Speech suppression without aphasia after bilateral perisylvian softenings (bilateral rolandic operculum damage)

The authors describe a patient who suffered two successive, right and left, strokes that caused bilateral rolandic operculum damage. The clinical picture was characterized by selective impairment of volitional facio-pharyngo-glosso-masticatory movements with sparing of automatic and reflex motor activity (Foix-Chavany-Marie syndrome). Though completely speechless, the patient was not aphasic. This dissociation is discussed in the light of the peculiar localization of lesions evidenced by CT-scan.

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Sommario Viene descritta una paziente portatrice di due lesioni ischemiche coinvolgenti l'opercolo rolandico in entrambi gli emisferi. Il quadro clinico era caratterizzato da una compromissione selettiva dei movimenti volontari (con integrità di quelli automatici e riflessi) bilateralmente a livello facio-faringo-glosso-masticatorio (sindrome di Foix-Chavany-Marie). La paziente, del tutto incapace di articolazione e fonazione, non risultava afasica ad una valutazione neuropsicologica. Questa dissociazione viene discussa in riferimento alla particolare localizzazione delle lesioni alla T.A.C. cerebrale.

     

Ultrasonographic renal volume measurements in early autosomal dominant polycystic disease: Comparison with CT-scan renal volume calculations

PurposeTo investigate the correlation and concordance between the ellipsoid volume calculated by ultrasonography measurements (Vol3DUS) and the reference kidney volume measured by CT (VolTDM) in early autosomal dominant polycystic kidney disease (ADPKD).Materials and methodsProspective study of the correlation and concordance of renal volumes in 24 patients with early ADPKD (48 kidneys analysed separately), with calculation of Vol3DUS using the formula for an ellipsoid in three different manners and VolTDM measurement by manual contouring. Calculations of correlation coefficients (r) and coefficients of intra-class correlation (ICC) with confidence intervals at 95%.ResultsThe US volume was strongly correlated with the CT volume by using the maximum width in a transverse section (r = 0.83) with a mean Vol3DUS = 692 ± 348 ml [180; 2069]. The most reproducible ultrasonography measurement was the height. When the kidney volume exceeded 800 ml, US underestimated the volume. However, the median error was −57.5 ml [−1090; 183] and 85% of the Vol3DUS calculated differed by more than 5% from the reference measurement.ConclusionThe correlation between the US calculated volumes and the CT volumes was strong. However, the median error with ellipsoid US volume was too high to detect a small renal variation in early ADPKD.     

How to evaluate the outflow tract of LVAD after minimally invasive implantation by 3D CT-scan

During a minimally invasive implantation technique, the outflow graft of left ventricular assist device (LVAD) is tunnelled blindly through the pericardium or left pleura, with an inability to assess for twisting or malposition. Three-dimensional computed tomography scan (CT-scan) has a role in qualitative evaluation of the different outflow tract configurations. The different surgical minimally invasive approaches include: (a) mini-sternotomy and left mini-thoracotomy, (b) right mini-thoracotomy and left mini-thoracotomy, (c) subclavian artery access and left mini-thoracotomy. The outflow graft could be anastomosed to the left axillary artery or the ascending aorta. CT-scan reconstruction using syngo InSpace4D (Siemens, Muenchen, Germany) was used to provide fast segmentation and high-resolution images. The 3D reconstructions permit an evaluation of different anastomosis configurations and to assess the route of outflow graft.     

新生儿缺氧缺血性脑病的CT表现及预后评估

目的:探讨足月新生儿缺氧缺血性脑病(HIE)的CT及临床表现与预后。方法:对40例临床确诊为HIE的足月新生儿进行CT检查及分度,并结合临床表现及分度对预后进行评估。结果:脑水肿低密度区的形态、大小、范围更具有诊断价值,也是预后评估的基础之一。结论:CT扫描对本病的诊断、病情估计、疗效观察及预后判断有重要临床价值。     

Measurement techniques to determine tibial rotation after total knee arthroplasty are less accurate than we think

Background

The present study assessed the inter- and intra-observer reliability of tibial and femoral rotation measures after total knee arthroplasty (TKA), and evaluated the correlation between these measurement techniques and their clinical relevance.

Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

Objective This prospective study investigated the factors which might indicate anastomotic leakage after low anterior resection. Method Thirty‐three patients who underwent anterior resection for rectal carcinoma (n = 32) and severe dysplasia (n = 1), were monitored daily by serum C‐reactive protein (CRP) and white blood cell count (WBC) estimations until discharge from hospital. Computed tomography (CT) scans were performed on postoperative days 2 and 7 and the amount of presacral fluid collection was assessed. All patients had a pelvic drain and the volume of drainage was measured daily. Results The level of the anastomosis was at a median 5 cm (3–12 cm) above the anal verge. There was no 30‐day mortality. Nine (27.2%) of the 33 patients developed a symptomatic anastomotic leakage which was diagnosed at a median of 8 days (range 4–14) postoperatively. The serum CRP was increased in patients who leaked from postoperative day 2 onwards (P = 0.004 on day 2; P < 0.001 on day 3–8). The WBC was decreased in preoperatively irradiated patients on days 1–5 (P ≤ 0.021), with no difference seen between patients with or without leakage. Patients with leakage had a larger presacral fluid collection on CT on day 7 (median 76 ml vs 52 ml; P = 0.016) and a larger increase in the fluid collection between the first and the second CT examinations (28 ml vs 3 ml; P = 0.046). Conclusion An early rise in serum CRP was a strong indicator of leakage. Monitoring of CRP for possible early detection of symptomatic anastomotic leakage is recommended.     

Contrast imaging techniques to diagnose hepatocellular carcinoma in cirrhotics outside regular surveillance

Introduction and aimThe American Association for the Study of the Liver (AASLD) recommends contrast computerized tomography (CT-scan) and magnetic resonance (MRI) to diagnose hepatocellular carcinoma (HCC) arising in cirrhotic patients under semiannual surveillance with abdominal ultrasound (US). A US guided fine needle biopsy (FNB) serves the same purpose in radiologically undiagnosed tumors and incidentally detected nodules in cirrhotics outside surveillance. In this population, we evaluated the performance of radiological diagnosis of HCC according to 2010 AASLD recommendations.Materials and methodsAll cirrhotic patients with a liver nodule incidentally detected by US were prospectively investigated with a sequential application of CT-scan/MRI examination and a FNB.ResultsBetween 2011 and 2015, 94 patients (mean age 67 years) had a liver nodule (total 120) detected by US in the context of histologically confirmed cirrhosis. Mean nodules diameter was 40 (10–160) mm, 87 (73%) <5 cm. At histology, 84 (70%) nodules were HCC, 8 (7%) intrahepatic cholangiocarcinoma, 6 (5%) metastases, 2 (2%) neuroendocrine tumors and 20 (16%) benign lesions. Hyperenhancement in arterial phase followed by wash-out in venous phases on at least one radiological technique was demonstrated in 62 nodules (61 HCC, 1 high grade dysplastic nodule), with a specificity of 97% (IC95%: 85–100%), sensitivity 73% (IC95%: 62–81%) and diagnostic accuracy 80%, being 64% for ≥5 cm HCC. Sensitivity of AFP >200 ng/mL was 12% (IC95%: 6–23%).ConclusionA single contrast imaging technique showing a typical contrast pattern confidently identifies HCC also in cirrhotic patients with an incidental liver nodule, thereby reducing the need for FNB examinations.