Tumors of the parapharyngeal space and upper neck: MR imaging characteristics

Magnetic resonance (MR) imaging characteristics of 40 tumors involving the parapharyngeal space and the upper part of the neck were reviewed. These lesions could be classified as being either hypervascular (glomus tumors or metastatic kidney, thyroid, or venous hemangiomas) or hypovascular (salivary gland tumors, neurogenic tumors, lymphomas, sarcomas). Detailed analysis of the contour of the neoplasm combined with clinical findings allowed further refinement of the differential diagnosis in each category. Most lesions had an intermediate signal intensity on T1-weighted images and a fairly high signal intensity on T2-weighted images. Hypervascular tumors had a number of "channel voids" caused by high-flow vessels on T1- and T2-weighted images, and on T2-weighted images there were areas of high signal intensity, presumably due to sites of slow flow within the image plane. The hypovascular lesions were quite homogeneous, and it was therefore more difficult to differentiate among the neoplasms in this group.     

D-患者输注D+红细胞输血政策的前瞻性研究

红细胞成分是有限的资源,因此应开发新的政策和输血准则以优化其使用.在理想情况下,D-患者应该输注D-红细胞.遗憾的是在一些情况下,如大量输血或者D-红细胞短缺时,D-病人需要输注D+红细胞,这样发生D-同种免疫就相当常见.健康D-志愿者输注D+红细胞后.发生抗D同种免疫风险高于80%.     

Spinal abnormalities in pediatric patients: MR imaging findings compared with clinical, myelographic, and surgical findings

Eighty-one pediatric patients with a variety of spinal disorders, including suspected dysrhaphism, scoliosis, neoplasia, and neurofibromatosis, underwent magnetic resonance (MR) imaging. The results were retrospectively compared with those of myelography followed by computed tomography (CT) and surgery. In patients with dysrhaphism, most abnormalities, including hydromyelia, inclusion tumors, and sites of cord tether, were demonstrated with MR imaging. Diastematomyelia and small hydromyelic cavities were indistinguishable on routine coronal and sagittal T1-weighted images; axial images with T2 weighting were optimal for this differentiation. MR imaging did not enable direct visualization of a thickened filum or evaluation of tethering with a thin, dorsally positioned neural placode. Congenital or severe scoliosis required lengthy studies with multiple planes of imaging or myelography and CT. Milder curvatures were readily evaluated with MR imaging, and neoplastic lesions, with the exception of intrathecal tumor seeding, were adequately defined.     

Presentation,management,and outcome of newly diagnosed glioblastoma in elderly patients

OBJECT: Optimum management for elderly patients with newly diagnosed glioblastoma(GBM) in the temozolomide(TMZ) era is not well defined.The object of this study was to clarify outcomes in this population.METHODS: The authors retrospectively reviewed 105 consecutive cases involving elderly patients(age ≥ 65 years) with newly diagnosed GBM who were treated at the Mayo Clinic between 2003 and 2008.RESULTS: The patients’ median age was 74 years(range 66-87 years),and the median Karnofsky Performance Status(KPS) score was 80(range 40-90).Half of the patients underwent biopsy and half underwent resection.Patients with deep-seated lesions(19 patients [18%]) or multifocal lesions(34 patients [32%]) were more likely to have biopsy than resection(p = 0.0001 and 0.0009,respectively).New persistent neurological deficits developed in 7 patients(6.7%).Postoperative hemorrhage occurred in 6 patients(5.7%),all of whom underwent biopsy.Complete follow-up data regarding adjuvant treatment was available in 84 patients.Forty-one(49%) were treated with chemotherapy(mostly TMZ) and radiation therapy(RT),and 23(27%) with RT alone.Nineteen(23%) received only palliative care after surgery(more common with biopsy,p = 0.03).Chemotherapy complications occurred in 28.6%(Grade 3 or 4 hematological complications in 11.9%).The median values for progression-free survival(PFS) and overall survival(OS) were 3.5 and 5.5 months.In a multivariate analysis,younger age(p = 0.03,risk ratio [RR] 0.34,95% CI 0.13-0.89),single lesion(p = 0.02,RR 0.51,95% CI 0.30-0.89),resection(p = 0.04,RR 0.54,95% CI 0.31-0.94),and adjuvant treatment(p = 0.0001,RR 0.24,95% CI 0.11-0.49) were associated with better OS.Only adjuvant treatment was significantly associated with prolonged PFS(p = 0.0007,RR 0.27,95% CI 0.13-0.57).With combined therapy with resection,RT,and chemotherapy,the median PFS and OS were 8 and 12.5 months,respectively.CONCLUSIONS: The prognosis for GBM worsens with increasing age in elderly patients.With important risks,resection and adjuvant treatment are associated with prolonged survival.Although selection bias cannot be excluded in this retrospective study,advanced age alone should not necessarily preclude optimal resection followed by adjuvant radiochemotherapy.     

Corticosteroids in severe community-acquired pneumonia: the path we choose depends on where we want to get

Severe community-acquired pneumonia is a major cause of admission to intensive care units and its mortality rates remain exceedingly high. In the search for adjunctive therapies, clinicians who were encouraged by available, though limited, evidence prescribed steroids in most patients with severe sepsis or septic shock, including those with community-acquired pneumonia. Current evidence demonstrates that, whereas corticosteroids should not be routinely employed as adjuvant therapy for severe community-acquired pneumonia, there is sufficient equipoise to continue studying the use of corticosteroids.