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Abudawood M, Alorini H, Samman MA, Bashir SM, AlSwayed A, Binhassan S, Peer-Zada AA. Fatal intracranial haemorrhage in acute promyelocytic leukemia patients with short isoform of PML-RARα: Review of molecular and radiological data. Saudi J Biol Sci 2023; 30:103710. [PMID: 37405260 PMCID: PMC10316003 DOI: 10.1016/j.sjbs.2023.103710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023] Open
Abstract
Three major PML-RARα fusion gene transcripts (long [bcr1], variant [bcr2], and short [bcr3]) are currently used in clinical laboratories for the diagnosis and treatment monitoring of APL patients. Despite highly improved outcome, relapse and intracranial haemorrhage that may lead to early death is still an unsolved complication in APL. We reviewed APL patients confirmed by qPCR for the presence of PML-RARα transcripts (n = 27) and studied their outcome in relation to the isoform expression at diagnosis and follow-up in King Fahad Medical City. Eight in twenty-seven patients showed bcr3 and nineteen patients with bcr1 as major isoforms at diagnosis. Half of the bcr3 patients (n = 4/8) showed early mortality, prolonged qPCR positivity, 4-fold higher neutrophil/lymphocyte ratio, higher creatinine levels, and significantly reduced relapse free and overall survival time compared with bcr1 patients. Radiological findings in bcr3 patients revealed CNS involvement in the form of intracranial haemorrhage and periventricular microangiopathy and no CNS involvement in bcr1 patients. In conclusion, PML-RARα isoform expression at diagnosis in selective patients influences disease course over time and may even lead to early mortality due to haemorrhage. Thus, timely reporting of the specific PML-RARα isoform by clinical laboratories and CNS assessment by radiology can prevent complications leading to death in some APL patients.
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Affiliation(s)
- Manal Abudawood
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Alorini
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Manar A. Samman
- Molecular Pathology, Research Center and Hematology Section, Pathology and Clinical Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Salman M. Bashir
- Molecular Pathology, Research Center and Hematology Section, Pathology and Clinical Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Azizah AlSwayed
- Molecular Pathology, Research Center and Hematology Section, Pathology and Clinical Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sarah Binhassan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Ali Peer-Zada
- Molecular Pathology, Research Center and Hematology Section, Pathology and Clinical Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
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Fusco R, Tesi C, Larentis O, Spina P, Campagnolo M, Licata M. A possible case of orbital osteomyelitis from the medieval cemetery of Sant' Agostino in Caravate (Varese, Northern Italy). Int J Paleopathol 2023; 41:50-54. [PMID: 36947955 DOI: 10.1016/j.ijpp.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This paper aims to present one of the first osteoarchaeological cases of orbital osteomyelitis and provides the best diagnostic criteria to identify its pathophysiological changes. MATERIALS A well-preserved skeleton of an adult male from the medieval cemetery of Sant' Agostino in Caravate, Italy. METHODS Macroscopic, tomographic, and histological analyses were performed using standard methods. RESULTS The skeleton shows irregularities in the architecture of the left supraorbital margin. CT analysis reveals the presence of a radiotransparent area involving the diploe and the external cranial table. This area is lateromedially oval-shaped and bordered by a thick irregular radiodense rim, associated with the presence of a cloaca on the roof of the orbit and surrounding periosteal reaction. Microscopic examination shows the formation of a thin layer of cortical bone and an osteoid-like matrix. CONCLUSION A careful differential diagnosis based on macroscopic, radiological, and histological evidence suggests a case of orbital osteomyelitis. SIGNIFICANCE This case study represents one of the few osteoarchaeological evaluations of ocular chronic osteomyelitis diagnosed using macroscopic skeletal, computed tomography, and histological analysis. As such, it provides a reference and an investigative criterion for future cases. LIMITATIONS The diagnosis cannot be stated with certainty, and only probable diagnoses can be proposed. Although we referred especially to clinical literature, it is necessary to consider that the severity of conditions may be modified by modern medical intervention. SUGGESTION FOR FURTHER RESEARCH This case provides further insights into the presence of this condition in the past.
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Affiliation(s)
- Roberta Fusco
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Chiara Tesi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Omar Larentis
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Spina
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy; Cantonal Institute of Pathology, EOC, Locarno, Switzerland, University of Eastern Piedmont, Novara, Italy
| | - Monica Campagnolo
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marta Licata
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Zhou N, Shi X, Dixit O, Firszt JB, Holden TA. Relationship between electrode position and temporal modulation sensitivity in cochlear implant users: Are close electrodes always better? Heliyon 2023; 9:e12467. [PMID: 36852047 PMCID: PMC9958279 DOI: 10.1016/j.heliyon.2022.e12467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/21/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
Temporal modulation sensitivity has been studied extensively for cochlear implant (CI) users due to its strong correlation to speech recognition outcomes. Previous studies reported that temporal modulation detection thresholds (MDTs) vary across the tonotopic axis and attributed this variation to patchy neural survival. However, correlates of neural health identified in animal models depend on electrode position in humans. Nonetheless, the relationship between MDT and electrode location has not been explored. We tested 13 ears for the effect of distance on modulation sensitivity, specifically targeting the question of whether electrodes closer to the modiolus are universally beneficial. Participants in this study were postlingually deafened and users of Cochlear Nucleus CIs. The distance of each electrode from the medial wall (MW) of the cochlea and mid-modiolar axis (MMA) was measured from scans obtained using computerized tomography (CT) imaging. The distance measures were correlated with slopes of spatial tuning curves measured on selected electrodes to investigate if electrode position accounts, at least in part, for the width of neural excitation. In accordance with previous findings, electrode position explained 24% of the variance in slopes of the spatial tuning curves. All functioning electrodes were also measured for MDTs. Five ears showed a positive correlation between MDTs and at least one distance measure across the array; 6 ears showed negative correlations and the remaining two ears showed no relationship. The ears showing positive MDT-distance correlations, thus benefiting from electrodes being close to the neural elements, were those who performed better on the two speech recognition measures, i.e., speech reception thresholds (SRTs) and recognition of the AzBio sentences. These results could suggest that ears able to take advantage of the proximal placement of electrodes are likely to have better speech recognition outcomes. Previous histological studies of humans demonstrated that speech recognition is correlated with spiral ganglion cell counts. Alternatively, ears with good speech recognition outcomes may have good overall neural health, which is a precondition for close electrodes to produce spatially confined neural excitation patterns that facilitate modulation sensitivity. These findings suggest that the methods to reduce channel interaction, e.g., perimodiolar electrode array or current focusing, may only be beneficial for a subgroup of CI users. Additionally, it suggests that estimating neural survival preoperatively is important for choosing the most appropriate electrode array type (perimodiolar vs. lateral wall) for optimal implant function.
