The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].     

U50,488H对正常及缺氧心肌细胞L型钙电流的作用

目的 探讨心脏阿片受体和β-受体相互作用的机制。方法 采用全细胞膜片钳技术，观察U50，488H(β-阿片受体选择性激动剂)对正常和缺氧心肌细胞L型钙电流的作用。结果 U50，488H剂量依赖性(0．1～100μmol／L)抑制正常心肌细胞的L型钙电流及异丙肾上腺素(0．1μmol／L)激动的钙电流，而细胞缺氧后，这一抑制作用减弱；U50，488H对Forskolin(10μmol／L)激动的L型钙电流无明显影响。结论 β-阿片受体对β-受体信号的负性调节作用在细胞缺氧后减弱，其作用位点可能发生于β-受体与腺苷酸环化酶环节之间。     

Overtraining syndrome : la piste de la suractivité ?

Introduction

Overtraining is clearly a multifactorial disturbance. We aimed at evaluating the relative importance of overactivity and nutritional imbalances.

Methods

A comparison of 17 footballers with seven subjects with a diagnosis of overtraining evidenced that the two groups differ by energy expenditure resulting from physical activity (1573 ± 378.6 kcal/d from 804.7 ± 184.7 kcal/d) while food intake does not exhibit significant differences.

Conclusion

In this sample of subjects, inadequate food intake is found in both groups, so that overtraining appears rather characterized by a higher level of physical activity. Therefore, a relative energy deficit resulting from overactivity rather than dietary mistakes appears to explain the syndrome in these athletes, who are thus truly “overtrained”.     

Prenatal detection of brain anomalies with ultrasonography

Ultrasound is the first-line imaging study of the fetal brain performed at 12, 22 and 32 weeks of gestation. The very structured evaluation of biometric and morphological data, facilitated by the use of a checklist, ensures a high quality examination. All patients where an anomaly of any key element is suspected should be referred to a center dedicated to prenatal diagnosis for confirmation irrespective of the gestational age. Prenatal diagnosis plays a significant role in France since medical interruption of pregnancy until term is authorized.     

Medición del T2* hepático y cardíaco en la hemocromatosis secundaria

Objective

To determine whether there is iron overload by calculating the T2* value in the liver and myocardium in patients with secondary haemochromatosis. To analyse the correlation of the values obtained with the iron levels in blood, with the liver iron concentration (LIC) calculated using magnetic resonance (MR) imaging, and the correlation between them.

Material and methods

A total of 16 patients (13 males, 3 females), with a mean age of 61 years, were included and evaluated in the years 2008 and 2009. Fifteen of them had received multiple transfusions, and one was diagnosed with hereditary sideroblastic anaemia.The measurements included, blood ferritin, LIC by MRI, cardiac function using MRI and the T2* value by means of multi-echo sequences in the liver (TR/TE1/ΔTE/No of echos/α: 21/1,18/1.0/20/35°) and myocardium (26/1.04/0.8/30/60°). A correlation-regression analysis was performed by comparing the cardiac and liver T2* values with the ferritin, LIC and between each of them.

Results

A total of 13 patients had ferritin values greater than 1000 ng/ml (median/minimum/maximum: 1762/294/3785 ng/ml). An increased LIC greater than 80 μmol/g (median/minimum/maximum: 125.4/41.2/241.5 μmol/g) was observed in 13 patients. In all cases cardiac function was conserved, and in 15 cases the liver T2* value was less than 6.3 ms. The myocardium T2* value was less than 20 ms. in only one case. A high correlation was observed between the liver T2* values and the LIC (r: -0.912). The correlation was statistically significant between the liver T2* value and ferritin (r: -0.541). The correlations between myocardium T2* and ferritin, myocardium T2* and LIC, and myocardium T2* and liver T2* were not statistically significant.

Conclusions

The liver T2* showed a high correlation with LIC and a statistically significant correlation with ferritin. No association was observed between the myocardium T2* values and ferritin in blood, the LIC or the liver T2* value.     

Comparison of irradiation for tomosynthesis and CT of the wrist

Purpose

Tomosynthesis is a novel imaging modality based on the use of flat-panel detector technology. Its impact in the evaluation of the post-traumatic wrist has yet to be defined. The low associated radiation dose is one of its main advantages. Comparison of radiation doses between tomosynthesis, radiographs and CT is thus necessary.

