Abdominal imaging features of HELLP syndrome: a 10-year retrospective review

OBJECTIVE: The purpose of this study was to describe the abdominal imaging features associated with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, a complication of pregnancy. CONCLUSION: The abdominal imaging features of HELLP syndrome include intraparenchymal and perihepatic hematomas and hemoperitoneum as noted on sonography, CT, and angiography.     

Early hormonal effects of head-down tilt (-10 degrees) in humans

The aim of this study was to determine the effects of a 5-h weightlessness simulation (using supine bed rest or head-down tilt at -10 degrees = HDT) on plasma renin activity (PRA), aldosterone (PA), and catecholamines (epinephrine-E, norepinephrine-NE, and dopamine-DA) and to compare the results with those obtained with horizontal bed rest (BR), which is often taken as a control situation for simulation studies. Ten healthy young volunteers submitted to the three following postural tests: 7 h sitting; 1 h sitting, 5 h supine, and 1 h sitting; 1 h sitting, 5 h HDT, and 1 h sitting. Our results show that a 5-h HDT or BR induced a significant progressive increase in plasma volume (14.5% for HDT and 7% for BR) and a decrease in diastolic blood pressure (18% for HDT and 17% for BR), PRA (60% for HDT and 40% for BR), PA (63% for HDT and 60% for BR), and NE (20% for HDT and 25% for BR) compared to the sitting position. E decreased only in HDT, and DA was unchanged. We concluded that the main part of the cephalad shift is achieved by bed rest as reflected by changes in hematocrit and plasma protein concentration. The decrease in diastolic blood pressure, the inhibition of the renin-angiotensin aldosterone system (in part explained by a decrease in NE) are similar in BR and HDT. We demonstrate that the use of a relevant body position as control is a major concern when investigating the hormonal effects of HDT. If recumbency is chosen as the control situation in HDT studies, it is not surprising to observe only few changes when HDT is applied.     

Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis

Objective

To investigate the usefulness of contrast-enhanced ultrasound (CEUS) in the evaluation of renal masses.

Methods

This study included 255 patients with renal masses. Ages ranged from 18–86 years. CEUS was used for determining malignancy or benignancy and findings were correlated with the histopathological outcome. Out of 255 lesions, 212 lesions were malignant (83.1%) and 43 were benign (16.9%). Diagnostic accuracy was tested using the histopathological diagnosis as the gold standard.

Results

CEUS showed a sensitivity of 99.1% [95% confidence interval (CI): 96.7%, 99.9%], a specificity of 80.5% (CI: 65.1%, 91.2%), a positive predictive value of 96.4% (CI: 93.0%, 98.4%) and a negative predictive value of 94.3% (CI: 80.8%, 99.3%). Kappa for diagnostic accuracy was κ = 0.85 (CI: 0.75, 0.94). Of 212 malignant lesions, 200 renal cell carcinomas and 12 other malignant lesions were diagnosed. Out of 43 benign lesions, 10 angiomyolipomas, 3 oncocytomas, 8 renal cysts and 22 other benign lesions were diagnosed.

Conclusion

CEUS is an useful method to differentiate between malignant and benignant renal lesions. To date, to our knowledge, this is the largest study in Europe for the evaluation of renal lesions using CEUS with a histopathological validation.

Key Points

? CEUS helps clinicians detect and characterise unclear solid and cystic renal lesions ? CEUS shows a high diagnostic accuracy in the characterization of these lesions ? Proper surgical treatment or follow-up can be given with better diagnostic confidence

     

Acute coronary syndrome and the 1992-1995 war in Bosnia and Herzegovina: a 10-year retrospective study