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Affiliation(s)
- Ning Zhou
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, 27834, USA
| | - Xuyang Shi
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, 27834, USA
| | - Omkar Dixit
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, 27834, USA
| | - Jill B Firszt
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| | - Timothy A Holden
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
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Sanmartin MX, Wang JJ, Boltyenkov AT, Katz JM, Malhotra A, White TG, O'Hara J, Convey A, Sanelli PC. Contrast-associated acute kidney injury in acute ischemic stroke patients following multi-dose iodinated contrast. Clin Neurol Neurosurg 2022; 220:107351. [PMID: 35810717 DOI: 10.1016/j.clineuro.2022.107351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE lthough intravenous contrast in neuroimaging has become increasingly important in selecting patients for stroke treatment, clinical concerns remain regarding contrast-associated acute kidney injury (CA-AKI). Given the increasing utilization of CT angiography and/or perfusion coupled with cerebral angiography, the purpose of this study was to assess the association of CA-AKI and multi-dose iodinated contrast in acute ischemic stroke (AIS) patients. MATERIALS AND METHODS etrospective review of AIS patients at a comprehensive stroke center was performed from January 2018 to December 2019. Data collection included patient demographics, stroke risk factors, stroke severity, discharge disposition, modified Rankin Scale, contrast type/volume, and creatinine levels (baseline, 48-72 h). CA-AKI was defined as creatinine increase ≥ 25 % from baseline. Bivariate analyses and multivariable logistic regression models were implemented to compare AIS patients with multi-dose and single-dose contrast. RESULTS Of 440 AIS patients, 215 (48.9 %) were exposed to a single-dose contrast, and 225 (51.1 %) received multi-dose. In single-dose patients, CA-AKI at 48/72 h was 9.7 %/10.2 % compared to 8.0 %/8.9 % in multi-dose patients. Multi-dose patients were significantly more likely to receive a higher volume of contrast (mean 142.1 mL versus 80.8 mL; p < 0.001), but there was no significant difference in their creatinine levels or CA-AKI. NIHSS score (OR=1.08, 95 % CI=[1.04,1.13]), and patient transfer from another hospital (OR=3.84, 95 % CI=[1.94,7.62]) were significantly associated with multi-dose contrast. CONCLUSIONS No significant association between multi-dose iodinated contrast and CA-AKI was seen in AIS patients. Concerns of CA-AKI should not deter physicians from pursuing timely and appropriate contrast-enhanced neuroimaging that may optimize treatment outcomes in AIS patients.
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Affiliation(s)
- Maria X Sanmartin
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, USA; Siemens Medical Solutions USA Inc., Malvern, PA, USA.
| | - Jason J Wang
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, USA
| | - Artem T Boltyenkov
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, USA; Siemens Medical Solutions USA Inc., Malvern, PA, USA
| | - Jeffrey M Katz
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset NY, USA; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA
| | - Timothy G White
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Joseph O'Hara
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, USA
| | - Alicia Convey
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, USA
| | - Pina C Sanelli
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, USA; Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset NY, USA
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Dudiki T, Nascimento DW, Childs LS, Kareti S, Androjna C, Zhevlakova I, Byzova TV. Progressive skeletal defects caused by Kindlin3 deficiency, a model of autosomal recessive osteopetrosis in humans. Bone 2022; 160:116397. [PMID: 35342016 PMCID: PMC9133165 DOI: 10.1016/j.bone.2022.116397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
Abstract
The cellular and molecular mechanisms of bone development and homeostasis are clinically important, but not fully understood. Mutations in integrins and Kindlin3 in humans known as Leukocyte adhesion deficiencies (LAD) cause a wide spectrum of complications, including osteopetrosis. Yet, the rarity, frequent misdiagnosis, and lethality of LAD preclude mechanistic analysis of skeletal abnormalities in these patients. Here, using inducible and constitutive tissue-specific Kindlin3 knockout (K3KO) mice, we show that the constitutive lack of embryonic-Kindlin3 in myeloid lineage cells causes growth retardation, edentulism, and skull deformity indicative of hydrocephaly. Micro-CT analysis revealed craniosynostosis, choanal stenosis, and micrognathia along with other skeletal abnormalities characteristic of osteopetrosis. A marked progression of osteosclerosis occurs in mature to middle-aged adults, resulting in the narrowing of cranial nerve foramina and bone marrow cavities of long bones. However, postnatal-Kindlin3 is less critical for bone remodeling and architecture. Thus, myeloid Kindlin3 is essential for skeletal development and its deficiency leads to autosomal recessive osteopetrosis (ARO). The study will aid in the diagnosis, management, and treatment choices for patients with LAD-III and ARO.
