lobe epilepsy.

PubMed

Silva, Ivaldo; Lin, Katia; Jackowski, Andrea P; Centeno, Ricardo da Silva; Pinto, Magali L; Carrete, Henrique; Yacubian, Elza M; Amado, Débora

2010-11-01

Sexual dimorphism has already been described in temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS). This study evaluated the effect of gender on amygdala volume in patients with TLE-MTS. One hundred twenty-four patients with refractory unilateral or bilateral TLE-MTS who were being considered for epilepsy surgery underwent a comprehensive presurgical evaluation and MRI. Amygdalas of 67 women (27 with right; 32 with left, and 8 with bilateral TLE) and 57 men (22 with right, 30 with left, and 5 with bilateral TLE) were manually segmented. Significant ipsilateral amygdala volume reduction was observed for patients with right and left TLE. No gender effect on amygdala volume was observed. Contralateral amygdalar asymmetry was observed for patients with right and left TLE. Although no gender effect was observed on amygdala volume, ipsilateral amygdala volume reductions in patients with TLE might be related to differential rates of cerebral maturation between hemispheres. Copyright © 2010 Elsevier Inc. All rights reserved.

Penetrating brain injury caused by nail guns: two case reports and a review of the literature.

PubMed

Luo, Wei; Liu, Hai; Hao, Shuyu; Zhang, Ying; Li, Jingsheng; Liu, Baiyun

2012-01-01

To the best of the authors' knowledge, there are few case reports of penetrating brain injuries (PBI) caused by nail guns and these have usually involved incomplete penetration of the skull. Complete penetration of a nail into the intracranial cavity is extremely rare. Here, two such cases are presented. In the first, the nail entered through the right temporal bone, lodged in the right temporal lobe and was removed via craniotomy with intra-operative ultrasound guidance. In the second, the nail destroyed the left parietal bone, damaged the left internal capsule and lodged in the left temporal lobe near the left petrous apex and the brain stem. According to the latest literature retrieval, this is the first reported case of nail-gun injury to the internal capsule. The position of the nail precluded removal without further neurologic damage. Treatment strategies designed to optimize outcome, with or without surgery, and possible complications are discussed in this report.

Multimodal imaging of language reorganization in patients with left temporal lobe epilepsy.

PubMed

Chang, Yu-Hsuan A; Kemmotsu, Nobuko; Leyden, Kelly M; Kucukboyaci, N Erkut; Iragui, Vicente J; Tecoma, Evelyn S; Kansal, Leena; Norman, Marc A; Compton, Rachelle; Ehrlich, Tobin J; Uttarwar, Vedang S; Reyes, Anny; Paul, Brianna M; McDonald, Carrie R

2017-07-01

This study explored the relationships among multimodal imaging, clinical features, and language impairment in patients with left temporal lobe epilepsy (LTLE). Fourteen patients with LTLE and 26 controls underwent structural MRI, functional MRI, diffusion tensor imaging, and neuropsychological language tasks. Laterality indices were calculated for each imaging modality and a principal component (PC) was derived from language measures. Correlations were performed among imaging measures, as well as to the language PC. In controls, better language performance was associated with stronger left-lateralized temporo-parietal and temporo-occipital activations. In LTLE, better language performance was associated with stronger right-lateralized inferior frontal, temporo-parietal, and temporo-occipital activations. These right-lateralized activations in LTLE were associated with right-lateralized arcuate fasciculus fractional anisotropy. These data suggest that interhemispheric language reorganization in LTLE is associated with alterations to perisylvian white matter. These concurrent structural and functional shifts from left to right may help to mitigate language impairment in LTLE. Copyright © 2017 Elsevier Inc. All rights reserved.

Regional cerebral blood flow (rCBF) in schizophrenia during verbal memory activation: a 99mTc-HMPAO single photon emission tomography (SPET) study.

PubMed

Busatto, G F; Costa, D C; Ell, P J; Pilowsky, L S; David, A S; Kerwin, R W

1994-05-01

Regional cerebral blood flow (rCBF) was investigated in a group of medicated DSM-III-R schizophrenic patients and age, sex and handedness matched normal volunteers using a split-dose 99mTc-HMPAO Single Photon Emission Tomography (SPET) protocol. Measures were taken during the performance of a verbal memory task aimed at activating the left medial temporal lobe, a region repeatedly suggested to be structurally abnormal in schizophrenia. In normal subjects, the performance of the task was associated with significant rCBF increases in the left medial temporal, left inferior frontal and anterior cingulate cortices, and right cerebellum. Despite their significantly poorer performance on the memory task, the degree of medial temporal activation measured in the schizophrenic patients was not significantly different from that found in the control group. This finding suggests that memory deficits in schizophrenia do not necessarily imply failure to activate the left medial temporal lobe as assessed by 99mTc-HMPAO SPET.

Thyroid associated orbitopathy

PubMed Central

Verma, Rajesh; Gupta, Mani; Mehta, Vinod Kumar

2013-01-01

Thyroid-associated orbitopathy (TAO) is a self-limiting auto-immune condition usually associated with Grave's disease. It is characterised by ocular pain, eyelid swelling, chemosis, proptosis and keratopathy. As the mechanism for ophthamoplegia and optic neuropathy is the orbital swelling leading to mechanical restriction of ocular muscles and compression of optic nerve, one expects proptosis rather than ptosis in TAO. We describe a case of a young adult woman who presented with acute onset restriction of movement along with partial ptosis and severe diminution of vision in left eye. The MRI of orbit revealed significant swelling of recti along with signal alteration consistent with TAO. The radio-isotope thyroid scan revealed thyroiditis, and thyroid peroxidase (TPO) antibody was significantly high; hence, the diagnosis of Hashimoto thyroiditis was considered. A course of intravenous methylprednisolone followed by oral steroid was administered, which produced marked improvement in vision and extraocular movement. PMID:23737589

Hyoid Bone and Thyroid Cartilage Metastases from Sigmoid Colon Adenocarcinoma: A Case Report.

PubMed

Bracanovic, Djurdja; Vukovic, Vesna; Janovic, Aleksa; Radosavljevic, Davorin; Rakocevic, Zoran

2017-05-05

Secondary tumours of the hyoid bone and thyroid cartilage are extremely rare. In this paper, we present a case of the hyoid bone and thyroid cartilage metastases in a patient treated for sigmoid colon adenocarcinoma. Four years after sigmoid colon adenocarcinoma was diagnosed and treated with surgery and chemotherapy, the patient developed bone metastases in the left sacroiliac joint and right proximal humerus. Although the patient did not complain of any related symptoms, in a bone scintigraphy the accumulation of Technetium-99m was incidentally detected in the two sites of the anterior neck. On ultrasound examination there were two hyperechoic and heterogeneous masses with calcifications placed in front of the hyoid bone and thyroid cartilage. Computerized tomography demonstrated massive hyoid bone and thyroid cartilage destruction. In patients with progressive sigmoid colon adenocarcinoma, destruction of the hyoid bone and thyroid cartilage could be suspected for metastases.

Face-name association task reveals memory networks in patients with left and right hippocampal sclerosis.

PubMed

Klamer, Silke; Milian, Monika; Erb, Michael; Rona, Sabine; Lerche, Holger; Ethofer, Thomas

2017-01-01

We aimed to identify reorganization processes of episodic memory networks in patients with left and right temporal lobe epilepsy (TLE) due to hippocampal sclerosis as well as their relations to neuropsychological memory performance. We investigated 28 healthy subjects, 12 patients with left TLE (LTLE) and 9 patients with right TLE (RTLE) with hippocampal sclerosis by means of functional magnetic resonance imaging (fMRI) using a face-name association task, which combines verbal and non-verbal memory functions. Regions-of-interest (ROIs) were defined based on the group results of the healthy subjects. In each ROI, fMRI activations were compared across groups and correlated with verbal and non-verbal memory scores. The face-name association task yielded activations in bilateral hippocampus (HC), left inferior frontal gyrus (IFG), left superior frontal gyrus (SFG), left superior temporal gyrus, bilateral angular gyrus (AG), bilateral medial prefrontal cortex and right anterior temporal lobe (ATL). LTLE patients demonstrated significantly less activation in the left HC and left SFG, whereas RTLE patients showed significantly less activation in the HC bilaterally, the left SFG and right AG. Verbal memory scores correlated with activations in the left and right HC, left SFG and right ATL and non-verbal memory scores with fMRI activations in the left and right HC and left SFG. The face-name association task can be employed to examine functional alterations of hippocampal activation during encoding of both verbal and non-verbal material in one fMRI paradigm. Further, the left SFG seems to be a convergence region for encoding of verbal and non-verbal material.

Effects of hemisphere speech dominance and seizure focus on patterns of behavioral response errors for three types of stimuli.

PubMed

Rausch, R; MacDonald, K

1997-03-01

We used a protocol consisting of a continuous presentation of stimuli with associated response requests during an intracarotid sodium amobarbital procedure (IAP) to study the effects of hemisphere injected (speech dominant vs. nondominant) and seizure focus (left temporal lobe vs. right temporal lobe) on the pattern of behavioral response errors for three types of visual stimuli (pictures of common objects, words, and abstract forms). Injection of the left speech dominant hemisphere compared to the right nondominant hemisphere increased overall errors and affected the pattern of behavioral errors. The presence of a seizure focus in the contralateral hemisphere increased overall errors, particularly for the right temporal lobe seizure patients, but did not affect the pattern of behavioral errors. Left hemisphere injections disrupted both naming and reading responses at a rate similar to that of matching-to-sample performance. Also, a short-term memory deficit was observed with all three stimuli. Long-term memory testing following the left hemisphere injection indicated that only for pictures of common objects were there fewer errors during the early postinjection period than for the later long-term memory testing. Therefore, despite the inability to respond to picture stimuli, picture items, but not words or forms, could be sufficiently encoded for later recall. In contrast, right hemisphere injections resulted in few errors, with a pattern suggesting a mild general cognitive decrease. A selective weakness in learning unfamiliar forms was found. Our findings indicate that different patterns of behavioral deficits occur following the left vs. right hemisphere injections, with selective patterns specific to stimulus type.

Resting-state functional connectivity predicts the strength of hemispheric lateralization for language processing in temporal lobe epilepsy and normals

PubMed Central

Doucet, Gaëlle E.; Pustina, Dorian; Skidmore, Christopher; Sharan, Ashwini; Sperling, Michael R.; Tracy, Joseph I.

2015-01-01

In temporal lobe epilepsy (TLE), determining the hemispheric specialization for language before surgery is critical to preserving a patient's cognitive abilities post-surgery. To date, the major techniques utilized are limited by the capacity of patients to efficiently realize the task. We determined whether resting-state functional connectivity (rsFC) is a reliable predictor of language hemispheric dominance in right and left TLE patients, relative to controls. We chose three subregions of the inferior frontal cortex (pars orbitalis, pars triangularis and pars opercularis) as the seed regions. All participants performed both a verb generation task and a resting-state fMRI procedure. Based on the language task, we computed a laterality index (LI) for the resulting network. This revealed that 96% of the participants were left-hemisphere dominant, although there remained a large degree of variability in the strength of left lateralization. We tested whether LI correlated with rsFC values emerging from each seed. We revealed a set of regions that was specific to each group. Unique correlations involving the epileptic mesial temporal lobe were revealed for the right and left TLE patients, but not for the controls. Importantly, for both TLE groups, the rsFC emerging from a contralateral seed was the most predictive of LI. Overall, our data depict the broad patterns of rsFC that support strong versus weak left hemisphere language laterality. This project provides the first evidence that rsFC data may potentially be used on its own to verify the strength of hemispheric dominance for language in impaired or pathologic populations. PMID:25187327

[Predictors of verbal memory decline following temporal lobe surgery].

PubMed

de Vanssay-Maigne, A; Boutin, M; Baudoin-Chial, S

2008-05-01

Verbal memory decline can occur after temporal lobe surgery, especially when the left dominant hemisphere is involved. This potential functional risk must be evaluated before surgery. Among all factors that have been identified by several studies, the side of surgery (left dominant) and high baseline memory performance have been found to be predictive of verbal memory decline. Other factors such as etiology, sex, age at surgery, age at seizure onset, and duration may influence memory decline, but the results are not clear. Our purpose was to identify, in our population of patients and among all risk factors, those that may be predictive of verbal memory decline. Logistic regression was used to examine the effect of each factor on the postoperative verbal memory index (WMS-R) in 101 patients who underwent a right (n=49) or left (n=52) anterior temporal lobe resection. In the group as a whole, 22 % of the patients demonstrated verbal memory decline of more than one standard deviation. The verbal memory decline was significantly related to surgery on the left side and a high level of verbal memory performance. These factors were significant predictors of decline. The other factors (etiology, sex, age at surgery, age at seizure onset, and duration) were not found to be predictive of this decline. Our analysis demonstrates that the patients who are most at risk of undergoing verbal memory deterioration are those who undergo left-sided temporal resection and have good memory scores preoperatively. The contradictions found in the literature about the other factors could be explained by the diversity of the tests and criteria used to assess memory decline.

GATE based Monte Carlo simulation of planar scintigraphy to estimate the nodular dose in radioiodine therapy for autonomous thyroid adenoma.

PubMed

Hammes, Jochen; Pietrzyk, Uwe; Schmidt, Matthias; Schicha, Harald; Eschner, Wolfgang

2011-12-01

The recommended target dose in radioiodine therapy of solitary hyperfunctioning thyroid nodules is 300-400Gy and therefore higher than in other radiotherapies. This is due to the fact that an unknown, yet significant portion of the activity is stored in extranodular areas but is neglected in the calculatory dosimetry. We investigate the feasibility of determining the ratio of nodular and extranodular activity concentrations (uptakes) from post-therapeutically acquired planar scintigrams with Monte Carlo simulations in GATE. The geometry of a gamma camera with a high energy collimator was emulated in GATE (Version 5). A geometrical thyroid-neck phantom (GP) and the ICRP reference voxel phantoms "Adult Female" (AF, 16ml thyroid) and "Adult Male" (AM, 19ml thyroid) were used as source regions. Nodules of 1ml and 3ml volume were placed in the phantoms. For each phantom and each nodule 200 scintigraphic acquisitions were simulated. Uptake ratios of nodule and rest of thyroid ranging from 1 to 20 could be created by summation. Quantitative image analysis was performed by investigating the number of simulated counts in regions of interest (ROIs). ROIs were created by perpendicular projection of the phantom onto the camera plane to avoid a user dependant bias. The ratio of count densities in ROIs over the nodule and over the contralateral lobe, which should be least affected by nodular activity, was taken to be the best available measure for the uptake ratios. However, the predefined uptake ratios are underestimated by these count density ratios: For an uptake ratio of 20 the count ratios range from 4.5 (AF, 1ml nodule) to 15.3 (AM, 3ml nodule). Furthermore, the contralateral ROI is more strongly affected by nodular activity than expected: For an uptake ratio of 20 between nodule and rest of thyroid up to 29% of total counts in the ROI over the contralateral lobe are caused by decays in the nodule (AF 3 ml). In the case of the 1ml nodules this effect is smaller: 9-11% (AF) respectively 7-8% (AM). For each phantom, the dependency of count density ratios upon uptake ratios can be modeled well by both linear and quadratic regression (quadratic: r(2)>0.99), yielding sets of parameters which in reverse allow the computation of uptake ratios (and thus dose) from count density ratios. A single regression model obtained by fitting the data of all simulations simultaneously did not provide satisfactory results except for GP, while underestimating the true uptake ratios in AF and overestimating them in AM. The scintigraphic count density ratios depend upon the uptake ratios between nodule and rest of thyroid, upon their volumes, and their respective position in a non-trivial way. Further investigations are required to derive a comprehensive rule to calculate the uptake or dose ratios based on post-therapeutic scintigraphy. Copyright © 2011. Published by Elsevier GmbH.

Levels of Processing with Free and Cued Recall and Unilateral Temporal Lobe Epilepsy

ERIC Educational Resources Information Center

Lespinet-Najib, Veronique; N'Kaoua, Bernard; Sauzeon, Helene; Bresson, Christel; Rougier, Alain; Claverie, Bernard

2004-01-01

This study investigates the role of the temporal lobes in levels-of-processing tasks (phonetic and semantic encoding) according to the nature of recall tasks (free and cued recall). These tasks were administered to 48 patients with unilateral temporal epilepsy (right ''RTLE''=24; left ''LTLE''=24) and a normal group (n=24). The results indicated…

Disruption of Spelling-to-Sound Correspondence Mapping during Single-Word Reading in Patients with Temporal Lobe Epilepsy

ERIC Educational Resources Information Center

Ledoux, Kerry; Gordon, Barry

2011-01-01

Processing and/or hemispheric differences in the neural bases of word recognition were examined in patients with long-standing, medically-intractable epilepsy localized to the left (N = 18) or right (N = 7) temporal lobe. Participants were asked to read words that varied in the frequency of their spelling-to-sound correspondences. For the right…

Temporal Lobe Epilepsy and the Selective Reminding Test: The Conventional 30-Minute Delay Suffices

ERIC Educational Resources Information Center

Bell, Brian D.; Fine, Jason; Dow, Christian; Seidenberg, Michael; Hermann, Bruce P.

2005-01-01

Conventional memory assessment may fail to identify memory dysfunction characterized by intact recall for a relatively brief period but rapid forgetting thereafter. This study assessed learning and retention after 30-min and 24-hr delays on auditory and visual selective reminding tests (SRTs) in right (n=20) and left (n=22) temporal lobe epilepsy…

Impaired Facial Expression Recognition in Children with Temporal Lobe Epilepsy: Impact of Early Seizure Onset on Fear Recognition

ERIC Educational Resources Information Center

Golouboff, Nathalie; Fiori, Nicole; Delalande, Olivier; Fohlen, Martine; Dellatolas, Georges; Jambaque, Isabelle

2008-01-01

The amygdala has been implicated in the recognition of facial emotions, especially fearful expressions, in adults with early-onset right temporal lobe epilepsy (TLE). The present study investigates the recognition of facial emotions in children and adolescents, 8-16 years old, with epilepsy. Twenty-nine subjects had TLE (13 right, 16 left) and…

Retrograde amnesia in patients with diencephalic, temporal lobe or frontal lesions.

PubMed

Kopelman, M D; Stanhope, N; Kingsley, D

1999-07-01

Patients with focal diencephalic, temporal lobe, or frontal lobe lesions were examined on various measures of remote memory. Korsakoff patients showed a severe impairment with a characteristic 'temporal gradient', whereas two patients with focal diencephalic damage (and anterograde amnesia) were virtually unimpaired on remote memory measures. Patients with frontal lobe pathology were severely impaired in the recall of autobiographical incidents and famous news events. Patients with temporal lobe pathology showed severe impairment but a relatively 'flat' temporal gradient, largely attributable to herpes encephalitis patients. From recognition and cued recall tasks, it is argued that there is an important retrieval component to the remote memory deficit across all the lesion groups. In general, the pattern of performance by the frontal lobe and temporal lobe groups was closely similar, and there was no evidence of any major access/storage difference between them. However, laterality comparisons across these groups indicated that the right temporal and frontal lobe regions may make a greater contribution to the retrieval of past episodic (incident and event) memories, whereas the left temporal region is more closely involved in the lexical-semantic labelling of remote memories.

The Continuous Wagon Wheel Illusion and the ‘When’ Pathway of the Right Parietal Lobe: A Repetitive Transcranial Magnetic Stimulation Study

PubMed Central

VanRullen, Rufin; Pascual-Leone, Alvaro; Battelli, Lorella

2008-01-01

A continuous periodic motion stimulus can sometimes be perceived moving in the wrong direction. These illusory reversals have been taken as evidence that part of the motion perception system samples its inputs as a series of discrete snapshots –although other explanations of the phenomenon have been proposed, that rely on the spurious activation of low-level motion detectors in early visual areas. We have hypothesized that the right inferior parietal lobe (‘when’ pathway) plays a critical role in timing perceptual events relative to one another, and thus we examined the role of the right parietal lobe in the generation of this “continuous Wagon Wheel Illusion” (c-WWI). Consistent with our hypothesis, we found that the illusion was effectively weakened following disruption of right, but not left, parietal regions by low frequency repetitive transcranial magnetic stimulation (1 Hz, 10 min). These results were independent of whether the motion stimulus was shown in the left or the right visual field. Thus, the c-WWI appears to depend on higher-order attentional mechanisms that are supported by the ‘when’ pathway of the right parietal lobe. PMID:18682842

[Primary hydatid cyst of the thyroid, an unusual localisation of hydatidosis].

