Recent Advances in Epilepsy Surgery

The modern practice of epilepsy surgery requires multiple modalities of presurgical investigations such as video-EEG, intracranial EEG, high-resolution imaging, advanced functional imaging, and clinical analysis. A multidisciplinary approach is essential, including close collaboration between neurosurgeons, neurologists, neurophysiologists, neuropsychologists, neuropsychiatrists, and neuroradiologists. Candidates for epilepsy surgery require a history of seizures that are refractory to appropriate medical therapy. A meticulous selection of candidates will lead to a better chance of freedom from seizure. Epilepsy surgery includes a variety of surgical procedures including resective surgery for focal refractory seizure, which offers a significant chance of seizure freedom in temporal and extratemporal lobe epilepsy. Palliative treatment for patients who are not candidates for resective surgery, such as vagal nerve stimulation, deep stimulation, and callosotomy, offers further options. We reviewed and analyzed the recent scientific literature and forthcoming advances that will impact on the future of epilepsy surgery. This chapter on recent advances in epilepsy surgery emphasizes improved methods of assessment, a better understanding of seizures, the development of new surgical techniques, and the outcome of epilepsy surgery

Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection

PURPOSE: To compare the accuracy of PET/MR imaging with that of FDG PET/CT and to determine the MR sequences necessary for the detection of liver metastasis using a trimodality PET/CT/MR set-up. METHODS: Included in this single-centre IRB-approved study were 55 patients (22 women, age 61 ± 11 years) with suspected liver metastases from gastrointestinal cancer. Imaging using a trimodality PET/CT/MR set-up (time-of-flight PET/CT and 3-T whole-body MR imager) comprised PET, low-dose CT, contrast-enhanced (CE) CT of the abdomen, and MR with T1-W/T2-W, diffusion-weighted (DWI), and dynamic CE imaging. Two readers evaluated the following image sets for liver metastasis: PET/CT (set A), PET/CECT (B), PET/MR including T1-W/T2-W (C), T1-W/T2-W with either DWI (D) or CE imaging (E), and a combination (F). The accuracy of each image set was determined by receiver-operating characteristic analysis using image set B as the standard of reference. RESULTS: Of 120 liver lesions in 21/55 patients (38 %), 79 (66 %) were considered malignant, and 63/79 (80 %) showed abnormal FDG uptake. Accuracies were 0.937 (95 % CI 89.5 - 97.9 %) for image set A, 1.00 (95 % CI 99.9 - 100.0 %) for set C, 0.998 (95 % CI 99.4 - 100.0 %) for set D, 0.997 (95 % CI 99.3 - 100.0 %) for set E, and 0.995 (95 % CI 99.0 - 100.0 %) for set F. Differences were significant for image sets D - F (P < 0.05) when including lesions without abnormal FDG uptake. As shown by follow-up imaging after 50 - 177 days, the use of image sets D and both sets E and F led to the detection of metastases in one and three patients, respectively, and further metastases in the contralateral lobe in two patients negative on PET/CECT (P = 0.06). CONCLUSION: PET/MR imaging with T1-W/T2-W sequences results in similar diagnostic accuracy for the detection of liver metastases to PET/CECT. To significantly improve the characterization of liver lesions, we recommend the use of dynamic CE imaging sequences. PET/MR imaging has a diagnostic impact on clinical decision making

PET/CT in Hodgkin Lymphoma: An Update

18F-FDG-PET/CT is now an integral part of the workup and management of patients with Hodgkin's lymphoma (HL). PET/CT is currently routinely performed for staging and for response assessment at the end of treatment. Interim PET/CT is typically performed after 1-4 of 6-8 chemo/chemoimmunotherapy cycles ± radiation for prognostication and potential treatment escalation or de-escalation early in the course of therapy, a concept known as response-or risk-adapted treatment. Quantitative PET is an area of growing interest. Metrics such as the standardized uptake value (SUV), metabolic tumor volume, total lesion glycolysis, and their changes with treatment are being investigated as more reproducible and, potentially, more accurate predictors of response and prognosis. Despite the progress made in standardizing the use of PET/CT in lymphoma, challenges remain, particularly with respect to its limited positive predictive value. This review highlights the most relevant applications of PET/CT in HL, its strengths and limitations, as well as recent efforts to implement PET/CT-based metrics as promising tools for precision medicine. Finally, the value of PET/CT for response assessment to immunotherapy is discussed

Esophageal 99mTc-pertechnetate uptake mimicking an autonomous thyroid adenoma in a patient with subacute thyroiditis: a case report

Subacute thyroiditis (SAT) is one of the most common causes of thyrotoxicosis. Thyroid scans with radioiodine or technetium-99m pertechnetate (99mTc) are often performed in the workup of patients with thyrotoxicosis, particularly to differentiate between SAT and Graves’s disease. Although very helpful, thyroid scans are prone to pitfalls that may occasionally lead to misdiagnosis. These pitfalls are largely related to physiologic uptake of radioiodine or 99mTc in non-thyroidal tissue, such as salivary gland and stomach that may result in false-positive findings. We present herein a very rare case of SAT misdiagnosed as an autonomous thyroid adenoma most likely due to focal 99mTc uptake in the esophagus. This case may have implications for the management of patients with suspected SAT, who undergo a radioiodine or 99mTc thyroid scan

Admission criteria and academic performance in medical school.

Different variables have been used to predict the academic performance of students in medical schools. The aim of this study was to assess the effect of demographics, admission system, and high-school background on the academic performance of medical students. We conducted this longitudinal cohort study on 808 students admitted to the Faculty of. Medicine at the University of Jordan (Amman, Jordan), in the years 2012 and 2013. Admission pathway, and academic performance data were collected and analyzed. A total of 808 students [i.e., 426 (52.7%) females, and 382(47.3%) males] were identified. Admitted students were holding 17 different types of high school degrees, and were accepted through 6 different quota pathways (open competition [National unified admission], underprivileged ["Makrumah"], parallel, children of university staff, international students, and others). Students admitted through the open competition and the underprivileged quota(Makrumah) were more likely to graduate on time and had higher graduation grades while students admitted through the parallel, international and others quota were more likely to fail and had lower graduation grades. Regarding highs school degrees, the students that were more likely to graduate were those with IB and the Jordanian high school degrees. The highest graduation GPA was for IB students followed by SAT, IGCSE as well as Jordanian and Syrian high school degrees respectively. IB, Jordanian, Kuwaiti and IGSC high school grades were significantly correlated with the graduation GPA. Admission criteria such as type of high school degree and grades as well as admission pathways can predict the likelihood to graduate and the graduation GPA of medical students. Open competition and underprivileged admission pathways as well as IB, IGCSE and Jordanian high school degrees seem to be better predictors of student performance in the medical school

Fear of Movement/[Re] Injury Among Arabic Low Back Pain Patients: Establishing the Validity of the Tampa Scale of Kinesiophobia - Arabic Version

status: publishe