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Affiliation(s)
- Tejasvi Dudiki
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel W Nascimento
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Lauren S Childs
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Swetha Kareti
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Charlie Androjna
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Irina Zhevlakova
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Tatiana V Byzova
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Stachel G, Abdel-Wahab M, de Waha-Thiele S, Desch S, Feistritzer HJ, Kitamura M, Farhan S, Eitel I, Kurz T, Thiele H. Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2022; 38:2469-2478. [PMID: 36434335 PMCID: PMC9700572 DOI: 10.1007/s10554-022-02657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
To evaluate the prognostic relevance of aortic annulus (AA) and left ventricular outflow tract (LVOT) Fractal dimension (FD). FD is a mathematical concept that describes geometric complexity of a structure and has been shown to predict adverse outcomes in several contexts. Computed tomography (CT) scans from the SOLVE-TAVI trial, which, in a 2 × 2 factorial design, randomized 447 patients to TAVI with the balloon-expandable Edwards Sapien 3 or the self-expanding Medtronic Evolut R, and conscious sedation or general anesthesia, were analyzed semi-automatically with a custom-built software to determine border of AA and LVOT. FD was measured by box counting using grid calibers between 0.8 and 6.75 mm and was compared between patients with none/trivial and mild/moderate paravalvular regurgitation (PVR). Overall, 122 patients had CT scans sufficient for semi-automatic PVR in 30-day echocardiography. PVR was none in 65(53.3%) patients, trace in 9(7.4%), mild in 46(37.7%), moderate in 2(1.6%) and severe in 0 patients. FD determined in diastolic images was significantly higher in patients with mild/moderate PVR (1.0558 ± 0.0289 vs. 1.0401 ± 0.0284, p = 0.017). Annulus eccentricity was the only conventional measure of AA and LVOT geometry significantly correlated to FD (R = 0.337, p < 0.01). Area under the curve (AUC) of diastolic annular FD for prediction of mild/moderate PVR in ROC analysis was 0.661 (0.542-0.779, p = 0.014). FD shows promise in prediction of PVR after TAVI. Further evaluation using larger patient numbers and refined algorithms to better understand its predictive performance is warranted.Trial Registration: www.clinicaltrials.gov , identifier: NCT02737150, date of registration: 13.04.2016.
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Affiliation(s)
- Georg Stachel
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany ,University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ingo Eitel
- University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany ,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Lübeck, Germany
| | - Thomas Kurz
- University Clinic Schleswig-Holstein, University Heart Center Luebeck, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Shaik NS, Cherukuri TK. Transfer learning based novel ensemble classifier for COVID-19 detection from chest CT-scans. Comput Biol Med 2021; 141:105127. [PMID: 34915332 DOI: 10.1016/j.compbiomed.2021.105127] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 12/05/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022]
Abstract
Coronavirus Disease 2019 (COVID-19) is a deadly infection that affects the respiratory organs in humans as well as animals. By 2020, this disease turned out to be a pandemic affecting millions of individuals across the globe. Conducting rapid tests for a large number of suspects preventing the spread of the virus has become a challenge. In the recent past, several deep learning based approaches have been developed for automating the process of detecting COVID-19 infection from Lung Computerized Tomography (CT) scan images. However, most of them rely on a single model prediction for the final decision which may or may not be accurate. In this paper, we propose a novel ensemble approach that aggregates the strength of multiple deep neural network architectures before arriving at the final decision. We use various pre-trained models such as VGG16, VGG19, InceptionV3, ResNet50, ResNet50V2, InceptionResNetV2, Xception, and MobileNet and fine-tune them using Lung CT Scan images. All these trained models are further used to create a strong ensemble classifier that makes the final prediction. Our experiments exhibit that the proposed ensemble approach is superior to existing ensemble approaches and set state-of-the-art results for detecting COVID-19 infection from lung CT scan images.
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Patel NH, Osborne MT, Teague H, Parel P, Svirydava M, Sorokin AV, Teklu M, Manyak G, Zhou W, Pantoja C, Scott C, Playford MP, Kapoor P, Rodante JA, Keel A, Chen M, Tawakol A, Mehta NN. Heightened splenic and bone marrow uptake of 18F-FDG PET/CT is associated with systemic inflammation and subclinical atherosclerosis by CCTA in psoriasis: An observational study. Atherosclerosis 2021; 339:20-6. [PMID: 34808541 DOI: 10.1016/j.atherosclerosis.2021.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Psoriasis is an immune-mediated inflammatory disease with increased risk of myocardial infarction. Preclinical studies in psoriasis models show an association between chronic inflammation and immune cell proliferation in the spleen and bone marrow (BM). We sought to test the hypothesis that splenic and BM 18F-fluorodeoxyglucose (18F-FDG) uptake is heightened in psoriasis and that higher uptake associates with systemic inflammation and subclinical atherosclerotic disease measures in this cohort. METHODS Multimodality imaging and biomarker assays were performed in 240 participants (210 with psoriasis and 30 healthy). Splenic and BM uptake was obtained using 18F-FDG positron emission tomography/computed tomography (PET/CT). Coronary artery plaque characteristics including non-calcified burden (NCB) and lipid rich necrotic core (LRNC) were quantified using a dedicated software for CT angiography. All analyses were performed with StataIC 16 (Stata Corp., College Station, TX, USA). RESULTS Splenic and BM 18F-FDG uptake was increased in psoriasis (vs. healthy volunteers) and significantly associated with proatherogenic lipids, immune cells and systemic inflammation. Higher splenic 18F-FDG uptake associated with higher total coronary burden (β = 0.37; p<0.001), NCB (β = 0.39; p<0.001), and LRNC (β = 0.32; p<0.001) in fully adjusted models. Similar associations were seen for BM 18F-FDG uptake in adjusted models (β = 0.38; β = 0.41; β = 0.24; respectively, all p<0.001). CONCLUSIONS Heightened splenic and BM uptake of 18F-FDG is associated with proatherogenic lipids, immune cells, inflammatory markers and coronary artery disease. These findings provide insights into atherogenic mechanisms in psoriasis and suggest that immune cell proliferation in the spleen and BM is associated with subclinical atherosclerosis.