PubMed

Lada, P; Lermite, E; Hennekinne-Mucci, S; Etienne, S; Pessaux, P; Arnaud, J-P

2005-04-23

Echinococcus granulosus, responsible for hydatidosis, most often lodges in the liver and lungs, but is found in other organs of the body in 10% of cases. A painless, left cervical tumefaction suddenly developed in a 28-year-old Portuguese man. After thyroid lobectomy with isthmusectomy, the pathology findings led to the diagnosis of hydatidosis. The thyroid is a rare location for a hydatid cyst. Diagnosis can be difficult and fine-needle aspiration cytology is not usually helpful. Treatment requires surgical excision, and administration of benzimidazole derivatives to prevent recurrence.

The advantages of subtotal thyroidectomy and suppression of TSH in the primary treatment of papillary carcinoma of the thyroid

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crile, G. Jr.; Antunez, A.R.; Esselstyn, C.B. Jr.

1985-06-01

Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (/sup 131/I). Moreover, distant metastases can be treated by either /sup 131/I or suppression as effectively after they are apparent on x-ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients oldermore » than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, /sup 131/I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by /sup 131/I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.« less

Gender differences in post-temporal lobectomy verbal memory and relationships between MRI hippocampal volumes and preoperative verbal memory.

PubMed

Trenerry, M R; Jack, C R; Cascino, G D; Sharbrough, F W; Ivnik, R J

1995-01-01

Thirty-three men and 42 women who underwent left, and 26 men and 24 women who underwent right temporal lobectomy (TL) were studied retrospectively to determine if there were sex differences in (1) verbal memory outcome, and (2) relationships between verbal memory and magnetic resonance imaging (MRI) hippocampal volumes. All patients were left hemisphere language dominant. The surgical specimen and MRI were consistent only with mesial temporal sclerosis (MTS). Verbal memory was evaluated by Logical Memory percent retention (LMPER) from the Wechsler Memory Scale-Revised (WMS-R). Women experienced a significant improvement while men experienced a significant decline in postoperative LMPER. The difference between right and left hippocampal volumes predicted verbal memory outcome in both men and women. Preoperative LMPER was positively correlated with both the left and right hippocampal volumes in left TL women only. No verbal memory sex differences or correlations between LMPER and MRI data were found in the right TL group. The data support the presence of human neurocognitive sexual dimorphism. Verbal memory abilities supported by the hippocampus are less lateralized in women with left temporal lobe epilepsy and mesial temporal sclerosis. Women appear to have greater verbal memory plasticity following early left mesial temporal lobe insult.

Computed tomography of partial anomalous pulmonary venous connection in adults.

PubMed

Haramati, Linda B; Moche, Ilana E; Rivera, Vivian T; Patel, Pavni V; Heyneman, Laura; McAdams, H Page; Issenberg, Henry J; White, Charles S

2003-01-01

To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.

Neuropsychological functioning and brain energetics of drug resistant mesial temporal lobe epilepsy patients.

PubMed

Osório, Camila Moreira; Latini, Alexandra; Leal, Rodrigo Bainy; de Oliveira Thais, Maria Emília Rodrigues; Vascouto, Helena Dresch; Remor, Aline Pertile; Lopes, Mark William; Linhares, Marcelo Neves; Ben, Juliana; de Paula Martins, Roberta; Prediger, Rui Daniel; Hoeller, Alexandre Ademar; Markowitsch, Hans Joachim; Wolf, Peter; Lin, Kátia; Walz, Roger

2017-12-01

Interictal hypometabolism is commonly measured by 18-fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) in the temporal lobe of patients with mesial temporal lobe epilepsy (MTLE-HS). Left temporal lobe interictal FDG-PET hypometabolism has been associated with verbal memory impairment, while right temporal lobe FDG-PET hypometabolism is associated with nonverbal memory impairment. The biochemical mechanisms involved in these findings remain unknown. In comparison to healthy controls (n=21), surgically treated patients with MTLE-HS (n=32, left side=17) had significant lower scores in the Rey Auditory Verbal Learning Test (RAVLT retention and delayed), Logical Memory II (LMII), Boston Naming test (BNT), Letter Fluency and Category Fluency. We investigated whether enzymatic activities of the mitochondrial enzymes Complex I (C I), Complex II (C II), Complex IV (C IV) and Succinate Dehydrogenase (SDH) from the resected samples of the middle temporal neocortex (mTCx), amygdala (AMY) and hippocampus (HIP) were associated with performance in the RAVLT, LMII, BNT and fluency tests of our patients. After controlling for the side of hippocampus sclerosis, years of education, disease duration, antiepileptic treatment and seizure outcome after surgery, no independent associations were observed between the cognitive test scores and the analyzed mitochondrial enzymatic activities (p>0.37). Results indicate that memory and language impairment observed in MTLE-HS patients are not strongly associated with the levels of mitochondrial CI, CII, SDH and C IV enzymatic activities in the temporal lobe structures ipsilateral to the HS lesion. Copyright © 2017 Elsevier B.V. All rights reserved.

[Clinical characteristics of epileptic seizures in insular gliomas].

PubMed

Buklina, S B; Bykanov, A E; Pitskhelauri, D I

To study the characteristics of epileptic seizures in insular gliomas. Forty-five patients with insular gliomas were examined. The spread of a tumor was established by MRI results and intraoperational findings. A tumor within the insular only was found in 9 out of 45 patients (7 left-sided and 2 right-sided). In 36 patients, a tumor slightly spread into temporal lobe pole and medial-basal regions of the frontal lobe (27 left-sided and 18 right-sided). The control group consisted of 50 patients with tumors of temporal and frontal lobes. Paroxysmal symptoms were similar in patients with tumors of the insular and patients with tumors of temporal lobes. Seizures in patients with frontal lobe tumors differed significantly from insular and temporal tumors, with the exception of a tumor localized in the opercula area. The following quantitative differences were identified: different forms of unconsciousness were significantly less frequent in symptomatic epilepsy in patients with insular tumor than in epilepsy caused by temporal lobe tumors (36% of patients vs 84% in temporal tumors (p<0.0001)). In patients with insular tumors, olfactory and taste hallucinations occur more often compared to temporal lobe tumors (51% vs 16% (p<0.003). The frequency of paroxysmal seizures of fear and anxiety in patients with those tumors was similar (20% with insular tumors and 14 with temporal tumors). An autonomic component of episeizures did not differ between tumors of both localizations. Olfactory and taste hallucinations were qualitatively similar in insular and temporal lobe tumors: smell and taste were unpleasant or associated with a danger: smell of burning, gas, something spoiled, sour, tart chemistry, taste of somethong metallic, chemical, sour. No pleasant smell or taste were reported. Epileptic seizures in insular tumors had similarities and certain differences compared with temporal seizures that well reflect function of the insula and its links, in the first turn, with limbic system structures.

Frontal Lobe Cavernous Malformations in Pediatric Patients: Clinical Features and Surgical Outcomes.

PubMed

Wang, Chengjun; Zhao, Meng; Wang, Jia; Wang, Shuo; Jiang, Zhongli; Zhao, Jizong

2018-01-01

The purpose of this study is to investigate the clinical manifestations, surgical treatment, and neurologic outcomes of frontal lobe cavernous malformations in children. A retrospective analysis of 23 pediatric frontal lobe cavernous malformation patients who underwent surgical treatment in Beijing Tiantan Hospital was performed. The case series included 16 boys and 7 girls. Gross total removal without surgical mortality was achieved in all patients. The mean follow-up period after surgery was 33.1 months. Two patients who left hospital with motor deficits gradually recovered after rehabilitative treatment, and other patients were considered to be in excellent clinical condition. For symptomatic frontal lobe cavernous malformations, neurosurgical management should be the treatment of choice. Conservative treatment may be warranted in asymptomatic frontal lobe cavernous malformations, especially the deep-seated or eloquently located cases.

Role of color Doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis

PubMed Central

Donkol, Ragab Hani; Nada, Aml Mohamed; Boughattas, Sami

2013-01-01

AIM: To evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis and compare it to technetium pertechnetate thyroid scanning. METHODS: Twenty-six patients with thyrotoxicosis were included in the study. Clinical history was taken and physical examination and thyroid function tests were performed for all patients. Thyroid autoantibodies were measured. The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-flow Doppler ultrasonography of the thyroid tissue was performed and spectral flow analysis of both inferior thyroid arteries was assessed. Technetium99 pertechnetate scanning of the thyroid gland was done for all patients. According to thyroid scintigraphy, the patients were divided into two groups: 18 cases with Graves’ disease and 8 cases with Hashimoto’s thyroiditis. All patients had suppressed thyrotropin. The diagnosis of Graves’ disease and Hashimoto’s thyroiditis was supported by the clinical picture and follow up of patients. RESULTS: Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves’ disease than in patients with thyroiditis (P = 0.004 in the right inferior thyroid artery and P = 0.001 in left inferior thyroid artery). Color-flow Doppler ultrasonography parameters demonstrated a sensitivity of 88.9% and a specificity of 87.5% in the differential diagnosis of thyrotoxicosis. CONCLUSION: Color Doppler flow of the inferior thyroid artery can be used in the differential diagnosis of thyrotoxicosis, especially when there is a contraindication of thyroid scintigraphy by radioactive material in some patients. PMID:23671754

Longitudinal Changes in Cortical Thickness in Children after Traumatic Brain Injury and their Relation to Behavioral Regulation and Emotional Control

PubMed Central

Wilde, Elisabeth A.; Merkley, Tricia L.; Bigler, Erin D.; Max, Jeffrey E.; Schmidt, Adam T.; Ayoub, Kareem W.; McCauley, Stephen R.; Hunter, Jill V.; Hanten, Gerri; Li, Xiaoqi; Chu, Zili D.; Levin, Harvey S.

2012-01-01

The purpose of this study was to assess patterns of cortical development over time in children who had sustained traumatic brain injury (TBI) as compared to children with orthopedic injury (OI), and to examine how these patterns related to emotional control and behavioral dysregulation, two common post-TBI symptoms. Cortical thickness was measured at approximately 3 and 18 months post-injury in 20 children aged 8.2 to 17.5 years who had sustained moderate-to-severe closed head injury and 21 children aged 7.4 to 16.7 years who had sustained OI. At approximately 3 months post-injury, the TBI group evidenced decreased cortical thickness bilaterally in aspects of the superior frontal, dorsolateral frontal, orbital frontal, and anterior cingulate regions compared to the control cohort, areas of anticipated vulnerability to TBI-induced change. At 18 months post-injury, some of the regions previously evident at 3 months post-injury remained significantly decreased in the TBI group, including bilateral frontal, fusiform, and lingual regions. Additional regions of significant cortical thinning emerged at this time interval (bilateral frontal regions and fusiform gyrus and left parietal regions). However, differences in other regions appeared attenuated (no longer areas of significant cortical thinning) by 18 months post-injury including large bilateral regions of the medial aspects of the frontal lobes and anterior cingulate. Cortical thinning within the OI group was evident over time in dorsolateral frontal and temporal regions bilaterally and aspects of the left medial frontal and precuneus, and right inferior parietal regions. Longitudinal analyses within the TBI group revealed decreases in cortical thickness over time in numerous aspects throughout the right and left cortical surface, but with notable “sparing” of the right and left frontal and temporal poles, the medial aspects of both the frontal lobes, the left fusiform gyrus, and the cingulate bilaterally. An analysis of longitudinal changes in cortical thickness over time (18 months – 3 months) in the TBI versus OI group demonstrated regions of relative cortical thinning in the TBI group in bilateral superior parietal and right paracentral regions, but relative cortical thickness increases in aspects of the medial orbital frontal lobes and bilateral cingulate and in the right lateral orbital frontal lobe. Finally, findings from analyses correlating the longitudinal cortical thickness changes in TBI with symptom report on the Emotional Control subscale of the Behavior Rating Inventory of Executive Function (BRIEF) demonstrated a region of significant correlation in the right medial frontal and right anterior cingulate gyrus. A region of significant correlation between the longitudinal cortical thickness changes in the TBI group and symptom report on the Behavioral Regulation Index was also seen in the medial aspect of the left frontal lobe. Longitudinal analyses of cortical thickness highlight an important deviation from the expected pattern of developmental change in children and adolescents with TBI, particularly in the medial frontal lobes, where typical patterns of thinning fail to occur over time. Regions which fail to undergo expected cortical thinning in the medial aspects of the frontal lobes correlate with difficulties in emotional control and behavioral regulation, common problems for youth with TBI. Examination of post-TBI brain development in children may be critical to identification of children that may be at risk for persistent problems with executive functioning deficits and the development of interventions to address these issues. PMID:22266409

Voxel-level comparison of arterial spin-labeled perfusion magnetic resonance imaging in adolescents with internet gaming addiction

PubMed Central

2013-01-01

Background Although recent studies have clearly demonstrated functional and structural abnormalities in adolescents with internet gaming addiction (IGA), less is known about how IGA affects perfusion in the human brain. We used pseudocontinuous arterial spin-labeling (ASL) perfusion functional magnetic resonance imaging (fMRI) to measure the effects of IGA on resting brain functions by comparing resting cerebral blood flow in adolescents with IGA and normal subjects. Methods Fifteen adolescents with IGA and 18 matched normal adolescents underwent structural and perfusion fMRI in the resting state. Direct subtraction, voxel-wise general linear modeling was performed to compare resting cerebral blood flow (CBF) between the 2 groups. Correlations were calculated between the mean CBF value in all clusters that survived AlphaSim correction and the Chen Internet Addiction Scale (CIAS) scores, Barratt Impulsiveness Scale-11 (BIS-11) scores, or hours of Internet use per week (hours) in the 15 subjects with IGA. Results Compared with control subjects, adolescents with IGA showed significantly higher global CBF in the left inferior temporal lobe/fusiform gyrus, left parahippocampal gyrus/amygdala, right medial frontal lobe/anterior cingulate cortex, left insula, right insula, right middle temporal gyrus, right precentral gyrus, left supplementary motor area, left cingulate gyrus, and right inferior parietal lobe. Lower CBF was found in the left middle temporal gyrus, left middle occipital gyrus, and right cingulate gyrus. There were no significant correlations between mean CBF values in all clusters that survived AlphaSim correction and CIAS or BIS-11 scores or hours of Internet use per week. Conclusions In this study, we used ASL perfusion fMRI and noninvasively quantified resting CBF to demonstrate that IGA alters the CBF distribution in the adolescent brain. The results support the hypothesis that IGA is a behavioral addiction that may share similar neurobiological abnormalities with other addictive disorders. PMID:23937918

Neural strategies for reading Japanese and Chinese sentences: a cross-linguistic fMRI study of character-decoding and morphosyntax.

PubMed

Huang, Koongliang; Itoh, Kosuke; Kwee, Ingrid L; Nakada, Tsutomu

2012-09-01

Japanese and Chinese share virtually identical morphographic characters invented in ancient China. Whereas modern Chinese retained the original morphographic functionality of these characters (hanzi), modern Japanese utilizes these characters (kanji) as complex syllabograms. This divergence provides a unique opportunity to systematically investigate brain strategies for sentence reading in Japanese-Chinese bi-literates. Accordingly, we investigated brain activation associated with Japanese and Chinese reading in 14 native Japanese speakers literate in Mandarin and 14 native Mandarin speakers literate in Japanese using functional magnetic resonance imaging performed on a 3T system. The activation pattern exhibited clearly distinct features specific for each language. Regardless of the subject's native language literacy, Chinese reading activated an area significantly larger than Japanese reading, suggesting that brain processes involved in Chinese reading were much more complex than Japanese reading. Significant recruitment of corresponding cortical areas in the right hemisphere with Chinese reading was also apparent. The activation patterns associated with Japanese reading by native Japanese literates was highly consistent with previous reports, and included the left inferior frontal gyrus (IFG), left posterior temporal lobe (PTL), and left ventral premotor cortex (PMv). The activation pattern associated with Chinese reading by native Chinese literates was also highly consistent with previous reports, namely the left IFG, left PTL, left PMv, left anterior temporal lobe (ATL), and bilateral parieto occipital lobes (LPOL). The activation pattern associated with Chinese reading by native Japanese literates was virtually identical to that by native Chinese literates, whereas the activation pattern associated with Japanese reading by native Chinese literates was signified by additional activation of LPOL compared to that by native Japanese literate. The study indicated that IFG and PTL are universal language areas, while PMv is the area for decoding complex syllabograms. LPOL is the "Chinese language area," while ATL is essential for languages with analytic morphosyntax. Copyright © 2012 Elsevier Ltd. All rights reserved.

Brain activity and desire for internet video game play

PubMed Central

Han, Doug Hyun; Bolo, Nicolas; Daniels, Melissa A.; Arenella, Lynn; Lyoo, In Kyoon; Renshaw, Perry F.

2010-01-01

Objective Recent studies have suggested that the brain circuitry mediating cue induced desire for video games is similar to that elicited by cues related to drugs and alcohol. We hypothesized that desire for internet video games during cue presentation would activate similar brain regions to those which have been linked with craving for drugs or pathological gambling. Methods This study involved the acquisition of diagnostic MRI and fMRI data from 19 healthy male adults (ages 18–23 years) following training and a standardized 10-day period of game play with a specified novel internet video game, “War Rock” (K-network®). Using segments of videotape consisting of five contiguous 90-second segments of alternating resting, matched control and video game-related scenes, desire to play the game was assessed using a seven point visual analogue scale before and after presentation of the videotape. Results In responding to internet video game stimuli, compared to neutral control stimuli, significantly greater activity was identified in left inferior frontal gyrus, left parahippocampal gyrus, right and left parietal lobe, right and left thalamus, and right cerebellum (FDR <0.05, p<0.009243). Self-reported desire was positively correlated with the beta values of left inferior frontal gyrus, left parahippocampal gyrus, and right and left thalamus. Compared to the general players, members who played more internet video game (MIGP) cohort showed significantly greater activity in right medial frontal lobe, right and left frontal pre-central gyrus, right parietal post-central gyrus, right parahippocampal gyrus, and left parietal precuneus gyrus. Controlling for total game time, reported desire for the internet video game in the MIGP cohort was positively correlated with activation in right medial frontal lobe and right parahippocampal gyrus. Discussion The present findings suggest that cue-induced activation to internet video game stimuli may be similar to that observed during cue presentation in persons with substance dependence or pathological gambling. In particular, cues appear to commonly elicit activity in the dorsolateral prefrontal, orbitofrontal cortex, parahippocampal gyrus, and thalamus. PMID:21220070

Accelerated long-term forgetting in temporal lobe epilepsy: evidence of improvement after left temporal pole lobectomy.

PubMed

Gallassi, Roberto; Sambati, Luisa; Poda, Roberto; Stanzani Maserati, Michelangelo; Oppi, Federico; Giulioni, Marco; Tinuper, Paolo

2011-12-01

Accelerated long term forgetting (ALF) is a characteristic cognitive aspect in patients affected by temporal lobe epilepsy that is probably due to an impairment of memory consolidation and retrieval caused by epileptic activity in hippocampal and parahippocampal regions. We describe a case of a patient with TLE who showed improvement in ALF and in remote memory impairment after an anterior left temporal pole lobectomy including the uncus and amygdala. Our findings confirm that impairment of hippocampal functioning leads to pathological ALF, whereas restoration of hippocampal functioning brings ALF to a level comparable to that of controls. Copyright © 2011 Elsevier Inc. All rights reserved.

Revival of Historical Kana Orthography in a Patient with Allographic Agraphia

PubMed Central

Maeda, Kengo; Shiraishi, Tomoyuki

2018-01-01

Japanese people born before World War II learned Japanese kana (Japanese syllabograms) writing in a style that is not currently used. These individuals had to learn the current style of kana orthography after the war. An 85-year-old man was taken to our hospital by his family who were surprised by his diary. It was written with kanji (Japanese ideograms) and katakana using the prewar style. A neuropsychological examination revealed impaired recall of hiragana. Neuroimaging studies revealed atrophy of the left fronto-parietal lobe and hypoperfusion of the left frontal lobe. His allographic agraphia might have resulted from the disturbance of the current style of kana orthography. PMID:29491278

Development of a microRNA-based molecular assay for the detection of papillary thyroid carcinoma in aspiration biopsy samples.

