Abnormal findings in hallucal sesamoids on MR imaging—Associated with different pathologies of the forefoot? An observational study

Background

To evaluate the prevalence and localization of abnormalities in the hallucal sesamoids detectable by magnetic resonance (MR) imaging in patients with forefoot pain and to determine which pathologies of tarsus, metatarsus and phalanges are associated with these abnormalities.

Materials and methods

The forefoot MRI examinations of 50 consecutive patients (32 females, 18 males; mean age 51 years, age range 20-86 years) were retrospectively analyzed by two musculoskeletal radiologists. A minimum of coronal and sagittal T1-weighted images and STIR images or T2-weighted images with fat saturation were performed on a 1.5-T scanner. Abnormal findings in the sesamoids were correlated with pathology in the I.MTP (metatarsal-phalangeal) joint, pathology in other parts of the forefoot and clinical information.

Results

Signal abnormalities of the sesamoids were found in 7 patients out of 50 (14%). Two patients presented a bone marrow edema (BME) in both sesamoids, in 1 patient only the lateral one was affected; all three associated with pathology and pain in the I.MTP joint. In four patients only the medial sesamoid was affected, not associated with pathology in the I.MTP joint but with pathology in other parts of the forefoot.

Conclusion

The prevalence of signal abnormalities in hallucal sesamoids was 14%. BME of the lateral sesamoid or of both were predominantly associated with pathology in the I.MTP joint. In contrast, signal abnormalities of the medial sesamoid, without affection of the lateral one, were associated with pathology in other parts of the forefoot suggesting an overuse injury as a result of compensating posture.     

Is marathon running toxic? An observational study of cardiovascular disease prevalence and longevity in 54 male marathon runners

Objectives: Recent literature suggests reduced benefits associated with high intensity (HIT) and or sustained intensity exercise training (SIT). While important, they tend to contrast with other studies of HIT and SIT and may not be representative of all individuals wishing to participate in activities such as marathon running. The purpose of this observational report is to describe a 45-year history of 54 long distance runners, their incidence of death from cardiovascular disease and their ages at death compared to the normal population.

Methods: Data were collected longitudinally on all 54 members of a Southern California mens running club by the author, a cardiologist with 45 years of experience, member of the running club, and personal physician for most of the men for over 40 years. Retrospective and observational data were collected from direct professional and personal contact with the 54 men in the running club.

Results: Closely monitored group of marathon runners with extreme HIT and SIT revealed a low incidence of cardiovascular disease (CVD) with an extended longevity relative to the general population.

Conclusion: The benefits of exercise for reducing risk of chronic disease, including CVD, are well known. Whether these benefits extend to the more intense and prolonged exercise associated with marathon running is unclear. However, as evidenced in the observational data presented here, at least in some populations, years of high-intensity, prolonged exercise may not be as toxic as suggested by others. Whether this is due to self-selection or predisposition is not well understood but merits further study.     

Is there a causal relationship between the hypoxia–ischaemia associated with cardiorespiratory arrest and subdural haematomas? An observational study