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Zhang X, Liu L. Angioleiomyoma of the sacrum: a case report and literature review of similar sacral lesions. Radiol Case Rep 2021; 16:1428-1432. [PMID: 33912258 PMCID: PMC8063708 DOI: 10.1016/j.radcr.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
Angioleiomyoma is a solitary smooth muscle cell tumor that originates from the tunical media of arteries and veins. Its origin in the sacrum is rare, only one case has been recorded in the literature to date, but cases with bone destruction are even rarer. We present a 49-year-old woman with lumbosacral pain, unsteady gait and right lower extremity pain for two years, accompanied by radiation pain. Through plain film, Computerized tomography (CT) and Magnetic resonance imaging (MRI) examination, we diagnosed this case as giant sacral schwannoma(GSS). After an operation, it was pathologically confirmed as angioleiomyoma. The diagnosis of angioleiomyoma should not be based on imaging alone. It requires histopathological examination combined with immunostaining. It should be considered as one of the differential diagnosis of sacral tumors.
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Affiliation(s)
- Xianchen Zhang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian City 271000, Shandong, China
| | - Luping Liu
- Department of Oncology, Tai'an City Cancer Prevention Hospital, Taian City Shandong, China
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10
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Sproll KC, Leydag S, Holtmann H, Schorn LK, Aissa J, Kröpil P, Kaisers W, Tóth C, Handschel J, Lommen J. Is the prediction of one or two ipsilateral positive lymph nodes by computerized tomography and ultrasound reliable enough to restrict therapeutic neck dissection in oral squamous cell carcinoma (OSCC) patients? J Cancer Res Clin Oncol 2021; 147:2421-2433. [PMID: 33521862 DOI: 10.1007/s00432-021-03523-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Proper management of the clinically involved neck in OSCC patients continues to be a matter of debate. Our aim was to analyze the accuracy of computerized tomography (CT) and ultrasound (US) in anticipating the exact location of lymph node (LN) metastases of OSCC patients across the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) levels ipsi- and contralaterally. Furthermore, we wanted to assess the suitability of therapeutic selective neck dissection (SND) in patients with one or two ipsilateral positive nodes upon clinical staging (cN1/cN2a and cN2b(2/x) patients). METHODS We prospectively analyzed the LN status of patients with primary OSCC using CT and US from 2007 to 2013. LNs were individually assigned to a map containing the AAO-HNS levels; patients bearing a single or just two ipsilateral positive nodes (designated cN1/cN2a or cN2b(2/x) patients either by CT (CT group) or US alone (US group) or in a group combining findings of CT and US (CTUS group)) received an ipsi-ND (I-V) and a contra-ND (I-IV). 78% of the LNs were sent individually for routine histopathological examination; the remaining were dissected and analyzed per neck level. RESULTS Upon the analysis of 1.670 LNs of 57 patients, the exact location of pathology proven LN metastases in cN1 patients was more precisely predicted by US compared to CT with confirmed findings only in levels IA, IB und IIA. Clearly decreasing the number of missed lesions, the findings in the CTUS group nearly kept the spatial reliability of the US group. The same analysis for patients with exactly two supposed ipsilateral lesions (cN2b(2/x)) yielded confirmed metastases from levels I to V for both methods individually and in combination and, therefore, render SND insufficient for these cases. CONCLUSION Our findings stress the importance of conducting both, CT and US, in patients with primary OSCC. Only the combination of their findings warrants the application of therapeutic SND in patients with a single ipsilateral LN metastasis (cN1/cN2a patients) but not in patients with more than one lesion upon clinical staging (≥ cN2b).
