Severe cardiomyopathy following treatment with the tumour necrosis factor‐α inhibitor adalimumab for Crohn's disease

Adalimumab belongs to the group of tumour necrosis factor‐α inhibitors and has been approved for the treatment Crohn's Disease since 2007. Herein we report a severe adverse reaction to adalimumab in a 25‐year‐old female patient. One week after the initial‐dose of adalimumab (160 mg), which was initiated due to an acute exacerbation of Crohn's disease, the patient developed a fulminant cardiomyopathy. In severe cardiogenic shock, the patient required an extracorporeal membrane‐oxygenation system for 8 days until cardiac recovery.     

Sympathetic skin response: monitoring of CT-guided lumbar sympathetic blocks

PURPOSE: To prospectively evaluate accuracy of sympathetic skin response (SSR) for monitoring computed tomography (CT)-guided lumbar sympathetic blocks, with palpable temperature increase in the foot 30 minutes after injection serving as the reference standard. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Seventy individual lumbar sympathetic blocks were performed in 13 patients (six female, seven male; mean age, 45 years) with reflex sympathetic dystrophy of the foot. A 22-gauge needle was advanced to the sympathetic trunk at midlumbar level with CT fluoroscopic guidance, and 1 mL of iopamidol (200 mg of iodine per milliliter) and 5 mL of 0.5% bupivacaine were injected. SSR was monitored in both feet before and after bupivacaine injection. SSRs were activated with painless low-strength (5-20-mA) electrical stimuli. SSR ratio (SSR in the injected foot versus SSR in the contralateral foot) was calculated before injection and repeatedly at 1-minute intervals thereafter. Needle tip position and distribution of bupivacaine were measured on CT images. Receiver operating characteristic curves for SSR ratio were calculated until 7 minutes after injection. Logistic regression analyses adjusted for clustering were calculated for SSR ratio, injection parameters, needle tip position, and bupivacaine distribution. RESULTS: Thirty minutes after injection, 83% of procedures were considered clinically successful. An SSR cutoff ratio of 1:10 was used, and sensitivity, specificity, and accuracy of SSR for prediction of clinical success were 84%, 92%, and 86%, respectively, 4 minutes after injection and 95%, 92%, and 94%, respectively, 7 minutes after injection. Needle tip position (P = .19), medial and lateral borders of bupivacaine distribution (P = .11 and .056), and distance between bupivacaine distribution and the vertebral body (P = .41) were not significantly different between successful and unsuccessful injections. CONCLUSION: SSR can be used to correctly identify needle tip position in lumbar sympathetic blocks 6 and 7 minutes after injection.     

Inflammatory tumour of the prostate in a 4-year-old boy

An inflammatory tumour of the prostate is very rare in young boys without genital anomalies. We report a 4.5-year-old boy presenting with pollakisuria, dysuria, secondary urinary incontinence and decreased urine stream. Ultrasonography, magnetic resonance imaging and transrectal tumour biopsy justified the diagnosis of an inflammatory tumour of the prostate with a size of 5 × 3 × 5 cm. Under antibiotic therapy the clinical symptoms disappeared within 6 weeks. Three months later ultrasonography revealed a normal prostate with a residual midline cyst of 3 × 4 mm. Follow-up examinations for 2 years did not show any evidence of relapse. We believe that the inflammatory tumour can be explained by the embryologic development of the prostate and the persistence of an intraprostatic cyst.     

Giant Aneurysm After Aortic Coarctation: Repair without Circulatory Arrest

Abstract We describe the case of a 23‐year‐old patient presenting for redo aortic arch surgery because of recoarctation and poststenotic aneurysm formation after patch aortoplasty in infancy. Using the hemi‐clamshell approach, the entire aortic arch was replaced and the supraaortic branches were reimplanted. The applied surgical technique using hypothermic extracorporeal circulation without cardiac arrest allowed an uninterrupted cerebral and spinal cord perfusion due to stepwise clamping of the aortic arch during reconstruction and resulted in an excellent neurologic outcome at six‐month follow‐up. (J Card Surg 2010;25:560‐562)     

Dermatofibrosarcoma Protuberans in Childhood Treated with Slow Mohs Micrographic Surgery

