Comparación de sistemas de evaluación diagnóstica de la severidad de la osteoartrosis en imágenes de TAC de las ATM

Objetivo: Comparar y validar sistemas diagnósticos de severidad de Osteoartrosis (OA) de las articulaciones temporomandibulares (ATM) en imágenes de tomografía computada (TAC). Método: Se efectuó un estudio observacional, retrospectivo, analítico y ciego. Se evaluaron 99 pacientes (198TAC-ATM), aplicando los criterios de siete diferentes sistemas diagnósticos. Un clínico calibrado (K=0,7) efectuó las evaluaciones. La validez de contenido se efectuó bajo los criterios Ahmad. La consistencia interna se determinó con Alpha de Cronbach. Se correlacionaron los datos con Rho de Spearman. Resultados: La severidad de la erosión condilar presenta alta correlación positiva entre las clasificaciones Alexiou/Arayasantiparb (rho=0,986) y baja entre Cömert/Alexiou (rho=0,421) y Cömert/Arayasantiparb (rho=0,422). La esclerosis condilar presentó fuerte correlación entre las clasificaciones de Cömert/Alexiou, Masilla/Alexiou y Cömert/Masilla (rho=857;rho=0,853;rho=0,998). Los datos presentaron alta consistencia interna (Alfa Cronbach=0,897) y baja validación de contenido (36,2%). Conclusiones: Las mediciones de los 7 sistemas presentan alta fiabilidad. La erosión ósea, esclerosis y osteofitos son medidos en cuatro niveles de severidad y con similar escala en tres sistemas de diagnóstico (Alexiou, Arayasantiparb y Cömert), sugiriendose complementar con determinación del espacio articular y movilidad condilar, como propone RDC/TMD para TTM. La validación de contenido fue baja, solo los sistemas diagnósticos de Cömert y Alexiou superaron el 50%.

Objective: To compare and validate diagnostic systems for the severity of Osteoarthrosis (OA) of the temporomandibular joints (TMJ) in computed tomography (CT) images. Method: An observational, retrospective, analytical, blinded, retrospective study was performed. Ninety-nine patients (198MSCT-ATM) were evaluated, applying the criteria of seven different diagnostic systems. A calibrated clinician (K=0.7) performed the evaluations. Content validity was performed under the Ahmad criteria. Internal consistency was determined with Cronbach's Alpha. Data were correlated with Spearman's Rho. Results: For condylar erosion severity, there was a high positive correlation between Alexiou/Arayasantiparb (rho=0.986) and a low one between Cömert/Alexiou (rho=0.421) and Cömert/Arayasantiparb (rho=0.422) classifications. For condylar sclerosis, we found a strong correlation between Cömert/Alexiou, Masilla/Alexiou and Cömert/Masilla classifications (rho=857; rho=0.853; rho=0.998). The data presented high internal consistency (Cronbach's alpha=0.897) and low content validation (36.2%). Conclusions: The measurements of the 7 systems have a high reliability. Bone erosion, sclerosis and osteophytes are measured at four levels of severity and with a similar scale in three diagnostic systems (Alexiou, Arayasantiparb and Cömert). We suggest to complement it with the determination of joint space and condylar mobility, as proposed by RDC/TMD. Content validity was low, only the Cömert and Alexiou diagnostic systems were higher than 50%.

CLINICAL AND THERAPEUTIC ASPECTS OF DIVERTICULITIS: A NARRATIVE REVIEW

Diverticulitis is a gastrointestinal condition in which diverticula (small sacs or pouches) in the colon become inamed or infected. This article is a review of the current understanding of diverticulitis and covers its causes, symptoms, diagnosis, and treatment. Epidemiological studies have shown that diverticulitis mainly affects older adults and the incidence increases with age. The Western diet, which is high in fat and low in ber, has been implicated in the development of diverticulitis. The most common presenting symptom is abdominal pain, often localized to the left lower quadrant, and other symptoms include fever, nausea, vomiting, and changes in bowel habits. The diagnosis of diverticulitis is based on a combination of clinical, radiologic, and laboratory ndings. The preferred imaging modality is computed tomography (CT) with intravenous contrast. Mild cases can often be managed with conservative measures, such as bowel rest, antibiotics, and pain management. More severe cases may require hospitalization, intravenous antibiotics, and, in some cases, surgical intervention. Surgery may be required in cases of complicated diverticulitis, such as perforation, abscess formation, or stula formation, and in patients with recurrent diverticulitis. In conclusion, further research is needed to better understand the epidemiology of diverticulitis and its risk factors, especially in developing countries where the incidence of diverticulitis is believed to be lower.

