Left atrium remodeling after acute myocardial infarction (results of the GISSI-3 Echo Substudy)

To evaluate the existence, timing, and determinants of post-infarction left atrial remodeling, we studied a subgroup of 514 patients from the Third Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Echo Substudy who underwent 4 serial 2-dimensional echocardiograms up to 6 months after acute myocardial infarction. This study is the first to demonstrate, in a large series of patients, the existence of early and late left atrial remodeling after low-risk acute myocardial infarction and the relation of left atrial remodeling to left ventricular remodeling.     

High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease

OBJECTIVE: To examine the prevalence and characteristics of shoulder involvement in ankylosing spondylitis (AS). To analyze the sensitivity and specificity of shoulder lesions defined by magnetic resonance imaging (MRI) in patients with AS. METHODS: Prevalence of shoulder involvement was ascertained by chart review of 400 AS patients. One hundred of these patients and 285 controls were selected for clinical evaluation. AS patients with a clinically defined shoulder disorder (n = 15) and a control group of 91 patients (94 shoulders) with nonspecific shoulder pain were studied with MRI. Fifty-four MRI-defined variables per shoulder were analyzed by 2 observers. A third cohort of patients with AS (n = 76) was prospectively evaluated by clinical exam for AS-specific shoulder lesions identified on MRI. RESULTS: Shoulder pain was recorded in 3.5% of patients by chart review. Shoulder involvement by clinical evaluation was noted in 24.7% of patients versus 14.2% of controls (odds ratio [OR] 8.17, 95% confidence interval [95% CI] 3.14-21.28, P < 0.001). Rotator cuff tendinitis was significantly more prevalent in patients (15.1%) than controls (3.5%; OR 8.17, 95% CI 2.66-25.14, P < 0.001). Acromioclavicular joint arthrosis was the most common lesion observed in AS shoulders (94%), although specificity was low (32%). Bone marrow edema at any entheseal site was noted in significantly more AS shoulders (70.6%) than in control (19.1%) shoulders (P < 0.001, corrected P = 0.02). Erosion of the greater tuberosity with or without adjacent bone edema had the best combination of sensitivity (58-65%) and specificity (86-92%). Intense acromial entheseal edema at the deltoid origin was observed only in AS shoulders (41.2%; P < 0.001). Evaluation of a prospective cohort of patients with AS showed that 22.4% had rotator cuff enthesopathy. CONCLUSION: Shoulder lesions in AS are common and characterized clinically by rotator cuff tendinitis and on MRI by intense bone edema localized to the supraspinatus/greater tuberosity and deltoid/acromial entheses. Intense acromial bone edema at the deltoid origin is a hitherto undescribed and highly specific feature of AS. Enthesopathy of the rotator cuff is underrecognized in AS and should be incorporated into instruments measuring enthesitis.     

Proportion of tuberculosis transmission that takes place in households in a high-incidence area

The prevalence of infection among household contacts of people with tuberculosis is high. This information frequently guides active case finding. We analysed DNA fingerprints of Mycobacterium tuberculosis from 765 tuberculosis patients in Ravensmead and Uitsig, adjacent suburbs of Cape Town, South Africa. In 129 households in which DNA fingerprints were available for more than one patient, we identified 313 patients, of whom 145 (46%) had a fingerprint pattern matching that of another member of the household. The proportion of transmission in the community that took place in the household was 19%, and therefore, in this high-incidence area, tuberculosis transmission occurs mainly outside the household.     

MRI and "tenderness guided" transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis

Purpose:

To compare the diagnostic accuracy of MRI and “tenderness‐guided” transvaginal ultrasonography (tg‐TVUS) in the identification of recto‐sigmoid endometriosis.

Materials and Methods:

Institutional Review Board approval for this study was obtained, and written informed consent was given by all patients. This study is compliant with the STARD (Standards for Reporting of Diagnostic Accuracy) method. Fifty‐nine patients (mean age, 33 years; range, 21–44 years) with clinical suspicion of deep pelvic endometriosis were prospectively enrolled. They underwent tg‐TVUS and MRI before surgery. The characteristics of the MRI signal were analyzed. Mapping of recto‐sigmoid endometriosis was performed and tg‐TVUS and MR imaging results were compared with surgical and pathological findings. Sensitivity, specificity, and the positive and negative likelihood ratio (LR+ and LR?) were calculated. Inter‐technique concordance was assessed using the Cohen statistic, and receiver operating characteristic (ROC) curves were obtained. Logistic regression analysis was performed.

Results:

The prevalence of recto‐sigmoid endometriosis was 51%. The specificity, sensitivity, and LR+ and LR? were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg‐TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter‐technique concordance using the Cohen statistic indicated a kappa value of 0.658 (± 0.098 SD). According to the logistic regression equation obtained, the use of both tg‐TVUS and MRI allows optimal diagnostic performance.

Conclusion:

MRI and tg‐TVUS show similar results in the identification of recto‐sigmoid endometriosis. The Cohen kappa value suggests that these methods may have complementary roles in the identification of recto‐sigmoid endometriosis, depending on the site affected. J. Magn. Reson. Imaging 2012;352‐360. © 2011 Wiley Periodicals, Inc.

     

Congenital Askin tumor with favorable outcome: case report and review of the literature

Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.