PubMed

Mazeh, Haggi; Mizrahi, Ido; Halle, David; Ilyayev, Nadia; Stojadinovic, Alexander; Trink, Barry; Mitrani-Rosenbaum, Stella; Roistacher, Marina; Ariel, Ilana; Eid, Ahmed; Freund, Herbert R; Nissan, Aviram

2011-02-01

Although thyroid nodules are common and diagnosed in over 5% of the adult population, only 5% harbor malignancy. Patients with clinically suspicious thyroid nodules need to undergo fine-needle aspiration biopsy (FNAB). The main limitation of FNAB remains indeterminate cytopathology. Only 20%-30% of the indeterminate nodules harbor malignancy, and therefore up to 80% of patients undergo unnecessary thyroidectomy. The aim of this study was to identify and validate a panel of microRNAs (miRNAs) that could serve as a platform for an FNAB-based diagnostic for thyroid neoplasms. The study population included 27 consecutive patients undergoing total thyroidectomy for FNAB-based papillary thyroid cancer (n = 20) and benign disorders (n = 7). Aspiration biopsy was performed from the index lesion and from the opposite lobe normal tissue in all study patients at the time of operation. RNA was extracted from all aspiration biopsy samples. Quantitative polymerase chain reaction on a panel of previously selected miRNAs was performed. Polymerase chain reaction results were compared with final histopathology. miRNA from tumor tissues was amplified using the highest value of each miRNA expression in normal tissue as a threshold for malignancy detection. Diagnostic characteristics were most favorable for mir-221 in differentiating benign from malignant thyroid pathology. mir-221 was overexpressed in 19 patients (p < 0.0001) with a sensitive yield of 95%. Specificity, negative and positive predictive value, and accuracy of the miRNA panel were 100%, 96%, 100%, and 98%, respectively. miRNA quantification for differential diagnosis of thyroid neoplasms within aspiration biopsy samples is feasible and may improve the accuracy of FNAB cytology.

‘Forced normalisation’ in the neurosurgical era

PubMed Central

Shahani, Lokesh

2012-01-01

The correlation between epilepsy and behavioural disorders is well known. Forced normalisation is a phenomenon where there is worsening of the patient's behavioural disorder when a better seizure control has been obtained. A complication of anti-epileptic treatment worsening the behavioural disorder is sometimes the proposed mechanism. The author presents the report of a young man with temporal lobe epilepsy and poor seizure control in the past 12 years. The patient had comorbid impulse control disorder previously well controlled with medications. MRI demonstrated left mesial temporal sclerosis and intracranial EEG recording located seizure foci in the left medial temporal lobe. The patient underwent left temporal lobectomy for seizure control with partial success. However, after operation, the patient's impulse control disorder worsened and he was involved in physical altercations leading to incarceration. This illustrates a case where partial seizure control was obtained with a surgical procedure, but resulted in worsening of the patient's behavioural disorder. PMID:22684833

Cervical chordoma in a domestic ferret (Mustela putorius furo) with pulmonary metastasis.

PubMed

Frohlich, Jennifer R; Donovan, Taryn A

2015-09-01

A 4-year-old, male neutered domestic ferret (Mustela putorius furo) was evaluated for a mass in the left cervical region. The owner elected humane euthanasia, and an autopsy was performed, revealing a neoplasm with infiltration into the left cranial articular fovea of the atlas and cervical vertebrae, with regional compression of the spinal cord. Histologic evaluation was consistent with cervical chordoma. At autopsy, a left cranial lung lobe nodule was observed. Additional sectioning and histologic evaluation revealed multiple foci of metastatic chordoma at this site. A small focus of micrometastasis was also detected in a section from the right lung lobes. Chordoma is the most common musculoskeletal neoplasm of ferrets, arising from remnant fetal notochord. To our knowledge, pulmonary chordoma metastasis has not been previously reported in the ferret. This case demonstrates the potential for visceral metastasis of chordoma in the ferret, as has been reported in other species. © 2015 The Author(s).

Kinesthetic alexia due to left parietal lobe lesions.

PubMed

Ihori, Nami; Kawamura, Mitsuru; Araki, Shigeo; Kawachi, Juro

2002-01-01

To investigate the neuropsychological mechanisms of kinesthetic alexia, we asked 7 patients who showed kinesthetic alexia with preserved visual reading after damage to the left parietal region to perform tasks consisting of kinesthetic written reproduction (writing down the same letter as the kinesthetic stimulus), kinesthetic reading aloud, visual written reproduction (copying letters), and visual reading aloud of hiragana (Japanese phonograms). We compared the performance in these tasks and the lesion sites in each patient. The results suggested that deficits in any one of the following functions might cause kinesthetic alexia: (1) the retrieval of kinesthetic images (motor engrams) of characters from kinesthetic stimuli, (2) kinesthetic images themselves, (3) access to cross-modal association from kinesthetic images, and (4) cross-modal association itself (retrieval of auditory and visual images from kinesthetic images of characters). Each of these factors seemed to be related to different lesion sites in the left parietal lobe. Copyright 2002 S. Karger AG, Basel

"God has sent me to you": Right temporal epilepsy, left prefrontal psychosis.

PubMed

Arzy, Shahar; Schurr, Roey

2016-07-01

Religious experiences have long been documented in patients with epilepsy, though their exact underlying neural mechanisms are still unclear. Here, we had the rare opportunity to record a delusional religious conversion in real time in a patient with right temporal lobe epilepsy undergoing continuous video-EEG. In this patient, a messianic revelation experience occurred several hours after a complex partial seizure of temporal origin, compatible with postictal psychosis (PIP). We analyzed the recorded resting-state EEG epochs separately for each of the conventional frequency bands. Topographical analysis of the bandpass filtered EEG epochs revealed increased activity in the low-gamma range (30-40Hz) during religious conversion compared with activity during the patient's habitual state. The brain generator underlying this activity was localized to the left prefrontal cortex. This suggests that religious conversion in PIP is related to control mechanisms in the prefrontal lobe-related processes rather than medial temporal lobe-related processes. Copyright © 2016 Elsevier Inc. All rights reserved.

Differences in visual vs. verbal memory impairments as a result of focal temporal lobe damage in patients with traumatic brain injury.

PubMed

Ariza, Mar; Pueyo, Roser; Junqué, Carme; Mataró, María; Poca, María Antonia; Mena, Maria Pau; Sahuquillo, Juan

2006-09-01

The aim of the present study was to determine whether the type of lesion in a sample of moderate and severe traumatic brain injury (TBI) was related to material-specific memory impairment. Fifty-nine patients with TBI were classified into three groups according to whether the site of the lesion was right temporal, left temporal or diffuse. Six-months post-injury, visual (Warrington's Facial Recognition Memory Test and Rey's Complex Figure Test) and verbal (Rey's Auditory Verbal Learning Test) memories were assessed. Visual memory deficits assessed by facial memory were associated with right temporal lobe lesion, whereas verbal memory performance assessed with a list of words was related to left temporal lobe lesion. The group with diffuse injury showed both verbal and visual memory impairment. These results suggest a material-specific memory impairment in moderate and severe TBI after focal temporal lesions and a non-specific memory impairment after diffuse damage.

Dissociating the semantic function of two neighbouring subregions in the left lateral anterior temporal lobe

PubMed Central

Sanjuán, Ana; Hope, Thomas M.H.; Parker Jones, 'Ōiwi; Prejawa, Susan; Oberhuber, Marion; Guerin, Julie; Seghier, Mohamed L.; Green, David W.; Price, Cathy J.

2015-01-01

We used fMRI in 35 healthy participants to investigate how two neighbouring subregions in the lateral anterior temporal lobe (LATL) contribute to semantic matching and object naming. Four different levels of processing were considered: (A) recognition of the object concepts; (B) search for semantic associations related to object stimuli; (C) retrieval of semantic concepts of interest; and (D) retrieval of stimulus specific concepts as required for naming. During semantic association matching on picture stimuli or heard object names, we found that activation in both subregions was higher when the objects were semantically related (mug–kettle) than unrelated (car–teapot). This is consistent with both LATL subregions playing a role in (C), the successful retrieval of amodal semantic concepts. In addition, one subregion was more activated for object naming than matching semantically related objects, consistent with (D), the retrieval of a specific concept for naming. We discuss the implications of these novel findings for cognitive models of semantic processing and left anterior temporal lobe function. PMID:25496810

Macrocystic lymphatic malformation in the pulmonary parenchyma.

PubMed

Schulman, Joshua M; Christison-Lagay, Emily R; Kozakewich, Harry P W; Boiselle, Phillip M; Burrows, Patricia E; Fox, Victor L; Fishman, Steven J

2009-05-01

We present a young girl with a diffuse, macrocystic lymphatic malformation with associated venous dilation involving the left lower pulmonary lobe and mediastinum. Recurrent hemoptysis necessitated left lower lobectomy. This is the first reported case of a macrocystic lymphatic lesion with venous anomalies located within the parenchyma of the lung.

The Role of Right and Left Parietal Lobes in the Conceptual Processing of Numbers

ERIC Educational Resources Information Center

Cappelletti, Marinella; Lee, Hwee Ling; Freeman, Elliot D.; Price, Cathy J.

2010-01-01

Neuropsychological and functional imaging studies have associated the conceptual processing of numbers with bilateral parietal regions (including intraparietal sulcus). However, the processes driving these effects remain unclear because both left and right posterior parietal regions are activated by many other conceptual, perceptual, attention,…

Mapping the convergent temporal epileptic network in left and right temporal lobe epilepsy.

PubMed

Fang, Peng; An, Jie; Zeng, Ling-Li; Shen, Hui; Qiu, Shijun; Hu, Dewen

2017-02-03

Left and right mesial temporal lobe epilepsy (mTLE) with hippocampal sclerosis (HS) exhibits similar functional and clinical dysfunctions, such as depressive mood and emotional dysregulation, implying that the left and right mTLE may share a common network substrate. However, the convergent anatomical network disruption between the left and right HS remains largely uncharacterized. This study aimed to investigate whether the left and right mTLE share a similar anatomical network. We examined 43 (22 left, 21 right) mTLE patients with HS and 39 healthy controls using diffusion tensor imaging. Machine learning approaches were applied to extract the abnormal anatomical connectivity patterns in both the left and right mTLE. The left and right mTLE showed that 28 discriminating connections were exactly the same when compared to the controls. The same 28 connections showed high discriminating power in comparisons of the left mTLE versus controls (91.7%) and the right mTLE versus controls (90.0%); however, these connections failed to discriminate the left from the right mTLE. These discriminating connections, which were diminished both in the left and right mTLE, were primarily located in the limbic-frontal network, partially agreeing with the limbic-frontal dysregulation model of depression. These findings suggest that left and right mTLE share a convergent circuit, which may account for the mood and emotional deficits in mTLE and may suggest the neuropathological mechanisms underlying the comorbidity of depression and mTLE. Copyright © 2016. Published by Elsevier B.V.

Intrinsic functional network architecture of human semantic processing: Modules and hubs.

PubMed

Xu, Yangwen; Lin, Qixiang; Han, Zaizhu; He, Yong; Bi, Yanchao

2016-05-15

Semantic processing entails the activation of widely distributed brain areas across the temporal, parietal, and frontal lobes. To understand the functional structure of this semantic system, we examined its intrinsic functional connectivity pattern using a database of 146 participants. Focusing on areas consistently activated during semantic processing generated from a meta-analysis of 120 neuroimaging studies (Binder et al., 2009), we found that these regions were organized into three stable modules corresponding to the default mode network (Module DMN), the left perisylvian network (Module PSN), and the left frontoparietal network (Module FPN). These three dissociable modules were integrated by multiple connector hubs-the left angular gyrus (AG) and the left superior/middle frontal gyrus linking all three modules, the left anterior temporal lobe linking Modules DMN and PSN, the left posterior portion of dorsal intraparietal sulcus (IPS) linking Modules DMN and FPN, and the left posterior middle temporal gyrus (MTG) linking Modules PSN and FPN. Provincial hubs, which converge local information within each system, were also identified: the bilateral posterior cingulate cortices/precuneus, the bilateral border area of the posterior AG and the superior lateral occipital gyrus for Module DMN; the left supramarginal gyrus, the middle part of the left MTG and the left orbital inferior frontal gyrus (IFG) for Module FPN; and the left triangular IFG and the left IPS for Module FPN. A neuro-functional model for semantic processing was derived based on these findings, incorporating the interactions of memory, language, and control. Copyright © 2016 Elsevier Inc. All rights reserved.

Critical Pitfalls in the use of BRAF Mutation as a Diagnostic Tool in Thyroid Nodules: a Case Report.

PubMed

Kuhn, Elisabetta; Ragazzi, Moira; Zini, Michele; Giordano, Davide; Nicoli, Davide; Piana, Simonetta

2016-09-01

Thyroid fine-needle aspiration (FNA) cytology is the primary tool for the diagnostic evaluation of thyroid nodules. BRAF mutation analysis is employed as an ancillary tool in indeterminate cases, as recommended by the American Thyroid Association management guidelines. Hereby, we report the case of a 73-year-old woman who presented an 8-mm-size, ill-defined, left thyroid nodule. FNA resulted "suspicious for papillary thyroid carcinoma". BRAF mutation status was analyzed, and somatic BRAF (V600E) mutation identified. The patient underwent a total thyroidectomy. At histological examination, the nodule was composed of Langerhans cells, admixed with many eosinophils. A final diagnosis of Langerhans cell histiocytosis of the thyroid was made. Our case emphasizes the critical diagnostic pitfalls due to the use of BRAF (V600E) mutation analysis in thyroid FNA. Notably, BRAF (V600E) mutation is common in melanoma, colorectal carcinoma, lung carcinoma, ovarian carcinoma, brain tumors, hairy cell leukemia, multiple myeloma, and histiocytoses. Therefore, in cases of indeterminate FNA with unclassifiable atypical cells BRAF (V600E) mutated, the possibility of a localization of hystiocytosis or a secondary thyroid malignancy should be taken into account.

Left ventricular functions in children with newly diagnosed Graves' disease. A single-center study from Upper Egypt.

PubMed

Metwalley, Kotb Abbass; Farghaly, Hekma Saad; Abdelhamid, Abdelrahman

2018-01-01

This study aimed to evaluate the left ventricular (LV) functions in a cohort of children with Graves' disease (GD). This is a cross-sectional case-control study. It included 36 children with GD and 36 healthy children matched for age and gender. Thyroid hormones (TSH, FT4, and FT3) and anti-thyroid autoantibodies [anti-thyroid peroxidase (anti-TPO), thyrotropin receptor (TRAbs), and thyroglobulin antibodies] were measured. Conventional and tissue Doppler imaging (TDI) echocardiographies were used to assess left ventricular systolic and diastolic functions. LV mass index (LVMI) and myocardial performance index (MPI) were also measured. Compared to healthy children, conventional echocardiography of patients with GD revealed higher LVMI (P = 0.001) indicating LV hypertrophy but normal LV functions while TDI revealed lower Em/Am ratio indicating LV diastolic dysfunction (P = 0.001). Significant correlations were reported between FT4 with LVMI (P = 0.05), Em/Am (P = 0.01), and MPI (P = 0.01). In multivariate analysis, a positive correlation was identified between FT4 with MPI (OR = 1.17; 95% CI = 1.09-1.15; P = 0.001). Children with newly diagnosed GD may have significant subclinical changes in LV structure and function (diastolic and global). TDI is more sensitive than conventional Doppler in detecting LV dysfunction. These findings highlight the importance of early monitoring of children with GD for left ventricular mass index and diastolic function. What is Known: • There is an increased risk for cardiac abnormalities in children with Graves' disease (GD). • Limited studies assessed left ventricular function in patients with GD. What is New: • Children with newly diagnosed GD may have significant subclinical changes in left ventricular structure and functions. • Children with newly diagnosed GD should be monitored for left ventricular mass index and diastolic function.

Temporal lobe dual pathology in malignant migrating partial seizures in infancy.

PubMed

Coppola, Giangennaro; Operto, Francesca Felicia; Auricchio, Gianfranca; D'Amico, Alessandra; Fortunato, Delia; Pascotto, Antonio

2007-06-01

A child had the characteristic clinical and EEG pattern of migrating partial seizures in infancy with left temporal lobe atrophy, hippocampal sclerosis and cortical-subcortical blurring. Seizures were drug-resistant, with recurring episodes of status epilepticus. The child developed microcephaly with arrest of psychomotor development. Focal brain lesions, in the context of migrating partial seizures, have not been previously reported.[Published with video sequences].

IgG4-related Mikulicz's disease associated with thyroiditis: a case report and review of the literature.

PubMed

Zhang, Yujiao; Du, Yi; Li, Kaijun; He, Jianfeng

2014-03-01

To report an unusual case of IgG4-related Mikulicz's disease associated with thyroiditis. We describe a 25-year-old Chinese man who presented with bilateral, painless swellings of the lachrymal glands, parotid glands, and thyroid nodules. The patient underwent left-sided dacryoadenectomy and the diagnosis of IgG4-related Mikulicz's disease was pathologically confirmed. The size of the right-sided lachrymal gland and parotid glands recovered fundamentally after one month of glucocorticoid therapy. IgG4-related Mikulicz's disease associated with thyroiditis should be considered in the differential diagnosis of bilateral swellings of lachrymal glands, salivary glands, and thyroid nodules. Surgical excision is recommended in order to treat the tumor and to ensure the pathological diagnosis. Glucocorticoid therapy should be considered in association with surgery after removal.

Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse: A case report.

PubMed

Kiriyama, Hiroyuki; Amiya, Eisuke; Hatano, Masaru; Hosoya, Yumiko; Maki, Hisataka; Nitta, Daisuke; Saito, Akihito; Shiraishi, Yasuyuki; Minatsuki, Shun; Sato, Tatsuyuki; Murakami, Haruka; Uehara, Masae; Manaka, Katsunori; Makita, Noriko; Watanabe, Masafumi; Komuro, Issei

2017-06-01

Heart failure is relatively common in patients with hyperthyroidism, but thyrotoxic cardiomyopathy with poor left ventricular (LV) systolic function is very rare. We experienced a representative case of a patient who presented with severe LV dysfunction related to thyroid storm and needed extracorporeal membrane oxygenation (ECMO) temporally. Thyrotoxic cardiomyopathy. Aggressive antithyroid therapy, including steroid pulse to hyperthyroidism, leads to the dramatic improvement of cardiac function and she was successfully weaned from ECMO. The most outstanding feature of the current case was the rapid decrease of cardiac injury and improvement of cardiac function by strengthening antithyroid therapy, including steroid pulse, without thyroid hormone level normalization. In thyroid storm, various systemic inflammatory reactions have different time courses and among them, the cardiac phenotype emerges in most striking and critical ways.

Distinct frontal lobe morphology in girls and boys with ADHD.

PubMed

Dirlikov, Benjamin; Shiels Rosch, Keri; Crocetti, Deana; Denckla, Martha B; Mahone, E Mark; Mostofsky, Stewart H

2015-01-01

This study investigated whether frontal lobe cortical morphology differs for boys and girls with ADHD (ages 8-12 years) in comparison to typically developing (TD) peers. Participants included 226 children between the ages of 8-12 including 93 children with ADHD (29 girls) and 133 TD children (42 girls) for which 3T MPRAGE MRI scans were obtained. A fully automated frontal lobe atlas was used to generate functionally distinct frontal subdivisions, with surface area (SA) and cortical thickness (CT) assessed in each region. Analyses focused on overall diagnostic differences as well as examinations of the effect of diagnosis within boys and girls. Girls, but not boys, with ADHD showed overall reductions in total prefrontal cortex (PFC) SA. Localization revealed that girls showed widely distributed reductions in the bilateral dorsolateral PFC, left inferior lateral PFC, right medial PFC, right orbitofrontal cortex, and left anterior cingulate; and boys showed reduced SA only in the right anterior cingulate and left medial PFC. In contrast, boys, but not girls, with ADHD showed overall reductions in total premotor cortex (PMC) SA. Further localization revealed that in boys, premotor reductions were observed in bilateral lateral PMC regions; and in girls reductions were observed in bilateral supplementary motor complex. In line with diagnostic group differences, PMC and PFC SAs were inversely correlated with symptom severity in both girls and boys with ADHD. These results elucidate sex-based differences in cortical morphology of functional subdivisions of the frontal lobe and provide additional evidence of associations among SA and symptom severity in children with ADHD.