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Affiliation(s)
- Karl Christoph Sproll
- Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany.
| | - Sabina Leydag
- Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Henrik Holtmann
- Department of Oral and Maxillofacial Surgery, Protestant Hospital Bethesda, Mönchengladbach, Germany
| | - Lara K Schorn
- Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Joel Aissa
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Patric Kröpil
- Department of Radiology, BG Clinic Duisburg, Duisburg, Germany
| | - Wolfgang Kaisers
- Department of Anesthesiology, Medical Faculty of the University of Witten-Herdecke, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Csaba Tóth
- Department of Pathology, Medical Faculty, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Handschel
- Clinic for Oral and Maxillofacial Surgery, Klinik Am Kaiserteich, Düsseldorf, Germany
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery, Medical Faculty, University Hospital of the Heinrich-Heine-University, Düsseldorf, Germany
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Melinosky C, Kincaid H, Claassen J, Parikh G, Badjatia N, Morris NA. The Modified Fisher Scale Lacks Interrater Reliability. Neurocrit Care 2021; 35:72-8. [PMID: 33200331 DOI: 10.1007/s12028-020-01142-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The modified Fisher scale (mFS) is a critical clinical and research tool for risk stratification of cerebral vasospasm. As such, the mFS is included as a common data element by the National Institute of Neurological Disorders and Stroke SAH Working Group. There are few studies assessing the interrater reliability of the mFS. METHODS We distributed a survey to a convenience sample with snowball sampling of practicing neurointensivists and through the research survey portion of the Neurocritical Care Society Web site. The survey consisted of 15 scrollable CT scans of patients with SAH for mFS grading, two questions regarding the definitions of the scale criteria and demographics of the responding physician. Kendall's coefficient of concordance was used to determine the interrater reliability of mFS grading. RESULTS Forty-six participants (97.8% neurocritical care fellowship trained, 78% UCNS-certified in neurocritical care, median 5 years (IQR 3-6.3) in practice, treating median of 80 patients (IQR 50-100) with SAH annually from 32 institutions) completed the survey. By mFS criteria, 30% correctly identified that there is no clear measurement of thin versus thick blood, and 42% correctly identified that blood in any ventricle is scored as "intraventricular blood." The overall interrater reliability by Kendall's coefficient of concordance for the mFS was moderate (W = 0.586, p < 0.0005). CONCLUSIONS Agreement among raters in grading the mFS is only moderate. Online training tools could be developed to improve mFS reliability and standardize research in SAH.
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Ihdayhid AR, Thakur U, Yap G, Goeller M, Nerlekar N, Adams D, Isa M, Joshi M, Cameron J, Seneviratne S, Dey D, Achenbach S, Leipsic J, Ko BS. Ethnic differences in coronary anatomy, left ventricular mass and CT-derived fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 15:249-257. [PMID: 33041249 DOI: 10.1016/j.jcct.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies have observed higher incidence of cardiovascular mortality in South Asians (SA), and lower prevalence in East Asians (EA), compared with Caucasians. These observations are not entirely explained by ethnic differences in cardiovascular risk factors and mechanistic factors such as variations in cardiac anatomy and physiology may play a role. This study compared ethnic differences in CT-assessed left ventricular (LV) mass, coronary anatomy and non-invasive fractional flow reserve (FFRCT). METHODS Three-hundred symptomatic patients (age 59 ± 7.9, male 51%) underwent clinically-mandated CT-coronary-angiography (CTA) were matched for age, gender, BMI and diabetes (100 each ethnicity). Assessment of coronary stenosis, luminal dimensions and vessel dominance was performed by independent observers. LV mass, coronary luminal volume and FFRCT were quantified by blinded core-laboratory. A sub-analysis was performed on patients (n = 187) with normal/minimal disease (0-25% stenosis). RESULTS Stenosis severity was comparable across ethnic groups. EA demonstrated less left-dominant circulation (2%) compared with SA (8.2%) and Caucasians (10.1%). SA compared with EA and Caucasians demonstrated smallest indexed LV mass, coronary luminal volumes and dimensions. EA compared with Caucasians had comparable indexed LV mass, coronary luminal dimensions and highest luminal volumes. The latter was driven by higher prevalence of right-dominance including larger and longer right posterior left ventricular artery. FFRCT in the left anterior descending artery (LAD) was lowest in SA (0.87) compared with EA (0.89; P = 0.009) and Caucasians (0.89; P < 0.001), with no difference in other vessels. All observed differences were consistent in patients with minimal disease. CONCLUSION This single-centre study identified significant ethnic differences in CT-assessed LV mass, coronary anatomy and LAD FFRCT. These hypotheses generating results may provide a mechanistic explanation for ethnic differences in cardiovascular outcomes and require validation in larger cohorts.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Grace Yap
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Markus Goeller
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Daniel Adams
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Mourushi Isa
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Mitwa Joshi
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Friedrich Alexander University Erlangen Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany
| | - Jonathan Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
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13
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Goeller M, Rahman Ihdayhid A, Cadet S, Lin A, Adams D, Thakur U, Yap G, Marwan M, Achenbach S, Dey D, Ko B. Pericoronary adipose tissue and quantitative global non-calcified plaque characteristics from CT angiography do not differ in matched South Asian, East Asian and European-origin Caucasian patients with stable chest pain. Eur J Radiol 2020; 125:108874. [PMID: 32087467 DOI: 10.1016/j.ejrad.2020.108874] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE South Asian (SA) have been observed to have higher cardiovascular mortality rates compared to East Asians (EA) and Caucasians. Pericoronary adipose tissue (PCAT) attenuation around the right coronary artery (RCA) from coronary CT angiography (CTA) has been associated with coronary inflammation and cardiac death. We aimed to investigate i) the relationship between plaque characteristics and PCAT attenuation and ii) to assess gender and ethnic differences in PCAT attenuation using a matched cohort of SA, EA and Caucasians. METHOD Three-hundred symptomatic patients who underwent CTA were matched for age, gender, BMI and diabetes (100 in each ethnic group). Semi-automated software was used to quantify the total volumes and burden of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP) and calcified plaque (CP) in blinded core-lab analysis. PCAT CT attenuation was measured around the RCA (10-50 mm from RCA ostium), the most standardized model for PCAT analysis. RESULTS The total volumes and burden of NCP, LD-NCP and CP were comparable in the ethnic groups (each p > 0.05). PCAT attenuation was higher in patients with coronary plaque. PCAT attenuation correlated with the total volumes and burden of NCP, LD-NCP and CP (r>0.17; p < 0.003). Within the RCA this correlation persisted only for NCP features (r>0.39;p < 0.001). Males showed higher PCAT attenuation (p < 0.001). PCAT attenuation was similar between Caucasian, EA and SA (p = 0.32). CONCLUSIONS PCAT CT attenuation correlated most with its surrounded NCP features further highlighting its role as surrogate measure of coronary inflammation. As coronary plaque burden and RCA PCAT attenuation did not differ between ethnic groups, causes of increased cardiac mortality in South Asians needs further investigations.
