Amenorrhea can cause bone loss, but not all mechanisms in this process are known. The degree of bone loss in amenorrheic women is determined by the cause of the amenorrhea. The aim of this study was ...to investigate the influence of secondary amenorrhea on bone density and to compare the bone density between hypogonadotropic amenorrheic women and hypergonadotropic amenorrheic women. Twenty-two amenorrheic and 12 eumenorrheic women under the age of 40 were involved in this study. Every woman underwent measurements of lumbar spine and femoral neck bone density, body mass index (BMI), and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and prolactin. According to FSH levels, we divided the women with amenorrhea into two groups: hypergonadotropic (n = 7; FSH, >40 IU/l) and hypogonadotropic (n = 15; FSH, < or =40 IU/l) amenorrheic women. Amenorrheic women had a lower lumbar spine bone density than eumenorrheic controls (P = 0.002). Hypergonadotropic amenorrheic women had lower lumbar spine bone density (P = 0.026) than hypogonadotropic ameneorrheic women. In the hypergonadotropic group, only FSH level had a correlation (negative) with lumbar spine bone density (P = 0.05), but in the hypogonadotropic group, there was no correlation between hormonal levels, BMI, age, or duration of amenorrhea. BMI was positively correlated with lumbar spine bone density in amenorrheic women (P < 0.025). Amenorrheic women had lower bone density than eumenorrheic women, but hypergonadotropic amenorrheic women had lower bone density than hypogonadotropic women. The greater bone loss in the hypergonadotropic amenorrheic group could have been caused by a potential direct effect of FSH on bone metabolism.
Purpose
The objective of the study was to evaluate the proposed cochlear duct length estimation based on the cochlear ‘A value’. Furthermore, we assessed the interobserver variability between ...radiology and otolaryngology attending physicians and otolaryngology trainees.
Methods
Thirteen pediatric cochlear implant candidates were retrospectively analyzed by three otolaryngology physicians (attending physician, second year, and fourth year trainees) and a radiology attending. The cochlear duct length was calculated based on the formula of Grover et al. The differences in acquired measurements between observers were compared using the Wilcoxon matched signed-rank test.
Results
The differences in measurements between the attending otolaryngologist and radiologist were not statistically different, while several significant differences were observed with regard to measurements of attending doctors compared to both residents. In particular, a significant difference between the second year otolaryngology resident and otolaryngology and radiology attending was observed for one side (right ear
p
= 0.034 and
p
= 0.012, respectively). Moreover, the fourth year resident calculated significantly different cochlear duct measurements when compared to the attending otolaryngologist (left ear
p
= 0.014) and radiologist (right ear
p
= 0.047). Interestingly, differently experienced otolaryngology residents provided significantly different measurements for both ears.
Conclusions
Based on these results, cochlear duct length measurement according to the proposed method may be a reliable and cost-effective method. Indeed, otolaryngology training may be sufficient to provide measurements comparable to radiologists. On the other hand, additional efforts should be invested during otolaryngology training in terms of the evaluation of radiological imaging which may increase the capabilities of otolaryngology residents in this regard.
Jugular foramen meningiomas are exceedingly rare tumors of the fossa jugularis. These meningiomas are characterized by an invasive growth pattern with extensive skull base infiltration in all ...directions and by the mixed permeative-sclerotic appearance of the bone margins of the jugular foramen. We report an unusual case of a primary jugular foramen meningioma in a 30-year-old woman. The unenhanced high-resolution CT of the temporal bones revealed extensive bone destruction around the left jugular foramen as well as bone destruction of the basilar part of the left occipital bone without sclerosis. These findings are unusual for meningiomas and correspond more to glomus jugulare tumors. In the literature, we did not find a case similar to ours. Conclusion. MRI and CT imaging provide accurate distinction between meningioma and glomus tumors or schwannomas in most cases. From high-resolution CT scans, in the case where a permeative-destructive pattern is dominant, and with the absence of hyperostosis and bone thickening around the jugular foramen, the differential diagnosis between jugular foramen meningiomas and other tumors, especially glomus jugulare tumors, is difficult. In that case the correct diagnosis should be based on the MRI findings.