Temporal Lobe and Frontal-Subcortical Dissociations in Non-Demented Parkinson's Disease with Verbal Memory Impairment.

PubMed

Tanner, Jared J; Mareci, Thomas H; Okun, Michael S; Bowers, Dawn; Libon, David J; Price, Catherine C

2015-01-01

The current investigation examined verbal memory in idiopathic non-dementia Parkinson's disease and the significance of the left entorhinal cortex and left entorhinal-retrosplenial region connections (via temporal cingulum) on memory impairment in Parkinson's disease. Forty non-demented Parkinson's disease patients and forty non-Parkinson's disease controls completed two verbal memory tests--a wordlist measure (Philadelphia repeatable Verbal Memory Test) and a story measure (Logical Memory). All participants received T1-weighted and diffusion magnetic resonance imaging (3T; Siemens) sequences. Left entorhinal volume and left entorhinal-retrosplenial connectivity (temporal cingulum edge weight) were the primary imaging variables of interest with frontal lobe thickness and subcortical structure volumes as dissociating variables. Individuals with Parkinson's disease showed worse verbal memory, smaller entorhinal volumes, but did not differ in entorhinal-retrosplenial connectivity. For Parkinson's disease entorhinal-retrosplenial edge weight had the strongest associations with verbal memory. A subset of Parkinson's disease patients (23%) had deficits (z-scores < -1.5) across both memory measures. Relative to non-impaired Parkinson's peers, this memory-impaired group had smaller entorhinal volumes. Although entorhinal cortex volume was significantly reduced in Parkinson's disease patients relative to non-Parkinson's peers, only white matter connections associated with the entorhinal cortex were significantly associated with verbal memory performance in our sample. There was also no suggestion of contribution from frontal-subcortical gray or frontal white matter regions. These findings argue for additional investigation into medial temporal lobe gray and white matter connectivity for understanding memory in Parkinson's disease.

Restricted growth and insulin-like growth factor-1 deficiency in mice lacking presenilin-1 in the neural crest cell lineage

PubMed Central

Nakajima, Mitsunari; Watanabe, Sono; Okuyama, Satoshi; Shen, Jie; Furukawa, Yoshiko

2012-01-01

Presenilin-1 (PS1) is a transmembrane protein that is in many cases responsible for the development of early-onset familial Alzheimer’s disease. PS1 is essential for neurogenesis, somitogenesis, angiogenesis, and cardiac morphogenesis. We report here that PS1 is also required for maturation and/or maintenance of the pituitary gland. We generated PS1-conditional knockout (PS1-cKO) mice by crossing floxed PS1 and Wnt1-cre mice, in which PS1 was lacking in the neural crest-derived cell lineage. Although the PS1-cKO mice exhibited no obvious phenotypic abnormalities for several days after birth, reduced body weight in the mutant was evident by the age of 3 to 5 weeks. Pituitary weight and serum insulin-like growth factor (IGF)-1 level were also reduced in the mutant. Histologic analysis revealed severe atrophy of the cytosol in the anterior and intermediate pituitary lobes of the mutant. Immunohistochemistry did not reveal clear differences in the expression levels of thyroid-stimulating hormone, adrenocorticotropic hormone, or prolactin in the mutant pituitary. In contrast, growth hormone expression levels were reduced in the anterior lobe of the mutant. PS1 was defective in the posterior lobe, but not the anterior or intermediate lobes, in the mutant pituitary. These findings suggest that PS1 indirectly mediates the development and/or maintenance of the anterior and intermediate lobes in the pituitary gland via actions in other regions, such as the posterior lobe. PMID:19665542

The concreteness effect: evidence for dual coding and context availability.

PubMed

Jessen, F; Heun, R; Erb, M; Granath, D O; Klose, U; Papassotiropoulos, A; Grodd, W

2000-08-01

The term concreteness effect refers to the observation that concrete nouns are processed faster and more accurately than abstract nouns in a variety of cognitive tasks. Two models have been proposed to explain the neuronal basis of the concreteness effect. The dual-coding theory attributes the advantage to the access of a right hemisphere image based system in addition to a verbal system by concrete words. The context availability theory argues that concrete words activate a broader contextual verbal support, which results in faster processing, but do not access a distinct image based system. We used event-related fMRI to detect the brain regions that subserve to the concreteness effect. We found greater activation in the lower right and left parietal lobes, in the left inferior frontal lobe and in the precuneus during encoding of concrete compared to abstract nouns. This makes a single exclusive theory unlikely and rather suggests a combination of both models. Superior encoding of concrete words in the present study may result from (1) greater verbal context resources reflected by the activation of left parietal and frontal associative areas, and (2) the additional activation of a non-verbal, perhaps spatial imagery-based system, in the right parietal lobe. Copyright 2000 Academic Press.

Age-related Effects on Word Recognition: Reliance on Cognitive Control Systems with Structural Declines in Speech-responsive Cortex

PubMed Central

Walczak, Adam; Ahlstrom, Jayne; Denslow, Stewart; Horwitz, Amy; Dubno, Judy R.

2008-01-01

Speech recognition can be difficult and effortful for older adults, even for those with normal hearing. Declining frontal lobe cognitive control has been hypothesized to cause age-related speech recognition problems. This study examined age-related changes in frontal lobe function for 15 clinically normal hearing adults (21–75 years) when they performed a word recognition task that was made challenging by decreasing word intelligibility. Although there were no age-related changes in word recognition, there were age-related changes in the degree of activity within left middle frontal gyrus (MFG) and anterior cingulate (ACC) regions during word recognition. Older adults engaged left MFG and ACC regions when words were most intelligible compared to younger adults who engaged these regions when words were least intelligible. Declining gray matter volume within temporal lobe regions responsive to word intelligibility significantly predicted left MFG activity, even after controlling for total gray matter volume, suggesting that declining structural integrity of brain regions responsive to speech leads to the recruitment of frontal regions when words are easily understood. Electronic supplementary material The online version of this article (doi:10.1007/s10162-008-0113-3) contains supplementary material, which is available to authorized users. PMID:18274825

Regional homogeneity changes in prelingually deafened patients: a resting-state fMRI study

NASA Astrophysics Data System (ADS)

Li, Wenjing; He, Huiguang; Xian, Junfang; Lv, Bin; Li, Meng; Li, Yong; Liu, Zhaohui; Wang, Zhenchang

2010-03-01

Resting-state functional magnetic resonance imaging (fMRI) is a technique that measures the intrinsic function of brain and has some advantages over task-induced fMRI. Regional homogeneity (ReHo) assesses the similarity of the time series of a given voxel with its nearest neighbors on a voxel-by-voxel basis, which reflects the temporal homogeneity of the regional BOLD signal. In the present study, we used the resting state fMRI data to investigate the ReHo changes of the whole brain in the prelingually deafened patients relative to normal controls. 18 deaf patients and 22 healthy subjects were scanned. Kendall's coefficient of concordance (KCC) was calculated to measure the degree of regional coherence of fMRI time courses. We found that regional coherence significantly decreased in the left frontal lobe, bilateral temporal lobes and right thalamus, and increased in the postcentral gyrus, cingulate gyrus, left temporal lobe, left thalamus and cerebellum in deaf patients compared with controls. These results show that the prelingually deafened patients have higher degree of regional coherence in the paleocortex, and lower degree in neocortex. Since neocortex plays an important role in the development of auditory, these evidences may suggest that the deaf persons reorganize the paleocortex to offset the loss of auditory.

Alteration of the Intra- and Cross- Hemisphere Posterior Default Mode Network in Frontal Lobe Glioma Patients.

PubMed

Zhang, Haosu; Shi, Yonghong; Yao, Chengjun; Tang, Weijun; Yao, Demin; Zhang, Chenxi; Wang, Manning; Wu, Jinsong; Song, Zhijian

2016-06-01

Patients with frontal lobe gliomas often experience neurocognitive dysfunctions before surgery, which affects the default mode network (DMN) to different degrees. This study quantitatively analyzed this effect from the perspective of cerebral hemispheric functional connectivity (FC). We collected resting-state fMRI data from 20 frontal lobe glioma patients before treatment and 20 healthy controls. All of the patients and controls were right-handed. After pre-processing the images, FC maps were built from the seed defined in the left or right posterior cingulate cortex (PCC) to the target regions determined in the left or right temporal-parietal junction (TPJ), respectively. The intra- and cross-group statistical calculations of FC strength were compared. The conclusions were as follows: (1) the intra-hemisphere FC strength values between the PCC and TPJ on the left and right were decreased in patients compared with controls; and (2) the correlation coefficients between the FC pairs in the patients were increased compared with the corresponding controls. When all of the patients were grouped by their tumor's hemispheric location, (3) the FC of the subgroups showed that the dominant hemisphere was vulnerable to glioma, and (4) the FC in the dominant hemisphere showed a significant correlation with WHO grade.

Abnormal Neural Network of Primary Insomnia: Evidence from Spatial Working Memory Task fMRI.

PubMed

Li, Yongli; Liu, Liya; Wang, Enfeng; Zhang, Hongju; Dou, Shewei; Tong, Li; Cheng, Jingliang; Chen, Chuanliang; Shi, Dapeng

2016-01-01

Contemporary functional MRI (fMRI) methods can provide a wealth of information about the neural mechanisms associated with primary insomnia (PI), which centrally involve neural network circuits related to spatial working memory. A total of 30 participants diagnosed with PI and without atypical brain anatomy were selected along with 30 age- and gender-matched healthy controls. Subjects were administered the Pittsburgh Sleep Quality Index (PSQI), Hamilton Rating Scale for Depression and clinical assessments of spatial working memory, followed by an MRI scan and fMRI in spatial memory task state. Statistically significant differences between PSQI and spatial working memory were observed between PI patients and controls (p < 0.01). Activation of neural networks related to spatial memory task state in the PI group was observed at the left temporal lobe, left occipital lobe and right frontal lobe. Lower levels of activation were observed in the left parahippocampal gyrus, right parahippocampal gyrus, bilateral temporal cortex, frontal cortex and superior parietal lobule. Participants with PI exhibited characteristic abnormalities in the neural network connectivity related to spatial working memory. These results may be indicative of an underlying pathological mechanism related to spatial working memory deterioration in PI, analogous to recently described mechanisms in other mental health disorders. © 2016 S. Karger AG, Basel.

The Association among Default Mode Network Functional Connectivity, Mentalization, and Psychopathology in a Nonclinical Sample: An eLORETA Study.

PubMed

Farina, Benedetto; Della Marca, Giacomo; Maestoso, Giulia; Amoroso, Noemi; Valenti, Enrico Maria; Carbone, Giuseppe Alessio; Massullo, Chiara; Contardi, Anna; Imperatori, Claudio

2018-01-01

We investigated default mode network (DMN) electroencephalography (EEG) functional connectivity differences between individuals with self-reported high mentalization capability and low psychopathological symptoms, versus participants with mentalization impairments and high psychopathological symptoms. Forty-nine students (35 women) with a mean age of 22.92 ± 2.53 years were administered the Mentalization Questionnaire (MZQ) and the Symptom Checklist-90-Revised. Five minutes of EEG during resting state were also recorded for each participant. DMN functional connectivity analyses were conducted by means of the exact Low Resolution Electric Tomography software (eLORETA). Compared to the individuals with high mentalization capability and lower self-reported psychopathological symptoms, participants with mentalization impairments and high psychopathological symptoms showed a decrease of EEG beta connectivity between: (i) the right and left medial frontal lobe, and (ii) the left medial frontal lobe and the right anterior cingulate cortex. Furthermore, while MZQ total score was positively associated with DMN network connections (i.e., right and left medial frontal lobes), several psychopathological symptoms (i.e., interpersonal sensitivity, depression, and psychoticism) were negatively associated with DMN connectivity. Our results may reflect a top-down emotion regulation deficit which is associated with both internalizing and externalizing behavior problems. © 2018 S. Karger AG, Basel.

Carcinoma showing thymus-like elements of the thyroid gland: report of three cases including one case with breast cancer history.

PubMed

Zhang, Guanjun; Liu, Xi; Huang, Wei; Li, Xiaofeng; Johnstone, Marianne; Deng, Yuan; Ke, Yongqiang; Nunes, Quentin M; Wang, Hongyan; Wang, Yili; Zhang, Xuebin

2015-01-01

Carcinoma showing thymus-like elements (CASTLE) is a rare malignant tumor of the thyroid or adjacent neck soft tissues, whose histogenesis is still debated. It may resemble other primary or metastatic poorly differentiated tumors histologically and the differential diagnosis is crucial for CASTLE has a better prognosis. However, CASTLE as a second primary tumor has not been reported in the literature. We report three cases of thyroid CASTLE, including a unique tumor following breast-conserving surgery for early-stage breast invasive carcinoma. There were two female and one male. All three tumors were located in the right lobe of the thyroid, and one tumor showed extension into the surrounding soft tissue. Histologically, all tumors showed expansive growth and consisted of cords, nests or sheets of epithelial cells divided into irregularly shaped lobules by fibrous connective tissue with lymphoplasmacytic infiltration. Focal squamous differentiation resembling Hassall's corpuscles were observed. All cases stained positively for CD5, CD117, high molecular weight cytokeratin, cytokeratin, P63, carcinoembryonic antigen and epithelial membrane antigen. Positive staining for Bcl-2 in two cases and chromogranin A in one case was noted. Ki-67 expression ranged from 15 to 25%. Thyroid transcription factor and CD3 were negative. There was no evidence of recurrent or metastatic disease at following surgery. These features demonstrated CASTLE may arise from branchial pouch remnants, the thyroid solid cell nests. CASTLE is a rare entity, awareness of its occurrence as a second primary tumor is important to avoid overtreatment because it is associated with a favorable prognosis.

Thyroid Regeneration: Characterization of Clear Cells After Partial Thyroidectomy

PubMed Central

Ozaki, Takashi; Matsubara, Tsutomu; Seo, Daekwan; Okamoto, Minoru; Nagashima, Kunio; Sasaki, Yoshihito; Hayase, Suguru; Murata, Tsubasa; Liao, Xiao-Hui; Hanson, Jeffrey; Rodriguez-Canales, Jaime; Thorgeirsson, Snorri S.; Kakudo, Kennichi; Refetoff, Samuel

2012-01-01

Although having the capacity to grow in response to a stimulus that perturbs the pituitary-thyroid axis, the thyroid gland is considered not a regenerative organ. In this study, partial thyroidectomy (PTx) was used to produce a condition for thyroid regeneration. In the intact thyroid gland, the central areas of both lobes served as the proliferative centers where microfollicles, and bromodeoxyuridine (BrdU)-positive and/or C cells, were localized. Two weeks after PTx, the number of BrdU-positive cells and cells with clear or faintly eosinophilic cytoplasm were markedly increased in the central area and continuous to the cut edge. Clear cells were scant in the cytoplasm, as determined by electron microscopy; some retained the characteristics of calcitonin-producing C cells by having neuroendocrine granules, whereas others retained follicular cell-specific features, such as the juxtaposition to a lumen with microvilli. Some cells were BrdU-positive and expressed Foxa2, the definitive endoderm lineage marker. Serum TSH levels drastically changed due to the thyroidectomy-induced acute reduction in T4-generating tissue, resulting in a goitrogenesis setting. Microarray followed by pathway analysis revealed that the expression of genes involved in embryonic development and cancer was affected by PTx. The results suggest that both C cells and follicular cells may be altered by PTx to become immature cells or immature cells that might be derived from stem/progenitor cells on their way to differentiation into C cells or follicular cells. These immature clear cells may participate in the repair and/or regeneration of the thyroid gland. PMID:22454152

Animal models of disease: feline hyperthyroidism: an animal model for toxic nodular goiter.

PubMed

Peterson, Mark E

2014-11-01

Since first discovered just 35 years ago, the incidence of spontaneous feline hyperthyroidism has increased dramatically to the extent that it is now one of the most common disorders seen in middle-aged to senior domestic cats. Hyperthyroid cat goiters contain single or multiple autonomously (i.e. TSH-independent) functioning and growing thyroid nodules. Thus, hyperthyroidism in cats is clinically and histologically similar to toxic nodular goiter in humans. The disease in cats is mechanistically different from Graves' disease, because neither the hyperfunction nor growth of these nodules depends on extrathyroidal circulating stimulators. The basic lesion appears to be an excessive intrinsic growth capacity of some thyroid cells, but iodine deficiency, other nutritional goitrogens, or environmental disruptors may play a role in the disease pathogenesis. Clinical features of feline toxic nodular goiter include one or more palpable thyroid nodules, together with signs of hyperthyroidism (e.g. weight loss despite an increased appetite). Diagnosis of feline hyperthyroidism is confirmed by finding the increased serum concentrations of thyroxine and triiodothyronine, undetectable serum TSH concentrations, or increased thyroid uptake of radioiodine. Thyroid scintigraphy demonstrates a heterogeneous pattern of increased radionuclide uptake, most commonly into both thyroid lobes. Treatment options for toxic nodular goiter in cats are similar to that used in humans and include surgical thyroidectomy, radioiodine, and antithyroid drugs. Most authorities agree that ablative therapy with radioiodine is the treatment of choice for most cats with toxic nodular goiter, because the animals are older, and the disease will never go into remission. © 2014 Society for Endocrinology.

Quantitative electroencephalographic and neuropsychological investigation of an alternative measure of frontal lobe executive functions: the Figure Trail Making Test.

PubMed

Foster, Paul S; Drago, Valeria; Ferguson, Brad J; Harrison, Patti Kelly; Harrison, David W

2015-12-01

The most frequently used measures of executive functioning are either sensitive to left frontal lobe functioning or bilateral frontal functioning. Relatively little is known about right frontal lobe contributions to executive functioning given the paucity of measures sensitive to right frontal functioning. The present investigation reports the development and initial validation of a new measure designed to be sensitive to right frontal lobe functioning, the Figure Trail Making Test (FTMT). The FTMT, the classic Trial Making Test, and the Ruff Figural Fluency Test (RFFT) were administered to 42 right-handed men. The results indicated a significant relationship between the FTMT and both the TMT and the RFFT. Performance on the FTMT was also related to high beta EEG over the right frontal lobe. Thus, the FTMT appears to be an equivalent measure of executive functioning that may be sensitive to right frontal lobe functioning. Applications for use in frontotemporal dementia, Alzheimer's disease, and other patient populations are discussed.

