RESUMEN
BACKGROUND AND PURPOSE: The Bern score is a quantitative scale characterizing brain MR imaging changes in spontaneous intracranial hypotension. Higher scores are associated with more abnormalities on brain MR imaging, raising the question of whether the score can serve as a measure of disease severity. However, the relationship between clinical symptom severity and the Bern score has not been evaluated. Our purpose was to assess correlations between Bern scores and clinical headache severity in spontaneous intracranial hypotension. MATERIALS AND METHODS: This study was a single-center, retrospective cohort of patients satisfying the International Classification of Headache Disorders-3 criteria for spontaneous intracranial hypotension. Fifty-seven patients who completed a pretreatment headache severity questionnaire (Headache Impact Test-6) and had pretreatment brain MR imaging evidence of spontaneous intracranial hypotension were included. Pearson correlation coefficients (ρ) for the Headache Impact Test-6 and Bern scores were calculated. Receiver operating characteristic curves were used to assess the ability of Bern scores to discriminate among categories of headache severity. RESULTS: We found low correlations between clinical headache severity and Bern scores (ρ = 0.139; 95% CI, -0.127-0.385). Subgroup analyses examining the timing of brain MR imaging, symptom duration, and prior epidural blood patch showed negligible-to-weak correlations in all subgroups. Receiver operating characteristic analysis found that the Bern score poorly discriminated subjects with greater headache severity from those with lower severity. CONCLUSIONS: Pretreatment Bern scores show a low correlation with headache severity in patients with spontaneous intracranial hypotension. This finding suggests that brain imaging findings as reflected by Bern scores may not reliably reflect clinical severity and should not replace clinical metrics for outcome assessment.
Asunto(s)
Hipotensión Intracraneal , Humanos , Hipotensión Intracraneal/diagnóstico , Hipotensión Intracraneal/diagnóstico por imagen , Estudios Retrospectivos , Imagen por Resonancia Magnética , Cefalea/diagnóstico por imagen , Cefalea/etiología , Parche de Sangre Epidural/métodos , BiomarcadoresRESUMEN
The purpose of the present study was to evaluate Herrnstein's law of effect as a description of socially significant behavior in an applied setting. The subject was an 18-year-old retarded girl with a history of autistic-like and aggressive behavior. Using a baseline design for two response classes and stimulus conditions, eight categories of subject and staff behavior were monitored over a 3-week period. A computerized observation system, developed for use in the present investigation, was used to obtain real-time durations of the behavior categories alone and in combination. Overlapping durations of teacher and subject behavior were then correlated to yield approximations to a functional definition of reinforcement. Plots of behavior by contingent reinforcement revealed a hyperbolic relationship for each response class, the shape of which varied as a function of extraneous reinforcement r0. In addition, estimated parameters in Herrnstein's equation did not differ significantly from those obtained through independent observation. Finally, Herrnstein's equation accounted for an average 63% of variance in response allocation. Results are discussed in terms of the relevance of matching-law theory to behavior in applied settings.
Asunto(s)
Atención , Terapia Conductista/métodos , Trastornos de la Conducta Infantil/terapia , Educación de las Personas con Discapacidad Intelectual , Adolescente , Agresión/psicología , Trastornos de la Conducta Infantil/psicología , Femenino , Humanos , Medio SocialRESUMEN
A family is presented that had what is believed to be a previously undescribed syndrome of granulomatous synovitis, bilateral recurrent uveitis, and cranial neuropathies. Affected members included the proband, his brother, father, and probably the decreased paternal grandmother. Disease onset was in childhood. Each had symmetric, boggy polysynovitis of the hands and wrists, resulting in nearly identical boutonniere deformities. Hand radiography in the proband and his brother revealed no erosions or joint destruction despite more than 20 years of disease. Synovectomy specimens in the proband and his brother showed granulomatous inflammation with giant cells. Recurrent, nongranulomatous, acute iridocyclitis with visual impairment afflicted the proband, brother, and father. Apparently corticosteroid-responsive bilateral neurosensory hearing loss occurred in the proband, and a transient sixth cranial nerve palsy in his brother. All members of the family were antinuclear antibody-, rheumatoid factor-, and HLA-B27-negative. Serum angiotensin-converting enzyme levels were within normal limits in all family members. The inheritance pattern of this syndrome is most consistent with an autosomal dominant mode.
Asunto(s)
Enfermedades de los Nervios Craneales/genética , Granuloma de Células Gigantes/genética , Sinovitis/genética , Uveítis/genética , Enfermedad Aguda , Adulto , Enfermedades de los Nervios Craneales/fisiopatología , Granuloma de Células Gigantes/fisiopatología , Antígenos HLA/genética , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Síndrome , Sinovitis/fisiopatología , Uveítis/fisiopatologíaRESUMEN
Concern that men may have an increased risk of the development of thrombophlebitis following vasectomy prompted the study of 58 vasectomized men and 37 age-matched controls. Eight patients undergoing total hip replacement also were studied, since they are known to have an increased risk of thrombotic complications. There were no changes in coagulation suggestive of a thrombotic tendency in the vasectomized population, though an increase in fibrinogen concentration was present preoperatively, and transient increases in factor V concentration, prothrombin time, and fibrinogen concentration were seen postoperatively in some cases. None of the vasectomized patients had clinical evidence suggestive of thrombosis.