Injury Patterns of Electric-Scooter Related Trauma: A Systematic Review With Proportion Meta-Analysis

Electric scooter (ES)-related injuries are increasing but poorly described. Clinicians need more information to be prepared for these patients. We supposed two prevalent patterns of patients: mildly injured (predominant upper-limb injuries) and severely injured (predominant head trauma). This study aims to understand the frequency of ES-related injuries and patients' characteristics despite the heterogeneity of data currently available. A systematic review with a proportion meta-analysis was conducted on studies with a multidisciplinary description of ES-related injuries in adult patients (PROSPERO-ID: CRD42022341241). Articles from inception to April 2023 were identified in MEDLINE, Embase, and Cochrane's databases. The risk of bias was evaluated using ROBINS-I. Twenty-five observational studies with 5387 patients were included in the meta-analysis, depending on reported data. Upper-limb (31.8%) and head (19.5%) injuries are the most frequent (25/25 studies included). When injured while riding, 19.5% of patients are intoxicated with drugs/alcohol, and only 3.9% use a helmet, increasing the possibility of severe injuries. About 80% of patients are victims of spontaneous falls. Half of the patients self-present to the ED, and 69.4% of cases are discharged directly from the ED. Studies' limitations include an overall moderate risk of bias and high heterogeneity. Electric scooter-related accidents are commonly associated with upper-limb injuries but often involve the head. Spontaneous falls are the most common mechanism of injury, probably related to frequent substance abuse and helmet misuse. This hot topic is not adequately investigated due to a lack of data. A prospective registry could fill this gap.

Treatment of Postoperative Neck Dissection Cervical Lymphocele With Percutaneous Bleomycin Sclerotherapy

Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.

Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study

BACKGROUND

Blunt cerebrovascular injury (BCVI) with concurrent traumatic brain injury (TBI) presents increased risk of both ischemic stroke and bleeding. This study investigated the safety and survival benefit of BCVI treatment (antithrombotic and/or anticoagulant therapy) in this population. We hypothesized that treatment would be associated with fewer and later strokes in patients with BCVI and TBI without increasing bleeding complications.

METHODS

Patients with head AIS >0 were selected from a database of BCVI patients previously obtained for an observational trial. A Kaplan-Meier analysis compared stroke survival in patients who received BCVI treatment to those who did not. Logistic regression was used to evaluate for confounding variables.

RESULTS

Of 488 patients, 347 (71.1%) received BCVI treatment and 141 (28.9%) did not. BCVI treatment was given at a median of 31 h post-admission. BCVI treatment was associated with lower stroke rate (4.9% vs 24.1%, P < .001 and longer stroke-free survival (P < .001), but also less severe systemic injury. Logistic regression identified motor GCS and BCVI treatment as the only predictors of stroke. No patients experienced worsening TBI because of treatment.

DISCUSSION

Patients with BCVI and TBI who did not receive BCVI treatment had an increased rate of stroke early in their hospital stay, though this effect may be confounded by worse motor deficits and systemic injuries. BCVI treatment within 2-3 days of admission may be safe for patients with mean head AIS of 2.6. Future prospective trials are needed to confirm these findings and determine optimal timing of BCVI treatment in TBI patients with BCVI.

The Correlation of Thyroid Hormone Levels and Anti-Thyroidal Drugs on Thyroid Size, Weight, and Ease of Surgical Dissection for Thyroidectomy for Graves' Disease

BACKGROUND

Patients with Graves' Disease often have a larger thyroid size than patients without thyroid disease. These patients also have elevated T3 and T4 with decreased TSH.

PURPOSE

We evaluate whether these thyroid labs, the use of antithyroid agents, or the size of a thyroid on ultrasound, correlate with the pathological size of a thyroid in patients who undergo total thyroidectomy for Graves' Disease. We further determine whether these parameters affect perioperative complications.

RESEARCH DESIGN

A retrospective review of patients undergoing total thyroidectomy for Graves' Disease was performed from January 2004 to December 2016 in a single institution.

STUDY SAMPLE

392 patients were included in the study.