Evaluation of 18FDG PET-CT-positive mediastinal-hilar lymph nodes in extrathoracic malignancies by EBUS-TBNA; correlation of SUVmax, and short-axis diameter with the final diagnosis

Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck , carcinoma breast ,and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8� as compared to 3� of malignant nodes. The size range of malignant and benign nodes were 8� mm and 8� mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8� mm) and the mean SUVmax was 9.1 (3.4�), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies.

Evaluation of the normal craniocervical junction craniometry in 137 asymptomatic patients / Evaluación de la craneometría de la unión craneocervical normal en 137 pacientes asintomáticos

SUMMARY: To our best knowledge, most of the craniometric studies on the normal craniocervical junction (CCJ), are still poorly studied and based on measurements taken from plain radiographs. In this study, the authors conducted a craniometric evaluation of the CCJ in a population without known CCJ abnormalities. The purpose of the study was to assess the normal CCJ craniometry based on measures obtained from CT scans. The authors examined 137 consecutive CCJ CT scans obtained in patients evaluated at their hospital for treatment of non-CCJ conditions between 2018 and 2019. Twelve craniometrical dimensions were conducted, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, and the clivus-canal angle (CCA).

Hasta donde sabemos, aun son escasos y pocos los estudios craneométricos respecto a la unión craneocervical normal (UCCN) y estos se basan en mediciones tomadas de radiografías simples. En este estudio, realizamos una evaluación craneométrica de la UCCN en una población sin anomalías conocidas. El propósito del estudio fue evaluar la craneometría UCCN normal en función de las medidas obtenidas de las tomografías computarizadas. Los autores examinaron 137 tomografías computarizadas UCCN consecutivas obtenidas en pacientes evaluados en su hospital para el tratamiento de condiciones no UCCN entre los años 2018 y 2019. Se realizaron doce dimensiones craneométricas, incluida la relación del proceso odontoides con la base del cráneo, el intervalo atlantodental (ADI), la longitud del clivus y el ángulo clivus-canal (CCA).

Prevalence of reported incidental adrenal findings in chest computerized tomography scans performed during the COVID-19 pandemic in a single center in Northeast Brazil

ABSTRACT Objective: We investigated the prevalence of adrenal incidentalomas (AIs) in a nonselected Brazilian population in chest computed tomography (CT) performed during the COVID-19 pandemic. Materials and methods: This was a retrospective cross-sectional observational study using chest CT reports from a tertiary in- and outpatient radiology clinic from March to September 2020. AIs were defined by changes in the shape, size, or density of the gland initially identified in the released report. Individuals with multiple studies were included, and duplicates were removed. Exams with positive findings were reviewed by a single radiologist. Results: A total of 10,329 chest CTs were reviewed, and after duplicate removal, 8,207 exams were included. The median age was 45 years [IQR 35-59 years], and 4,667 (56.8%) were female. Thirty-eight lesions were identified in 36 patients (prevalence 0.44%). A higher prevalence was observed with age, with 94.4% of the findings in patients aged 40 years and over (RR 9.98 IC 2.39-41.58, p 0.002), but there was no significant difference between the sexes. Seventeen lesions (44.7%) had more than 10 HU, and five lesions (12.1%) were more than 4 cm. Conclusions: The prevalence of AIs in an unselected and unreviewed population in a Brazilian clinic is low. The impact on the health system caused by AIs discovered during the pandemic should be small regarding the need for specialized follow-up.

Analysis of CT doses to paediatric patients in four children′s hospitals in Shanghai / 中华放射医学与防护杂志

