Pharyngeal enterogenous cyst associated with canalis basilaris medianus in a newborn

We report the CT and MR characteristics of a newborn with a rare, complex malformation characterised by a large rhinopharyngeal and oropharyngeal enterogenous cyst, associated with an osseous defect of the basiocciput, called canalis basilaris medianus (CBM). A partial herniation of the bulb was demonstrated through the bony defect on the midline. The enterogenous cyst occupied the rhinopharynx and oropharynx, narrowing the pharyngeal lumen and making it difficult for the introduction of an orotracheal tube.     

Gastroesophageal reflux in patients treated for congenital diaphragmatic hernia: short- and long-term evaluation with multichannel intraluminal impedance

Purpose

The incidence of GER, related symptoms and complications in patients treated for congenital diaphragmatic hernia (CDH) are poorly defined. The aim was to evaluate incidence and development of GER in children treated for CDH in a short- and long-term follow-up period, identifying potential risk factors of morbidity.

Methods

Thirty-six patients were evaluated with pH-MII at a median age of 6 months (T1) and re-evaluated with pH-MII and endoscopy at a median age of 5 years (T2).

Results

The incidence of reflux was 83 % in T1 and 61 % in T2; the incidence of symptoms was 62 % in T1 and 38 % in T2. In both groups the reflux was mainly non-acidic. Patch, intrathoracic stomach and esophageal dysmotility were risk factors for GER.

Conclusions

The incidence of GER and symptoms decrease over the time but it was higher than in the literature, probably because it is mainly non-acidic and evaluable only with MII. The esophageal dysmotility was found to be the main risk factor. An high incidence of reflux and esophagitis was found also in asymptomatic patients, and so a close follow-up is recommended in all patients even if it is asymptomatic.     

Advanced virtual magnetic resonance imaging (MRI) techniques in neurovascular conflict: bidimensional image fusion and virtual cisternography

Purpose

The aim of this study was to evaluate the advantages and limits of virtual magnetic resonance techniques in planning surgery for microvascular decompression in patients with neurovascular conflict.

Materials and methods

Between December 2010 and December 2011, we prospectively observed 32 patients (30 with trigeminal neuralgia and two with hemifacial spasm), with a suspected clinical diagnosis of neurovascular conflict. To assess the contact between nerve and vessel, magnetic resonance imaging (MRI) by three-dimensional (3D) constructive interference in steady state (CISS) and high-resolution MR angiography (MRA) were performed in all cases. Moreover, we performed presurgical simulation of microvascular decompression using MR two-dimensional image fusion and virtual cisternography. The neuroradiological findings were compared with the surgical findings.

Results

In all cases, we demonstrated the anatomical relations between cranial nerves and offending vessels with an optimal correlation between radiological and surgical patterns.

Conclusions

Advanced virtual MRI techniques, such as image fusion and virtual cisternography, are able to depict the complex anatomical relationships between neural and vascular structures within the cisternal spaces of the skull base. These techniques can be considered an optimal presurgical tool to support traditional MRI evaluation of this region.     

Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules

Purpose

The aim of this study was to analyse factors predicting the diagnostic accuracy of computed tomography (CT)-guided transthoracic fine-needle aspiration (TTFNA) for solid noncalcified, subsolid and mixed pulmonary nodules, with particular attention to those responsible for false negative results with a view to suggesting a method for their correction.

Materials and methods

From January 2007 to March 2010, we retrospectively reviewed the CT images of 198 patients of both sexes (124 males and 74 females; mean age, 70 years; range age, 44–90) used for the guidance of TTFNA of pulmonary nodules. Aspects considered were: lesion size and density, distance from the pleura, and lesion site. Multiplanar reformatted images (MPR) were retrospectively obtained in the sagittal and axial oblique planes relative to needle orientation.

Results

The overall diagnostic accuracy of TTFNA CTguided biopsy was 86% for nodules between 0.7 and 3 cm, 83.3% for those between 0.7 and 1.5 cm, and 92% for those between 2 and 3 cm. Accuracy was 95.1% for solid pulmonary nodules, 84.6% for mixed nodules, and 66.6% for subsolid nodules. The diagnostic accuracy of CT-guided TTFNA in relation to the distance between the nodule and the pleural plane was 95.6% for lesions adhering to the pleura and 83.5% for central ones. The diagnostic accuracy was 84.2% for the pulmonary upper lobe nodules, 85.3% for the lower lobe and 90.9% for those in the lingula and middle lobe. In 75% of false negative and inadequate/insufficient cases the needle was found to lie outside the lesion, after reconstruction of the needle path by MPR.

Conclusions

The positive predictive factors of CT-guided TTFNA are related to the nodule size, density and distance from the pleural plane. The most common negative predictive factor of CT-guided TTFNA is the wrong position of the needle tip, as observed in the sagittal and axial oblique sections of the MPR reconstructions. The diagnostic accuracy of CT-guided TTFNA can therefore be improved by using the MPR technique to plan the needle path during the FNA procedure.     

