Can MRI replace CT in evaluating semicircular canal dehiscence?

BACKGROUND AND PURPOSE: Patients with symptoms of semicircular canal dehiscence often undergo both CT and MR imaging. We assessed whether FIESTA can replace temporal bone CT in evaluating patients for SC dehiscence. MATERIALS AND METHODS: We retrospectively reviewed 112 consecutive patients (224 ears) with vestibulocochlear symptoms who underwent concurrent MR imaging and CT of the temporal bones between 2007 and 2009. MR imaging protocol included a FIESTA sequence covering the temporal bone (axial 0.8-mm section thickness, 0.4-mm spacing, coronal/oblique reformations; 41 patients at 1.5T, 71 patients at 3T). CT was performed on a 64-row multidetector row scanner (0.625-mm axial acquisition, with coronal/oblique reformations). Both ears of each patient were evaluated for dehiscence of the superior and posterior semicircular canals in consensual fashion by 2 neuroradiologists. Analysis of the FIESTA sequence and reformations was performed first for the MR imaging evaluation. CT evaluation was performed at least 2 weeks after the MR imaging review, resulting in a blinded comparison of CT with MR imaging. CT was used as the reference standard to evaluate the MR imaging results. RESULTS: For SSC dehiscence, MR imaging sensitivity was 100%, specificity was 96.5%, positive predictive value was 61.1%, and negative predictive value was 100% in comparison with CT. For PSC dehiscence, MR imaging sensitivity was 100%, specificity was 99.1%, positive predictive value was 33.3%, and negative predictive value was 100% in comparison with CT. CONCLUSIONS: MR imaging, with a sensitivity and negative predictive value of 100%, conclusively excludes SSC or PSC dehiscence. Negative findings on MR imaging preclude the need for CT to detect SC dehiscence. Only patients with positive findings on MR imaging should undergo CT evaluation.

Horizontal vestibulo-ocular reflex dynamics in acute vestibular neuritis and viral labyrinthitis: evidence of otolith-canal interaction.

OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular reflex (h-VOR) in the acute stage of two common labyrinthine diseases that provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis (vestibular loss alone) and viral labyrinthitis (cochleovestibular loss). MATERIAL AND METHODS: Sixty-three patients were investigated: 42 were diagnosed with vestibular neuritis and 21 with viral labyrinthitis. The h-VOR function was evaluated by conventional caloric and impulsive testing. A simplified model of vestibular function was used to analyze the vestibulo-ocular response to rotational stimulation. RESULTS: The results showed a significant difference in h-VOR characteristics between the two pathologies. Patients with vestibular neuritis exhibited a strong horizontal semicircular canal deficit, but no h-VOR asymmetry between the two rotational directions. In contrast, patients with viral labyrinthitis demonstrated moderate canal paresis and a marked h-VOR deficit in rotation toward the affected ear. CONCLUSION: These findings support the hypothesis that the h-VOR dynamic asymmetry that occurs after an acute unilateral inner ear lesion is not due to canal dysfunction alone, but involves complex adaptive changes in the central VOR that may implicate the otolith system. Based on histopathologic and clinical differences in the two pathologies reported in the literature, we postulate that this otolith-canal interaction is mainly linked to the loss of saccular function.

Syndromes vertigineux en pratique ambulatoire [Dizziness in a general practice]

The symptoms of vertigo are frequent complaints. With the anamnestic features and the quite long and tiresome clinical examination alone, the general practitioner should make the difference between a benign peripheral and a potentially fatal central pathology. A good knowledge of the anamnestic and clinical particularities and the diagnostic manoeuvres of the main types of vertigo allows in about two thirds of the cases to distinguish their origin. If a central origin is suspected or if the etiology is uncertain, the patient should be referred to a neurologist for further examination and radiological investigations.

Résistances tacites face à la requalification d'un quartier urbain en voie de gentrification : Regard à partir du quartier Le Maupas, Lausanne.

Quand un vent de changement souffle sur une ville, comment les quartiers qui la composent résistent-ils ? Le Maupas, une portion de la ville de Lausanne, présente les signes précurseurs d'un quartier en voie de gentrification. L'adoption dans cette recherche d'une approche praxéologique des espaces publics urbains implique une définition de ce phénomène, capable de rendre compte de ses caractéristiques dynamique et processuelle. Il s'agit d'étudier l'impact des aménagements urbains et de leurs usages. Je propose ici de recourir à des éléments en rapport avec la culture, la mobilité et la convivialité, afin de fournir un éclairage sur les tendances que peut prendre le quartier du Maupas. Ces tendances ne s'accomplissent pas sans quelques résistances explicites et tacites capables de contrecarrer, ou du moins ralentir la reclassification en cours. « Le Maupas » is part of the city of Lausanne. Because of some precursory signs, this neighbourhood is considered to be in the process of gentrification. This article deals with a praxeologic approach. It involves a dynamic conception of the urban public spaces and of gentrification. Studying the culture, the mobility and the conviviality features of « le Maupas », I try to highlight how social uses of urban settings manage resistance to change.

