NEWER CONCEPTS AND MANAGEMENT OF NEONATAL SEPSIS

Despite extensive research into its patho-physiology, investigations and treatment, sepsis remains an important cause of neonatal morbidity and mortality. The incidence in developing countries is 10 times that in the developed world. A large number of pro-and anti-inflammatory cytokines (interleukins, eicosanoids, tumour necrosis factor-alpha, nitric oxide) have been identified, the interplay of which leads to the Systemic Inflammatory Response Syndrome (SIRS) which can have devastating consequences on all systems of the body. In India the common organisms include Staphylococcus, E coli, Klebsiella and Candida. A number of maternal and neonatal risk factors have been identified. The initial signs and symptoms are subtle and can easily be missed. Early investigations and screening tests are important and a promising number of new tests are being studied. The gold standard for diagnosis is a positive culture from a body fluid or local source in the presence of SIRS. The threshold for starting antibiotics should be low in high-risk neonates and broad spectrum antibiotics covering the likely organisms should be given intravenously in all suspected cases in a hospital setting. This should be continued for at least 24-48 hours (till negative reports are available) in suspected cases and for 2-3 weeks in proven cases. Prophylaxis is aimed at preventing nosocomial and cross infections. Strict hand-washing, meticulous asepsis protocols, identification of high risk groups and prompt and better screening tests are essential in controlling this problem.KEY WORDS: Neonate, Sepsis, Systemic inflammatory response syndrome     

Digital colposcopy: ready for use? An overview of literature

The aims of this review were to summarise the various methods of digital colposcopy and to provide an overview of their efficacy. We conducted a literature search and focused on papers that described a technique for colposcopy, other than conventional colposcopy, and compared this with conventional colposcopy and/or histology and included digitalisation of the process. All papers have been classified in one of the following categories: digital imaging and telecolposcopy, spectroscopy, computerised colposcopy, optical coherence tomography and confocal microcolposcopy. Among the most promising developments is spectroscopy, allowing a more or less automated analysis and interpretation of the colposcopic image.     

肥胖与青少年多囊卵巢综合征

多囊卵巢综合征（PCOS）是育龄妇女常见生殖内分泌疾病。近年发现,随着儿童肥胖患病率增加,青少年PCOS发病率也逐年提高。肥胖可通过增加外周循环胰岛素水平影响PCOS发病机制,PCOS患者高雄激素血症也会增加内脏脂肪沉积。肥胖会增加与PCOS相关的代谢和心血管方面的并发症的患病风险,如胰岛素抵抗（IR）、高脂血症、高血压以及临床症状不明显的动脉粥样硬化等。早期识别青春期PCOS,有利于及时纠正、阻断其内分泌紊乱,防止近期及远期并发症发生。     

Neuroradiologic applications with routine C-arm flat panel detector CT: evaluation of patient dose measurements

BACKGROUND AND PURPOSE: Since the introduction of flat panel detector–equipped C-arms, the use of flat panel detector CT (FPCT) in the neuroradiologic angiography suite has become more frequent. This examination implicates its own specific radiation exposure. We used the CT dose index (CTDI) concept and adapted it to the special FPCT geometry to provide a consistent comparison with multisection head CT (cCT).MATERIALS AND METHODS: Exposure data obtained for routine scanning during a period of 1 year were used to assess a specific dose of a total of 217 rotational scans performed in 105 patients. One hundred seventy-two scans were 3D digital subtraction angiography (DSA) scans. There were 45 scans that were performed to achieve high-quality, soft-tissue resolution. Dose measurements in cylindrical polymethylmethacrylate (PMMA) phantoms were used to determine the CTDI value and to compare it with the reference values for cCT. In addition, the dose-area product (DAP) was registered and correlated with the CTDI and corresponding dose-length product (DLP) values. Exposure data and dose values were compared with cCT.RESULTS: Mean-weighted CTDI value of 3D-DSA was approximately 9 mGy per scan. High-quality, soft-tissue resolution FPCT scans, comparable with cCT, revealed a mean dose value of 75 mGy (reference value for cCT, CTDI_w ∼ 60 mGy).CONCLUSION: The high-speed scans used for 3D-DSA revealed a significantly lower CTDI_w and DLP compared with clinical CT. The high-quality FPCT protocol resulted in a higher dose and should therefore be limited to acute cases, when patient transfer to a CT scanner is considered to be a disadvantage for patient management.