DATA COLLECTION AND/OR ANALYSIS

Univariate analyses were performed to compare thyroid size on US and pathology as well as weight to preoperative thyroid hormone values and medical comorbidities. Spearman rank correlation and ANOVA were used to identify factors associated with thyroid weight, total pathology size, and differences in size. Multivariate analysis was also performed to evaluate for correlation between thyroid function and perioperative complications.

RESULTS

We found that elevated pre-operative T3 levels were associated with larger pathologic size (P = .027) and a greater difference in pathology vs. US thyroid volumes (P = .005), but not increased thyroid weight (P = .286). No significant differences were found for thyroid weight, pathology size, or difference in size for TSH, T4, or any specific preoperative ATD given. Only postoperative calcium levels were found to be statistically significant for TSH < 0.27 (P = .024) for peri-operative complications.

CONCLUSIONS

These findings may allow for more accurate preoperative planning and intraoperative expectations in patients with Graves' Disease.

The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism?

BACKGROUND

With a demonstrated association between adiposity and parathyroid hormone (PTH) levels, we hypothesized that patients with a higher body mass index (BMI) would have lower rates of postoperative hypoparathyroidism following total thyroidectomy.

METHODS

retrospective review of patients undergoing total thyroidectomy from 2015 to 2021. Demographics, BMI, surgical indications, and laboratory data including pre- and postoperative PTH values were examined.

RESULTS

Of the 352 patients with complete clinicopathologic data, most were female (n = 272, 77.3%) with an average age of 42.7 (SD+/-19.4). Obese (BMI 30-39.99) was most common BMI group (n = 108, 30.8%), with 11.7% (n = 41) morbidly obese (BMI > 40). Morbidly obese patients had significantly higher postoperative PTH levels than BMI < 18.5 (46.0 vs 19.3 pg/mL, P = .004). Patient race was significantly associated with pre- and postoperative PTH (P = .03, P = .004.) On multivariable analysis, preoperative PTH, race, and BMI were independent predictors of higher postoperative PTH (P < .05 for all).

DISCUSSION

Patients with higher BMI and non-white race have relative protection from postoperative hypoparathyroidism.

Total Parathyroidectomy Without Autotransplantation for ESRD Patients With Secondary Hyperparathyroidism; an Effective Alternative

BACKGROUND

The most common operations performed for secondary hyperparathyroidism include subtotal parathyroidectomy (STPX) and total parathyroidectomy with autotransplantation (TPX + AT). We present a series of ESRD patients treated with total parathyroidectomy without autotransplantation (TPX).

METHODS

This is a retrospective cohort analysis of ESRD patients, age 18 years or older, with three or more glands resected on final pathology and follow-up parathyroid hormone levels obtained up to 1.5 years postoperatively. The primary endpoint was recurrence of hyperparathyroidism (defined as PTH > 500 pg/mL).

RESULTS

The incidence of recurrent hyperparathyroidism at 1.5 years was 5.9% (2/34). The incidence of persistent hyperparathyroidism at 1.5 years was 11.8% (4/34). In this series, no patients were hospitalized for symptomatic hypocalcemia or experienced pathologic bone fractures.

CONCLUSIONS

Recurrence rates are low with TPX. The most common cause of recurrent and persistent disease is resection of three rather than four glands. The known complications of TPX, pathologic fractures, and severe hypocalcemia, were not seen in this study.

"The President's Syndrome": The Diagnosis and Treatment of Gerald Ford's Lingual Actinomycosis

Gerald R. Ford was the 38th president of the United States. He was appointed as vice president by Richard Nixon in 1974 upon the resignation of Spiro T. Agnew. In the midst of the Watergate Crisis, Nixon resigned making Ford the only president to serve without being elected as either president or vice president. In the year 2000, 13 years after his abbreviated term in office, he was attending the Republican National Convention in Philadelphia where he developed pain in his tongue, slurring of his speech, and signs of a stroke. He was taken to the emergency room of Hahnemann University Hospital where a CT scan showed a posterior circulation stroke. Within 24 hours, all of Ford's symptoms improved except for his tongue pain and speech. An MRI of the head and neck showed a tongue mass and he was taken to the operating room where an abscess was found. The bacteriology confirmed actinomycosis of the tongue and Ford rapidly improved after the incision and drainage. This paper will review the clinical course of Gerald Ford's lingual actinomycosis and will discuss this rare condition.

