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In our clinical experience, individuals with Treacher Collins syndrome (TCS) present with more complaints of oral dryness and higher caries activity than seen in the general population. A literature review identified no reports of salivary gland pathology and glandular dysfunction associated with TCS. Twenty-one Norwegian individuals with TCS underwent ultrasound examinations and salivary secretion tests of the submandibular and parotid glands. Intraglandular architecture patterns were analyzed and subsequently classified as either normal, dysplastic, or aplastic. The results were compared with salivary secretion rates and subjective reports of oral dryness. Ultrasound examination revealed pathological appearance of the salivary glands in approximately half (48%) of the individuals, with dysplasia identified in six (29%) participants and aplasia in four (19%). Almost all participants had co-existing low salivary secretion rates. A few individuals had low salivary secretion rates despite normal appearance of the salivary gland tissue on ultrasound examination. Subjective experience of oral dryness did not correlate significantly with low salivary secretion rates. We conclude that mild to severe salivary gland pathology and dysfunction can be associated with TCS. Further investigation is needed to clarify this association., (Copyright © 2012 Wiley Periodicals, Inc.)

There are several treatment options available for drooling; botulinum toxin injections into the major salivary glands are one. There is no consensus as to how many and which glands should be injected. A research project on this topic was terminated because of adverse effects. Individual results and the adverse effects are described and discussed in this article. Six individuals with cerebral palsy were randomly allocated to 2 treatment groups, with five individuals receiving ultrasound-guided injections to parotid and submandibular glands and one receiving injections to the submandibular glands only. Reduction of observed drooling was registered in 3, while 4 patients reported subjective improvement (Visual Analog Scale). Two participants reported adverse effects, including dysphagia, dysarthria, and increased salivary viscosity. Injections with botulinum toxin can be a useful treatment option but there is a risk of adverse effects. Multidisciplinary evaluation and informed discussions with patients/caregivers are important factors in the decision-making process.

Epidural hematomas occurring at the vertex are uncommon, and they can be difficult to diagnose by axial CT. We report a case of acute traumatic vertex epidural hematoma, which resolved spontaneously with time. We stress the importance of MR investigations in this diagnostic challenge.

Purpose: To assess the radiological characteristics of post-traumatic cerebral infarctions (PTCIs), the etiology and site of infarction, and to provide neuroimaging indicators of a poor clinical outcome., Material and Methods: A retrospective study of 16 patients with the neuroimaging-based diagnosis of PTCI was carried out. All CT, MR examinations, cerebral angiograms and medical records of the patients were reviewed., Results: Infarcts were diagnosed in the territory of the posterior cerebral artery in 9 patients, in the middle cerebral artery in 5, in the anterior cerebral artery in 3, lenticulostriate-thalamoperforating in 2, vertebrobasilar in 3, and cortical infarcts in 2 patients. Neuroimaging studies suggested focal mass effect and/or acquired intracranial herniations as the cause of infarction in 13/16 patients (81.2%). In 3/16 patients (18.8%), PTCI was due to vascular injury of which 2 were angiographically documented (carotid artery dissection). Eight of the 16 patients in this study died or were left in a persistent vegetative state. Patients with associated subdural hematoma, brain swelling/edema and traumatic subarachnoid hemorrhage (tSAH) exhibited the worst outcome., Conclusion: Gross mechanical shift of the brain and herniation across the falx and/or tentorium accounted for infarction in a majority of cases in our study. The overall death rate was 43.8% and this result suggests that PTCI is an indication of a poor clinical outcome, especially among patients with associated subdural hematoma, brain swelling/edema and tSAH.

The introduction of high resolution computed tomography (CT) has significantly improved the quality of imaging of neck masses. Incremental dynamic scanning immediately after a quick bolus injection of contrast medium is essential in a majority of patients in order to obtain an optimum of information. This is especially true in the identification, mapping and staging of malignant lesions, which is the main indication for the examination. CT is also very sensitive, and yields detailed information about the location and extent of cystic and other benign lesions. Owing to the low attenuation of fat, the examination is very specific with respect to lipomas. CT has low specificity in the differentiation between benign and malignant lesions, and between cysts and solid tumours of the thyroid gland. In thyroid and parathyroid imaging other modalities such as ultrasound and scintigraphy are often more specific.