Single port thoracoscopic treatment of thoracic duct injury after thyroidectomy with neck dissection

PubMed Central

Teksoz, Serkan; Ersen, Ezel; Ferahman, Sina; Kaynak, Kamil; Dionigi, Gianlorenzo; Bukey, Yusuf

2017-01-01

Chylous leakage is a complication of thyroidectomy accompanied by bilateral neck dissection with incidence of 0.5–6.2%. A 51-year-old female patient underwent total thyroidectomy, bilateral and central neck dissection for papillary thyroid carcinoma. In post-operative 4th day, left sided chylous leakage was observed as 1,500 cc/day through neck drain. Leakage did not cease after 1-month conservative treatment so single port thoracoscopic intervention was performed. Under general anesthesia, patient was placed in left lateral decubitus position. An Alexis® retractor was placed through sixth intercostal space. Thoracic cavity was visualized with 30º scope. Posteroinferior edge of lower lobe was retracted superior posteriorly with a Foerster clamp to display inferior pulmonary ligament, which was then divided with electrocautery. Posterior mediastinal pleura between azygous vein and chest wall was incised to mobilize the vein. After that, mediastinal pleura between azygous vein and esophagus was cut longitudinally and esophagus was retracted anteriorly to dissect towards aorta. By dissection, thoracic duct was revealed as a thin tubular structure with occasional peristalsis. After isolation of the duct, it was clipped using Hem-o-lok®. Finally, fibrin sealant was applied to decrease risk of recurrence. One chest tube was placed to ensure adequate drainage of thoracic cavity and complete re-expansion of lung. Neck drain and chest tube was extracted in postoperative second and fourth day respectively and patient was discharged at 8th day. Single port thoracoscopy is a safe choice for treatment of chylous leakages due to cervical ductus thoracicus injury with faster recovery. PMID:29142855

Gender Differences in Regional Brain Activity in Patients with Chronic Primary Insomnia: Evidence from a Resting-State fMRI Study

PubMed Central

Dai, Xi-Jian; Nie, Xiao; Liu, Xuming; Pei, Li; Jiang, Jian; Peng, De-chang; Gong, Hong-Han; Zeng, Xian-Jun; Wáng, Yì-Xiáng J.; Zhan, Yang

2016-01-01

Study Objectives: To explore the regional brain activities in patients with chronic primary insomnia (PCPIs) and their sex differences. Methods: Forty-two PCPIs (27 females, 15 males) and 42 good sleepers (GSs; 24 females, 18 males) were recruited. Six PCPIs (3 males, 3 females) were scanned twice by MRI to examine the test-retest reliability. Amplitude of low frequency fluctuation (ALFF) method was used to assess the local brain features. The mean signal values of the different ALFF areas were analyzed with a receiver operating characteristic (ROC) curve. Simple linear regression analysis was performed to investigate the relationships between clinical features and different brain areas. Results: Both female and male PCPIs showed higher ALFF in the temporal lobe and occipital lobe, especially in female PCPIs. Female PCPIs had lower ALFF in the bilateral cerebellum posterior lobe, left dorsolateral prefrontal cortex, and bilateral limbic lobe; however, male PCPIs showed lower ALFF in the left occipital gyrus. The mean signal value of the cerebellum in female PCPIs showed negative correlations with negative emotions. Compared with male PCPIs, female PCPIs showed higher ALFF in the bilateral middle temporal gyrus and lower ALFF in the left limbic lobe. The different areas showed high test-retest stability (Clusters of contiguous volumes ≥ 1080 mm3 with an intraclass correlation coefficient ≥ 0.80) and high degree of sensitivity and specificity. Conclusions: Female PCPIs showed more regional brain differences with higher and lower ALFF responses than male PCPIs. However, they shared analogous excessive hyperarousal mechanism and wide variations in aberrant brain areas. Citation: Dai XJ, Nie X, Liu X, Pei L, Jiang J, Peng D, Gong HH, Zeng XJ, Wáng YX, Zhan Y. Gender differences in regional brain activity in patients with chronic primary insomnia: evidence from a resting-state fMRI study. J Clin Sleep Med 2016;12(3):363–374. PMID:26715399

Brain reactivity to visual food stimuli after moderate-intensity exercise in children.

PubMed

Masterson, Travis D; Kirwan, C Brock; Davidson, Lance E; Larson, Michael J; Keller, Kathleen L; Fearnbach, S Nicole; Evans, Alyssa; LeCheminant, James D

2017-09-19

Exercise may play a role in moderating eating behaviors. The purpose of this study was to examine the effect of an acute bout of exercise on neural responses to visual food stimuli in children ages 8-11 years. We hypothesized that acute exercise would result in reduced activity in reward areas of the brain. Using a randomized cross-over design, 26 healthy weight children completed two separate laboratory conditions (exercise; sedentary). During the exercise condition, each participant completed a 30-min bout of exercise at moderate-intensity (~ 67% HR maximum) on a motor-driven treadmill. During the sedentary session, participants sat continuously for 30 min. Neural responses to high- and low-calorie pictures of food were determined immediately following each condition using functional magnetic resonance imaging. There was a significant exercise condition*stimulus-type (high- vs. low-calorie pictures) interaction in the left hippocampus and right medial temporal lobe (p < 0.05). Main effects of exercise condition were observed in the left posterior central gyrus (reduced activation after exercise) (p < 0.05) and the right anterior insula (greater activation after exercise) (p < 0.05). The left hippocampus, right medial temporal lobe, left posterior central gyrus, and right anterior insula appear to be activated by visual food stimuli differently following an acute bout of exercise compared to a non-exercise sedentary session in 8-11 year-old children. Specifically, an acute bout of exercise results in greater activation to high-calorie and reduced activation to low-calorie pictures of food in both the left hippocampus and right medial temporal lobe. This study shows that response to external food cues can be altered by exercise and understanding this mechanism will inform the development of future interventions aimed at altering energy intake in children.

Resting-state functional connectivity predicts the strength of hemispheric lateralization for language processing in temporal lobe epilepsy and normals.

PubMed

Doucet, Gaëlle E; Pustina, Dorian; Skidmore, Christopher; Sharan, Ashwini; Sperling, Michael R; Tracy, Joseph I

2015-01-01

In temporal lobe epilepsy (TLE), determining the hemispheric specialization for language before surgery is critical to preserving a patient's cognitive abilities post-surgery. To date, the major techniques utilized are limited by the capacity of patients to efficiently realize the task. We determined whether resting-state functional connectivity (rsFC) is a reliable predictor of language hemispheric dominance in right and left TLE patients, relative to controls. We chose three subregions of the inferior frontal cortex (pars orbitalis, pars triangularis, and pars opercularis) as the seed regions. All participants performed both a verb generation task and a resting-state fMRI procedure. Based on the language task, we computed a laterality index (LI) for the resulting network. This revealed that 96% of the participants were left-hemisphere dominant, although there remained a large degree of variability in the strength of left lateralization. We tested whether LI correlated with rsFC values emerging from each seed. We revealed a set of regions that was specific to each group. Unique correlations involving the epileptic mesial temporal lobe were revealed for the right and left TLE patients, but not for the controls. Importantly, for both TLE groups, the rsFC emerging from a contralateral seed was the most predictive of LI. Overall, our data depict the broad patterns of rsFC that support strong versus weak left hemisphere language laterality. This project provides the first evidence that rsFC data may potentially be used on its own to verify the strength of hemispheric dominance for language in impaired or pathologic populations. © 2014 Wiley Periodicals, Inc.

Differential Effect of Left vs. Right White Matter Hyperintensity Burden on Functional Decline: The Northern Manhattan Study.

PubMed

Dhamoon, Mandip S; Cheung, Ying-Kuen; Bagci, Ahmet; Alperin, Noam; Sacco, Ralph L; Elkind, Mitchell S V; Wright, Clinton B

2017-01-01

Asymmetry of brain dysfunction may disrupt brain network efficiency. We hypothesized that greater left-right white matter hyperintensity volume (WMHV) asymmetry was associated with functional trajectories. Methods: In the Northern Manhattan Study, participants underwent brain MRI with axial T1, T2, and fluid attenuated inversion recovery sequences, with baseline interview and examination. Volumetric WMHV distribution across 14 brain regions was determined separately by combining bimodal image intensity distribution and atlas based methods. Participants had annual functional assessments with the Barthel index (BI, range 0-100) over a mean of 7.3 years. Generalized estimating equations (GEE) models estimated associations of regional WMHV and regional left-right asymmetry with baseline BI and change over time, adjusted for baseline medical risk factors, sociodemographics, and cognition, and stroke and myocardial infarction during follow-up. Results: Among 1,195 participants, greater WMHV asymmetry in the parietal lobes (-8.46 BI points per unit greater WMHV on the right compared to left, 95% CI -3.07, -13.86) and temporal lobes (-2.48 BI points, 95% CI -1.04, -3.93) was associated with lower overall function. Greater WMHV asymmetry in the parietal lobes (-1.09 additional BI points per year per unit greater WMHV on the left compared to right, 95% CI -1.89, -0.28) was independently associated with accelerated functional decline. Conclusions: In this large population-based study with long-term repeated measures of function, greater regional WMHV asymmetry was associated with lower function and functional decline. In addition to global WMHV, WHMV asymmetry may be an important predictor of long-term functional status.

Left inferior-parietal lobe activity in perspective tasks: identity statements

PubMed Central

Arora, Aditi; Weiss, Benjamin; Schurz, Matthias; Aichhorn, Markus; Wieshofer, Rebecca C.; Perner, Josef

2015-01-01

We investigate the theory that the left inferior parietal lobe (IPL) is closely associated with tracking potential differences of perspective. Developmental studies find that perspective tasks are mastered at around 4 years of age. Our first study, meta-analyses of brain imaging studies shows that perspective tasks specifically activate a region in the left IPL and precuneus. These tasks include processing of false belief, visual perspective, and episodic memory. We test the location specificity theory in our second study with an unusual and novel kind of perspective task: identity statements. According to Frege's classical logical analysis, identity statements require appreciation of modes of presentation (perspectives). We show that identity statements, e.g., “the tour guide is also the driver” activate the left IPL in contrast to a control statements, “the tour guide has an apprentice.” This activation overlaps with the activations found in the meta-analysis. This finding is confirmed in a third study with different types of statements and different comparisons. All studies support the theory that the left IPL has as one of its overarching functions the tracking of perspective differences. We discuss how this function relates to the bottom-up attention function proposed for the bilateral IPL. PMID:26175677

Thyroid Storm with Heart Failure Treated with a Short-acting Beta-adrenoreceptor Blocker, Landiolol Hydrochloride.

PubMed

Yamashita, Yugo; Iguchi, Moritake; Nakatani, Rieko; Usui, Takeshi; Takagi, Daisuke; Hamatani, Yasuhiro; Unoki, Takashi; Ishii, Mitsuru; Ogawa, Hisashi; Masunaga, Nobutoyo; Abe, Mitsuru; Akao, Masaharu

2015-01-01

Beta-adrenoreceptor blockers are essential in controlling the peripheral actions of thyroid hormones and a rapid heart rate in patients with thyroid storm, although they should be used with great caution when there is the potential for heart failure. A 67-year-old woman was diagnosed as having thyroid storm in addition to marked tachycardia with atrial fibrillation and heart failure associated with a reduced left ventricular function. The administration of an oral beta blocker, bisoprolol fumarate, induced hypotension and was not tolerable for the patient, whereas landiolol hydrochloride, a short-acting intravenous beta-adrenoreceptor blocker with high cardioselectivity and a short elimination half-life, was useful for controlling the patient's tachycardia and heart failure without causing hemodynamic deterioration.

Charles Bonnet Syndrome in a Patient With Right Medial Occipital Lobe Infarction: Epileptic or Deafferentation Phenomenon?

PubMed

Kumral, Emre; Uluakay, Arzu; Dönmez, İlknur

2015-07-01

Charles Bonnet syndrome (CBS) is an uncommon disorder characterized by complex and recurrent visual hallucinations in patients with visual pathway pathologic defects. To describe a patient who experienced complex visual hallucinations following infarction in the right occipital lobe and epileptic seizure who was diagnosed as having CBS. A 65-year-old man presented acute ischemic stroke caused by artery to artery embolism involving the right occipital lobe. Following ischemic stroke, complex visual hallucinations in the left visual field not associated with loss of consciousness or delusion developed in the patient. Hallucinations persisted for >1 month and during hallucination, no electrographic seizures were recorded through 24 hours of videoelectroencephalographic monitoring. CBS may develop in a patient with occipital lobe infarction following an embolic event. CBS associated with medial occipital lobe infarction and epilepsy may coexist and reflects the abnormal functioning of an integrated neuronal network.

Differential neuropsychological test sensitivity to left temporal lobe epilepsy.

PubMed

Loring, David W; Strauss, Esther; Hermann, Bruce P; Barr, William B; Perrine, Kenneth; Trenerry, Max R; Chelune, Gordon; Westerveld, Michael; Lee, Gregory P; Meador, Kimford J; Bowden, Stephen C

2008-05-01

We examined the sensitivity of the Rey Auditory Verbal Learning Test (AVLT), California Verbal Learning Test (CVLT), Boston Naming Test (BNT), and Multilingual Aphasia Examination Visual Naming subtest (MAE VN) to lateralized temporal lobe epilepsy (TLE) in patients who subsequently underwent anterior temporal lobectomy. For the AVLT (n = 189), left TLE patients performed more poorly than their right TLE counterparts [left TLE = 42.9 (10.6), right TLE = 47.7 (9.9); p < .002 (Cohen's d = .47)]. Although statistically significant, the CVLT group difference (n = 212) was of a smaller magnitude [left LTE = 40.7 (11.1), right TLE = 43.8 (9.9); (p < .03, Cohen's d = .29)] than the AVLT. Group differences were also present for both measures of confrontation naming ability [BNT: left LTE = 43.1 (8.9), right TLE = 48.1 (8.9); p < .001 (Cohen's d = .56); MAE VN: left TLE = 42.2, right TLE = 45.6, p = .02 (Cohen's d = .36)]. When these data were modeled in independent logistic regression analyses, the AVLT and BNT both significantly predicted side of seizure focus, although the positive likelihood ratios were modest. In the subset of 108 patients receiving both BNT and AVLT, the AVLT was the only significant predictor of seizure laterality, suggesting individual patient variability regarding whether naming or memory testing may be more sensitive to lateralized TLE.

Temporal lobe epilepsy in a cat with a pyriform lobe oligodendroglioma and hippocampal necrosis.

PubMed

Vanhaesebrouck, An E; Posch, Barbara; Baker, Sam; Plessas, Ioannis N; Palmer, Anthony C; Constantino-Casas, Fernando

2012-12-01

A 14-year-old male domestic shorthair cat presented with an acute onset of aggressive behaviour, fear and hypersalivation. Neurological examination revealed bilateral mydriasis and left-sided facial twitching and hemiparesis. Magnetic resonance imaging (MRI) showed moderate bilateral symmetrical T2-hyperintensity along the entire hippocampus and bilateral asymmetric T2-hyperintensity in the pyriform lobes. Marked bilateral contrast enhancement of the hippocampus was evident on post-contrast T1-weighted images. The partial complex seizures were refractory to medical treatment and the cat was euthanased 4 days after admission. The clinical and MRI findings were consistent with feline hippocampal necrosis (FHN). On histopathology, neuronal necrosis and astrocytosis were present in the hippocampi and pyriform lobes. In addition, an oligodendroglioma was detected in the right pyriform lobe. Contrary to previous reports of FHN in which no underlying cause could be identified, we believe that in this case the seizure focus arose from a neoplastic lesion within the right pyriform lobe. This unique case report represents the so-called 'dual pathology' of temporal lobe epilepsy in humans, in which an extrahippocampal lesion within the temporal lobe results in hippocampal sclerosis.

Enhanced Neuroactivation during Working Memory Task in Postmenopausal Women Receiving Hormone Therapy: A Coordinate-Based Meta-Analysis.

PubMed

Li, Ke; Huang, Xiaoyan; Han, Yingping; Zhang, Jun; Lai, Yuhan; Yuan, Li; Lu, Jiaojiao; Zeng, Dong

2015-01-01

Hormone therapy (HT) has long been thought beneficial for controlling menopausal symptoms and human cognition. Studies have suggested that HT has a positive association with working memory, but no consistent relationship between HT and neural activity has been shown in any cognitive domain. The purpose of this meta-analysis was to assess the convergence of findings from published randomized control trials studies that examined brain activation changes in postmenopausal women. A systematic search for fMRI studies of neural responses during working memory tasks in postmenopausal women was performed. Studies were excluded if they were not treatment studies and did not contain placebo or blank controls. For the purpose of the meta-analysis, 8 studies were identified, with 103 postmenopausal women taking HT and 109 controls. Compared with controls, postmenopausal women who took HT increased activation in the left frontal lobe, including superior frontal gyrus (BA 8), right middle frontal gyrus (BA 9), anterior lobe, paracentral lobule (BA 7), limbic lobe, and anterior cingulate (BA 32). Additionally, decreased activation is noted in the right limbic lobe, including parahippocampal gyrus (BA 28), left parietal lobe, and superior parietal lobule (BA 7). All regions were significant at p ≤ 0.05 with correction for multiple comparisons. Hormone treatment is associated with BOLD signal activation in key anatomical areas during fMRI working memory tasks in healthy hormone-treated postmenopausal women. A positive correlation between activation and task performance suggests that hormone use may benefit working memory.

Fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment using computed tomography volumetry.

PubMed

Fujita, Nobuhiro; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Ushijima, Yasuhiro; Takayama, Yukihisa; Okamoto, Daisuke; Shirabe, Ken; Yoshizumi, Tomoharu; Kotoh, Kazuhiro; Furusyo, Norihiro; Hida, Tomoyuki; Oda, Yoshinao; Fujioka, Taisuke; Honda, Hiroshi

2016-10-28

To evaluate the diagnostic performance of computed tomography (CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD). A total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment (LLS), left medial segment, caudate lobe, and right lobe (RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis stage. The volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage ( r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage ( r = -0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: ≥ F1, 0.896; ≥ F2, 0.929; ≥ F3, 0.955; and ≥ F4, 0.923. The best cut-off for advanced fibrosis (F3-F4) was 4.789%, 85.7% sensitivity and 94.1% specificity. The volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.

The effect of vitamin D on thyroid autoimmunity in non-lactating women with postpartum thyroiditis.

PubMed

Krysiak, R; Kowalcze, K; Okopien, B

2016-05-01

The study included 38 non-lactating l-thyroxine-treated women with postpartum thyroiditis (PPT) and 21 matched healthy postpartum women. Women with vitamin D deficiency were treated with oral vitamin D (4000 IU daily), whereas women with vitamin D insufficiency and women with normal 25-hydroxy vitamin levels were either treated with vitamin D (2000 IU daily) or left untreated. Serum hormone levels and thyroid antibody titers were measured at the beginning of the study and 3 months later. 25-hydroxy vitamin D levels were lower in women with PPT than in healthy women. Thyroid peroxidase and thyroglobulin antibody titers inversely correlated with vitamin D status. Apart from increasing serum levels of 25-hydroxy vitamin D and decreasing serum levels of parathyroid hormone, vitamin D reduced titers of thyroid peroxidase antibodies and this effect was stronger in women with vitamin D deficiency. The study's results suggest that vitamin D supplementation may bring benefits to l-thyroxine-treated women with PPT.

Developmental trajectories of the fronto-temporal lobes from infancy to early adulthood in healthy individuals.

PubMed

Tanaka, Chiaki; Matsui, Mie; Uematsu, Akiko; Noguchi, Kyo; Miyawaki, Toshio

2012-01-01

Brain development during early life in healthy individuals is rapid and dynamic, indicating that this period plays a very important role in neural and functional development. The frontal and temporal lobes are known to play a particularly important role in cognition. The study of healthy frontal and temporal lobe development in children is therefore of considerable importance. A better understanding of how these brain regions develop could also aid in the diagnosis and treatment of neurodevelopmental disorders. Some developmental studies have used magnetic resonance imaging (MRI) to examine infant brains, but it remains the case that relatively little is known about cortical brain development in the first few years of life. In the present study we examined whole brain, temporal lobe and frontal lobe developmental trajectories from infancy to early adulthood in healthy individuals, considering gender and brain hemisphere differences. We performed a cross-sectional, longitudinal morphometric MRI study of 114 healthy individuals (54 females and 60 males) aged 1 month to 25 years old (mean age ± SD 8.8 ± 6.9). We measured whole brain, temporal and frontal lobe gray matter (GM)/white matter (WM) volumes, following previously used protocols. There were significant non-linear age-related volume changes in all regions. Peak ages of whole brain, temporal lobe and frontal lobe development occurred around pre-adolescence (9-12 years old). GM volumes for all regions increased significantly as a function of age. Peak age was nevertheless lobe specific, with a pattern of earlier peak ages for females in both temporal and frontal lobes. Growth change in whole brain GM volume was larger in males than in females. However, GM volume growth changes for the temporal and frontal lobes showed a somewhat different pattern. GM volume for both temporal and frontal lobes showed a greater increase in females until around 5-6 years old, at which point this tendency reversed (GM volume changes in males became greater), with male GM volume increasing for a longer time than that of females. WM volume growth changes were similar across regions, all increasing rapidly until early childhood but slowing down thereafter. All regions displayed significant rightward volumetric asymmetry regardless of sex. Furthermore, the right temporal and frontal lobes showed a greater volumetric increase than the left for the first several years, with this tendency reversing at around 6 years of age. In addition, the left frontal and temporal lobes increased in volume for a longer period of time. Taken together, these findings indicated that brain developmental trajectories differ depending on brain region, sex and brain hemisphere. Gender-related factors such as sex hormones and functional laterality may affect brain development. Copyright © 2012 S. Karger AG, Basel.