Blunt Cerebrovascular Injury (BCVI) Management: Is There a Right Answer?

Blunt cerebrovascular injury (BCVI) results from blunt trauma causing injury to the carotid and/or vertebral arteries. Its most severe manifestation is stroke. The purpose of this study was to evaluate the incidence, management, and outcomes of BCVI at a level one trauma/stroke center. Data on patients diagnosed with BCVI from 2016 to 2021 were extracted from the USA Health trauma registry with associated intervention performed and patient outcomes. Of the 97 patients identified, 16.5% presented with stroke-like symptoms (SS). Medical management was employed for 75%. Intravascular stent alone was utilized for 18.8%. The mean age of symptomatic BCVI patients was 37.6 with a mean injury severity score (ISS) of 38.2. Within the asymptomatic population, 58% received medical management and 3.7% underwent combination therapy. The mean age of asymptomatic BCVI patients was 46.9 with a mean ISS of 20.3. There were 6 mortalities, only one BCVI related.

Acquired Tracheomalacia Requiring Urgent Tracheostomy Exchange in Patients With COVID-19

Tracheostomy for prolonged ventilation of patients with COVID-19 was often delayed due to high viral loads and persistent high ventilatory requirements. With prolonged intubation and significant dose corticosteroid use, patients with COVID-19 are at risk for tracheomalacia, and urgent tube exchange may be required to address persistent cuff leak and to maintain adequate mechanical ventilation. We sought to describe our single center experience with COVID-19 patients requiring tracheostomy and the tracheal complications that followed. We performed a review of patients with COVID-19 who underwent tracheostomy from June 2020 to October 2021. 45 patients were identified; 82.2% survived their index hospitalization. Tracheostomy was performed after 16.4 days of mechanical ventilation. 22.2% required urgent exchange to an extended length tracheostomy tube after 7.2 days from initial tracheostomy. Placement of an extended length tracheostomy tube can reduce cuff leak in ventilated COVID-19 patients and may be considered during initial tracheostomy placement.

Treatment of Primary Hyperparathyroidism in the Setting of Tatton-Brown-Rahman Syndrome

Tatton-Brown-Rahman syndrome (TBRS) is a rare overgrowth syndrome first described in 2014.1 This report describes a 17-year-old male with TBRS who presented with primary hyperparathyroidism (PH) and was found to have sestamibi positive imaging. The patient underwent a bilateral neck exploration where an ectopic parathyroid gland was localized and removed. The patient had no surgical complications, and his follow up visit showed normalization of parathyroid hormone and calcium levels. This report represents the importance of obtaining multiple imaging modalities during preoperative preparation for a parathyroidectomy in patients with TBRS. It also demonstrates the need for further publications of anatomic anomalies associated with PH in patients with TBRS in the future.

Head and Neck Ultrasound - EFSUMB Training Recommendations for the Practice of Medical Ultrasound in Europe

Different surgical and medical specialists increasingly use head and neck ultrasound and ultrasound-guided interventions as part of their clinical practice. We need to ensure high quality and standardized practice across specialties, and this position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describes the training requirements for head and neck ultrasound. Traditionally, a minimum number of ultrasound examinations indicates competence, but this is unreliable, and a general shift towards competence-based training is ongoing. For each EFSUMB level, we will outline the theoretical knowledge and skills needed for clinical practice. The recommendations follow the three EFSUMB competency levels for medical ultrasound practice. Level 1 describes the skills required to perform essential head and neck ultrasound examinations independently, level 2 includes ultrasound-guided interventions, while level 3 involves the practice of high-level neck ultrasound and use of advanced technologies. Our goal is to ensure high quality and standardized head and neck ultrasound practice performed by different clinical specialists with these recommendations.