Purpose: To study CT findings in general practice patients with a clinical diagnosis of acute sinusitis, and to examine the interobserver variation between 2 radiologists with regard to their CT evaluation., Material and Methods: Two hundred and one patients were examined with coronal CT images of the paranasal sinuses within 2 days of the clinical diagnosis. Patients with chronic sinusitis were excluded. Fluid level or total opacification of any sinus were used as evidence of sinusitis., Results: One hundred and twenty-seven (63%) patients had fluid level or total opacification in a sinus region, most in more than one region. One hundred and fifteen had CT signs of sinusitis in the ethmoid region, 84 in the maxillary, 18 in the frontal, and 10 in the sphenoid. Forty-nine patients had a negative Ct. In the evaluation of interobserver agreement, the overall assessment of the CT yielded a kappa value of 0.70., Conclusion: The study demonstrated great variation in the CT findings in general practice patients with suspected acute sinusitis. More than one sinus region was affected in most patients in whom sinusitis was confirmed by CT imaging; the most common combination was ethmoid and maxillary sinuses. The interobserver agreement was substantial.

Objectives: This study evaluated different symptoms, signs, and blood tests in the diagnostic process of patients with a clinical diagnosis of acute sinusitis., Methods: A total of 201 primary care patients in southern Norway aged 15 years or older with a clinical diagnosis of acute sinusitis were evaluated. Computed tomography (CT) was used as a reference standard to divide the patients into two groups: one with and one without confirmed sinusitis. Fluid level or total opacification of any sinus on CT were used as hallmarks of confirmed sinusitis. Blood tests that included erythrocyte sedimentation rate (ESR), C-reactive protein, and white blood count were taken. The patients were evaluated in a standardized way for the medical history and the clinical investigation., Results: A total of 127 (63%) patients had fluid level or total opacification in one or more sinus regions. "Double sickening," purulent rhinorrhoea, purulent secretion in cavum nasi, and ESR > 10 had the highest likelihood ratios and were independently associated with acute sinusitis., Conclusions: This study confirms the uncertainty of the clinical diagnosis of acute sinusitis in primary care, based on the clinical evaluation alone. Only four symptoms and signs had a high likelihood ratio and were independently associated with acute sinusitis. A combination of at least three of these four symptoms and signs gave a specificity of .81 and a sensitivity of .66.

Aims: The investigation was carried out in order to compare the accuracy of CT and MR imaging in depicting whether disk hernias were contained by the posterior longitudinal ligament (PLL). This is crucial in the evaluation of patients who are possible candidates for percutaneous nucleotomy, which is considered effective only in contained hernias., Results: Of 124 pathologic disks examined in 114 patients, CT was more accurate than MR imaging in 7 patients due to misinterpretation of the integrity of the PLL by MR. These hernias were therefore erroneously classified as noncontained. There was consistency between the classification by CT and MR imaging in the other 117 disks, of which 109 were correct. Both methods overstaged a large hernia that was contained by the PLL, and failed to demonstrate that 7 others were noncontained., Conclusions: CT, which has higher sensitivity in depicting calcifications, representing further contraindications to percutaneous nucleotomy, is therefore recommended as the primary examination in these patients. Additional MR imaging should be considered if the results of CT are equivocal or at variance with the clinical presentation.

Human umbilical vein endothelial cells in culture synthesize thromboplastin upon stimulation with phytohaemagglutinin (PHA) or the tumor promotor 12-O-tetradecanoyl-phorbol-13-acetate (TPA). The thromboplastin activity is further strongly enhanced in a time dependent reaction by the presence of gel-filtered platelets or platelet aggregates. This effect was demonstrable at platelet concentrations lower than those normally found in plasma, it may thus be of pathophysiological relevance. The thromboplastin activity increased with increasing number of platelets added. Cycloheximide inhibited the increase, suggesting that de novo synthesis of the protein component of thromboplastin, apoprotein III, is necessary. When care was taken to remove monocytes no thromboplastin activity and no apoprotein III antigen could be demonstrated in suspensions of gel-filtered platelets, platelets aggregated with thrombin or homogenized platelets when studied with a coagulation assay and an antibody neutralization technique.