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Affiliation(s)
- Markus Goeller
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Sebastien Cadet
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Daniel Adams
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Grace Yap
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
| | - Mohamed Marwan
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany.
| | - Stephan Achenbach
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany.
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia.
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Pandey AK, Bansal C, Maithani T, Varma A, Singh VP. A Perspective of Clinical Behaviour and Management of Deep Neck Space Infections (DNSI): The Clinical Conundrum. Indian J Otolaryngol Head Neck Surg 2019; 71:594-604. [PMID: 31742027 DOI: 10.1007/s12070-018-1423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022] Open
Abstract
The diagnosis and management of deep neck space infections remain a challenging task for otolaryngologists. A retrospective observational analysis of 137 cases of deep neck infections at a tertiary care centre was reviewed. We present 137 treated cases of DNSIs in a retrospective 5 years clinical study conducted in the department of otolaryngology at a tertiary care center from January 2012 to December 2016. Demographic information, Socio-economic data, etiopathogenesis, clinical presentation, spaces involved, diagnosis, and treatment strategies, associated morbidities, course and complications were analysed and compared with past experiences. Odontogenic and salivary gland infections causes were the most common source of DNIs. Major complication observed was skin defect. In this study, submandibular space infection was found to be the most common space involved in DNSI. Pain (100%) was the most common clinical complaint followed by neck swelling (65.69%). Staphylococcus aureus (38 cases) was the most common micro-organism isolated. Surgical intervention was the main modality of treatment and there was one mortality. DNSIs are fairly common challenging and potentially lethal entities which can lead to severe complications in a very short time, should there be delay in its prompt diagnosis and management. Computerized Tomography Scan (CT scan) with contrast is the investigation of choice in diagnosing DNSIs. Assessment of airway control must take precedence.
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15
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Özer N. Gallstone ileus with evident forchet sign:case report. Int J Surg Case Rep 2019; 61:153-156. [PMID: 31382234 PMCID: PMC6690574 DOI: 10.1016/j.ijscr.2019.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/23/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022] Open
Abstract
GSI is clinical entity of mechanical intestinal obstruction. It’s most commonly seen in elderly patients. CT scanning is the most sensitive and spesific radiological diagnostic method. Also riglers triad, forchet sign and petren sign are pathognomonic for CT scanning in GSI.
Introduction Gallstone ileus (GSİ) is a rare complication of cholelithiasis (gallbladderstone), which may lead to obstruction of the small intestine. Particularly, computerized tomographic (CT) imaging method and special findings in these images help diagnosing of gallstone ileus. Treatment of this disease is surgery, surgery involves cholecystectomy + fistula repair + enterolitotomy, but it is controversial to perform cholecystectomy with enterolitotomy and fistula repair in the same session. Presentation of case A 75-year-old male patient consulted to the emergency department with the complaints of nausea and vomiting. In the examinations of the patient, bilienteric fistula and gallstones that impacted in the jejunum leading to obstruction were observed in abdominal CT images of the patient who has ileus. The patient was evaluated as gallstone ileus. In addition, on tomographic images significant Forchet sign and Rigler’s triad images were viewed which were pathognomonic for gallstone ileus and did not have images as clear as in our case in the literature search. Laparotomy was performed on the patient due to the fact that he was elderly and the duration of anesthesia was wanted to be kept short and stone was extracted by enterolitotomy. Cholecystectomy and fistula repair were left for another session because of gallbladder and surrounding tissues were edematous. The patient was discharged with full recovery on the 6th post-operative day. Discussion–conclusion As well as this disease is a rare cause of mechanical bowel obstruction, it is mostly seen in elderly patients. The most sensitive and specific imaging method in diagnosis is contrast-enhanced abdominal computerized tomography. In the tomographic images, especially the Rigler’s triad, Forchet sign and Petren sign are pathognomonic for gallstone ileus.
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Affiliation(s)
- Nazmi Özer
- Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey.
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16
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Wilhelm CM, Hickey J, McConnell P, Hor KN, Mah ML. Ventricular Dysfunction in a 40-Year-Old With Coronary Compression From Aortic Aneurysm Following Waterston Shunt and Complete Repair of Tetralogy of Fallot. ACTA ACUST UNITED AC 2019; 3:44-45. [PMID: 31049477 PMCID: PMC6479195 DOI: 10.1016/j.case.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adult congenital patients with tetralogy of Fallot require life long follow-up. Early left ventricular dysfunction in repaired tetralogy of Fallot warrants evaluation. Multimodality imaging should be used when unusual echocardiography findings are present.