Dissociation of Short- and Long-Term Face Memory: Evidence from Long-Term Recency Effects in Temporal Lobe Epilepsy

ERIC Educational Resources Information Center

Bengner, T.; Malina, T.

2007-01-01

We tested whether memory deficits in temporal lobe epilepsy (TLE) are better described by a single- or dual-store memory model. To this aim, we analyzed the influence of TLE and proactive interference (PI) on immediate and 24-h long-term recency effects during face recognition in 16 healthy participants and 18 right and 21 left non-surgical TLE…

A rare neoplastic growth on the ear lobe.

PubMed

Rovere, R K; Hilgert, S F; da Costa, P Camara; de Lima, A S

2014-01-01

We report a case of an 83-year-old previously healthy female patient presenting with a swiftly evolving erythematous violaceous, infiltrative, ulcerated onion like mass with hyperkeratotic surface on the left ear lobe. The lesion was excised and resulted as an atypical fibroxanthoma, an extremely rare neoplastic growth, being a superficial variant of pleomorphic malignant fibrous histiocytoma. A brief review of dia-gnosis, treatment and prognosis is discussed.

Oxidative Stress and Heart Failure in Altered Thyroid States

PubMed Central

Mishra, Pallavi; Samanta, Luna

2012-01-01

Increased or reduced action of thyroid hormone on certain molecular pathways in the heart and vasculature causes relevant cardiovascular derangements. It is well established that hyperthyroidism induces a hyperdynamic cardiovascular state, which is associated with a faster heart rate, enhanced left ventricular systolic and diastolic function whereas hypothyroidism is characterized by the opposite changes. Hyperthyroidism and hypothyroidism represent opposite clinical conditions, albeit not mirror images. Recent experimental and clinical studies have suggested the involvement of ROS tissue damage under altered thyroid status. Altered-thyroid state-linked changes in heart modify their susceptibility to oxidants and the extent of the oxidative damage they suffer following oxidative challenge. Chronic increase in the cellular levels of ROS can lead to a catastrophic cycle of DNA damage, mitochondrial dysfunction, further ROS generation and cellular injury. Thus, these cellular events might play an important role in the development and progression of myocardial remodeling and heart failure in altered thyroid states (hypo- and hyper-thyroidism). The present review aims at elucidating the various signaling pathways mediated via ROS and their modulation under altered thyroid state and the possibility of antioxidant therapy. PMID:22649319

Neural Correlates of Subliminal Language Processing.

PubMed

Axelrod, Vadim; Bar, Moshe; Rees, Geraint; Yovel, Galit

2015-08-01

Language is a high-level cognitive function, so exploring the neural correlates of unconscious language processing is essential for understanding the limits of unconscious processing in general. The results of several functional magnetic resonance imaging studies have suggested that unconscious lexical and semantic processing is confined to the posterior temporal lobe, without involvement of the frontal lobe-the regions that are indispensable for conscious language processing. However, previous studies employed a similarly designed masked priming paradigm with briefly presented single and contextually unrelated words. It is thus possible, that the stimulation level was insufficiently strong to be detected in the high-level frontal regions. Here, in a high-resolution fMRI and multivariate pattern analysis study we explored the neural correlates of subliminal language processing using a novel paradigm, where written meaningful sentences were suppressed from awareness for extended duration using continuous flash suppression. We found that subjectively and objectively invisible meaningful sentences and unpronounceable nonwords could be discriminated not only in the left posterior superior temporal sulcus (STS), but critically, also in the left middle frontal gyrus. We conclude that frontal lobes play a role in unconscious language processing and that activation of the frontal lobes per se might not be sufficient for achieving conscious awareness. © The Author 2014. Published by Oxford University Press.

Fronto-ethmoidal Osteoma with Secondary Intradural Mucocele Extension causing Frontal Lobe Syndrome and Pneumocephalus: Case Report and Review of the Literature.

PubMed

Maria, Licci; Christian, Zweifel; Jürgen, Hench; Raphael, Guzman; Jehuda, Soleman

2018-04-18

Paranasal sinus osteoma is a common, asymptomatic, histologically benign, and slow-growing tumor. However, it can give rise to secondary pathologies such as a mucocele in about 50% of the cases. Rarely, intracranial and orbital extension is present leading to rhinoliquorrhea, pneumocephalus, or neurological and visual impairment, which might be potentially life-threatening. A 49-year old man presented with an acute frontal lobe syndrome and rhinoliquorrhea. Cranial magnetic resonance tomography showed a suspected fronto-ethmoidal osteoma with a mucocele expanding intradurally, into the left frontal lobe. It was accompanied by pneumocephalus and showed communication with the left lateral ventricle. Through a bifrontal craniotomy in toto resection of the fronto-ethmoidal bony tumor and the intradural mucocele was performed, while thereafter the frontal sinus was cranialized using a pedunculated periosteal flap. Postoperative recovery was uneventful with complete resolvement of the tension pneumocephalus and the rhinoliquorrhea, and led to an improvement of the frontal lobe syndrome. We present a rare case of pneumocephalus caused by a fronto-ethmoidal osteoma associated with an intradural mucocele. A review of the literature, focusing on the surgical strategies in such cases, is provided. Copyright © 2018 Elsevier Inc. All rights reserved.

Parametric fMRI analysis of visual encoding in the human medial temporal lobe.

PubMed

Rombouts, S A; Scheltens, P; Machielson, W C; Barkhof, F; Hoogenraad, F G; Veltman, D J; Valk, J; Witter, M P

1999-01-01

A number of functional brain imaging studies indicate that the medial temporal lobe system is crucially involved in encoding new information into memory. However, most studies were based on differences in brain activity between encoding of familiar vs. novel stimuli. To further study the underlying cognitive processes, we applied a parametric design of encoding. Seven healthy subjects were instructed to encode complex color pictures into memory. Stimuli were presented in a parametric fashion at different rates, thus representing different loads of encoding. Functional magnetic resonance imaging (fMRI) was used to assess changes in brain activation. To determine the number of pictures successfully stored into memory, recognition scores were determined afterwards. During encoding, brain activation occurred in the medial temporal lobe, comparable to the results obtained by others. Increasing the encoding load resulted in an increase in the number of successfully stored items. This was reflected in a significant increase in brain activation in the left lingual gyrus, in the left and right parahippocampal gyrus, and in the right inferior frontal gyrus. This study shows that fMRI can detect changes in brain activation during variation of one aspect of higher cognitive tasks. Further, it strongly supports the notion that the human medial temporal lobe is involved in encoding novel visual information into memory.

Dynamic Granger-Geweke causality modeling with application to interictal spike propagation

PubMed Central

Lin, Fa-Hsuan; Hara, Keiko; Solo, Victor; Vangel, Mark; Belliveau, John W.; Stufflebeam, Steven M.; Hamalainen, Matti S.

2010-01-01

A persistent problem in developing plausible neurophysiological models of perception, cognition, and action is the difficulty of characterizing the interactions between different neural systems. Previous studies have approached this problem by estimating causal influences across brain areas activated during cognitive processing using Structural Equation Modeling and, more recently, with Granger-Geweke causality. While SEM is complicated by the need for a priori directional connectivity information, the temporal resolution of dynamic Granger-Geweke estimates is limited because the underlying autoregressive (AR) models assume stationarity over the period of analysis. We have developed a novel optimal method for obtaining data-driven directional causality estimates with high temporal resolution in both time and frequency domains. This is achieved by simultaneously optimizing the length of the analysis window and the chosen AR model order using the SURE criterion. Dynamic Granger-Geweke causality in time and frequency domains is subsequently calculated within a moving analysis window. We tested our algorithm by calculating the Granger-Geweke causality of epileptic spike propagation from the right frontal lobe to the left frontal lobe. The results quantitatively suggested the epileptic activity at the left frontal lobe was propagated from the right frontal lobe, in agreement with the clinical diagnosis. Our novel computational tool can be used to help elucidate complex directional interactions in the human brain. PMID:19378280

Supplementary motor area activation in patients with frontal lobe tumors and arteriovenous malformations.

PubMed

Sailor, Janet; Meyerand, M Elizabeth; Moritz, Chad H; Fine, Jason; Nelson, Lindsey; Badie, Behnam; Haughton, Victor M

2003-10-01

Some patients who undergo surgical resection of portions of the supplementary motor area (SMA) have severe postoperative motor and language deficits, whereas others have no deficits. We tested the hypothesis that in some patients with lesions affecting the SMA, the contralateral SMA exhibits some of the activation normally associated with the ipsilateral SMA. Functional MR imaging studies in seven healthy volunteers and 19 patients with frontal lobe tumors or arteriovenous malformations were reviewed retrospectively. The hemisphere in which the SMA activation predominated was tabulated for right and left motor tasks. The relative hemispheric dominance in the SMA for the right and left motor tasks was compared in the healthy and patient groups and with the location of the lesion in the patient group. None of the control subjects performing a right hand motor task activated predominantly the right SMA. Fifty percent of the patients with lesions overlapping the left SMA performing the right motor task activated predominantly the right SMA. Fifty-seven percent of control subjects performing the left hand motor task activated the left SMA predominantly. One hundred percent of patients with lesions overlapping the right frontal SMA performing the left motor task activated the left SMA predominantly. Differences between patients and controls were statistically significant. A lesion that contacts or overlaps the SMA is associated with an increased functional MR imaging response within the contralateral SMA.

Frontal lobe regulation of blood glucose levels: support for the limited capacity model in hostile violence-prone men.

PubMed

Walters, Robert P; Harrison, Patti Kelly; Campbell, Ransom W; Harrison, David W

2016-12-01

Hostile men have reliably displayed an exaggerated sympathetic stress response across multiple experimental settings, with cardiovascular reactivity for blood pressure and heart rate concurrent with lateralized right frontal lobe stress (Trajanoski et al., in Diabetes Care 19(12):1412-1415, 1996; see Heilman et al., in J Neurol Neurosurg Psychiatry 38(1):69-72, 1975). The current experiment examined frontal lobe regulatory control of glucose in high and low hostile men with concurrent left frontal lobe (Control Oral Word Association Test [verbal]) or right frontal lobe (Ruff Figural Fluency Test [nonverbal]) stress. A significant interaction was found for Group × Condition, F (1,22) = 4.16, p ≤ .05 with glucose levels (mg/dl) of high hostile men significantly elevated as a function of the right frontal stressor (M = 101.37, SD = 13.75) when compared to the verbal stressor (M = 95.79, SD = 11.20). Glucose levels in the low hostile group remained stable for both types of stress. High hostile men made significantly more errors on the right frontal but not the left frontal stressor (M = 17.18, SD = 19.88) when compared to the low hostile men (M = 5.81, SD = 4.33). These findings support our existing frontal capacity model of hostility (Iribarren et al., in J Am Med Assoc 17(19):2546-2551, 2000; McCrimmon et al., in Physiol Behav 67(1):35-39, 1999; Brunner et al., in Diabetes Care 21(4):585-590, 1998), extending the role of the right frontal lobe to regulatory control over glucose mobilization.

Pleuroparenchymal fibroelastosis: report of two cases in Brazil.

PubMed

Gomes, Paula Silva; Shiang, Christina; Szarf, Gilberto; Coletta, Ester Nei Aparecida Martins; Pereira, Carlos Alberto de Castro

2017-01-01

Pleuroparenchymal fibroelastosis (PPFE) is a rare lung disease. It can be idiopathic or associated with any one of various conditions. To our knowledge, this is the first report of two cases of PPFE in Brazil. Our first patient presented with pleural and subpleural fibrosis in the upper lobes; a spiculated nodule in the left upper lobe; and a mild reticular pattern in the lower lobes. Surgical lung biopsy revealed PPFE in the upper lobes, including the nodule, and unclassified interstitial pneumonia in the left lower lobe. Our second patient had a history of exposure to domestic birds, indicating a risk of hypersensitivity pneumonitis, and presented with advanced lung disease, predominantly in the upper lobes, together with subpleural fibrosis.That patient underwent lung transplantation. In the explant specimen, PPFE and granulomas were identified, suggesting hypersensitivity pneumonitis as an associated cause. RESUMO A fibroelastose pleuroparenquimatosa (FEPP) é uma doença pulmonar rara, podendo ser idiopática ou associada a diversas condições. Pelo que sabemos, este é o primeiro relato de dois casos de FEPP no Brasil. Nosso primeiro paciente apresentava fibrose pleural e subpleural nos lobos superiores, um nódulo espiculado no lobo superior esquerdo e um padrão reticular discreto nos lobos inferiores. A biópsia pulmonar cirúrgica demonstrou FEPP nos lobos superiores, incluindo no nódulo, e pneumonia intersticial não classificada no lobo inferior esquerdo. Nosso segundo paciente tinha história de exposição a aves domésticas, indicando um risco de pneumonite de hipersensibilidade, e doença pulmonar avançada predominando em lobos superiores, com fibrose subpleural. Esse paciente foi submetido a transplante pulmonar. No espécime do explante, FEPP e granulomas foram identificados, sugerindo pneumonite de hipersensibilidade como causa associada.

Mesial Temporal Sclerosis: Accuracy of NeuroQuant versus Neuroradiologist.

PubMed

Azab, M; Carone, M; Ying, S H; Yousem, D M

2015-08-01

We sought to compare the accuracy of a volumetric fully automated computer assessment of hippocampal volume asymmetry versus neuroradiologists' interpretations of the temporal lobes for mesial temporal sclerosis. Detecting mesial temporal sclerosis (MTS) is important for the evaluation of patients with temporal lobe epilepsy as it often guides surgical intervention. One feature of MTS is hippocampal volume loss. Electronic medical record and researcher reports of scans of patients with proved mesial temporal sclerosis were compared with volumetric assessment with an FDA-approved software package, NeuroQuant, for detection of mesial temporal sclerosis in 63 patients. The degree of volumetric asymmetry was analyzed to determine the neuroradiologists' threshold for detecting right-left asymmetry in temporal lobe volumes. Thirty-six patients had left-lateralized MTS, 25 had right-lateralized MTS, and 2 had bilateral MTS. The estimated accuracy of the neuroradiologist was 72.6% with a κ statistic of 0.512 (95% CI, 0.315-0.710) [moderate agreement, P < 3 × 10(-6)]), whereas the estimated accuracy of NeuroQuant was 79.4% with a κ statistic of 0.588 (95% CI, 0.388-0.787) [moderate agreement, P < 2 × 10(-6)]). This discrepancy in accuracy was not statistically significant. When at least a 5%-10% volume discrepancy between temporal lobes was present, the neuroradiologists detected it 75%-80% of the time. As a stand-alone fully automated software program that can process temporal lobe volume in 5-10 minutes, NeuroQuant compares favorably with trained neuroradiologists in predicting the side of mesial temporal sclerosis. Neuroradiologists can often detect even small temporal lobe volumetric changes visually. © 2015 by American Journal of Neuroradiology.

Use of endobronchial valve insertion to treat relapsing pneumothorax: a case report and literature review.

PubMed

Qi, Fei; Tian, Qing; Chen, Liang'an; Li, Chunyan; Zhang, Shu; Liu, Xingchen; Xiao, Binbin

2017-07-01

Backgorund and Aims: Unidirectional endobronchial valves have recently been shown to be beneficial as treatment for persistent air leaks. This report presents a first case of endobronchial valve implantation to treat relapsing pneumothorax in a Chinese patient, and also presents a review of the literature on the use of one-way valve insertion for the treatment of persistent air leaks. The patient did undergo a recent but failed chest tube intervention. By bronchoscopy and using Chartis® system measurements, the upper left lobe (including the left apical bronchus) was closed using a catheter. After the expected decrease in airflow following bronchial occlusion, increased air pressure and decreased spilled air were noted; it was concluded that the pneumothorax was located in the left upper lobe. A Zephyr ® endobronchial valve was placed in the left upper apical bronchus. The health benefits of the procedure were noticed in the following days. Our review suggests that the use of endobronchial valves could be used as an effective, minimally invasive, low-risk intervention for patients with pneumothorax that cannot be treated surgically. © 2015 John Wiley & Sons Ltd.

Combined Growth Hormone and Thyroid-Stimulating Hormone Deficiency in a Japanese Patient with a Novel Frameshift Mutation in IGSF1.

PubMed

Asakura, Yumi; Abe, Kiyomi; Muroya, Koji; Hanakawa, Junko; Oto, Yuji; Narumi, Satoshi; Hasegawa, Tomonobu; Adachi, Masanori

2015-01-01

Recent reports have indicated that loss-of-function mutations in the immunoglobulin superfamily member 1 gene (IGSF1, OMIM 300888) cause congenital central hypothyroidism with macroorchidism. We conducted a next-generation sequencing-based comprehensive mutation screening for pituitary hormone deficiencies to elucidate molecular mechanisms other than anatomical abnormalities of the pituitary that might be responsible for multiple anterior hormone deficiency in a male patient who originally visited our institute complaining of short stature. He was born large for gestational age (4,370 g, +3.0 SD) after an obstructed labour. Endocrinological evaluation revealed growth hormone and thyroid-stimulating hormone deficiency. Magnetic resonance imaging showed a discontinuity of the pituitary stalk with an ectopic posterior lobe and a hypoplastic anterior lobe, likely explaining multiple anterior pituitary hormone deficiency. We identified a novel hemizygous IGSF1 mutation (c.1137_1138delCA, p.Asn380Glnfs*6) in the patient. In reviewing the literature, we noticed that all reported Japanese male IGSF1 mutation carriers were born larger than mean standards for gestational age (mean birth weight SD score of +2.0, 95% confidence interval 1.0-3.0). This case suggests that more attention should be paid to intrauterine growth and birth history when patients are suspected of having an IGSF1 mutation. © 2015 S. Karger AG, Basel.

Thyrotoxicosis in patients with hypothyroidism is not just overtreatment.

PubMed

Kempegowda, Punith; Nayak, Ananth U

2017-07-14

A 62-year-old Caucasian woman presented with hypothyroid symptoms and biochemical thyrotoxic picture. Previously, she underwent right-sided subtotal thyroidectomy and left partial thyroid lobectomy for thyroid lumps, and treated with thyroxine replacement for hypothyroidism. Although there were no significant findings on clinical examination, investigations confirmed thyrotoxicosis with positive autoimmunity against thyroid glandâ€"all in line with a diagnosis of Graves’ hyperthyroidism. We would like to highlight atypical presentations of thyroid dysfunction and conversion of underactive to overactive thyroid status with this case. Early recognition, diagnosis and intervention are essential to prevent and/or reduce associated morbidity and mortality. When encountered with such clinical conundrums, we recommend seeking opinion from an experienced endocrinologist while interpreting such situation. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of thyroid tissue by Raman spectroscopy

NASA Astrophysics Data System (ADS)

Teixeira, C. S. B.; Bitar, R. A.; Santos, A. B. O.; Kulcsar, M. A. V.; Friguglietti, C. U. M.; Martinho, H. S.; da Costa, R. B.; Martin, A. A.

2010-02-01

Thyroid gland is a small gland in the neck consisting of two lobes connected by an isthmus. Thyroid's main function is to produce the hormones thyroxine (T4), triiodothyronine (T3) and calcitonin. Thyroid disorders can disturb the production of these hormones, which will affect numerous processes within the body such as: regulating metabolism and increasing utilization of cholesterol, fats, proteins, and carbohydrates. The gland itself can also be injured; for example, neoplasias, which have been considered the most important, causing damage of to the gland and are difficult to diagnose. There are several types of thyroid cancer: Papillary, Follicular, Medullary, and Anaplastic. The occurrence rate, in general is between 4 and 7%; which is on the increase (30%), probably due to new technology that is able to find small thyroid cancers that may not have been found previously. The most common method used for thyroid diagnoses are: anamnesis, ultrasonography, and laboratory exams (Fine Needle Aspiration Biopsy- FNAB). However, the sensitivity of those test are rather poor, with a high rate of false-negative results, therefore there is an urgent need to develop new diagnostic techniques. Raman spectroscopy has been presented as a valuable tool for cancer diagnosis in many different tissues. In this work, 27 fragments of the thyroid were collected from 18 patients, comprising the following histologic groups: goitre adjacent tissue, goitre nodular tissue, follicular adenoma, follicular carcinoma, and papillary carcinoma. Spectral collection was done with a commercial FTRaman Spectrometer (Bruker RFS100/S) using a 1064 nm laser excitation and Ge detector. Principal Component Analysis, Cluster Analysis, and Linear Discriminant Analysis with cross-validation were applied as spectral classification algorithm. Comparing the goitre adjacent tissue with the goitre nodular region, an index of 58.3% of correct classification was obtained. Between goitre (nodular region and adjacent tissue) and papillary carcinoma, the index of correct classification was 64.9%, and the classification between benign tissues (goitre and follicular adenoma) and malignant tissues (papillary and follicular carcinomas), the index was 72.5%.

