Intracranial complications from ENT infections

Sinonasal and temporal bone infections may extend to the skull, skull base, meninges, pericerebral spaces, brain parenchyma, dural sinuses, deep cerebral or cortical veins, intracranial arteries and cranial nerves either via contiguous or hematogeneous spread. The site of infection dictates the sites of potential complications: orbital with ethmoid sinusitis, cavernous sinus thrombophlebitis and oculomotor palsies with sphenoid sinusitis, transverse sinus thrombophlebitis with mastoiditis and superior sagittal sinus thrombophlebitis with frontal sinusitis. All may result in brain abscess. Congenital and acquired defects of the skull and meninges, with or without associated meningocele or meningoencephalocele, perilymphatic fistulas, and some anomalies of the inner ear may predispose to the intracranial extension of ENT infections.     

Intra-arterial treatment of liver metastases from colorectal carcinoma

Colorectal carcinoma is a major public health concern with its yearly mondial incidence of about one million cases and yearly mortality of 500,000 cases. The liver is the organ most frequently affected by metastases with a frequency of 40 to 60% (contemporaneous in 25% of cases). While surgical resection is the only curative therapy, many patients are not such candidates due to the infiltrative nature of the liver metastases. Systemic chemotherapy and biotherapy regimens are the conventional treatment options for patients with multiple liver metastases. Under such circumstances, intra-arterial therapy may play a major role. We will review the main types of endovascular therapies for liver metastases from colorectal carcinoma including indications, results and potential complications.     

Imaging evaluation of head and neck infections

Infections of the head and neck are frequent and usually have a good prognosis even though complications may sometimes be life threatening. In addition to airway compromise, intracranial and thoracic extension may occur. Diagnosis usually is made on clinical examination and imaging may play a significant role in assessing the extent of the disease, detecting complications and assist in surgical planning. The imaging protocol should be appropriate for the proposed diagnosis and suspected complications. CT of the soft tissues of the neck and chest is the imaging test of choice. Interpretation requires knowledge of the anatomy to understand the modalities of local and distant spread of the disease. Imaging evaluation is important but should not delay emergently needed treatment for entities such as epiglottitis and necrotizing fasciitis.     

Percutaneous radiofrequency and other liver ablation techniques: 2011 update

Percutaneous ablation of liver tumors was initially limited to patients that were not surgical candidates and with a limited number of relatively small liver lesions. Because of the diversification of techniques and technologies, percutaneous liver ablation has progressively been integrating to more and more complex therapeutic strategies available to a wider group of patients. Local knowledge and expertise with these techniques, largely dominated by radiofrequency ablation, often dictate the role of these techniques in the management of patients with liver tumors. We will review the clinical indications of percutaneous ablation techniques for liver tumors based on clinical considerations as well as ablation techniques.     

Gamna-Gandy bodies in cirrhosis: a meaningless finding?

Purpose

To determine the presence of Gamna-Gandy bodies (GGB) on MRI in patients with liver cirrhosis.

Patients and methods

A total of 117 consecutive patients with cirrhosis followed-up by MRI were retrospectively reviewed. Two groups were defined: the first group included patients with GGB on MRI (n = 15), the other group included patients without GGB (n = 102). Both characteristics of groups were reviewed using standard cirrhosis criteria evaluation: sex, age, etiology of cirrhosis, Child-Pugh score, presence of esophageal varices, splenomegaly, ascitis, recanalization of the periumbilical veins, and presence of hepatic encephalopathy. Fisher's exact test and student t-test were used to compare both groups.

Results

GGB were more frequently observed in patients with splenomegaly (P = 0.035). Hemochromatosis was the only etiology for cirrhosis statistically correlated to the presence of GGB (P = 0.006) in our series. No other statistically significant association was noted between GGB and other characteristics of our cirrhotic patients.

Conclusion

Easily identified on all MRI pulse sequences, GGB do not correlate with the severity of cirrhosis. However, they are strongly correlated with the presence of splenomegaly and may be the result of segmental splenic hypertension. They are frequent in patients with hemochromatosis.     

Vascular complications following renal transplantation: diagnostic evaluation

Vascular complications after renal transplantation are the most frequent type of complication following urological complications. They may affect the function of the transplant. Early vascular complications include renal artery or vein thrombosis, lesions to the iliac vessels and cortical necrosis. Delayed complications mainly include renal artery stenosis, arteriovenous fistula, and rarely false aneurysm. Doppler sonography, sometimes with the use of intravenous contrast, is the imaging modality of choice in the acute setting or routine follow-up. MRI may be performed for additional morphological and functional evaluation while CT may provide additional evaluation of the arterial supply. Angiography is performed prior to endovascular treatment.     

Postoperative Surgicel mimicking abscesses following cholecystectomy and liver biopsy

In postoperative patients presenting with abdominal pain or fever, a computed tomography (CT) finding of gas in the operative site raises concern for abscess but can be mimicked by the normal postoperative appearance of oxidized regenerated cellulose (Surgicel). Information about the operative use of Surgicel and its location is important for accurate CT interpretation of postoperative studies. This case illustrates a scenario in which knowledge of the use of Surgicel offered an explanation for the CT findings, resulting in successful conservative management.     

Correction de l’hypoxémie d’exercice chez le BPCO : variabilité des réponses, enjeux et problèmes posés dans le cadre de la réhabilitation respiratoire

Aim

To define in chronic obstructive pulmonary disease patients (COPD) moderately hypoxemic in resting conditions, if controlled acute oxygen supplementation was always able to increase exercise tolerance when partial oxygen saturation SpO₂ was corrected.

Results

In hyperoxia, endurance time (T_LIM) was significantly and consistently increased in 14 COPD (+68%) and decreased in seven others (–36%). These two subgroups exhibited no difference in resting values or in their disease severity. COPD with a decreased T_LIM under hyperoxic conditions had an abnormal response to O₂: unchanged cardiac output and ventilation, increased breathing frequency.

Conclusion

This work shows that acute O₂ supplementation responses in COPD are not univocal, either on exercise tolerance or cardio-respiratory variables typically affected by hyperoxia.