Le catastrophisme écologique contre la démocratie

Il s'agit dans cet article d'interroger le régime temporel spécifique associé au catastrophisme écologique, et en particulier dans sa variante climatique. Nous cherchons à montrer que les images du futur qui sont utilisées dans les discours catastrophistes, que nous décrivons et dont nous analysons les différentes formes, produisent des positions politiques antidémocratiques. Dès lors, nous plaidons pour leur remplacement par une autre conception du futur, de la temporalité, et du temps lui-même dont nous esquissons les contours sur un plan théorique. Il ne s'agit nullement pour nous de contester la profondeur des crises écologiques que le monde expérimente actuellement, mais au contraire, en les ramenant dans le présent d'une part, et en montrant leur multiplicité contradictoire d'autre part, d'en faire prendre la mesure réelle. C'est ainsi que la possibilité d'une politique démocratique des rapports socio-écologiques peut être comprise.

Harvinaisten maakotiloiden esiintymisestä Lounais-Suomessa ja niiden elinympäristövaatimuksista

Julkaisun tarkoituksena on lisätä tietämystä harvinaisten maakotiloiden (Mollusca, Gastropoda) esiintymisestä ja ekologiasta. Lisäksi tarkoituksena on edistää kotiloharrastusta sekä luoda tietopohjaa mahdollisille suojelupäätöksille. Maakotiloita on tutkittu Suomessa niukasti, joten julkaisuja ja kirjallisuutta on vähän. Tämä raportti on jatkoa aiemmin julkaistulle kahden siemenkotilolajin tarkastelulle (Kapeasiemenkotilon Vertigo angustior ja pienisiemenkotilon Vertigo pygmaea esiintymisestä ja ekologiasta Suomessa. Lounais-Suomen ympäristökeskuksen raportteja 20/2008). Julkaistavat tiedot pohjautuvat kirjoittajan kattavasti Lounais-Suomesta keräämien noin 1100:n maaperänäytteen tutkintaan sekä Turun yliopiston eläinmuseon laajoihin kokoelmiin. Kaikki tiedot perustuvat olemassa oleviin talletettuihin kuorinäytteisiin ellei toisin mainita. Tarkemmin esitellään kuusi maakotilolajia: laukkakotilo (Oxychilus alliarius), piikkikotilo (Acanthinula aculeata), poimusulkukotilo (Macrogastra plicatula), uurteiskotilo (Balea perversa), kääpiösarvikotilo (Carychium minimum) ja kaksihammaskotilo (Perforatella bidentata). Havaintopaikat, yksityiskohtainen sijainti, löytövuosi, yksilömäärä, havainnoitsija sekä löydön elinympäristötiedot esitetään taulukkomuodossa. Esiintymiskartoissa havainnot on jaoteltu ennen ja jälkeen vuotta 1990 tehtyihin. Harvinaisten lajien seuralaiskotilot esitetään taulukkomuodossa. Myös esiintymispaikkojen putkilokasvit esitellään kolmen maakotilolajin osalta. Populaatiorakennetta tarkastellaan piikkikotilon lounaissuomalaisilta löytöpaikoilta ja uurteiskotilon osalta yhdeltä saarelta. Lounais-Suomen lehtometsistä esitellään tarkemmin Turun Ruissalon alue. Vuosien 1991 - 2009 tutkimuksissa saarelta löydettiin 40 maakotilolajia, osa harvinaisuuksia.Seitsemän lähteen 11 näytealan tulokset esitellään. Lähdepurojen varsilla, lähdehetteiköissä ja avolähteitten laiteilla elää maakotiloharvinaisuuksia.Kaksihammaskotilo ja laukkakotilo ovat Lounais-Suomessa harvinaisia ja vähälukuisia. Piikkikotilo ja kääpiösarvikotilo ovat melko harvinaisia, mutta esiintymispaikoillaan usein runsaita. Poimusulkukotilo on melko yleinen alueen itäosassa. Uurteiskotilo on yleinen saaristokivikoiden laji, mutta kenties harvinaistumassa. Näin on tapahtunut toiselle Lounais-Suomen kalliolajille nappikotilolle.