The association of polymorphisms in the type 1 and 2 deiodinase genes with circulating thyroid hormone parameters and atrophy of the medial temporal lobe.

PubMed

de Jong, Frank Jan; Peeters, Robin P; den Heijer, Tom; van der Deure, Wendy M; Hofman, Albert; Uitterlinden, André G; Visser, Theo J; Breteler, Monique M B

2007-02-01

Thyroid function has been related to Alzheimer disease (AD) and neuroimaging markers thereof. Whether thyroid dysfunction contributes to or results from developing AD remains unclear. Variations in the deiodinase type 1 (DIO1) and type 2 (DIO2) genes that potentially alter thyroid hormone bioactivity may help in elucidating the role of thyroid function in AD. We investigated the association of recently identified polymorphisms in the DIO1 (D1a-C/T, D1b-A/G) and DIO2 (D2-ORFa-Gly3Asp, D2-Thr92Ala) genes with circulating thyroid parameters and early neuroimaging markers of AD. The Rotterdam Scan Study is a population-based cohort study among 1,077 elderly individuals aged 60-90 yr. DIO1 and DIO2 polymorphisms and serum TSH, free T4, T3, and reverse T3 (rT3) levels were determined in 995 nondemented elderly, including 473 persons with assessments of hippocampal and amygdalar volume on brain magnetic resonance imaging. Carriers of the D1a-T allele had higher serum free T4 and rT3, lower T3, and lower T3/rT3. The D1b-G allele was associated with higher serum T3 and T3/rT3. The DIO2 variants were not associated with serum thyroid parameters. No associations were found with hippocampal or amygdalar volume. This is the first study to report an association of D1a-C/T and D1b-A/G polymorphisms with iodothyronine levels in the elderly. Polymorphisms in the DIO1 and DIO2 genes are not associated with early magnetic resonance imaging markers of AD. This suggests that the previously reported association between iodothyronine levels and brain atrophy reflects comorbidity or nonthyroidal illness rather than thyroid hormones being involved in developing AD.

Total fixation of cricoarytenoid joint of a patient with rheumatoid arthritis and Hashimoto thyroiditis.

PubMed

Stojanović, Stevan P; Zivić, Ljubica; Stojanović, Jasmina; Belić, Branislav

2010-01-01

The incidence of cricoarytenoid joint fixation in case of rheumatoid arthritis is 17 to 33%. In later stages of rheumatoid arthritis, a gradual fixation of cricoarytenoid joint develops and both halves of the larynx become less movable which calls for endotracheal intubation; while total fixation of this joint demands surgical tracheotomy. Hashimoto thyroiditis can display symptoms which are difficult to distinguish from the ones present in total fixation of cricoarytenoid joint caused by rheumatoid arthritis. A 60-year-old woman in terminal stage of rheumatoid arthritis and Hashimoto thyroiditis, diagnosed after clinical and other examinations. She was treated for strident breathing with surgical tracheotomy. The microscopic examination of the larynx with the use of laryngoscopic pincers suggested the immovability of the right and very limited movability of the left arytenoid cartilage. A computerized endovideostroboscopy showed only passive vertical vibrating movements of the right vocal cord and irregular vibrations of the left vocal cord. Total fixation of the cricoarytenoid joint can be caused by many pathological processes, but so far references have shown no case of rheumatoid arthritis and Hashimoto thyroiditis. In differential diagnostics, one of many examinations is the microscopic examination of the larynx, but it is very important to determine the movability of the arytenoid cartilage with the use of appropriate instruments in total endotracheal anaesthesia while the patient is fully relaxed. Movements in cricoarytenoid joints in patients with Hashimoto thyroiditis and the same conditions are preserved.

[Hemisphere dominance of cortical speech processing and its dynamics in the course of aphasia therapy. A psychophysiologic contribution to the discussion of the neuronal plasticity hypothesis].

PubMed

Maier, R; Lünser, W

1991-01-01

Examinations of aphasic patients by using cognitive tasks were based on the hypothesis that semantically evoked potentials correlate to the processing of information in the cortical areas of Broca and Wernicke. Some of the examined right-handed patients with ischemic lesions of the left hemisphere produced characteristic potentials in the right temporal lobe, and not in the dominant left lobe as was expected. These case histories suggest that in these patients speech processing moved into the subdominant hemisphere as a result of compensation after cerebral damage by using the faculty of neuroplasticity. Furthermore an extended classification of aphasias is presented, illustrated by a three-parameter model.

Multivariate pattern analysis reveals anatomical connectivity differences between the left and right mesial temporal lobe epilepsy.

PubMed

Fang, Peng; An, Jie; Zeng, Ling-Li; Shen, Hui; Chen, Fanglin; Wang, Wensheng; Qiu, Shijun; Hu, Dewen

2015-01-01

Previous studies have demonstrated differences of clinical signs and functional brain network organizations between the left and right mesial temporal lobe epilepsy (mTLE), but the anatomical connectivity differences underlying functional variance between the left and right mTLE remain uncharacterized. We examined 43 (22 left, 21 right) mTLE patients with hippocampal sclerosis and 39 healthy controls using diffusion tensor imaging. After the whole-brain anatomical networks were constructed for each subject, multivariate pattern analysis was applied to classify the left mTLE from the right mTLE and extract the anatomical connectivity differences between the left and right mTLE patients. The classification results reveal 93.0% accuracy for the left mTLE versus the right mTLE, 93.4% accuracy for the left mTLE versus controls and 90.0% accuracy for the right mTLE versus controls. Compared with the right mTLE, the left mTLE exhibited a different connectivity pattern in the cortical-limbic network and cerebellum. The majority of the most discriminating anatomical connections were located within or across the cortical-limbic network and cerebellum, thereby indicating that these disease-related anatomical network alterations may give rise to a portion of the complex of emotional and memory deficit between the left and right mTLE. Moreover, the orbitofrontal gyrus, cingulate cortex, hippocampus and parahippocampal gyrus, which exhibit high discriminative power in classification, may play critical roles in the pathophysiology of mTLE. The current study demonstrated that anatomical connectivity differences between the left mTLE and the right mTLE may have the potential to serve as a neuroimaging biomarker to guide personalized diagnosis of the left and right mTLE.

Delayed recovery of left ventricular function after antithyroid treatment. Further evidence for reversible abnormalities of contractility in hyperthyroidism.

PubMed Central

Forfar, J C; Matthews, D M; Toft, A D

1984-01-01

Sequential measurements of systolic time intervals, left ventricular dimensions, and the derived indices of contractility were undertaken at rest and during isometric exercise in 15 hyperthyroid patients before, during, and after antithyroid treatment. At rest hyperthyroidism was characterised by a shortened pre-ejection period and increased velocity of circumferential shortening of the left ventricle. During isometric exercise, however, the pre-ejection period increased significantly beyond that predicted for normal subjects, and the velocity of circumferential fibre shortening fell by 30%. In contrast, both the pre-ejection period and the velocity of circumferential fibre shortening were unchanged during exercise after a stable euthyroid state had been achieved for at least three months. Comparison between exercise responses and thyroid status during antithyroid treatment showed that a biochemical euthyroid state may be achieved many weeks before normalisation of contractile response to exercise. These findings support the hypothesis of reversible depression of left ventricular function in hyperthyroidism. Responses at rest principally reflect the peripheral actions of thyroid hormone excess. PMID:6743439

Exercise training versus T3 and T4 hormones treatment: The differential benefits of thyroid hormones on the parasympathetic drive of infarcted rats.

PubMed

Teixeira, Rayane Brinck; Zimmer, Alexsandra; de Castro, Alexandre Luz; Carraro, Cristina Campos; Casali, Karina Rabello; Dias, Ingrid Gonçalves Machuca; Godoy, Alessandra Eifler Guerra; Litvin, Isnard Elman; Belló-Klein, Adriane; da Rosa Araujo, Alex Sander

2018-03-01

This study aimed to investigate whether beneficial effects of thyroid hormones are comparable to those provided by the aerobic exercise training, to verify its applicability as a therapeutic alternative to reverse the pathological cardiac remodeling post-infarction. Male rats were divided into SHAM-operated (SHAM), myocardial infarction (MI), MI subjected to exercise training (MIE), and MI who received T3 and T4 treatment (MIH) (n = 8/group). MI, MIE and MIH groups underwent an infarction surgery while SHAM was SHAM-operated. One-week post-surgery, MIE and MIH groups started the exercise training protocol (moderate intensity on treadmill), or the T3 (1.2 μg/100 g/day) and T4 (4.8 μg/100 g/day) hormones treatment by gavage, respectively, meanwhile SHAM and MI had no intervention for 9 weeks. The groups were accompanied until 74 days after surgery, when all animals were anesthetized, left ventricle echocardiography and femoral catheterization were performed, followed by euthanasia and left ventricle collection for morphological, oxidative stress, and intracellular kinases expression analysis. Thyroid hormones treatment was more effective in cardiac dilation and infarction area reduction, while exercise training provided more protection against fibrosis. Thyroid hormones treatment increased the lipoperoxidation and decreased GSHPx activity as compared to MI group, increased the t-Akt2 expression as compared to SHAM group, and increased the vascular parasympathetic drive. Thyroid hormones treatment provided differential benefits on the LV function and autonomic modulation as compared to the exercise training. Nevertheless, the redox unbalance induced by thyroid hormones highlights the importance of more studies targeting the ideal duration of this treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Determinants of brain metabolism changes in mesial temporal lobe epilepsy.

PubMed

Chassoux, Francine; Artiges, Eric; Semah, Franck; Desarnaud, Serge; Laurent, Agathe; Landre, Elisabeth; Gervais, Philippe; Devaux, Bertrand; Helal, Ourkia Badia

2016-06-01

To determine the main factors influencing metabolic changes in mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). We prospectively studied 114 patients with MTLE (62 female; 60 left HS; 15- to 56-year-olds) with (18) F-fluorodeoxyglucose-positron emission tomography and correlated the results with the side of HS, structural atrophy, electroclinical features, gender, age at onset, epilepsy duration, and seizure frequency. Imaging processing was performed using statistical parametric mapping. Ipsilateral hypometabolism involved temporal (mesial structures, pole, and lateral cortex) and extratemporal areas including the insula, frontal lobe, perisylvian regions, and thalamus, more extensively in right HS (RHS). A relative increase of metabolism (hypermetabolism) was found in the nonepileptic temporal lobe and in posterior areas bilaterally. Voxel-based morphometry detected unilateral hippocampus atrophy and gray matter concentration decrease in both frontal lobes, more extensively in left HS (LHS). Regardless of the structural alterations, the topography of hypometabolism correlated strongly with the extent of epileptic networks (mesial, anterior-mesiolateral, widespread mesiolateral, and bitemporal according to the ictal spread), which were larger in RHS. Notably, widespread perisylvian and bitemporal hypometabolism was found only in RHS. Mirror hypermetabolism was grossly proportional to the hypometabolic areas, coinciding partly with the default mode network. Gender-related effect was significant mainly in the contralateral frontal lobe, in which metabolism was higher in female patients. Epilepsy duration correlated with the contralateral temporal metabolism, positively in LHS and negatively in RHS. Opposite results were found with age at onset. High seizure frequency correlated negatively with the contralateral metabolism in LHS. Epileptic networks, as assessed by electroclinical correlations, appear to be the main determinant of hypometabolism in MTLE. Compensatory mechanisms reflected by a relative hypermetabolism in the nonepileptic temporal lobe and in extratemporal areas seem more efficient in LHS and in female patients, whereas long duration, late onset of epilepsy, and high seizure frequency may reduce these adaptive changes. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Dosimetric evaluation of the feasibility of stereotactic body radiotherapy for primary lung cancer with lobe-specific selective elective nodal irradiation.

PubMed

Komatsu, Tetsuya; Kunieda, Etsuo; Kitahara, Tadashi; Akiba, Takeshi; Nagao, Ryuta; Fukuzawa, Tsuyoshi

2016-01-01

More than 10% of all patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer develop regional lymph node recurrence. We evaluated the dosimetric feasibility of SBRT with lobe-specific selective elective nodal irradiation (ENI) on dose-volume histograms. A total of 21 patients were treated with SBRT for Stage I primary lung cancer between January 2010 and June 2012 at our institution. The extents of lobe-specific selective ENI fields were determined with reference to prior surgical reports. The ENI fields included lymph node stations (LNS) 3 + 4 + 11 for the right upper lobe tumors, LNS 7 + 11 for the right middle or lower lobe tumors, LNS 5 + 11 for the left upper lobe tumors, and LNS 7 + 11 for the left lower lobe tumors. A composite plan was generated by combining the ENI plan and the SBRT plan and recalculating for biologically equivalent doses of 2 Gy per fraction, using a linear quadratic model. The V20 of the lung, D(1cm3) of the spinal cord, D(1cm3) and D(10cm3) of the esophagus and D(10cm3) of the tracheobronchial wall were evaluated. Of the 21 patients, nine patients (43%) could not fulfill the dose constraints. In all these patients, the distance between the planning target volume (PTV) of ENI (PTVeni) and the PTV of SBRT (PTVsrt) was ≤2.0 cm. Of the three patients who developed regional metastasis, two patients had isolated lymph node failure, and the lymph node metastasis was included within the ENI field. When the distance between the PTVeni and PTVsrt is >2.0 cm, SBRT with selective ENI may therefore dosimetrically feasible. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Task activation and functional connectivity show concordant memory laterality in temporal lobe epilepsy.

PubMed

Sideman, Noah; Chaitanya, Ganne; He, Xiaosong; Doucet, Gaelle; Kim, Na Young; Sperling, Michael R; Sharan, Ashwini D; Tracy, Joseph I

2018-04-01

In epilepsy, asymmetries in the organization of mesial temporal lobe (MTL) functions help determine the cognitive risk associated with procedures such as anterior temporal lobectomy. Past studies have investigated the change/shift in a visual episodic memory laterality index (LI) in mesial temporal lobe structures through functional magnetic resonance imaging (fMRI) task activations. Here, we examine whether underlying task-related functional connectivity (FC) is concordant with such standard fMRI laterality measures. A total of 56 patients with temporal lobe epilepsy (TLE) (Left TLE [LTLE]: 31; Right TLE [RTLE]: 25) and 34 matched healthy controls (HC) underwent fMRI scanning during performance of a scene encoding task (SET). We assessed an activation-based LI of the hippocampal gyrus (HG) and parahippocampal gyrus (PHG) during the SET and its correspondence with task-related FC measures. Analyses involving the HG and PHG showed that the patients with LTLE had a consistently higher LI (right-lateralized) than that of the HC and group with RTLE, indicating functional reorganization. The patients with RTLE did not display a reliable contralateral shift away from the pathology, with the mesial structures showing quite distinct laterality patterns (HG, no laterality bias; PHG, no evidence of LI shift). The FC data for the group with LTLE provided confirmation of reorganization effects, revealing that a rightward task LI may be based on underlying connections between several left-sided regions (middle/superior occipital and left medial frontal gyri) and the right PHG. The FCs between the right HG and left anterior cingulate/medial frontal gyri were also observed in LTLE. Importantly, the data demonstrate that the areas involved in the LTLE task activation shift to the right hemisphere showed a corresponding increase in task-related FCs between the hemispheres. Altered laterality patterns based on mesial temporal lobe epilepsy (MTLE) pathology manifest as several different phenotypes, varying according to side of seizure onset and the specific mesial structures involved. There is good correspondence between task LI activation and FC patterns in the setting of LTLE, suggesting that reliable visual episodic memory reorganization may require both a shift in nodal activation and a change in nodal connectivity with mesial temporal structures involved in memory. Copyright © 2018. Published by Elsevier Inc.

Simultaneous branchial cleft and thyroid disorders may present a management challenge.

PubMed

Harding, Jane L; Veivers, David; Sidhu, Stan B; Sywak, Mark S; Shun, Albert; Delbridge, Leigh W

2005-09-01

Cysts, sinuses or abscesses arising from second, third or fourth branchial cleft remnants may lie either within the body of, or in close proximity to the thyroid gland. Given their infrequent nature they may pose both diagnostic and management challenges for the treating surgeon when they occur in association with thyroid disorders. This is a case series. All patients with concomitant thyroid disorders and a branchial cleft anomaly treated in the University of Sydney Endocrine Surgical Unit in the 10-year period 1994-2003 comprised the study group. Patient demographics, clinical presentation, imaging, surgical management, definitive histology and outcomes were documented. Six patients were identified with an age range of 3-76 years and a male : female ratio of 1:5. Five branchial cleft anomalies were left sided, one was right sided. Two patients had second cleft anomalies, both of which were initially thought to represent metastatic lymph nodes in association with thyroid cancer. A further two patients had third cleft abnormalities presenting as suppurative thyroiditis. The final two patients had fourth cleft abnormalities causing intraoperative management problems. Branchial cleft remnants and anomalies are rare but may occur in association with thyroid disease. They may pose a diagnostic and management dilemma either preoperatively, when mistaken for metastatic thyroid cancer, or intraoperatively when mistaken for a thyroid nodule.

[Age characteristics of the cardiovascular system, depending on the thyroid function in type 2 diabetes mellitus].

PubMed

Ignateva, P A; Ballyuzek, M F; Shpakov, A O

To study the features of cardiovascular system in patients with diabetes mellitus type 2 considering the thyroid pathology and age, 264 patients were examined. They were divided into three groups: 1st - patients with diffuse-nodular changes in the thyroid gland, 2nd - patients with autoimmune thyroid disease, 3rd - a control group of patients without thyroid disease. The patients of different ages were examined in each of these groups. All patients were in euthyroid state. It was established that identified in diabetes mellitus type 2 thyroid pathology and the thyroid disease contribute special features to the clinical picture for combined diabetic and cardiovascular pathology even in a euthyroid state including the age features. The laboratory and instrumental researches showed that the patients with combined diabetes and thyroid pathology have a higher incidence of atrial fibrillation, ischemic heart disease, and ventricular arrhythmias of high grades. They also were noticed to have a more adverse form of the left ventricle remodeling, also the combination of diastolic and systolic dysfunctions were found to be more frequent. It was concluded about the necessity of early diagnosis and correction of the cardiovascular disorders and thyroid systems in type 2 diabetes mellitus patients, including euthyroid patients.

Frontal and temporal lobe sources for a marker of controlled auditory attention: the negative difference (Nd) event-related potential.

PubMed

Jemel, Boutheina; Oades, Robert D; Oknina, Ljubov; Achenbach, Christiane; Röpcke, Bernd

2003-01-01

Frontal and temporal lobe sources for electrical activity associated with auditory controlled attention (negative difference, Nd) were sought for comparison with those reported to arise from the earlier detection of stimulus-change (mismatch negativity, MMN: Jemel et al. 2002). In two sessions a month apart (T1 and T2), 14 subjects were presented with a 3-tone oddball passively, then as a discrimination task. In EEG recordings (32 sites), Nd was calculated by subtraction of the event-related potential elicited by a non-attended stimulus from that after the same frequency-deviant as target Putative generators in the 180-228 ms latency-range were modelled with brain electrical source analysis and mapped to the modified Montreal brain-atlas. Initial T1-analyses located bilateral Nd dipoles in the superior temporal gyrus (BA22) and the dorsolateral prefrontal cortex (BA8). Re-test allowed estimates of the temporal and spatial extension of activity. Peak activity occurred 14 ms later. Step-by-stepanalysis showed that the best spatial fit for the inverse-solutions extended 3-6 mm from the point sources, but for temporal lobe sources this increased 15 mm caudally. The right mid-frontal source (BA10) was rostral and ventral from that in the left superior frontal gyrus (BAB). T1 and T2 dipole strengths were well correlated. Nd measures of controlled attention localised to areas associated with sustained attention, problem-solving and working-memory. Temporal lobe sources were later and more posterior and medial than for automatic change-detection. Frontal Nd sources were more dorsal on the right and more rostral on the left than MMN dipoles reported for the right inferior frontal and left anterior cingulate. The sequence of information processing is reviewed.