The aim of this study was to determine the frequency of subdural haematomas (SDHs) occurring in infants presenting following atraumatic cardiorespiratory collapse. This study was a review of retrospective case notes, brain imaging and post-mortem examinations carried out in the paediatric intensive care unit (PICU) and emergency department (ED) in a tertiary paediatric centre in the UK. The study included infants and children less than 4 years old dying in the ED or admitted to the PICU after atraumatic cardiorespiratory arrest. We identified macroscopic SDHs on brain imaging or post-mortem examination. Of those children who experienced a cardiorespiratory arrest from a non-traumatic cause and met inclusion criteria, 33 presented and died in the ED and 17 were admitted to the PICU. These children had a post-mortem examination, brain imaging or both. None of these infants had a significant SDH. One child had a small clot adherent to the dura found on post-mortem and two had microscopic intradural haemorrhage, but it is unclear in each case whether this was artefact, as each had otherwise normal brains. Subdural haematoma arising in infants or young children in the context of catastrophic cardiorespiratory compromise from a non-traumatic cause was not observed.There is wide consensus that the triad of coincidental injuries consisting of encephalopathy, subdural haematoma (SDH) and retinal haemorrhages is strongly associated with non-accidental head injury (NAHI). However, in the absence of other somatic signs or symptoms of trauma, such as unusual bruises or fractures, the diagnosis of NAHI based solely upon the triad of findings remains contentious. The possibility of a non-accidental cause may be suggested by an inconsistent or changing history. In such cases the interpretation of radiological and pathological findings is often central to the determination of a diagnosis.Recent publications have reviewed the anatomy of the dura, with particular reference to that of the infant [1], and the putative role of hypoxia–ischaemia in the causation of SDHs in infancy [2]. If a causal relationship between hypoxia–ischaemia associated with cardiorespiratory arrest and SDH is confirmed, the significance of SDHs seen in infants admitted with unexplained encephalopathy and who are found to have SDHs on admission brain imaging may have potentially profound medicolegal implications. So far, this association has been generated by research emanating from neuropathological sources and has not been supported by widespread clinical experience, the general literature of hypoxic–ischaemic encephalopathy in early life [3, 4], radiological literature [5–10] and a recent multicentre multinational post-mortem (PM) examination study [11]. It is particularly pertinent that the extensive imaging literature relating to radiological manifestations of hypoxic–ischaemic injury in early life does not refer to or identify SDH as a component of the injury spectrum or as a sequela.In this retrospective study, we investigate a cohort of infants and young children who have experienced cardiorespiratory arrest, with the aim of determining whether severe hypoxic–ischaemic episodes result in macroscopic SDH.     

Estimation of sex and age of “virtual skeletons”–a feasibility study

This article presents a feasibility study with the objective of investigating the potential of multi-detector computed tomography (MDCT) to estimate the bone age and sex of deceased persons. To obtain virtual skeletons, the bodies of 22 deceased persons with known age at death were scanned by MDCT using a special protocol that consisted of high-resolution imaging of the skull, shoulder girdle (including the upper half of the humeri), the symphysis pubis and the upper halves of the femora. Bone and soft-tissue reconstructions were performed in two and three dimensions. The resulting data were investigated by three anthropologists with different professional experience. Sex was determined by investigating three-dimensional models of the skull and pelvis. As a basic orientation for the age estimation, the complex method according to Nemeskéri and co-workers was applied. The final estimation was effected using additional parameters like the state of dentition, degeneration of the spine, etc., which where chosen individually by the three observers according to their experience. The results of the study show that the estimation of sex and age is possible by the use of MDCT. Virtual skeletons present an ideal collection for anthropological studies, because they are obtained in a non-invasive way and can be investigated ad infinitum.     

Gender differences in female and male Australian Football injuries — A prospective observational study of emergency department presentations

ObjectivesTo compare injury-profiles of females and males presenting to Emergency Departments (EDs) with an Australian Football injury.DesignProspective observational study.MethodsAll patients presenting to one of 10 EDs in Victoria, Australia, with an Australian Football injury were included in the study. Data were prospectively collected over a 10 month period, coinciding with a complete Australian Football season, including pre-season training and practice matches. Relevant information was extracted from patient medical records regarding injury-type, body part injured, investigations and treatments required. Female and male data were compared with chi-squared and Fisher’s exact tests.Results1635 patients were included, of whom 242 (14.8%) were female. Females had a higher proportion of hand/finger injuries (34.3% v 23.4%), neck injuries (6.6% v 2.5%) and patella dislocations (2.9% v 0.6%). Males had a higher proportion of shoulder injuries (11.5% v 5.8%), skin lacerations (8.0% v 1.7%), and thorax/abdominal/pelvic injuries (5.7% v 2.1%). Concussion rates were similar between the genders, occurring in 14.1% of all patients. Anterior cruciate ligament injuries were infrequent (1.0%) and not significantly different between genders. Females received more imaging investigations (83.1% v 74.7%) and analgesia (62.4% v 48.5%). A higher proportion of males required admission to hospital (5.0% v 2.1%), usually for surgery.ConclusionAustralian Football injury profiles differed between females and males. Gender-specific injury prevention and management programs would be indicated based on the study findings.     