OBJECTIVE: To examine the effects of war in Bosnia and Herzegovina on the occurrence of acute coronary syndrome among civilians. METHODS: The incidences of acute myocardial infarctions (first and recurrent) and unstable angina pectoris were examined among the residents of Mostar and the nine neighboring districts. The study population was the population that lived in the area before the war (182,000 in the 1991 census). Others who immigrated into the area were not taken into consideration. Five consecutive years (1987-1991) before the war and 5 consecutive years (1992-1996) during the war were analyzed. RESULTS: In the 5-year period during the war, 267 men and 161 women suffered from acute myocardial infarctions, compared with 246 men and 119 women in the 5-year period before the war. The wartime increase in acute myocardial infarctions for the combined male-female population was statistically significant (p = 0.025). For women, the wartime increase was statistically significant only for the age group of 60 to 69 years (p = 0.007). The smaller increase among men was not statistically significant (p = 0.354). The increase to a wartime number of 52 cases of recurrent myocardial infarctions from a prewar level of 24 was statistically significant (p = 0.001). The percentage of fatal myocardial infarctions among women, however, was lower during the war (18.6%) than before the war (32.8%) (p = 0.048). During the war, 109 men with unstable angina pectoris were hospitalized, compared with 84 before the war; the cases among women were 76 and 41, respectively. The increase was statistically significant among women (p = 0.001) but not among men (p = 0.072). There was a statistically significant increase (p < 0.001) in the total number of unstable angina pectoris cases during the war (185 cases, compared with 125 prewar cases). CONCLUSION: The common population during the war in Bosnia and Herzegovina had increased numbers of acute myocardial infarctions and unstable angina pectoris cases.     

Epidemiology of male breast diseases: A 10-year institutional review

ObjectiveTo review breast imaging utilization and epidemiology of breast diseases in male patients referred to our breast center.Material and methodsA retrospective analysis of all male patients who underwent breast imaging at our institution over a 10 year period (03/14/2008 to 03/13/2018) was performed. Patient history, imaging findings, biopsy reports, surgical interventions and follow-up data were reviewed.ResultsOver the 10 year period, 143 male patients (0.1% of referred breast center patients) underwent breast imaging (versus 139,134 female patients). Mean age was 57.4 years (SD 19.7, median 59, range 21–92 years). The most common indication for referral was a palpable breast mass (98%). The most common diagnosis was gynecomastia (72%). Of the 20 (14%) patients who underwent core biopsy; 1 (0.7%) had breast cancer and the remaining 19 had benign pathologies. Follow-up imaging was recommended for 22 (15.4%) patients, of whom 15 (68%) were lost to follow-up. Two patients under the age of 25 years inadvertently underwent initial mammography instead of ultrasound.ConclusionThe epidemiology of breast diseases in our male patient population mirrors that of the general male population worldwide; with an overwhelming 99.3% cases falling into benign category. Two-thirds of our male patients for whom short interval follow up was recommended were lost to follow-up, signifying the need for a more proactive approach in ensuring their compliance. It is important to increase awareness among referring clinicians and general radiologists regarding male breast imaging recommendations so that the appropriate imaging study is performed.     

Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI

Purpose

To report on our initial experiences with a new method of real-time virtual sonography (RVS)-guided 11-gauge vacuum-assisted breast biopsy for lesions that were initially detected with breast MRI.

Materials and methods

RVS-guided 11-gauge vacuum-assisted biopsy is performed when a lesion with suspicious characteristics is initially detected with breast MRI and is occult on mammography, sonography, and physical examination. Live sonographic images were co-registered to the previously loaded second-look spine contrast-enhanced breast MRI volume data to correlate the sonography and MR images.

Results

Six lesions were examined in six consecutive patients scheduled to undergo RVS-guided 11-gauge vacuum-assisted biopsy. One patient was removed from the study because of non-visualization of the lesion in the second-look spine contrast-enhanced breast MRI. Five patients with non-mass enhancement lesions were biopsied. The lesions ranged in size from 9 to 13 mm (mean 11 mm). The average procedural time, including the sonography and MR image co-registration time, was 25 min. All biopsies resulted in tissue retrieval. One was fibroadenomatous nodules, and those of four were fibrocystic changes. There were no complications during or after the procedures.

Conclusion

RVS-guided 11-gauge vacuum-assisted breast biopsies provide a safe and effective method for the examination of suspicious lesions initially detected with MRI.     

Pattern of unnatural death in a city mortuary: a 10-year retrospective study

This paper investigates the pattern of autopsy findings in the Forensic Medicine Department of Sir Salimullah Medical College, Dhaka, Bangladesh. We examined 2534 autopsy reports that were carried out over a period of 10 years from January 1, 1988 to December 31, 1997. Findings have been presented in the aggregate as well as by gender and the manner of death. The manner of death is categorized into four groups: homicide, suicide, accident and natural. We have also included negative autopsies and undecided cases as separate categories. In our study period, 73% of the cases were male. Total growth of autopsy rates in male and female were 7 and 5%, respectively. In terms of incidence most autopsy cases related to accidents (37%), followed by homicide (21%) and suicide (18%). There were numerous problems with chemical reports that led to undue delay in disbursement of justice. In many cases autopsy findings remained undecided because the manner of death could not be determined due to lack of coordination between the forensic doctors and the legal authorities. Undecided and negative autopsy cases were increasing at a very high rate.     