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Affiliation(s)
| | | | | | - Kan N Hor
- Nationwide Children's Hospital, Columbus, Ohio
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17
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Miller TA, Robinson KR, Li H, Seiwert TY, Haraf DJ, Lan L, Giger ML, Ginat DT. Prognostic value of pre-treatment CT texture analysis in combination with change in size of the primary tumor in response to induction chemotherapy for HPV-positive oropharyngeal squamous cell carcinoma. Quant Imaging Med Surg 2019; 9:399-408. [PMID: 31032187 DOI: 10.21037/qims.2019.03.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background To determine the additive value of quantitative radiomic texture features in predicting progression in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) based on pre-treatment CT. Methods Retrospective analysis of a single-center cohort of adult patients enrolled in a response-adapted radiation volume de-escalation trial treated with induction chemotherapy. Texture analysis of HPV-positive OPSCC was performed via primary tumor site contouring on pre-treatment contrast-enhanced CT scans. Percent change in size of the tumor in response to induction chemotherapy based on RECIST 1.1 criteria and progression free survival were clinically determined for this cohort. Receiver operating characteristic (ROC) analysis was performed to compare the accuracy of percent change in tumor size after induction chemotherapy with a combination of change in tumor size and radiomic texture features for predicting tumor progression. Results Radiomic texture analysis of the primary tumors in 38 patients with OPSCC depicted on pre-treatment neck CT scans using skewness and entropy in combination with percent change in tumor size after induction chemotherapy yielded a statistically significant increase in accuracy for predicting tumor progression over change in tumor size alone, with an area under the curve of 0.80 versus 0.56 (one-tailed P=0.0087). Conclusions This pilot study suggests that disease progression in patients with HPV-positive OPSCC is more accurately predicted using a combination of texture features on pre-treatment CT scans, along with change in tumor size compared to change in tumor size alone and could therefore serve as a radiomic texture signature.
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Affiliation(s)
- Tamari A Miller
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Kayla R Robinson
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Hui Li
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Tanguy Y Seiwert
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Daniel J Haraf
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Li Lan
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Maryellen L Giger
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
| | - Daniel T Ginat
- 1Pritzker School of Medicine, 2Department of Radiology, 3Section of Hematology-Oncology, Department of Medicine, 4Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL 60637, USA
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Abstract
BACKGROUND Recently high-resolution, noninvasive, multimodality in-vivo molecular imaging with PET, SPECT, CT and MRI, employing fusion algorithms has revolutionized personalized medicine. However, novel discovery of specific radiopharmaceuticals (RPs) for the accurate diagnosis and effective treatment of progressive neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, drug addiction, and other cognitive impairments still remains a significant challenge. OBJECTIVE The primary objective of this review is to highlight the clinical significance of multimodality fusion neuroimaging for the determination of: pharmacokinetics and pre-clinical development of radiopharmaceuticals (RPs); in-vivo monitoring of stem cell transplantation therapy; nicotinic acetylcholine receptors (nAChRs) investigations; and regional cerebral blood flow and glucose metabolism in cognitively-impaired subjects employing multimodality noninvasive PET, CT, MRI/MRS, and SPECT imaging. METHOD Recent methodology to perform multimodality imaging employing computer-based fusion algorithms is provided with a primary emphasis on nanoSPECT/CT, PET-CT, and PET-MRI in experimental animals. Multimodality imaging is performed to detect CNS infections using 99mTc-HMPAO SPECT and 18F-FDG PET/CT. Furthermore, limitations of individual neuroimaging system, body movements due to cardiorespiratory activity, and co-registration of multimodality neuroimaging data are described. RESULTS Multimodality neuroimaging is clinically-significant because it emphasizes the importance of complementary imaging for theranostic applications and minimizes the inherent limitations of individual neuroimaging approach. However, it may increase the radiation dose to a susceptible pediatric population. CONCLUSION Future developments in specific RPs with minimum radiation exposure will facilitate early differential diagnosis, prevent, slowdown and/or cure neurodegenerative diseases, cardiovascular diseases, and cancer. Eventually, conventional and functional neuroimaging, combined with clinical, laboratory and - omics analyses will facilitate theranostics to accomplish the ultimate goal of personalized medicine.
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Affiliation(s)
- Sushil Sharma
- Saint James School of Medicine, Cane Hall, St Vincent, St Vincent & Grenadine
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19
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Abbas J, Slon V, Stein D, Peled N, Hershkovitz I, Hamoud K. In the quest for degenerative lumbar spinal stenosis etiology: the Schmorl's nodes model. BMC Musculoskelet Disord 2017; 18:164. [PMID: 28424050 PMCID: PMC5397788 DOI: 10.1186/s12891-017-1512-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 03/31/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis (DLSS) is a common health problem in the elderly and usually associated with three-joint complex degeneration. Schmorl's nodes (SNs) are described as vertical herniation of the disc into the vertebral body through a weakened part of the end plate that can lead to disc degeneration. Since SNs can harm the spine unit stability, the association between DLSS and SNs is expected. The aim of this study is to shed light on the relationship between degenerative lumbar spinal stenosis and SNs. METHODS Two groups of individuals were studied: the first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms (age range: 40-99, sex ratio: 90 M/90 F). The presence or absence of SNs on the cranial and caudal end plate surfaces at the lumbosacral region (from L1 to S1 vertebra) was recorded, using CT images (Brilliance 64 Philips Medical System, Cleveland Ohio, thickness of the sections was 1-3 mm and MAS, 80-250). Chi-Square test was taken to compare the prevalence of SNs between the study groups (control and stenosis) by lumbar disc level, for each gender separately. Multivariable logistic regression analysis was also used to determine the association between DLSS and SNs. RESULTS The prevalence rate of SNs was significantly greater in the stenosis males (L1-2 to L5-S1) and females (L4-5 and L4-S1) compared to their counterparts in the control (P < 0.001). In addition, the presence of SNs in both males and females was found to increase the likelihood for DLSS. CONCLUSIONS Our results indicate that SNs prevalence is significantly greater in the DLSS group compared to the control. Furthermore, SNs are strongly associated with DLSS.