Dermatofibrosarcoma protuberans (DFSP) in childhood is a rare tumor with high recurrence rates. Wide local excision can result in disfiguring mutilation, whereas Mohs micrographic surgery (MMS) reduces surgical margins. MMS in children is not performed routinely, as the required infrastructures such as a histopathology lab in close proximity to the operating room is often lacking. We retrospectively reviewed children diagnosed with DFSP treated at our hospital over 2 years. We recorded surgical treatment details, including margins, duration of inpatient stay, outcome, follow‐up, and molecular genetic tumor tissue analysis. Four children with a median age of 6.8 years (range 6.0–8.8 years) were identified who had a diagnostic delay of a median of 2.5 years (range 0.5–4.0 years); all underwent complete tumor excision using the slow MMS technique using vacuum‐assisted closure systems between repeated excisions and before wound closure. The median maximal safety margins were 1.5 cm (range 1.0–3.0 cm). By using vacuum‐assisted closure systems, no dressing changes were needed, pain was limited, and full mobility was maintained in all children. The median total time in the hospital was 11 days (range 10–14 days). No relapses occurred during a median follow‐up of 25.8 months (range 11.3–32.6 months). Collagen 1A1/platelet‐derived growth factor B (COL1A1/PDGFB) translocation on chromosomes 17 and 22 was detected in all three analyzable specimens. Lesions suspected of being DFSP warrant prompt histologic evaluation; interdisciplinary management is mandatory in particular for children. Micrographic surgery allows smaller surgical margins than wide excision and should be considered as the treatment of choice in children with DFSP. The interim usage of vacuum‐assisted closure systems increases patient comfort. Translocations in the COL1A1/PDGFB gene imply susceptibility to targeted treatment modalities for therapy‐resistant cases.     

Assessment of fat content in supraspinatus muscle with proton MR spectroscopy in asymptomatic volunteers and patients with supraspinatus tendon lesions

PURPOSE: To evaluate proton magnetic resonance (MR) spectroscopy in the assessment of lipid content of the supraspinatus muscle in asymptomatic volunteers and patients with supraspinatus tendon lesions. MATERIALS AND METHODS: Single-voxel proton MR spectroscopy was used to assess lipid content of the supraspinatus muscle in asymptomatic volunteers (n = 30) and patients with partial-thickness supraspinatus tendon tears (n = 30), newly diagnosed full-thickness supraspinatus tendon tears (n = 30), and chronic full-thickness supraspinatus tendon tears (n = 30). The apparent lipid content of the supraspinatus muscle measured with proton MR spectroscopy was related to its appearance on sagittal-oblique T1-weighted spin-echo MR images (grades 0-4). One-way analysis of variance was performed to test for significant differences, and the Tukey honestly significant difference procedure was performed for post hoc comparisons. RESULTS: Mean apparent lipid content was 13.7% (95% confidence interval [CI]: 11.5%, 15.8%) for asymptomatic volunteers, 29.5% (95% CI: 25.1%, 34.0%) for patients with partial-thickness tears, 48.6% (95% CI: 41.3%, 55.9%) for patients with full-thickness tears, and 66.1% (95% CI: 57.7%, 74.5%) for patients with chronic tears. Values were significantly different (analysis of variance, P <.001; P <.001-.002 for all post hoc pairwise comparisons). Mean apparent lipid content for the supraspinatus muscle was as follows: grade 0, 19.6% (95% CI: 16.7%, 22.6%); grade 1, 36.8% (95% CI: 33.2%, 40.4%); grade 2, 53.6% (95% CI: 43.1%, 64.2%); grade 3, 67.5% (95% CI: 52.6%, 82.3%); and grade 4, 79.2% (95% CI: 73.2%, 85.3%). With analysis of variance (P <.001), all post hoc pairwise comparisons were significant (P 相似文献   

Lumbar disk herniation: do MR imaging findings predict recurrence after surgical diskectomy?

PURPOSE: To retrospectively evaluate if the degree of disk degeneration and disk herniation volume at magnetic resonance (MR) imaging are risk factors for recurrent disk herniation. MATERIALS AND METHODS: The institutional review board permits such retrospective studies, and individual informed consent was not required. MR imaging findings obtained before initial diskectomy in 30 patients (mean age, 42.8 years; 10 women, 20 men) with recurrent disk herniation (study group) and 30 patients (mean age, 42.2 years; nine women, 21 men) without recurrence for at least 2 years after surgery (control group) were compared. Disk degeneration was assessed on T2-weighted sagittal MR images with a five-point grading system (grade I indicated no degeneration; grade II, horizontal hypointense bands within disk; grade III, inhomogeneous disk with intermediate signal intensity; grade IV, no distinction between inner and outer parts of disk; and grade V, collapsed hypointense disk). Disk herniation was classified as representing protrusion, extrusion, or sequestration. The volume of both the affected intervertebral disk and the herniated disk material was measured. Qualitative and quantitative analyses were performed by two readers. The chi(2) test was used for comparison of categorical variables. For comparison of disk degeneration and volumes between patients with and those without recurrence, a paired two-tailed t test was used. Odds ratios based on the extent of disk degeneration were calculated for the entire sample. RESULTS: Advanced disk degeneration (grades IV and V) was significantly less frequent in the study group than in the control group (P < .006). The risk of recurrent disk herniation decreased by a factor of 3.4 for each increase in grade of disk degeneration (odds ratio: 3.58; 95% confidence interval: 1.3, 9.6; P = .011). Mean disk herniation volume as a percentage of intervertebral disk volume was 10.59% +/- 3.41 in the study group and 11.56% +/- 3.84 in the control group. This difference was not significant (P = .31). CONCLUSION: Minor disk degeneration but not herniation volume represents a risk factor for the recurrence of disk herniation after diskectomy.     