Wegener's granulomatosis (WG) is a systemic vasculitis that can affect any organic system, but primarily involves the upper and lower respiratory tracts and the kidneys. WG relatively frequently ...affects the nervous system (in 30-50%), usually in the form of peripheral or cranial neuropathy. Involvement of the brain is reported in a very small percentage of patients (2%-8%). Three major mechanisms have been described as the cause of central nervous system (CNS) disease in WG: contiguous invasion of granuloma from extracranial sites, remote intracranial granuloma and CNS vasculitis. CNS involvement caused by contiguous invasion of granuloma from extracranial sites is the rarest. We report the case of a 37-year-old man with WG, manifested as a pulmonary and paranasal sinuses disease, with orbital and CNS involvement, caused by contiguous invasion from the paranasal sinuses. In this report, the rich spectrum of findings achieved by computed tomography and magnetic resonance are demonstrated. The importance of computed tomography in bony destruction PNS findings, and the importance of MR imaging in evaluation of the direct intracranial spread from nasal, paranasal and orbital disease are also emphasized.
Cilj studije bio je ispitati promjene u nalazu Dopplerove sonografije, elektroencefalografije (EEG) i spoznajnoj funkciji u bolesnika mlađih od 60 godina s atrofijom moždane kore. U studiju je bilo ...uključeno 60 osoba u dobi od 60 godina i mlađih s atrofijom moždane kore otkrivenom kvalitativnim metodama pomoću CT (eksperimentalna skupina) i 60 osoba s normalnim endokranijskim CT nalazom podjednake dobi, spola i razine obrazovanja. Transkranijskom Dopplerovom sonografijom (TCD) mjerene su srednje brzine krvnog protoka (MBFV), indeks otpornosti (RI) i indeks pulsatilnosti (PI). EEG je provedena uz izračunavanje postotka učestalosti elektroencefalografskih valova. Testovi spoznajnih funkcija provedeni su pomoću Mini Mental Status Examination (MMSE) i Wechsler Memory Scale. MBFV su bile značajno niže u osoba s atrofijom moždane kore u usporedbi s kontrolnom skupinom (p<0,0001): u srednjoj moždanoj arteriji 53 cm/s (eksperimentalna skupina) prema 65 cm/s (kontrolna skupina); u prednjoj moždanoj arteriji 38 prema 49 cm/s; u stražnjoj moždanoj arteriji 34 prema 39 cm/s; i u bazilarnoj arteriji 35 prema 43,5 cm/s. Mjerenja RI i PI Dopplerovom sonografijom pokazala su znatno više vrijednosti obaju parametara u ispitanika s atrofijom moždane kore u svim arterijama (p<0,001). Analiza postotne učestalosti elektroencefalografskih valova pokazala je značajno višu učestalost polaganih delta i teta valova u osoba s atrofijom moždane kore nego u kontrolnoj skupini (21% prema 5,6%, odnosno 11,5% prema 3,7%; p<0,0001). Rezultati MMSE i Wechsler Memory Scale bili su znatno niži u bolesnika s atrofijom moždane kore u usporedbi s kontrolnom skupinom (26,3 prema 29,0, odnosno 97 prema 125; p<0,0001). Spoznajne promjene nisu ovisile o dobi i spolu, ali su bile ovisne o razini obrazovanja. Zaključeno je kako se promjene u nalazu Dopplerove sonografije, EEG i spoznajnoj funkciji kreću između normalnih nalaza i nalaza u bolesnika s ranom demencijom. U ovih osoba potrebno je dugoročno praćenje i povremeno motrenje spoznajne funkcije te nalaza TCD i EEG.
To present a case of Terson's syndrome consequent to ruptured intracranial aneurism treated successfully with a combined therapeutic approach.
Case report. A 37 year old man was urgently referred to ...the UCC Tuzla with sudden headache, vomiting and unconsciousness. CT scan showed ruptured aneurism of anterior communicant artery with signs of retinal thickening. Later ocular examination showed the massive bilateral vitreous haemorrhage.
Patient was treated with medicamentous therapy for 7 months with no significant improvement. 7 months after aneurism rupture patient agreed to a surgical treatment. Right eye was treated surgically and left eye continued with conservative therapy. Visual acuity after vitrectomy improved in right eye to 1.0 and 0.5 in left eye.
Terson's syndrome is relatively common complication of subarchnoid haemorrhage. Vitrectomy is safe and efficient approach to treat patients with Terson's syndrome.