An experimental and theoretical study of pendellösung fringes in synchrotron section topographs of silicon wafers

X-ray section topographs of nearly perfect Czochralski-grown wafers were made with synchrotron radiation having a continuous spectrum. An intensity curve measured from the x-ray film is compared to the calculated curve obtained using the dynamical theory of x-ray diffraction. A computer simulation of the topograph is also presented. A good agreement between theory and experiment is found except in the middle part of the topograph.     

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management

Background

Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair.

Material and methods

Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as “minor CT findings.” The presence of abdominal guarding and/or abdominal pain was considered as “clinical signs.” Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI).

Results

Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p?=?0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR?=?8.1; 95% CI, 1.2–53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively).

Conclusion

In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more “minor CT findings” is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

     

Embolization with “Ethibloc” of vascular tumors and arteriovenous malformations in the head and neck

Summary Ethibloc has been used almost exclusively until now for embolization of tumors and bleeding vessels in the liver and kidney. Unlike with Gelfoam-particles, there is no recanalization. The resorption occurs so slowly that there is no interference with the necrosis of the embolized tumor. Due to its low viscosity, it passes catheters with thin lumina and fills the capillary bed of the tumor without danger of reaching the venous vessels. In this paper we describe a new technic of percutaneous catheter-embolization with Ethibloc using a coaxial catheter which we believe enhances safety and effectiveness. It has been successfully used in five patients. In the meantime two more patients have been treated successfully.Presented in part at the 17th Annual Meeting of the German Society of Neuroradiology, 9–10 October 1981 in Tübingen, FRG.     

An autopsy case report of tramline bruises with various shapes –histological and mechanistic considerations–

An autopsy case involving a child showing various shapes of tramline bruises caused by a single weapon is described. On autopsy, multiple tramline bruises in different orientations were found, mainly on the back. Shapes of the tramline bruises were variable, including linear, arcuate, nodular, hook-like, and hook-like with a knot at the end. Due to the presence of severe subcutaneous hemorrhages and the absence of other potentially fatal injuries or diseases, we determined the cause of death to be traumatic shock. Microscopically, of the many tramline bruises, characteristic hemorrhages were observed on the right abdominal and left lumbar regions. Those hemorrhages were observed in the dermis, corresponding to macroscopic tramline bruises. Hemorrhage was also observed in the subcutis, corresponding to the pallor of the outer surface. The mechanisms by which tramline bruises occurred in the dermis and subcutis in this case are discussed with reference to the literature. We also propose subcutaneous and intradermal hemorrhagic types of tramline bruising.     

Is chemoradiation as effective as surgery with postoperative radiotherapy for locally advanced (operable) head and neck cancer? A retrospective observational study

OBJECTIVE: To determine whether chemoradiation (CX) is as effective as surgery with postoperative radiotherapy (SX) for operable, locally advanced head and neck cancer (LAHNC). METHODS: A retrospective review of 78 patients with operable stage III or IV cancer of the upper aerodigestive tract who were treated by CX (n = 25) or SX (n = 53) during a 20-year period was undertaken. RESULTS: Fewer patients relapsed regionally when treated by SX than by CX (p = 0.006). On the other hand, there was no significant difference in local recurrence, distant metastasis, 2-year survival rate, or 5-year survival rate between the two patient groups. CONCLUSION: Our results suggesting that CX is not as effective as SX for patients with operable LAHNC calls for a randomized trial comparing CX to SX in such cases.     

Twitter and brachytherapy: An analysis of “tweets” over six years by patients and health care professionals