The Management of Penetrating Neck Injury With Retained Knife: 15-Year Experience From a Major Trauma Center in South Africa

BACKGROUND

This study reviews our cumulative experience with the management of patients presenting with a retained knife following a penetrating neck injury (PNI).

METHODS

A retrospective cohort study was conducted at a major trauma center in South Africa over a 15-year period from July 2006 to December 2020. All patients who presented with a retained knife in the neck following a stab wound (SW) were included.

RESULTS

Twenty-two cases were included: 20 males (91%), mean age: 29 years. 77% (17/22) were retained knives and 23% (5/22) were retained blades. Eighteen (82%) were in the anterior neck, and the remaining 4 cases were in the posterior neck. Plain radiography was performed in 95% (21/22) of cases, and computed tomography (CT) was performed in 91% (20/22). Ninety-five percent (21/22) had the knife or blade extracted in the operating room (OR). Formal neck exploration (FNE) was undertaken in 45% (10/22) of cases, and the remaining 55% (12/22) underwent simple extraction (SE) only. Formal neck exploration was more commonly performed for anterior neck retained knives than the posterior neck, although not statistically significant [56% (10/18) vs 0% (0/18), P = .096]. There were no significant differences in the need for intensive care admission, length of hospital stay, morbidities, or mortalities between anterior and posterior neck retained knives.

DISCUSSION

Uncontrolled extraction of a retained knife in the neck outside of the operating room may be dangerous. Retained knives in the anterior neck commonly required formal neck exploration but not for posterior neck retained knives.

Delayed Hematogenous Metastasis Versus Second Primary Squamous Cell Carcinoma of the Neck in a Patient With Previous Cancer of the Cervix

Squamous cell carcinoma (SCC) of the uterine cervix commonly spreads through direct infiltration and disseminates by lymphatic or hematogenous pathways. The most frequent locations for metastasis are lungs, liver, and bone. Other distant metastatic sites are rare, with only 1 reported case of neck metastasis. We present here a 73-year-old female with a prior human papillomavirus (HPV) + SCC of the cervix that had metastasized to her peri-aortic lymph nodes. Eight years after diagnosis and treatment, she returned with a hypermetabolic supraclavicular lymph node and new left-sided neck mass. Biopsy of the neck mass revealed invasive SCC positive for high-risk HPV genotype. The presence of high-risk HPV genotypes in both the cervix and supraclavicular lymph node, without evidence of second primary tumor, implies that the neck mass is a delayed metastasis of the patient's previous cervical cancer. This marks the second recorded case of neck metastasis from a SCC of the cervix.

Reconstruction After Grizzly Bear Attack in Wyoming

Bear attacks are rare, although global incidents have been increasing. Injury patterns of bear attacks against humans consistently include injuries to the face, head, neck, chest, and upper extremities. Here, we have a brief report of a 59-year-old male hunter who was attacked by a grizzly bear in Wyoming. He sustained multiple lacerations to his face which included an avulsion of his nose and upper lip, as well as extensive associated facial fractures. Additional injuries included soft tissue and bony injuries to the upper extremities. He underwent 53 operations during his first hospitalization, primarily of facial reconstruction, which required nose and upper lip replant to his arm. His course was complicated by pressure ulcers, bacteria, acute kidney injury, and a urinary tract infection. After successful coordinated multidisciplinary care and a prolonged hospitalization, he was ultimately discharged to his home.

Favorable Early Outcomes With Thyroid Lobectomy for Low-Risk Papillary Thyroid Cancer: The Mayo Clinic Experience

BACKGROUND

Until 2015, standard of care for low-risk papillary thyroid cancer (PTC) >1 cm was a total or near-total thyroidectomy. Despite changes in guidelines and surgical management of low-risk PTC since 2015, little data are available regarding the effect on the need for additional surgery or risk for development of lymph node metastases. Our aim was to determine outcomes in patients who underwent initial thyroid lobectomy for low-risk PTC at a high-volume tertiary care institution.

METHODS

Retrospective review of patients ≥18 years old with biopsy proven low-risk PTC 1-4 cm who underwent partial thyroidectomy (eg, lobectomy/isthmusectomy) at Mayo Clinic, Rochester, MN, between March 2016 and June 30, 2019.