El Holoceno medio palustre de la llanura litoral del río Ter (Baix Empordá, Girona)

The paludal deposits presented here belong to a geomorphological unit identified between Palafrugell Corridor and the littoral plains of Ter River (Baix Ter), associated to a carbonate-rich spring system. The sections show a distintic clay level, mixed with black silts, very rich in snail remains. The malacological assemblage contained stillwaters species (Bithynia leachii, Galba truncatula, Pisidium milium, Radix peregra) along with damp species (Monacha cartusiana, Oxyloma elegans, Succinea putris, Succinella oblonga, Vallonia pulchella, Vertigo sp.). Some open-dry species are also present (Cernuella virgata, Eobania vermiculata, Pomatias elegans, Rumina decollata) revailing a mosaic-like landscape. Radiocarbon dates place this level ca. 7.000BPwithin the Holocene sequence of the Baix Ter basin. Colluvial deposits on top of these paludal levels have a typical open-dry malacological assemblage (Cernuella virgata, Cochlicella acuta, Eobania vermiculata, Pomatias elegans, Rumina decollata, Trochoidea elegans) the same assemblage that inhabits the Empordà littoral plains nowadays

Cual los imbéciles, buscando un bastón (En torno al enmarañado viaje de Henri Michaux al Ecuador)[Estudio]

En Ecuador. Journal de Voyage (1929) Henri Michaux quisiera ir más allá del vértigo del vacío y de la nada, dar con los significados que se le escapan, dar quizás con lo “transreal”. Con esa lente, y teniendo en cuenta el contexto histórico e ideológico, hay que entrar en la relación del autor belga-francés a lo largo del Atlántico, por la región andina ecuatoriana, y por la Amazonía. Por eso vale ilustrar, aunque sea tangencialmente, la práctica literaria que caracteriza esa obra para no hacer de ella un mero reportaje de viaje cuando, en efecto, se trata de un libro de exigente lectura, de un esfuerzo, por no decir de un tratado, de inspiración poética, teórica, que responde a una estética y a un diseño, a una estilizada y hasta sistemática cosmovisión. Las analogías y yuxtaposiciones de inspiración vanguardista entregan un mundo en que coinciden, estallan y contrastan lo exterior y lo interior, lo dinámico y lo estático, lo cotidiano y lo extraño, lo íntimo y lo vasto, lo sagrado y lo profano, lo limitado y lo infinito. Palabras clave: Henri Michaux, viaje, búsqueda, historia, Ecuador/ecuador, Europa, Atlántico, Andes, Amazonía, yuxtaposición, contraste, analogías, espacio, viviendas rústicas, música, remedos, límites, borroso, infinito.

Co-operative explanatory capabilities in organizational design and personnel management

Based on an online image archive documenting the construction and history of an early computing company, the fictional story of "Co-Operative Explanatory Capabilities in Organizational Design and Personnel Management” follows the development of an experimental approach to worker productivity into a religious cult. The project investigates the place of creativity in efficiency management and the operation of bureaucratic systems in a post-industrial work environment. The project has spawned a series of collages, featured on the Economic Thought Projects 7" collaboration with Gelbart, The Eleventh Voyage, as well as the film of Co-Operative Explanatory Capabilities in Organizational Design and Personnel Management, which has also been published as a short story in Vertigo of the Modern and on Sacrifice Press.

Deficiência de hormônio do crescimento após radioterapia por meduloblastoma na infância: relato de caso

A radiação do crânio para tratamento das neoplasias do sistema nervoso central na infância pode evoluir com sequelas neuroendócrinas, sendo a deficiência de hormônio do crescimento (GH) com retardo do crescimento linear, uma das mais frequentes. Relatamos o caso de menino de 10 anos com cefaléia occipital associada a vertigem, náuseas e vômitos. A tomografia do crânio demonstrou processo expansivo no hemisfério cerebelar esquerdo, que foi retirado cirurgicamente. O exame histopatológico revelou meduloblastoma e o paciente foi submetido a radioterapia crânio-espinhal. Evoluiu sem recidiva da neoplasia e sem déficits neurológicos durante 4 anos. Apresentou retardo do crescimento estatural, sendo confirmada a hipótese de deficiência de GH. Atualmente, encontra-se em uso de GH 0,1 U/kg/dia, tendo apresentado incremento de 4cm na estatura em 6 meses. O presente caso destaca a importância do acompanhamento criterioso de pacientes submetidos à radiação do crânio para tratamento oncológico na infância, visto que podem evoluir com deficiências neuroendócrinas e serem beneficiados com reposição hormonal.

Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Associação entre otalgia, zumbido, vertigem e hipoacusia com desordens temporomandibulares

Because nonespecific symptoms and signs are associated with others well-established in the temporomandibular disorders, it is difficult for the clinician to decide what symptoms and signs should be considered during the diagnosis and the treatment plan. Therefore, the aim of this literature review was to evaluate the prevalence of aural symptoms (otalgias, tinnitus, dizziness and deafness) in patients with orofacial pain. Although several hypotheses have been proposed to explain the association between aural symptoms and temporomandibular disorders, the results of the previous studies differed in magnitude. For this reason, it is difficult to establish the prevalence of these aural symptoms concomitantly with temporomandibular disorders. Moreover, such relationship does not necessarily imply a cause-effect relationship. Because of the diagnosis complexity, different treatments must be considered, so the nonespecific symptoms of temporomandibular disorders can be effectively controlled as well. It is crucial for the the clinician to be aware of the possible etiology of aural symptoms, so he should determine if such symptoms may be associated with temporomandibular disorders and thus include them in the treatment.