Swiss teleradiology survey: present situation and future trends

The purpose of this study was to obtain a survey about the present situation including the usage pattern, technical characteristics and the anticipated future of teleradiology in Switzerland. An internet-based questionnaire was made available to all members of the Swiss Society of Radiology. Questions concerning current teleradiology usage, the type of transmitted modalities, the technology employed, security, billing issues and the anticipated future of teleradiology were addressed. One hundred and two (22.67%) of 450 radiologists responded to the survey. Of the total, 41.2% (42) were teleradiology users, 35.3% (36) planned to use teleradiology in the near future and 24.5% (25) did not use or plan to use teleradiology. The mean number of examinations transmitted per month was 198 (range 1–2,000) and the mean distance was 33 km (range 1,250 km). An emergency service was considered the most important purpose (mean score 6.90; minimum 1, maximum 10) for the use of teleradiology, followed by image distribution (mean 6.74) and expert consultation (mean 6.61). The most commonly transmitted modality was computed tomography (mean 8.80), followed by conventional X-rays (8.40) and magnetic resonance imaging (8.32). The most commonly transmitted format was Digital Imaging and Communications in Medicine (DICOM) (66.7%), followed by bitmap/Joint Photographic Experts Group (jpg) (38.1%), using the DICOM send/receive protocol (52.4%), followed by the hypertext transfer protocol (26.2%) and e-mail (21.4%). For security a secure connection (54.8%) followed by encryption (14.3%) and anonymization (9.5%) was used. For the future, image distribution was rated the most important aspect of teleradiology (7.88), followed by emergency (7.22) and expert consultation (6.53). Development of legal regulations is considered most important (8.17), followed by data security guidelines (8.15). Most radiologists believe that insurance companies should pay for the costs of teleradiology (37.3%), followed by the radiologist (33.3%). In conclusion, in Switzerland a wide spectrum of teleradiology applications and technologies is in use. Guidelines and reimbursement issues remain to be solved.     

Blood pressure lowering in essential hypertension with an oral renin inhibitor, aliskiren

Inhibition of the first and rate-limiting step of the renin-angiotensin system has long been an elusive therapeutic goal. Aliskiren, the first known representative of a new class of completely nonpeptide, orally active, renin inhibitors, has been shown to inhibit the production of angiotensin I and II in healthy volunteers and to reduce blood pressure (BP) in sodium-depleted marmosets. The aim of this randomized, double-blind, active comparator trial study was to assess the BP-lowering efficacy and safety of aliskiren. Two hundred twenty-six patients, 21 to 70 years of age, with mild to moderate hypertension, were randomly assigned to receive 37.5 mg, 75 mg, 150 mg, or 300 mg aliskiren or 100 mg losartan daily for 4 weeks. Dose-dependent reductions in daytime ambulatory systolic pressure (mean change, mm Hg [SD of change]; -0.4 [11.7], -5.3 [11.3], -8.0 [11.0], and -11.0 [11.0], P=0.0002) and in plasma renin activity (median change % [interquartile range]; -55 [-64, -11], -60 [-82, -46], -77 [-86, -72], and -83 [-92, -71], P=0.0008) were observed with 37.5, 75, 150, and 300 mg aliskiren. The change in daytime systolic pressure with 100 mg losartan (-10.9 [13.8]) was not significantly different from the changes seen with 75, 150, and 300 mg aliskiren. Aliskiren was well tolerated at all doses studied. This study demonstrates that aliskiren, through inhibition of renin, is an effective and safe orally active BP-lowering agent. Whether renin inhibition results in protection from heart attack, stroke, and nephropathy, similar to angiotensin-converting enzyme inhibition and angiotensin receptor blockade, needs to be researched.