A 10-year retrospective review of airline transport pilots aged 60 to 63 in Japan

BACKGROUND: On May 14, 1991, the Japanese Ministry of Transport issued an official notice allowing medically certified airline transport pilots aged 60 to 63 yr old (aged pilot) to work on non-scheduled flights. Since September 24, 1996, the official notice was revised to allow them to work on scheduled flights. The regulation requires pilots to pass both routine and additional aviation medical examinations. METHOD: Ten years have passed since the first regulation, so the medical records and the present status of aged pilots were reviewed and summarized. RESULTS: By the end of October 2000, 159 pilots had undergone their first additional examination. Two pilots failed due to coronary ischemia, two due to brain infarction, and one due to complete right bundle branch block (CRBBB) on ECG. One pilot failed the examination at the age of 62 due to coronary ischemia and another at the age of 62.5 due to atrial fibrillation. Thirteen pilots retired prior to the age of 63 for unknown reasons. At the time of review, 44 pilots had reached the age of 63 and retired. Subsequent flight time as aged pilot was 83,872 h in total (617 +/- 483 h; mean +/- SD) with monthly flight time of 41 +/- 27 h. Japan Aircraft Accident Investigation Commision reported 323 accidents, including 27 airtransport accidents in the past 10 yr. There were no accidents involving any of the aged pilots. CONCLUSION: The review suggests that the aged pilots who are deemed medically qualified by the official notice criteria are flying safely without mishap incidence.     

Whitmore, Henschke, and Hilaris: The reorientation of prostate brachytherapy (1970-1987)

PurposeUrologists had performed prostate brachytherapy for decades before New York’s Memorial Hospital retropubic program. This paper explores the contribution of Willet Whitmore, Ulrich Henschke, Basil Hilaris, and Memorial’s physicists to the evolution of the procedure.Methods and MaterialsLiterature review and interviews with program participants.ResultsMore than 1000 retropubic implants were performed at Memorial between 1970 and 1987. Unlike previous efforts, Memorial’s program benefited from the participation of three disciplines in its conception and execution.ConclusionsMemorial’s retropubic program was a collaboration of urologists, radiation therapists, and physicists. Their approach focused greater attention on dosimetry and radiation safety, and served as a template for subsequent prostate brachytherapy programs.     

Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience

BACKGROUND AND PURPOSE: We retrospectively analyzed our results with Guglielmi detachable coils (GDCs) for the endovascular occlusion of acutely ruptured saccular cerebral aneurysms over 10 years. METHODS: Between 1991-2000, 83 patients (mean age, 56.1 years) with aneurysmal subarachnoid hemorrhage were treated with endovascular GDCs. Patients with aneurysms due to trauma or dissection and those with mycotic or fusiform aneurysms were excluded. Mean follow-up in survivors was 19.1 months, and the mean Hunt-Hess grade at admission was 2.2. Angiographic follow-up was performed in 93% of surviving patients (mean interval, 11.6 months). The basilar caput (34 patients) and anterior communicating artery complex (19 patients) were most commonly treated. RESULTS: Sixty-four patients (77%) had a Glasgow Outcome Scale score (GOS) of 4 or 5, nine (11%) had a score of 2 or 3, and 10 (12%) died. At follow-up, 24 patients (35%) had complete aneurysm occlusion, 18 (26%) had a dog-ear remnant, 24 (35%) had a residual neck, and two (3%) had residual aneurysm filling. No treated aneurysm rebled. Three patients required surgical repair after incomplete endovascular treatment. Two or more GDC occlusion procedures were required in 28 patients (34%). Major procedural complications occurred in two patients (2%), resulting in serious neurologic disability or death. CONCLUSION: Endovascular treatment of ruptured cerebral aneurysms with GDCs has low morbidity, and it facilitates good overall outcomes in patients after subarachnoid hemorrhage. The short-term effectiveness of GDC occlusion in preventing aneurysmal rebleeding was excellent. Durability of the treatment in preventing long-term rebleeding as compared with direct surgical clipping warrants further study. Advances in device technology and technique may improve future outcomes.