sproutside8

BACKGROUND Superficial siderosis is an irreversible disease in the central nervous system caused by the deposition of hemosiderin in the subpial tissue due to persistent bleeding in the subarachnoid space. The main symptoms include sensorineural hearing loss, cerebellar ataxia, and pyramidal tract disorder. Superficial siderosis is mainly idiopathic, but bleeding factors such as tumors or history of surgery often play an important role in its pathogenesis. CASE DESCRIPTION A 66-year-old man with a history of surgery for a cerebellar tumor 37 years ago complained of hearing loss. Magnetic resonance imaging showed recurrence of the tumor on T2-weighted images and hypointense areas along the cerebellar sulci on T2*-weighted images. During the operation, microscopic bleeding was observed on the surface of the tumor. The pathological diagnosis was pilocytic astrocytoma. A biopsy obtained during the first surgery revealed almost the same pathological findings as those from a biopsy obtained during the second surgery, but the first specimen showed no hemosiderin deposition or active bleeding, which the second specimen did show. CONCLUSIONS Recurrent pilocytic astrocytoma with intratumoral hemorrhage was the suspected cause for superficial siderosis. The source of chronic bleeding was identified with intraoperative and pathological findings. We describe the first report of superficial siderosis associated with a pilocytic astrocytoma that recurred 37 years after an initial tumor was excised. OBJECTIVE The purpose of this report is to analyze the relationship between cognitive performance and white matter (WM) integrity in patients with temporal lobe epilepsy (TLE), in order to establish a radiologic criteria to help with patient selection for surgery. METHODS Nineteen adults with TLE were included in the study. A tractography analysis of the fractional anisotropy (FA) and the mean diffusivity (MD) of the following fascicles were calculated arcuate (AF), cingulum (CG), fornix (FORX), inferior frontooccipital (IFOF), inferior longitudinal (FLI), parahipocampal (PHC) and uncinate (UNC). The Wechsler Memory Scale-Third Edition (WMS-III) neuropsychological test was performed to evaluate short and long-term verbal (LM-I and II) and nonverbal (VR-I and II) memory. see more Relationships between memory scores and diffusion were calculated. RESULTS Lower LM-I scores were correlated with lower MD of right-IFOF, while lower LM-II scores, were related to higher values of FA in bilateral CG, right-UF, right-PHC and lower MD in left-CG. Finally, lower values in VR-I scores were associated to lower values in MD in right-CG and IFOF. CONCLUSIONS Structural changes of some WM tracts were associated with deterioration of both short and long-term memory. These alterations were more associated to verbal memory than to non-verbal memory. These changes mainly consist in an increase in FA and a decrease in MD; which could be interpreted as reorganization phenomena. DTI could be a useful tool for cognitive assessment in surgical candidates with TLE that are not suitable for neuropsychological testing, or in whom their results do not lead to definitive conclusions. BACKGROUND The impact of cirrhosis on outcomes of acute colonic diverticulitis (ACD) has been studied infrequently. We investigated the effect of cirrhosis on outcomes of surgical patients with ACD treated either by an open or laparoscopic approach. MATERIALS AND METHODS A cross-sectional study was performed using the Nationwide Inpatient Sample (NIS) 2012-2014. Patients with ACD were stratified into Cirrhotics [compensated (CC) and decompensated (DC)] for comparisons of demographics, hospital length of stay (HLOS), complications, mortality, and cost. Groups were stratified according to surgical treatment open colectomy (OC), and laparoscopic colectomy (LC). A comparative effectiveness analyses of outcomes was performed between the two surgical treatments. Univariate comparisons between groups and multivariate regression analysis were performed to identify risk factors for mortality and specific complications. RESULTS Out of 1,172,875 patients hospitalized with the diagnosis of ACD during the study period, 1,145 were cirrhotic. The majority were male (59%). There were 660 CC patients and 485 DC patients and all underwent either open (n=875) or laparoscopic colectomy (n=270). Consistently, a marked increase in mortality, HLOS, and cost was observed in DC regardless of the type of treatment. LC was accompanied by shorter HLOS, lower costs, and significantly decreased mortality rate when compared to OC in CC and DC. CONCLUSIONS The presence of cirrhosis markedly impacts outcomes in patients with ACD, leading to prolonged hospitalization, higher cost and increased complications and deaths. LC is associated with better outcomes in patients requiring surgical management, including those with decompensated cirrhosis. BACKGROUND New Zealand has a multi-ethnic population and a national cardiac inherited disease registry (CIDRNZ). Ancestry is reflected in the spectrum and prevalence of genetic variants in Long QT Syndrome (LQTS). OBJECTIVE To study the genetic testing yield and mutation spectrum of CIDRNZ LQTS probands stratified by self-identified ethnicity. METHODS A 15-year retrospective review of clinical CIDRNZ LQTS probands with a Schwartz score ≥2, who had undergone genetic testing was performed. RESULTS Of 264 included LQTS probands, 160 reported European, 79 NZ Māori and Pacific peoples (Polynesian), and 25 Other ethnicities, with comparable clinical characteristic across ethnic groups (cardiac events in 72%, age at presentation 28±19 years, QTc 512±55 ms). Despite comparable testing (5.3±1.4 LQTS genes), a class III-V LQTS variant was identified in 35% of Polynesian probands, compared to 63% of European and 72% of Other probands, p less then 0.0001. Among variant-positive CIDRNZ LQTS probands (n=148), Polynesians were more likely to have non-missense variants (57% compared to 39% and 25% in probands of European and Other ethnicity, respectively, p=0.005), as well as LQT1-3 variants not reported elsewhere (71% compared to European 22% and Other 28%, p less then 0.0001). Variants found in multiple probands were more likely to be shared within the same ethnic group, p less then 0.01. CONCLUSION Genetic testing of Polynesian LQTS probands has a lower diagnostic yield, despite comparable testing and clinical disease severity. Rare LQTS variants are more common in Polynesian LQTS probands. These data emphasize the importance of increasing the knowledge of genetic variation in the Polynesian population.