PurposeTwitter may reflect attitudes underrepresented in traditional surveys. This study aimed to understand professionals' and patients’ thoughts regarding brachytherapy on Twitter.Methods and MaterialsTwitter was queried with “brachytherapy” to identify all tweets about patients' experiences from January 2012 to May 2017. A random sample of tweets by health care professionals containing “brachytherapy” was obtained using the first weekly tweet in the same interval. Consensus coding was used to categorize tweets as “patient” or “professional” based on content about receiving brachytherapy or self-identification as a health care professional. Tweets were analyzed for positive, neutral, or negative sentiment and recurrent themes using manual, iterative coding. Patient tweets were analyzed for whether they were shared before or after treatment and whether the patient, friends, or family had posted them. Professional tweets were analyzed to identify temporal theme changes.ResultsOne hundred sixty-two patient tweets and 260 professional tweets were obtained from January 2012 to May 2017. On average, 2.5 patient tweets were shared monthly compared to 69 for providers. Among tweets by patients and professionals, 57% vs. 12% expressed positive sentiment, 21% vs. 3% negative sentiment, and 22% vs. 85% neutral sentiment, respectively. The most common patient and professional codes were “general sharing of experience/casual conversation” (32%) and “science” (21%), respectively.ConclusionsPatients tweeted less about brachytherapy than professionals and generally expressed favorable and negative sentiments regarding their radiation treatment experiences. Professionals tended to express neutral sentiment and focus on research. Opportunities exist for greater radiation oncologist engagement in this medium.     

Comparison of manual and semi-automatic measuring techniques in MSCT scans of patients with lymphoma: a multicentre study

Objectives

Multicentre evaluation of the precision of semi-automatic 2D/3D measurements in comparison to manual, linear measurements of lymph nodes regarding their inter-observer variability in multi-slice CT (MSCT) of patients with lymphoma.

Methods

MSCT data of 63 patients were interpreted before and after chemotherapy by one/tworadiologists in five university hospitals. In 307 lymph nodes, short (SAD)/long (LAD) axis diameter and WHO area were determined manually and semi-automatically. Volume was solely calculated semi-automatically. To determine the precision of the individual parameters, a mean was calculated for every lymph node/parameter. Deviation of the measured parameters from this mean was evaluated separately. Statistical analysis entailed intraclass correlation coefficients (ICC) and Kruskal–Wallis tests.

Results

Median relative deviations of semi-automatic parameters were smaller than deviations of manually assessed parameters, e.g. semi-automatic SAD 5.3 vs. manual 6.5 %. Median variations among different study sites were smaller if the measurement was conducted semi-automatically, e. g. manual LAD 5.7/4.2 % vs. semi-automatic 3.4/3.4 %. Semi-automatic volumetry was superior to the other parameters (2.8 %).

Conclusions

Semi-automatic determination of different lymph node parameters is (compared to manually assessed parameters) associated with a slightly greater precision and a marginally lower inter-observer variability. These results are with regard to the increasing mobility of patients among different medical centres and in relation to the quality management of multicentre trials of importance.

Key Points

? In a multicentre setting, semi-automatic measurements are more accurate than manual assessments. ? Lymph node volumetry outperforms all other semi-automaticallyand manually performed measurements. ? Use of semi-automatic lymph node analyses can reduce the inter-observer variability.     

Comparative study of on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease

Minimalinvasivesurgeryhasbecomepopularsince2 0thcentury .Withregardtocoronaryarterybypasssurgery,avoidingcardiopulmonarybypass(CPB)hasavitalsignificanceoftheminimalinvasivesurgery ,foritcanavoidtheischemia reperfusioninjuryandaseriesofpathophysiologicaldisordersoftheorgansbroughtbytheCPB .SinceBenettiandBuffolo[1-2 ] firstreportedtheirexperiencesofoff pumpCABG ,(OPCAB) ,quiteafewliteratureshavecomparedtheeffectbetweenOPCABandconventionalon pumpCABG (CCABG ) .Forthedifferenceofpatie…     

Inadvertent intraarterial injection of ¹⁸F-FDG: a case report and literature review of hot forearm and hot hand signs

Unintentional intraarterial injection of radiotracers may cause artifacts leading to difficulties in accurately interpreting PET/CT images. We report a case of a 73-y-old man with a history of metastatic colon cancer who underwent a PET/CT scan for restaging. In the PET scan, there was intense and diffuse distribution of (18)F-FDG in his left forearm and hand. This is a classic sign of an accidental intraarterial injection of (18)F-FDG in the antecubital region. Similar phenomena after inadvertent intraarterial injection of other radiotracers are reviewed. The associated risk factors, preventive measures, and radiation dose to the arm are discussed.