Differences in the neural correlates of frontal lobe tests.

PubMed

Matsuoka, Teruyuki; Kato, Yuka; Imai, Ayu; Fujimoto, Hiroshi; Shibata, Keisuke; Nakamura, Kaeko; Yamada, Kei; Narumoto, Jin

2018-01-01

The Executive Interview (EXIT25), the executive clock-drawing task (CLOX1), and the Frontal Assessment Battery (FAB) are used to assess executive function at the bedside. These tests assess distinct psychometric properties. The aim of this study was to examine differences in the neural correlates of the EXIT25, CLOX1, and FAB based on magnetic resonance imaging. Fifty-eight subjects (30 with Alzheimer's disease, 10 with mild cognitive impairment, and 18 healthy controls) participated in this study. Multiple regression analyses were performed to examine the brain regions correlated with the EXIT25, CLOX1, and FAB scores. Age, gender, and years of education were included as covariates. Statistical thresholds were set to uncorrected P-values of 0.001 at the voxel level and 0.05 at the cluster level. The EXIT25 score correlated inversely with the regional grey matter volume in the left lateral frontal lobe (Brodmann areas 6, 9, 44, and 45). The CLOX1 score correlated positively with the regional grey matter volume in the right orbitofrontal cortex (Brodmann area 11) and the left supramarginal gyrus (Brodmann area 40). The FAB score correlated positively with the regional grey matter volume in the right precentral gyrus (Brodmann area 6). The left lateral frontal lobe (Brodmann area 9) and the right lateral frontal lobe (Brodmann area 46) were identified as common brain regions that showed association with EXIT25, CLOX1, and FAB based only a voxel-level threshold. The results of this study suggest that the EXIT25, CLOX1, and FAB may be associated with the distinct neural correlates of the frontal cortex. © 2018 Japanese Psychogeriatric Society.

Dopamine D4 Receptor Gene Associated with the Frontal-Striatal-Cerebellar Loop in Children with ADHD: A Resting-State fMRI Study.

PubMed

Qian, Andan; Wang, Xin; Liu, Huiru; Tao, Jiejie; Zhou, Jiejie; Ye, Qiong; Li, Jiance; Yang, Chuang; Cheng, Jingliang; Zhao, Ke; Wang, Meihao

2018-06-01

Attention deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder that has been linked to the dopaminergic system. This study aimed to investigate the effects of regulation of the dopamine D4 receptor (DRD4) on functional brain activity during the resting state in ADHD children using the methods of regional homogeneity (ReHo) and functional connectivity (FC). Resting-state functional magnetic resonance imaging data were analyzed in 49 children with ADHD. All participants were classified as either carriers of the DRD4 4-repeat/4-repeat (4R/4R) allele (n = 30) or the DRD4 2-repeat (2R) allele (n = 19). The results showed that participants with the DRD4 2R allele had decreased ReHo bilaterally in the posterior lobes of the cerebellum, while ReHo was increased in the left angular gyrus. Compared with participants carrying the DRD4 4R/4R allele, those with the DRD4 2R allele showed decreased FC to the left angular gyrus in the left striatum, right inferior frontal gyrus, and bilateral lobes of the cerebellum. The increased FC regions included the left superior frontal gyrus, medial frontal gyrus, and rectus gyrus. These data suggest that the DRD4 polymorphisms are associated with localized brain activity and specific functional connections, including abnormality in the frontal-striatal-cerebellar loop. Our study not only enhances the understanding of the correlation between the cerebellar lobes and ADHD, but also provides an imaging basis for explaining the neural mechanisms underlying ADHD in children.

A comparative study of brain perfusion single-photon emission computed tomography and magnetic resonance imaging in patients with post-traumatic anosmia.

PubMed

Atighechi, Saeid; Salari, Hadi; Baradarantar, Mohammad Hossein; Jafari, Rozita; Karimi, Ghasem; Mirjali, Mehdi

2009-01-01

Loss of smell is a problem that can occur in up to 30% of patients with head trauma. The olfactory function investigation methods so far in use have mostly relied on subjective responses given by patients. Recently, some studies have used magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) to evaluate patients with post-traumatic anosmia. The present study seeks to detect post-traumatic anosmia and the areas in the brain that are related to olfactory impairment by using SPECT and MRI as imaging techniques. The study was conducted on 21 patients suffering from head injury and consequently anosmia as defined by an olfactory identification test. Two control groups (traumatic normosmic and nontraumatic healthy individuals) were selected. Brain MRI, qualitative and semiquantitative SPECT with 99mtc-ethyl-cysteinate-dimer were taken from all the patients. Then the brain SPECT and MRI were compared with each other. Semi-quantitative assessment of the brain perfusion SPECT revealed frontal, left parietal, and left temporal hypoperfusion as compared with the two control groups. Eighty-five percent of the anosmic patients had abnormal brain MRI. Regarding the MRI, the main abnormality proved to be in the anterior inferior region of the frontal lobes and olfactory bulbs. The findings of this study suggest that damage to the frontal lobes and olfactory bulbs as shown in the brain MRI and hypoperfusion in the frontal, left parietal, and left temporal lobes in the semiquantitative SPECT corresponds to post-traumatic anosmia. Further neurophysiological and imaging studies are definitely needed to set the idea completely.

A Case Report: A Third/Fourth Branchial Pouch Anomaly Presented by Solid Thyroid and Lateral Cervical Neck Masses.

PubMed

Nasreldin, Magda H A; Ibrahim, Eman A; Saad El-Din, Somaia A

2016-01-01

Branchial pouch-derived anomalies may arise from remnants of the first, second, or third/fourth branchial arches. Branchial pouch-related structures are found within the thyroid gland in the form of solid cell rests, epithelial lined cyst with or without an associated lymphoid component, thymic and/or parathyroid tissue, and less commonly in the form of heterotopic cartilage. We present a rare case of left solid thyroid swelling nearby two cervical nodules in a seven-year-old female with a clinical diagnosis suggestive of malignant thyroid tumor with metastasis to the cervical lymph nodes. Histopathological examination revealed that it was compatible with third/fourth branchial pouch-derived anomaly composed of mature cartilage and thymic and parathyroid tissues for clinical and radiological correlations.

A Case Report: A Third/Fourth Branchial Pouch Anomaly Presented by Solid Thyroid and Lateral Cervical Neck Masses

PubMed Central

Nasreldin, Magda H. A.; Ibrahim, Eman A.; Saad El-Din, Somaia A.

2016-01-01

Branchial pouch-derived anomalies may arise from remnants of the first, second, or third/fourth branchial arches. Branchial pouch-related structures are found within the thyroid gland in the form of solid cell rests, epithelial lined cyst with or without an associated lymphoid component, thymic and/or parathyroid tissue, and less commonly in the form of heterotopic cartilage. We present a rare case of left solid thyroid swelling nearby two cervical nodules in a seven-year-old female with a clinical diagnosis suggestive of malignant thyroid tumor with metastasis to the cervical lymph nodes. Histopathological examination revealed that it was compatible with third/fourth branchial pouch-derived anomaly composed of mature cartilage and thymic and parathyroid tissues for clinical and radiological correlations. PMID:26819565

The lateralising significance of hypergraphia in temporal lobe epilepsy.

PubMed

Roberts, J K; Robertson, M M; Trimble, M R

1982-02-01

Six patients with hypergraphia and epilepsy are presented and their clinical features compared with other patients reported in the literature. It is suggested that hypergraphia occurs more frequently in patients with right-sided non-dominant temporal lobe lesions, in contrast for example to the schizophreniform presentation of left-sided lesions. Other features of psychopathology possibly associated with non-dominant lesions, including elation, hypereligiosity and déjà vu experiences, are also discussed.

Mental Number Line Disruption in a Right-Neglect Patient after a Left-Hemisphere Stroke

ERIC Educational Resources Information Center

Pia, Lorenzo; Corazzini, Luca Latini; Folegatti, Alessia; Gindri, Patrizia; Cauda, Franco

2009-01-01

A right-neglect patient with focal left-hemisphere damage to the posterior superior parietal lobe was assessed for numerical knowledge and tested on the bisection of numerical intervals and visual lines. The semantic and verbal knowledge of numbers was preserved, whereas the performance in numerical tasks that strongly emphasize the visuo-spatial…

Improved Spatial Ability Correlated with Left Hemisphere Dysfunction in Turner's Syndrome. Implications for Mechanism.

ERIC Educational Resources Information Center

Rovet, Joanne F.

This study contrasts the performance of a 17-year-old female subject with Turner's syndrome before and after developing left temporal lobe seizures, as a means of identifying the mechanism responsible for the Turner's syndrome spatial impairment. The results revealed a deficit in spatial processing before onset of the seizure disorder. Results…

Quantitative thyroid scintigraphy in greyhounds suspected of primary hypothyroidism.

PubMed

Pinilla, Manuel; Shiel, Robert E; Brennan, Sheila F; McAllister, Hester; Mooney, Carmel T

2009-01-01

The existence of hypothyroidism in greyhounds remains controversial and its investigation is complicated by the low circulating thyroid hormone concentrations typically found in healthy dogs of this breed. Quantitative measurement of thyroidal technetium-99m pertechnetate ((99m)TcO4-) uptake is known to be useful in assessing thyroid function in other breeds. The aim of this study was to evaluate thyroid scintigraphy as a method of assessing thyroid function in greyhounds suspected of primary hypothyroidism. Twenty greyhounds (eight females, 12 males) were studied. Thirteen had bald thigh syndrome and seven poor performance and low total T4. Total T4 concentrations were decreased in 18 (90%), and free T4 in two (10%) dogs. All canine thyroid stimulating hormone concentrations were within the reference interval. Thyroidal (99m)TcO4- uptake values (mean +/- SD, 0.76 +/- 0.26%) were within the reference limits published for euthyroid dogs (0.39-1.86%) making hypothyroidism highly unlikely. There were no significant differences (P < 0.05) when comparing data between dogs with bald thigh syndrome (13 dogs) and the remaining dogs (seven dogs). Seventeen (85%) dogs had higher uptake in the left thyroid gland than in the right that might reflect an anatomic feature of the greyhound breed. Calculation of percent thyroidal uptake of (99m)TcO4- is more accurate than thyroid: salivary gland ratios because of high variability in salivary gland uptake. Percent thyroidal uptake of (99m)TcO4- should be used when assessing thyroid function scintigraphically in the greyhound breed.

Jazz, guitar, and neurosurgery: the Pat Martino case report.

PubMed

Galarza, Marcelo; Isaac, Claire; Pellicer, Olga; Mayes, Andrew; Broks, Paul; Montaldi, Daniela; Denby, Christine; Simeone, Frederick

2014-01-01

We present the case of a professional jazz guitarist with temporal lobe epilepsy secondary to an arteriovenous cerebral malformation. The patient underwent a left temporal lobectomy in 1980. After surgery, he presented with severe retrograde amnesia and complete loss of musical interest and capabilities. The patient's musical abilities recovered over time, and he regained his previous virtuoso status. In 2007, his medical history, neuropsychologic functions, and structural magnetic resonance imaging study were examined and revealed a remarkable degree of recovery of memory and musical abilities in the context of extensive temporal lobe resection. The neuropsychologic findings and neuroanatomic features of the magnetic resonance imaging study were analyzed to try to understand the high degree of recovery of both long-term memory and musical processing abilities in this musician. This case reveals the possibility of an unusual degree of cerebral plasticity and reorganization. Additionally, it emphasizes the question of musical virtuosity. This report shows that the musical capabilities of professional musicians, in specific cases, can completely recover even when much of the left temporal lobe has been removed. Copyright © 2014 Elsevier Inc. All rights reserved.

[A case of brain metastasis discovered after surgery for lung cancer based on changes in CEA, in which long-term survival was obtained by repeated gammaknife irradiation].

PubMed

Kakeya, Hiroshi; Inoue, Yuichi; Sawai, Toyomitsu; Ikuta, Yasushi; Ohno, Hideaki; Yanagihara, Katsunori; Higashiyama, Yasuhito; Miyazaki, Yoshitsugu; Soda, Hiroshi; Tashiro, Takayoshi; Kohno, Shigeru

2005-12-01

A 58-year-old man underwent right lower lobectomy for lung adenocarcinoma in June 1998. Since a high level of tumor marker CEA persisted after surgery, chemotherapy was additionally performed, and the CEA level subsequently normalized. However, the CEA level increased in April 1999, and brain metastasis was found in the left occipital lobe, and the first gammaknife irradiation was performed. Multiple brain metastases were found when CEA increased again in August 1999, and the second gammaknife irradiation was performed. Moreover, brain metastases were found in the left frontal and occipital lobes in February 2000, and the third gammaknife irradiation was performed. CEA normalized thereafter, but increased in February 2001. Brain metastasis was found in the right occipital lobe, and the fourth gammaknife irradiation was performed. CEA has remained within the normal range for about 4 years thereafter. Long-term survival was possible by repeated gammaknife irradiation for brain metastases. Monitoring of CEA played an important role in finding recurrent brain metastasis in this patient.

Transcortical Sensory Aphasia after Left Frontal Lobe Infarction: Loss of Functional Connectivity.

PubMed

Kwon, Miseon; Shim, Woo Hyun; Kim, Sang-Joon; Kim, Jong S

2017-01-01

The underlying mechanism of transcortical sensory aphasia (TSA) caused by lesions occurring in the left frontal lobe remains unclear. We attempted to investigate the mechanism with the use of functional MRI (fMRI). We studied 2 patients with TSA after a left frontal infarction identified by diffusion-weighted MRI. As control subjects, a patient with transcortical motor aphasia and a healthy normal adult were chosen. The Korean version of Western Aphasia Battery was performed initially and at 3 months post stroke. We performed fMRI using verb generation and sentence completion tasks. Resting-state fMRI (rs-fMRI) was also obtained for network-level analysis initially and at 3 months post stroke. The results of diffusion- and perfusion-weighted MRI revealed no diffusion-perfusion mismatch. Initial fMRI in patients with TSA showed no reversed inter-/intrahemispheric activation patterns. rs-fMRI showed significantly decreased resting-state functional connectivity in the language network in patients with TSA compared with the control subjects. Follow-up rs-fMRI studies showed improvement in functional connectivity along with the recovery of patients' language function. Our data showed that the auditory comprehension deficits in patients with frontal lobe infarcts is attributed to difficulty accessing the posterior language area due to functional disconnection between language centers in the acute stage of stroke. © 2017 S. Karger AG, Basel.

Changes in cortical activation in craniomandibular disorders during splint therapy - a single subject fMRI study.

PubMed

Lickteig, Rita; Lotze, Martin; Lucas, Christian; Domin, Martin; Kordass, Bernd

2012-03-20

There is some controversial discussion within the therapy of craniomandibular disorders (CMDs) about the mode of action of occlusal splints. Here we present a case report on one CMD-patient measuring cerebral activation changes with functional magnetic resonance imaging (fMRI) before and after therapy with a stabilization splint. Wearing the Michigan splint for 11 nights and partially days resulted in substantial pain relief and changes in occlusal movement performance. Cerebral activation during occlusion was decreased after therapy (PRE-POST) in bilateral sensorimotor regions but also additional areas such as left posterior insula, right superior temporal cortex and bilateral occipital lobe. During the first usage of the splint in the scanner (PRE) increased activation in the left dorsolateral prefrontal lobe (BA 9) was observed. After splint training occlusion with the splint compared to without a splint increasingly involved the left superior parietal lobe (BA 7, POST). Whereas BA 9 might be associated with increasing working memory load due to the manipulation with an unusual object, the BA 7 activation in the POST session might document increased sensorimotor interaction after getting used to the splint. Our findings indicate that wearing an occlusion splint triggers activation in parietal sensorimotor integration areas, also observed after long periods of sensorimotor training. These additional recourses might improve coordination and physiological handling of the masticatory system. Copyright © 2011. Published by Elsevier GmbH.

A functional near-infrared spectroscopy study of lexical decision task supports the dual route model and the phonological deficit theory of dyslexia.

PubMed

Sela, Itamar; Izzetoglu, Meltem; Izzetoglu, Kurtulus; Onaral, Banu

2014-01-01

The dual route model (DRM) of reading suggests two routes of reading development: the phonological and the orthographic routes. It was proposed that although the two routes are active in the process of reading; the first is more involved at the initial stages of reading acquisition, whereas the latter needs more reading training to mature. A number of studies have shown that deficient phonological processing is a core deficit in developmental dyslexia. According to the DRM, when the Lexical Decision Task (LDT) is performed, the orthographic route should also be involved when decoding words, whereas it is clear that when decoding pseudowords the phonological route should be activated. Previous functional near-infrared spectroscopy (fNIR) studies have suggested that the upper left frontal lobe is involved in decision making in the LDT. The current study used fNIR to compare left frontal lobe activity during LDT performance among three reading-level groups: 12-year-old children, young adult dyslexic readers, and young adult typical readers. Compared to typical readers, the children demonstrated lower activity under the word condition only, whereas the dyslexic readers showed lower activity under the pseudoword condition only. The results provide evidence for upper left frontal lobe involvement in LDT and support the DRM and the phonological deficit theory of dyslexia.

Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry.

PubMed

Hikspoors, Jill P J M; Peeters, Mathijs M J P; Kruepunga, Nutmethee; Mekonen, Hayelom K; Mommen, Greet M C; Köhler, S Eleonore; Lamers, Wouter H

2017-12-07

Couinaud based his well-known subdivision of the liver into (surgical) segments on the branching order of portal veins and the location of hepatic veins. However, both segment boundaries and number remain controversial due to an incomplete understanding of the role of liver lobes and vascular physiology on hepatic venous development. Human embryonic livers (5-10 weeks of development) were visualized with Amira 3D-reconstruction and Cinema 4D-remodeling software. Starting at 5 weeks, the portal and umbilical veins sprouted portal-vein branches that, at 6.5 weeks, had been pruned to 3 main branches in the right hemi-liver, whereas all (>10) persisted in the left hemi-liver. The asymmetric branching pattern of the umbilical vein resembled that of a "distributing" vessel, whereas the more symmetric branching of the portal trunk resembled a "delivering" vessel. At 6 weeks, 3-4 main hepatic-vein outlets drained into the inferior caval vein, of which that draining the caudate lobe formed the intrahepatic portion of the caval vein. More peripherally, 5-6 major tributaries drained both dorsolateral regions and the left and right ventromedial regions, implying a "crypto-lobar" distribution. Lobar boundaries, even in non-lobated human livers, and functional vascular requirements account for the predictable topography and branching pattern of the liver veins, respectively.

Sex dependence of brain size and shape in bipolar disorder: an exploratory study.

PubMed

Mackay, Clare E; Roddick, Elina; Barrick, Thomas R; Lloyd, Adrian J; Roberts, Neil; Crow, Tim J; Young, Allan H; Ferrier, I Nicol

2010-05-01

Anomalies of asymmetry and sex differences in brain structure have frequently been described in schizophrenic illnesses but have seldom been explored in bipolar disorder. We measured volumes of the left and right frontal, temporal, parietal, and occipital lobes and computed the magnitude of brain torque (i.e., rightward frontal and leftward occipital asymmetry) for 49 patients with bipolar disorder and 47 healthy controls and performed an exploratory analysis of sex differences in patients and controls. Patients had significantly greater cerebrospinal fluid volume than controls, but no difference in total brain volume. There were no main effects of diagnosis in gray matter lobe volume or brain torque, but when analyses were performed separately for male and female subjects, significant sex-by-diagnosis interactions were found in the volume of the left frontal, left temporal, right parietal, and right occipital lobes, such that male patients with bipolar disorder tend toward larger, more symmetric brains than male controls, whereas female patients tend toward smaller, more asymmetric brains than female controls. The lateralised nature of these interactions was such that the normal sex difference in volume was significantly accentuated, whilst the normal sex difference in asymmetry tended to be diminished in patients with bipolar disorder. We conclude that bipolar disorder in part reflects an interaction between brain growth and sex along the anterior-posterior axis of the human brain.