Future outpatient health-care utilisation in an ageing population: projections up to the year 2020 based on the Study of Health in Pomerania (SHIP)

Aim

The population in the German federal state of Mecklenburg-West Pomerania is growing older. The resulting increase in the incidence of age-related diseases will lead to a higher demand for medical care although the population is declining. The aim of the study was to project the future outpatient health-care utilisation.

Subjects and methods

Representative data on health-care utilisation were derived from the Study of Health in Pomerania (SHIP). Participants (n?=?3,292, age 25–84 years) were asked whether they had consulted a physician in the past year and if so, the type of physician and the total number of visits. These data were combined with demographic forecasts for Mecklenburg-West Pomerania and its rural and urban districts up to the year 2020 to project the number of patients and their number of consultations with general practitioners and specialists in outpatient care.

Results

The projected number of annual consultations will increase in 2020 as compared to 2008 for urologists (+14.5 %), internists (+11.2 %), ophthalmologists (+7.7 %), neurologists (+6.0 %) and general practitioners (+5.8 %). In contrast, visits to gynaecologists will decrease until 2020 (?10.8 %). The predicted changes in the number of consultations show considerable heterogeneity between the districts.

Conclusion

Physicians who are consulted mainly by senior patients will face a higher number of consultations in 2020. Similar developments will probably occur in other German federal states and other industrialised countries in which demographic transition is already evident. These changes have to be considered in a rational planning of future medical-care provision.     

Why those who drink the most coffee appear to be at increased risk of disease. A modest proposal

A sample of 2,706 adults, considered representative of the United States, was interviewed by telephone about coffee consumption and about experiences and personal characteristics that have been considered antecedents or risk factors of vascular diseases and malignancies. Consumption of more than 5.6 cups per day placed a person in the top quartile of total daily coffee. People in the top quartile of caffeine‐containing coffee consumption averaged 429 mg of caffeine in coffee each day and were more likely than others to smoke cigarettes, and less likely to take vitamin supplements and to consume a “healthy” diet (i.e., containing large amounts of fiber, vitamins and cruciferous vegetables, and small amounts of fat). Thus, the heightened risk of disease sometimes associated with coffee consumption might reflect the characteristics and disease‐promoting activities of some drinkers and not necessarily their consumption of caffeine and coffee. The findings of this study are consistent with the hypothesis that drinkers of relatively large amounts of coffee are less likely than others to feel the need for health‐promoting behaviors.     

Disease Mapping with Spatially Uncertain Data

Objective

Uncertainty regarding the location of disease acquisition, as well as selective identification of cases, may bias maps of risk. We propose an extension to a distance-based mapping method (DBM) that incorporates weighted locations to adjust for these biases. We demonstrate this method by mapping potential drug-resistant tuberculosis (DRTB) transmission hotspots using programmatic data collected in Lima, Peru.

Introduction

Uncertainty introduced by the selective identification of cases must be recognized and corrected for in order to accurately map the distribution of risk. Consider the problem of identifying geographic areas with increased risk of DRTB. Most countries with a high TB burden only offer drug sensitivity testing (DST) to those cases at highest risk for drug-resistance. As a result, the spatial distribution of confirmed DRTB cases under-represents the actual number of drug-resistant cases[1]. Also, using the locations of confirmed DRTB cases to identify regions of increased risk of drug-resistance may bias results towards areas of increased testing. Since testing is neither done on all incident cases nor on a representative sample of cases, current mapping methods do not allow standard inference from programmatic data about potential locations of DRTB transmission.

Methods

We extend a DBM method [2] to adjust for this uncertainty. To map the spatial variation of the risk of a disease, such as DRTB, in a setting where the available data consist of a non-random sample of cases and controls, we weight each address in our study by the probability that the individual at that address is a case (or would test positive for DRTB in this setting). Once all locations are assigned weights, a prespecified number of these locations (from previously published country-wide surveillance estimates) will be sampled, based on these weights, defining our cases. We assign these sampled cases to DRTB status, calculate our DBM, repeat this random selection and create a consensus map[3].

Results

Following [2], we select reassignment weights by the inverse probability of each untested case receiving DST at their given location. These weights preferentially reassign untested cases located in regions of reduced testing, reflecting an assumption that in areas where testing is common, individuals most at risk are tested. Fig. 1 shows two risk maps created by this weighted DBM, one on the unadjusted data (Fig.1, L) and one using the informative weights (Fig. 1, R). This figure shows the difference, and potentially the improvement, made when information related to the missingness mechanism, which introduces spatial uncertainty, is incorporated into the analysis.

Conclusions

The weighted DBM has the potential to analyze spatial data more accurately, when there is uncertainty regarding the locations of cases. Using a weighted DBM in combination with programmatic data from a high TB incidence community, we are able to make use of routine data in which a non-random sample of drug resistant cases are detected to estimate the true underlying burden of disease.Open in a separate window(L) Unweighted DBM of risk of a new TB case that received DST being positive for DRTB, compared to all new TB cases that received DST. (R) Weighted DBM of the risk of a new TB case that received DST being positive for DRTB, based on lab-confirmed DRTB cases and IPW selected non-DST TB cases, compared to all new TB cases.