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Affiliation(s)
- Janan Abbas
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Physical Therapy, Zefat Academic College, Zefat, Israel
| | - Viviane Slon
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Stein
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, Haifa, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kamal Hamoud
- Department of Physical Therapy, Zefat Academic College, Zefat, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
- Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Tiberias, Israel
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20
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Abbas J, Slon V, May H, Peled N, Hershkovitz I, Hamoud K. Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis? BMC Musculoskelet Disord 2016; 17:422. [PMID: 27724897 PMCID: PMC5057209 DOI: 10.1186/s12891-016-1282-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS. Methods Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40–99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS. Results Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS. Conclusions Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.
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Affiliation(s)
- Janan Abbas
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Physical Therapy, Zefat Academic College, Zefat, Israel.
| | - Viviane Slon
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila May
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Peled
- Department of Radiology, Carmel Medical Center, Haifa, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kamal Hamoud
- Department of Physical Therapy, Zefat Academic College, Zefat, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.,Department of Orthopaedic Surgery, The Baruch Padeh Poriya Medical Center, Tiberias, Israel
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21
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Cox E, Ghasemloonia A, Nakoneshny SC, Zareinia K, Hudon M, Lysack JT, Sutherland GR, Dort JC. Improved transoral surgical tool design by CT measurements of the oral cavity and pharynx. J Robot Surg 2016; 11:179-185. [PMID: 27664143 DOI: 10.1007/s11701-016-0639-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Abstract
The majority of head and neck cancers arise from the oral cavity and oropharynx. Many of these lesions will be amenable to surgical resection using transoral approaches including transoral robotic surgery (TORS). To develop and control TORS tools, precise dimensions of the oral cavity and pharynx are desirable. CT angiograms of 76 patients were analyzed. For the oral cavity, only the maximum length and width were measured, while for the pharynx, the width, length, and areas of the airway were all measured and the volume calculated. A prototype TORS tool was developed and tested based on the findings and dimensions. The design modification of the tool is in progress. The mean male oral cavity width and length were 93.3 ± 4.3 and 77.0 ± 7.2 mm, respectively, and the mean male pharyngeal width, length, area, and volume were 26.5 ± 7.2 mm, 16.2 ± 8.8 mm, 325 ± 149 mm2, and 28,440 ± 14,100 mm3, respectively, while the mean female oral cavity width and length were 84.5 ± 12.9 and 71.0 ± 6.3 mm, respectively, and the mean female pharyngeal width, length, area, and volume were 24.8 ± 5.6 mm, 13.7 ± 3.2 mm, 258 ± 98 mm2, and 17,660 ± 7700 mm3, respectively. The developed TORS tool was tested inside the oral cavity of an intubation mannequin. These data will also be used to develop an electronic no-go cone-shape tunnel to improve the safety of the surgical field. Reporting the oral cavity and pharyngeal dimensions is important for design of TORS tools and creating control zones for the workspace of the tool inside the oral cavity.
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Affiliation(s)
- Emily Cox
- Department of Clinical Neuroscience and the Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ahmad Ghasemloonia
- Project neuroArm, Department of Clinical Neuroscience and the Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Department of Surgery, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kourosh Zareinia
- Project neuroArm, Department of Clinical Neuroscience and the Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark Hudon
- Division of Neuroradiology, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John T Lysack
- Division of Neuroradiology, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Garnette R Sutherland
- Project neuroArm, Department of Clinical Neuroscience and the Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph C Dort
- Ohlson Research Initiative, Department of Surgery, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Abstract
Peripheral lung nodules remain challenging for accurate localization and diagnosis. Once identified, there are many strategies for diagnosis with heterogeneous risk benefit analysis. Traditional strategies such as conventional bronchoscopy have poor performance in locating and acquiring the required tissue. Similarly, while computerized-assisted transthoracic needle biopsy is currently the favored diagnostic procedure, it is associated with complications such as pneumothorax and hemorrhage. Video-assisted thoracoscopic and open surgical biopsies are invasive, require general anesthesia and are therefore not a first-line approach. New techniques such as ultrathin bronchoscopy and image-based guidance technologies are evolving to improve the diagnosis of peripheral lung lesions. Virtual bronchoscopy and electromagnetic navigation systems are novel technologies based on assisted-computerized tomography images that guide the bronchoscopist toward the target peripheral lesion. This article provides a comprehensive review of these emerging technologies.
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Affiliation(s)
- Kashif Ali Khan
- Department of Interventional Pulmonary Medicine, Cork University Hospital/University College Cork, Cork, Ireland.
| | - Pietro Nardelli
- School of Engineering, University College Cork, Cork, Ireland
| | - Alex Jaeger
- School of Engineering, University College Cork, Cork, Ireland
| | - Conor O'Shea
- School of Engineering, University College Cork, Cork, Ireland
| | | | - Marcus P Kennedy
- Department of Interventional Pulmonary Medicine, Cork University Hospital/University College Cork, Cork, Ireland
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