Flat panel detectors (FPD) mounted on dedicated gantry systems or interventional C-arms are currently used for CT scanning. These scanners are used for interventional radiology and angiography or image-guided radiation therapy units and offer large coverage of up to 200 mm.^1-6 Volumetric imaging provided in the operating room has proved to be valuable for intraoperative procedures and is available for navigation and fusion with other preoperative or postoperative imaging modalities.^6-8Neuroradiology may benefit from the dual capabilities of such scanners.^8-12 Conventional digital subtraction angiography (DSA) can be combined with rotational digital subtraction angiography (3D-DSA). Furthermore, rotational datasets can also be used to reconstruct native or contrast CT datasets of the brain and skull. The image quality of modern C-arm scanners has improved, especially with respect to low-contrast detectability.^4-6 The first C-arms with use of CT functionality were equipped with image intensifier tubes and had their application, especially in the very-high-contrast angiographic imaging, working with contrast differences of more than 1000 HU. Current systems are equipped with FPDs and offer a significant improvement in low-contrast resolution. Contrast differences of down to 10 HU can be detected, which is a qualitative highlight.^1,4 Imaging of cerebral bleeding, which was only detectable on conventional CT, now is possible within the angiography suite with use of FPCT. Nevertheless, low-contrast image quality is inferior compared with clinical CT.^3,5,6 On the other hand, imaging of small, high-contrast targets, like intracranial microstents, seems to be superior compared with conventional multisection CT.⁹ Bone imaging with FPCT, a high-contrast target again, at least is equal to multisection CT, which is published for lumbar myelography and postmyelographic FPCT.¹⁰The frequent use of FPCT is associated with an increase of radiation dose to the patient when FPCT is performed as an additional examination. It is not surprising that this concern has led to increased scrutiny with regard to the accuracy of radiation dose assessment to patients who undergo CT examinations. C-arm FPCT again has substantial changes in geometry, providing collimations by far higher than the 100-mm recommended integration length of the CT dose index (CTDI) standard.^13-19 In addition, the systems use partial rotation scanning, which is expected to result in inhomogeneous dose distributions in the patient.^6,20 It is also questionable if the common phantoms are sufficient for dosimetry with use of wide-beam fields.^15,19 Although these scanners perform CT scanning, there is no consensus yet on estimating the patient dose for FPCT imaging. Because the systems emerged from radiography and angiography, many manufacturers provide the dose-area product (DAP) omitting any CT-specific terminology.²¹ Still, it is important for intermodality comparison reasons to adapt dose metrics used for FPCT to provide an accurate and flexible dose assessment.In this study, we used the CTDI concepts as they are defined for standard CT and adapted them to the special C-arm geometry to provide a consistent comparison between clinical CT and C-arm CT. The exposure data are provided for routine scanning for 1 year with use of automatic exposure control for the acquisition of 105 patients with C-arm FPCT.     

Flat panel detector angiographic CT in the management of aneurysmal rupture during coil embolization

Angiographic CT (ACT) produces CT-like images within minutes in the angiography suite. We present the cases of 2 patients with intraprocedural aneurysmal rupture in which ACT enabled the neuroradiologist to rapidly assess the extent of bleeding during endovascular treatment. Additionally, ACT revealed pronounced rebleeding within the time between conventional CT and onset of treatment. In the management of aneurysmal rupture during coil embolization, ACT may be a valuable adjunct.     

Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience

Objective

We evaluated radiation exposure and image quality of a new coronary CT angiography protocol, high-pitch spiral acquisition, using dual source CT (DSCT).

Material and methods

Coronary CTA was performed in 25 consecutive patients with a stable heart rate of 60 bpm or less after premedication, using 2?×?128 0.6-mm sections, 38.4-mm collimation width and 0.28-s rotation time. Tube settings were 100 kV/320 mAs and 120 kV/400 mAs for patients below and above 100-kg weight, respectively. Data acquisition was prospectively ECG-triggered at 60% of the R–R interval using a pitch of 3.2 (3.4 for the last 10 patients). Images were reconstructed with 75-ms temporal resolution, 0.6-mm slice thickness and 0.3-mm increment. Image quality was evaluated using a four-point scale (1 = excellent, 4 = unevaluable).