RESULTS

From 1481 thyroidectomies performed during study period, 940 contained PTC on final pathology. Of these, 87 (of 123) patients who had an initial thyroid lobectomy met inclusion criteria. Five (6%) of these patients proceeded to completion thyroidectomy (CT), with 3 requiring CT and radioactive iodine in the first postoperative year and 2 undergoing only CT in the second postoperative year. No postoperative complications were reported. No patient in this cohort required additional surgery or treatment for newly discovered lymph node metastases during the follow-up period. 43 (of 72, 60%) patients not on thyroxine therapy preoperatively were started on thyroxine therapy postoperatively.

CONCLUSIONS

Early outcomes for those undergoing thyroid lobectomy for low-risk PTC at our institution have been favorable. These results support the 2015 American Thyroid Association guidelines to offer lobectomy for those with low-risk PTC 1-4 cm.

Posterior Mediastinal Goiter Removal Through Cervical Incision

Intrathoracic goiter when encountered can be treated by thyroidectomy using cervical incision, only occasionally requiring extra cervical approach. We are reporting one such case in a patient with pituitary macroadenoma with extension of the adenomatous goiter into the posterior mediastinum. It was removed through the cervical collar incision using a vessel sealing device. There were no intraoperative and postoperative complications during the procedure. The need for extra cervical incision should be decided on a case-to-case basis to avoid the increased morbidity associated with sternotomy and lateral thoracotomy incision.

A Standard Protocol for the Production and Bioevaluation of Ethical In Vivo Models of HPV-Negative Head and Neck Squamous Cell Carcinoma

Preclinical cancer research increasingly demands sophisticated models for the development and translation of efficient and safe cancer treatments to clinical practice. In this regard, tumor-grafted chorioallantoic membrane (CAM) models are biological platforms that account for the dynamic roles of the tumor microenvironment and cancer physiopathology, allowing straightforward investigations in agreement to the 3Rs concept (the concept of reduction, refinement, and replacement of animal models). CAM models are the next advanced model for tumor biological explorations as well as for reliable assessment regarding initial efficacy, toxicity, and systemic biokinetics of conventional and emerging neoplasm treatment modalities. Here we report a standardized and optimized protocol for the production and biocharacterization of human papillomavirus (HPV)-negative head and neck chick chorioallantoic membrane models from a commercial cell line (SCC-25). Oral malignancies continue to have severe morbidity with less than 50% long-term survival despite the advancement in the available therapies. Thus, there is a persisting demand for new management approaches to establish more efficient strategies toward their treatment. Remarkably, the inclusion of CAM models in the preclinical research workflow is crucial to ethically foster both the basic and translational oncological research on oral malignancies as well as for the advancement of efficient cancer treatment approaches.

Management of Pediatric Nasoorbitoethmoid Complex Fractures at a Level 1 Trauma Center

PURPOSE

A universally accepted treatment algorithm for rare pediatric nasoorbitoethmoid (NOE) fractures has yet to be established. In this study, the authors examine how severity of pediatric NOE fractures interplays with patient characteristics, management choices, and complications from injury and surgical intervention at our institution.

METHODS

A retrospective chart review was performed for all cases of pediatric NOE fracture at a level 1 trauma center (University Hospital in Newark, New Jersey) between 2002 and 2014.

RESULTS

Fifteen of 1922 patients met our inclusion criteria. Ten (66.7%) demonstrated Markowitz type I injuries, 2 (13.3%) had type II NOEs, and 3 (20%) sustained type III fractures. Five (33.3%) of our patients were only monitored. Six (40.0%) were treated with plate fixation. One patient (6.7%) required enucleation alone, while 1 (6.7%) warranted enucleation with medial canthoplasty and plate fixation. Transnasal canthopexy was performed for 1 patient (6.7%). Zero patients managed without surgery had complications at 1-year follow-up. Surgical intervention was associated with complications in 4 of 15 patients. Both nonoperative treatment and plate fixation were associated with a higher rate of complications from initial injury or subsequent therapy when than other mentioned forms of treatment (P = .004).