Objective:To study the distribution of CT doses to paediatric patients in Shanghai by investigating the CT dose parameters availiable in Shanghai′s children′s hospticals, and to provide the basis for establishing the diagnostic reference level for the paediatic patients subjected to CT scanning in Shanghai.Methods:In 2021, a general survey was carried out of the CT doses to the head, chest and abdomen of the scanned paediatric patients in four children′s hospitals in the municipality. The scanned paediatic patients were divided into four age groups of 0-, 1-, 5- and 10-15 years old, each with 30 subjects. The basic information were collected on the subjects, CT scanning parameters, volume CT dose index (CTDI vol) and dose length product (DLP). SPSS 16.0 was used to carry out statistical analysis of the differences in CTDI vol and DLP between different age groups at the same site and between different hospitals for the same age group at the same site. Results:The 75 th percentile values of CTDI vol and DLP for 0-, 1-, 5- and 10-15 age groups were 25, 25, 28, 43 mGy and 402, 477, 504, 752 mGy·cm, respectively, for head scanning; 2.7, 2.2, 2.8, 5.4 mGy and 40, 48, 75 and 176 mGy·cm for chest; and 4.9, 4.4, 8.2, 12 mGy and 106, 131, 273, 471 mGy·cm for abdomen. There were significant differences in CTDI vol and DLP between different age groups at the same site and between different hospitals for the same age group at the same site (head, chest and abdomen CTDI vol:χ2=221.68, 167.27, 127.07, DLP: χ2=220.63, 261.46, 216.61; for four age groups, CTDI vol: head χ2=30.46, 38.39, 25.21, 73.04, chest χ2=30.46, 35.69, 58.92, and 48.03, abdomen χ2=66.58, 41.62, 48.93, and 67.38; DLP: head χ2=28.82, 72.49, 47.72, 52.34, chest χ2=28.82, 35.95, 50.66, 41.64, abdomen χ2=45.53, 26.02 39.34, 44.24, P <0.05 ). Conclusions:The 75 th percentile values of CTDI vol and DLP for head, chest and abdomen in 4 children′s hospitals in Shanghai are lower or close to the values given in the relevant national standards and the diagnostic reference levels in some European countries, with higher DLP values on some scanning sites. The CT scanning procedures for paediatric patients needs to be further optimized.

A review of the clinical significance of lumbar puncture in the diagnostic approach of Aneurysmal Subarachnoid Hemorrhage (SAH): A case report of CT-Negative and Lumbar Puncture–Positive SAH

@#Headaches are a common presentation in the emergency department (ED). Even though not all are potentially serious, some such as subarachnoid hemorrhage (SAH) can be more dangerous than others. SAH is a medical emergency with an almost 50% mortality rate. It is crucial not to miss the diagnosis of SAH, as a missed or delayed diagnosis can be severely detrimental. It classically presents as thunderclap headache, a severe, sudden-onset headache. There are various approaches in diagnosing or excluding SAH, which is classically done by performing a computed tomography (CT) scan followed by a lumbar puncture (LP). But with the improved sensitivity of more modern diagnostic tools, more physicians are in support of changing this classical teaching. The aim of this case report is to review the advantages and disadvantages of LP in diagnosing SAH, along with other diagnostic tools commonly used.

Comparison of the diagnostic accuracy of CT scan with oral and intravenous contrast versus CT scan with intravenous contrast alone in the diagnosis of blunt abdominal trauma / 中华创伤杂志(英文版)

PURPOSE@#Abdominal CT scan using oral and intravenous (IV) contrast is helpful in the diagnosis of intra-abdominal injuries. However, the use of oral and IV contrast delays the process of diagnosis and increases the risk of aspiration. It has also been shown that CT scan with IV contrast alone is as helpful as CT scan with oral and IV contrast and rectal CT scan in detecting abdominal injuries. Therefore, the present study aims to prospectively compare the diagnostic value of CT scan with oral and IV contrast versus CT scan with IV contrast alone in the diagnosis of blunt abdominal trauma (BAT).@*METHODS@#Altogether 123 BAT patients, 60 (48.8%) women and 63 (51.2%) men with the mean age of (40.4 ± 18.7) years who referred to the emergency department of Imam Khomeini Educational and Medical Center in Sari, Iran (a tertiary trauma center in north of Iran) from November 2014 to March 2017 and underwent abdominal CT scans + laparotomy were investigated. Those with penetrating trauma or hemodynamically unstable patients were excluded. The participants were randomly allocated to two groups: abdominal CT scan with oral and IV contrast (n = 63) and CT scan with IV contrast alone (n = 60). No statistically significant difference was found between two groups regarding the hemodynamic parameters, age, gender, injury mechanisms (all p > 0.05). The results of CT scan were compared with that of laparotomy results. The collected data were recorded in SPSS version 22.0 for Windows. Quantitative data were presented as mean and SD.@*RESULTS@#The sensitivity and specificity of CT scan using oral and IV contrast in the diagnosis of BAT were estimated at 96.48 (95% CI: 90.73 - 99.92) and 92.67 (95% CI: 89.65 - 94.88), respectively; while CT scan with IV contrast alone achieved a comparable sensitivity and specificity of 96.6 (95% CI: 87.45 - 99,42 and 92.84 (95% CI: 89.88 - 95.00), respectively.@*CONCLUSION@#CT scan with IV contrast alone can be used to assess visceral injuries in BAT patients with normal hemodynamics to avoid diagnostic delay.