Materials and methods

The delivered doses for a five-view wrist radiographic examination, frontal and lateral tomosynthesis and CT were measured using radiothermoluminescent dosimeters.

Results

Biplane tomosynthesis has the lowest delivered dose with 25% less radiation than a standard five-view radiographic examination (0.72 versus 0.96 mGy), and a 28-fold radiation reduction compared to CT (19.8 mGy).

Conclusion

Tomosynthesis delivers less radiation than a standard radiographic examination. For the wrist, it results in a 28-fold reduction in radiation compared to CT.     

Advanced imaging of melorheostosis with emphasis on MRI

Objective: To describe the CT and MR imaging appearance of both osseous and extraosseous manifestations of melorheostosis. Design and patients: We retrospectively reviewed the CT (n=7) and/or MR imaging findings (n=12) of 17 patients with characteristic radiographic findings of melorheostosis (undulating cortical hyperostosis with marked uptake on radionuclide bone scintigraphy). Results: CT and MR imaging revealed cortical hyperostosis as high attenuation and low signal intensity on all MR pulse sequences, respectively. Encroachment on the marrow space was seen in all cases resulting from endosteal involvement. Thirteen patients demonstrated 14 soft tissue masses with infiltrative margins in 80% of cases and seven showed extensive mineralization on CT or MR imaging (low intensity on all pulse sequences). Seven soft tissue masses were predominantly nonmineralized with intermediate signal intensity on T1-weighted and intermediate to high signal on T2-weighted MR images corresponding to vascularized fibrous tissue with variable collagen content pathologically. Enhancement after intravenous gadolinium was seen in all patients imaged with soft tissue masses (n=2). Two patients demonstrated muscle atrophy resulting from nerve involvement. Conclusions: The osseous abnormalities in melorheostosis are identical on advanced imaging and radiographs. Mineralized or nonmineralized soft tissue masses should be recognized as another manifestation of this disease as opposed to a more ominous finding, making biopsy unwarrranted. Received: 16 January 2001 Accepted: 21 February 2001     

Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures)

Fractures involving the articulating surfaces of bone are a common cause of chronic disability after joint injury. Acute fractures of the articular surface typically run parallel to the surface and are confined to the cartilage and/or the immediate subchondral cancellous bone. They should be distinguished from vertical or oblique bone fractures with intra-articular extension. This article reviews the mechanism of acute articular surface injuries, as well as their incidence, clinical presentation, radiologic appearance and treatment. A classification is presented based on direct inspection (arthroscopy) and imaging (especially MRI), emphasizing the distinction between lesions with intact (subchondral impaction and subchondral bone bruises) and disrupted (chondral, osteochondral lesions) cartilage. Hyaline cartilage, subchondral bone plate and subchondral cancellous bone are to be considered an anatomic unit. Subchondral articular surface lesions, osteochondral fractures and solely chondral fractures are different manifestations of impaction injuries that affect the articulating surface. Of the noninvasive imaging modalities, conventional radiography and MRI provide the most relevant information. The appropriate use of short tau inversion recovery, T1-weighted and T2-weighted (turbo) spin-echo as well as gradient-echo sequences, enables MRI to classify the various acute articular surface lesions with great accuracy and provides therapeutic guidance. Received: 5 April 1999 Revision requested: 6 May 1999 Revision received: 21 June 1999 Accepted: 12 July 1999     

Effect of contrast media on single‐shot echo planar imaging: Implications for abdominal diffusion imaging

Purpose:

The goal of this study was to determine the effect of contrast media on the signal behavior of single‐shot echo planar imaging (ssEPI) used for abdominal diffusion imaging.

Materials and Methods:

The signal of an ssEPI spin echo sequence in a water phantom with varying concentrations of gadolinium was modeled with Bloch equations and the predicted behavior validated on a phantom at 1.5T. Six volunteers were given gadolinium contrast and signal intensity (SI) time courses for regions of interest (ROIs) in the liver, pancreas, spleen, renal cortex, and medulla were analyzed. Student's t‐test was used to compare precontrast SI to 0, 1, 4, 5, 10, and 13 minutes following contrast.