CONCLUSION

Nonoperative management for nondisplaced fractures is associated with zero complications at 1-year follow-up in our data; plate fixation and watchful waiting yield significantly fewer postoperative complications and injury sequelae than surgical intervention for medial canthal tendon and globe injuries.

Craniofacial venous malformations treated by percutaneous sclerotherapy using polidocanol: a single-center experience

BACKGROUND

Percutaneous therapy with various sclerosants is an established treatment of venous malformations in general. We investigated the safety and effectiveness of polidocanol in the craniofacial region.

PURPOSE

To present and evaluate our subjective and objective mid- and long-term results of patients with craniofacial venous malformations (CFVM) after percutaneous sclerotherapy using polidocanol.

MATERIAL AND METHODS

Twenty patients with CFVM treated by percutaneous sclerotherapy were followed up and asked to fill in a questionnaire comparing levels of the following CFVM-related symptoms before and after treatment: pain; functional impairment; cosmetic deformities; and impairment in daily life. Additionally, both size reduction as well as procedural-related complication rates were analyzed.

RESULTS

Evaluation of the questionnaire revealed an improvement or complete relief of CFVM-related symptoms with significant reduced impairment in daily life after percutaneous sclerotherapy. Eighteen (90%) patients noticed a post-sclerotherapy improvement of at least one of their corresponding symptoms and expressed satisfaction with regard to their treatment. For 13 patients, a > 50% size reduction of the CFVM could be observed, while seven exhibited a < 50% size reduction. One minor complication was encountered in 56 treatment sessions (1.8%).

CONCLUSION

Percutaneous sclerotherapy using polidocanol is a well-tolerated treatment for CFVM with a low complication rate. Size reduction and positive results with improvement of different clinical symptoms can be achieved.

Ultrasonographic Detection of Airway Obstruction in a Model of Obstructive Sleep Apnea

Purpose Obstructive sleep apnea (OSA) is a common clinical disorder characterized by repetitive airway obstruction during sleep. The gold standard for diagnosis of OSA, polysomnogram (PSG), cannot anatomically localize obstruction. Precise identification of obstruction has potential to improve outcomes following surgery. Current diagnostic modalities that provide this information require anesthesia, involve ionizing radiation or disrupt sleep. To mitigate these problems, we conceived that ultrasound (US) technology may be adapted (i) to detect, quantify and localize airway obstruction and (ii) for translational application to home-based testing for OSA. Materials and Methods Segmental airway collapse was induced in 4 fresh cadavers by application of negative pressure. Following visualization of airway obstruction, a rotary US probe was used to acquire transcervical images of the airway before and after induction of obstruction. These images (n=800) were analyzed offline using image processing algorithms. Results Our results show that the non-obstructed airway consistently demonstrated the presence of a US air-tissue interface. Importantly, automated detection of the air-tissue interface strongly correlated with manual measurements. The algorithm correctly detected an air-tissue interface in 90% of the US images while incorrectly detecting it in 20% (area under the curve=0.91). Conclusion The non-invasive detection of airway obstruction using US represents a major step in expanding OSA diagnostics beyond PSG. The preliminary data obtained from our model could spur further research in non-invasive localization of obstruction. US offers the benefit of precise localization of the site of obstruction, with potential for improving outcomes in surgical management.

Can New Ultrasound Signs Help in Identifying Follicular Variant of Papillary Carcinoma of Thyroid? - A Pilot Study

AIM

To describe two new ultrasound signs for thyroid nodules - "nodule in nodule" and "hypoechoic internal septae" and assess their usefulness in differentiating follicular variant of papillary thyroid carcinoma (FVPTC) from benign thyroid nodules (BTN).

METHODOLOGY

Ultrasound findings of 210 patients with histopathologically proven FVPTC (68 nodules, M:F=13:47 with mean age of 39.5±11.9 years) and BTN (165 nodules, (M:F=41:109 with mean age of 44±11.3 years) were retrospectively reviewed from PACS by a single radiologist blinded to the final diagnosis. Logistic regression analysis was performed to identify the best predictors of FVPTC and their diagnostic performance was assessed.