Results

Mean range of data acquisition was 113?±?22 mm, mean duration was 268?±?23 ms. Of 363 coronary artery segments, 327 had an image quality score of 1, and only 2 segments were rated as “unevaluable”. Mean dose–length product (DLP) was 71?±?23 mGy cm, mean effective dose was 1.0?±?0.3 mSv (range 0.78–2.1 mSv). For 21 patients with a body weight below 100 kg, mean DLP was 63?±?5 mGy cm (0.88?±?0.07 mSv; range 0.78–0.97 mSv).

Conclusion

Prospectively ECG-triggered high-pitch spiral CT acquisition provides high and stable image quality at very low radiation dose.     

Detection of complete response to imatinib mesylate (Glivec/Gleevec) with 18F-FDG PET/CT for low-grade endometrial stromal sarcoma

Malignant mesenchymal tumors consist of approximately 10% of uterine tumors. The majority of uterine sarcomas are leiomyosarcoma and endometrial stromal sarcoma (ESS). Surgery, radiotherapy, chemotherapy, and hormonal therapy are used for the treatment of ESS. Imatinib mesylate is indicated in the management of gastrointestinal stromal tumor and chronic myelogeneus leukemia. There is an interest to use imatinib mesylate in the treatment of c-kit positive ESS. We reported a case of 42-year-old female low-grade ESS progressed on chemotherapy and presented with objective response to imatinib mesylate. The treatment response was evaluated with FDG PET/CT. Complete metabolic response was detected. FDG PET, a sensitive method for tumor response evaluation on the basis of tumor metabolism changes, is useful for the evaluation of imatinib treatment in low-grade ESS. An erratum to this article can be found at     

肾上腺外伤性血肿的CT诊断

目的:评价肾上腺外伤性血肿的CT检查的意义。方法:回顾分析了经临床随访证实6例肾上腺外伤性血肿的CT资料。结果:6例肾上腺外伤性血肿均发生于右侧,6例在外伤10d内行CT检查。CT平扫:表现为卵圆形、梭形块影。病灶最大径4.5 cm×2.0 cm,其中,高密度4例、等密度1例、低密度1例。CT值在24~62 Hu之间。增强扫描:病灶不强化,2例在血肿边缘可见强化的肾上腺,其外周可见等密度条索影;4例合并少量腹水;2例合并肝撕裂伤。结论:CT可以早期明确肾上腺外伤性血肿的诊断。对于腹部闭合性损伤患者应早期行CT检查,必要的增强扫描,对于肯定和/或排除肾上腺血肿的诊断有重要价值。     

Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively). Benefit was minimal for those with stenosis of the renal artery ostium or renal insufficiency. Determining levels of renal vein renin before angioplasty is helpful in selecting patients; following angioplasty, this has considerable significance in predicting the success of the procedure.     

The thoracic aorta studied by MR imaging

Thirty-three patients with a variety of disorders of the thoracic aorta (aneurysm, dissection, Marfan syndrome, coarctation/pseudocoarctation, L-transposition, and Takayasu disease) were evaluated with magnetic resonance (MR) imaging. MR imaging delineated the presence and extent of thoracic aortic aneurysms and showed the relationship of the aneurysm to arch vessels; it also demonstrated intimal flaps and individual lumina in types A and B aortic dissection. Dilation of the ascending aorta in Marfan syndrome and focal narrowing of the aorta in coarctation were well visualized. The anteroposterior and side-to-side relationships of the aorta and pulmonary artery in L-transposition were demonstrated, as were aortic wall thickening and branch vessel narrowing in Takayasu arteritis. Initial experience suggests that MR imaging may provide a noninvasive method for evaluating thoracic aortic disease. Limitations include inferior spatial resolution, occasional difficulty in imaging the entire region of interest in one section, lack of signal from calcifications, and inability to monitor critically ill patients.