Results:

The results show that following contrast ssEPI SI goes through a nadir, recovering differently for each organ. Maximal contrast‐related signal losses relative to precontrast signal are 20%, 20%, 53%, and 67% for the liver, pancreas, renal cortex, and medulla, respectively. The SIs remain statistically below the precontrast values for 5, 4, and 1 minute for the pancreas, liver, and spleen, and for all times measured for the renal cortex and medulla.

Conclusion:

Abdominal diffusion imaging should be performed prior to contrast due to adverse effects on the signal in ssEPI. J. Magn. Reson. Imaging 2009;30:1203–1208. © 2009 Wiley‐Liss, Inc.     

Kausalitätsprobleme beim nachweis der tötung des neugeborenen

Zusammenfassung ]1. In den Jahren 1948–1968 wurden 89 Obduktionen von Tot- und Lebendgeburten im Hinblick auf den Nachweis eines fremden Verschuldens durchgeführt. In 22 Fällen (24,7%) konnte die Todesursache durch die Obduktion allein geklärt werden. Hiervon war in 20 Fällen (22,5%) der gewaltsame Tod des Neugeborenen zu beweisen.2. Nach Durchführung feingeweblicher Untersuchungen und Hinzuziehung der Ermittlungsakten konnte in weiteren 11 Fällen (12,4%) das Tötungsdelikt bestätigt werden. In 7 Fällen (7,8%) wies zwar die Geburtssituation auf eine Tötung des Neugeborenen hin, der Tod ließ sich jedoch durch Geburtskomplikationen erklären.3. In 49 Fällen (55,0%) konnte die gestellte Beweisfrage nicht geklärt werden. Es Bestanden sowohl Hinweise, daß gegen das Kind gerichtete Handlungen bzw. Unterlassungen stattgefunden haben, als auch pathologisch-anatomische Befunde, die als Geburtskomplikationen zu interpretieren sind. Darüber hinaus war die Aufklärung durch weiter fortgeschrittene Leichenzersetzung erschwert.4. Nach unserem Material hat sich die Häufigkeit der Tötung des Neugeborenen, sowie die Art und Weise der Begehung dieses Deliktes in den letzten 20 Jahren nicht verändert.

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Problems in the diagnosis of homicide in newborns

Summary In the years of 1948 to 1968 there were carried out 89 forensic post mortem investigations of still borns and life borns.In two cases there could be proved by post mortem investigation an intrauterine death of fetus with beginning mazeration. There were no indications of outside influences that might have caused the death of the newborns.In another 20 cases violent death could be proved only by post mortem investigation.There are the following manners of death: Partial to complete severance from the neck with sharp instruments (scissors, knife, spade) 3 cases. Strangulation 5 cases. Suffocation by violent occlusion of mouth and nose (soft coverings, manual, by gag) 7 cases. Scald (immediatetly after birth the newborn was held under hot water) 1 case.Consequently only 24,7% of the cases could be cleared through post mortem investigation. Of the remaining 67 post mortem investigations that is 75,3%, 11 cases could be proved to be violent cases of death with the help of histological examinations and consulting of the investigation results.There are the following manners of death: Death by drowning (birth into the lavatory, pail or other containers) 5 cases. Death by suffocation or drowning (newborn was left lying between the legs of mother) 3 cases. Death by suffocation 2 cases. Death by suffocation (child was wrapped up in a towel and put into a wardrobe) 1 case.In some further 7 cases the outer circumstances gave hint to an hostile action towards the newborn (i.e. concealment of pregnancy and birth, birth into the lavatory, into a pail), however death could be also explained as a consequence of birth-complications as there are premature birth, lesion of the tentorium cerebelli, aspiration of amniotic fluid.In 49 cases (55%) there could not be proved either killing nor death by birth injuries. This high rate deals mainly with unknown corpses (35 cases), which were found in water, in ruins, on cemeteries, in houses and left luggage offices. The corpses were in bad condition, sometimes only the torso or the extremities were left.From 89 post mortem investigations there were 39 (43,8%) premature births. The reason for the relatively high premature birth rate is under discussion.According to our material the frequency of homicide as well as the way of committing this delict has not changed during the last 20 years.

     

Bilateral obturator hernias: Case report, radiographic characteristics, and brief review of literature

Obturator hernia is a rare cause of intestinal obstruction, and bilateral obturator hernias are even rarer. Early diagnosis can decrease the morbidity and mortality associated with these lesions. We present the case of a patient with bilateral obturator hernias, discuss the radiographic findings, and briefly review the literature.