RESULTS

The "nodule in nodule" sign was seen in 80.9% of FVPTC and only 12.1% of BTN. The "hypoechoic internal septae" sign was seen in 44.1% of FVPTC and 17% of BTN. Younger patients, heterogeneous echotexture, nodule in nodule sign, thick incomplete non-uniform halo and presence of significant nodes were the best predictors of FVPTC (p<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and relative risk for FVPTC given as odds ratio (95% CI) for heterogeneous echotexture and nodule in nodule sign which were the best 2 predictors of FVPTC were 91.2%, 81.8%, 67.3%, 95.7%, 84.5%, 46.5 (18.5-117.4) and 80.9%, 87.7%, 74.3%, 91.2%, 86.2%, 32.5 (15.04-70.2), respectively. There was improvement in the specificity (91.5%) and accuracy (86.6%) when a combined criterion of heterogeneous echotexture and nodule in nodule sign was applied to predict FVPTC.

CONCLUSION

The "nodule in nodule" sign is common in FVPTC and when combined with heterogeneous echotexture can differentiate FVPTC and BTN with high specificity.

Ventricular dilatation in ex-prematures: only confined to the occipital region? MRI-based normative standards for 19-year-old ex-prematures without major handicaps

BACKGROUND

Premature birth may be associated with white matter injury later developing with widening of the ventricles. However, population-based data on normal ventricular size by age are sparse, making the evaluation of possible ventricular dilatation difficult.

PURPOSE

To present the linear measurements of the ventricular system, to compare these to subjectively assessed ventricular size, and to examine differences in ventricular size between ex-prematures and controls.

MATERIAL AND METHODS

Eligible survivors (n = 113) from the initial birth cohort (n = 217, born in 1986-1988, birth weight <2000 g) underwent MRI during 2006-2007. One hundred and three were ex-premature and included in the study. The ventricular size was subjectively judged by a pediatric neuroradiologist, and scored as normal, mildly, moderately, or severely dilated. Objective measurements, including width and depth of the frontal and occipital horns, were performed in a blinded fashion, by a pediatric radiologist.

RESULTS

The normative standards for different parts of the ventricular system in ex-premature young adults varied considerably. We found significant associations between the objective measurements and the subjectively classification of ventricular dilatation. Ex-prematures had smaller heads than those born term (control group). After adjustment for head circumference, there were no significant group differences regarding the frontal horns, but the occipital horns were proportionately wider among ex-prematures.

CONCLUSION

Young adults born prematurely, with a birth weight <2000 g, do not have larger lateral ventricles than healthy controls born term, even after correcting for a smaller head size. However, they do have larger occipital horns, confirming previous studies and strengthening our belief of a specific vulnerability of the occipital region.

Acute prevertebral calcific tendinitis: a source of non-surgical acute cervical pain

BACKGROUND

Prevertebral calcific tendinitis results from calcium hydroxyapatite crystal deposits in the longus colli muscles, which induce symptoms similar to some surgically-treated conditions, such as retropharyngeal abscesses. Imaging techniques are critical for accurate diagnosis.

PURPOSE

To describe the computed tomography (CT) findings associated with prevertebral calcific tendinitis.

MATERIAL AND METHODS

Retrospective analysis performed in an 18-month period, searching for patients with neck CT and reports with diagnosis of "calcific longus collis tendinitis" or "prevertebral calcific tendinitis". CT images and clinical data available in the medical records were analyzed.

RESULTS

One hundred and thirty-four examinations were performed in the period studied. Nine patients who fulfilled inclusion criteria were identified and their CT imaging characteristics are presented. Six presented with calcific deposits in the right longus colli muscle. CT matched the clinical pain lateralization in all cases. Eight patients had no significant enhancement post injection of contrast media.

CONCLUSION

Prevertebral calcific tendinitis is a cause of acute cervical pain that clinically mimics a retropharyngeal abscess, however on neck CT has a characteristic appearance. Correct identification of this pathologic condition will help avoiding unnecessary invasive procedures.