Primary jugular foramen meningioma with unusual extensive bone destruction: case report and review of literature

Jugular foramen meningiomas are exceedingly rare tumors of the fossa jugularis. These meningiomas are characterized by an invasive growth pattern with extensive skull base infi ltraskull base infi ltraskull 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 highresolution 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

The developmental venous anomaly associated with the cavernous malformation

No abstract available

Th e infl uence of breast density on the sensitivity and specifi city of ultrasound and mammography in breast cancer diagnosis

Objective. Th e aim of this study was to analyse the sensitivity and specificity of ultrasound and mammography according to breast densityand determine which of these diagnostic imagings is a more accuratetest for diagnosis of breast cancer. Patients and methods. By meansof a cross-sectional study, ultrasound and mammographic examinationsof 148 women with breast disease symptoms were analysed.All women underwent surgery and all lesions were examined by histological examination which revealed the presence of 63 breast cancers,and 85 benign lesions. Histological examination was used as the “goldstandard”. In relation to breast density, the women were separated into two groups, group A: women with “fatty breast” (ACR BI-RADS density categories 1 and 2) and group B: women with “dense breast”(categories 3 and 4). Ultrasound and mammographic findings were classified on the BI-RADS categorical scale of 1-5. For statistical data processing, the logistic regression analysis and the McNemar chi-square test for paired proportions was used. Th e differences on the level of p<0.05 were considered statistically significant. Results. In the group of women with breast density categories 1 and 2 the difference in the sensitivities (p=1) as well as in the specificities (p=0.11) of the two imaging tests was not statistically significant. In the group of women with breast density categories 3 and 4 the ultrasound sensitivity was significantly higher than the mammographic sensitivity (p=0.03) without a statistically significant difference in specificity (p=0.26). Sensitivity of mammography was (linearly – ex; linearity exists between breast density and the logarithm of odds for a positive result) associated with breast density (likelihood ratio χ2 =15.99, p =0.0001). Th e odds ratio for (the probability of – ex) a positive mammographic result was 0.25 (95% CI, 0.11-0.58). Thesensitivity of ultrasound and specificity of each test were not (linearly - ex) associated with breast density. Conclusion. Breast density had a significant influence on the sensitivity of mammography but not on specificity. Th is is very important because a certain percentage of women, not only under 40 but also aft er 40, have heterogenous and extremely dense breasts (density categories 3 and 4). In these women, ultrasound is a more accurate imaging test than mammography, while in the women with fatty breasts (density categories 1 and 2) these imaging tests are almost equally accurate in breast cancer diagnosis

Fostering the practice of rooming-in in newborn care

Practice of rooming-in meant that baby and mother stayed together in the same room day and night in the hospital, right from the time of delivery till the time of discharge. Adoption of rooming-in offers multiple benefits to the newborn, mother, and mother-child as a unit. It is a cost-effective approach where<br />fewer instruments are required and spares additional manpower. Rooming-in endeavors the opportunity to contribute signifi cantly in the child’s growth, development and survival by assisting in timely initiation of breastfeeding. To ensure universal application of rooming-in in hospitals, a comprehensive and technically sound strategy should be formulated and implemented with active participation of healthcare professionals. Measures such as advocating institutional delivery through outreach awareness activities; adoption of baby-friendly hospital initiative; inculcating a sense of ownership among health professionals, can be strategically enforced for better maternal and child health related outcomes

Dural tail sign adjacent to different intracranial lesions on contrast-enhanced MR images

Introduction: The aim of this study is to determine the prevalence of dural tail sign (DTS) in meningiomas, glioblastomas multiforme, metastasis, pituitary macro-adenomas, acoustic neuromas, medulloblastomas, lymphomas and Wegener’s granulomatosis, and to reveal if DTS is specifi c for meningiomas. Methods: In this retrospective, cross sectional study 96 patients were included with 95 intracranial and 1 extracranial lesions. The study was conducted in the period from January 2008 to May 2010 and the group pattern was made consecutively. The patients underwent surgery and all 96 lesions were examined by histopathology analysis. DTS was analysed on contrast T1- weighted spin echo images after injection of 0.1 mmol/kg gadolinium contrast medium. The presence of this sign was defi ned using Goldsher et al’s criteria. Results: Histopathology results of the 96 lesions revealed the presence of: 35 meningiomas, 25 glioblastomas multiforme, 13 metastasis, 10 pituitary adenomas, 5 acoustic neuromas, 4 medulloblastomas, 3 lymphomas and 1 Wegener’s granulomatosis. On the contrast-enhanced T1 MR images, DTS was noted in 31 (32.3%) lesions, in the following histological samples: meningioma, GBM, adenoma, schwannoma, medulloblastoma and Wegener’s granulomatosis, while in the cases of metastasis and lymphomas DTS was not noted. We found the dural tail sign to have a sensitivity of 68.6% and specifi city of 88.5% in the diagnosis of meningioma. Conclusion: The dural tail is a common but not a pathognomic sign of meningioma on contrast-enhanced T1 MR images. Other intracranial lesions, such as glioblastoma multiforme, pituitary adenoma, schwannoma, medulloblastoma and Wegener’s granulomatosis may also be represented with this sign