Évaluation tomodensitométrique des variations anatomiques du toit de l'os ethmoïde chez l'adulte noir / Computed tomography evaluation of anatomical variations of the ethmoid bone roof in black adults

Etudier à la tomodensitométrie, les variations anatomiques du toit de l'os ethmoïde en déterminant la prévalence des variantes à haut risque. Matériels et méthodes: Etude transversale, avec une collecte rétrospective, descriptive et analytique menée sur une période de 06 mois dans deux services de radiologie et imagerie médicale à Lomé. Elle portait sur des examens de tomodensitométrie normaux des sinus de l'adulte. Résultats: L'âge moyen était de 50,69 ± 16,18 ans. La profondeur moyenne de la fosse olfactive dans le sexe masculin était de 4,03± 1,40 mm contre 4,45±1,59 mm dans le sexe féminin (p=0,0136). Le type III de Keros a été retrouvé dans 11 cas (3,5%). L'asymétrie de la profondeur de la fosse olfactive a été observée chez 107 (69%) patients. L'angle de Gera mesurait en moyenne 58,5±14,6 degrés et 60 (19,4%) toits de l'ethmoïde étaient classés dans le type III. On notait une asymétrie de l'angle de Gera chez 102 (65,8%) patients. La longueur moyenne de la lamelle latérale de la lame criblée était de 5,34 ± 1,4 mm. La longueur moyenne de la fovéa ethmoïdale chez les hommes était de 10 ± 2,5 mm contre 9,3 ± 2,2 chez les femmes (p=0,0078). Il existait une corrélation linéaire positive entre la profondeur de la fosse olfactive et l'angle de Gera (r=0,498; p=0,002). Conclusion: La fréquence élevée de l'asymétrie du toit ethmoïdal suggère que ces variations soient précisées par les radiologues dans les compte-rendu des examens de tomodensitométrie des sinus pour bilan préopératoire

Asymptomatic Acute Dissection of the Abdominal Aorta as a Rare Complication of Takayasu Disease

The present study describes a case of a 24-year-old who had an asymptomatic acute dissection of the abdominal sub-renal aorta along with an inflammatory syndrome suggestive of Takayasu disease. Aortic dissection is a rare complication of Takayasu's disease that has only been reported a few times in the literature. The type of aortic dissection (type III b, according to the classification of De Bakey and Stanford) confirmed by computed tomography scan of the aorta (CT scan) in our patient. The patient underwent conservative medical treatment.

COARCTATION OF AORTA IN A 33 YEARS-OLD UNCONTROLLED HYPERTENSIVE FEMALE PATIENT – A CASE REPORT

We report a 33-year-female patient of hypertension detected at the age of 19 year. Her blood pressure was not well controlled. The case was investigated for secondary hypertension. CT Thoracic and Abdominal aorta Angiogram of the present case showing the narrowing in the thoracic aorta extending at the level of T8 to T10 vertebral body level for the length of 7.5cm. Reconstructed CT of the case showed multiple tortuous collaterals between the branches of internal mammary artery and external iliac artery and between axillary and intercostal artery. Relevant history was reviewed and discussed.

Coronary Artery Connection Abnormality Revealed by Acute Coronary Syndrome: A Case Report and Review of the Literature

Coronary artery connection abnormalities are rare with an angiographic prevalence of approximately 1%. Their symptomatology is very varied, from incidental discovery to sudden death by myocardial ischemia, especially during exercise, hence the importance of early diagnosis and management. Angiographic diagnosis is generally easy, but it is sometimes difficult to specify the initial course of the ectopic vessel, hence the interest of non-invasive imaging, in particular the coronary CT scan. This latter represents the innovative imaging of choice for assessing the anatomical risk and selecting candidates for surgical treatment. We report a case of abnormal connection of the left coronary revealed by an acute coronary syndrome and we present a review of the literature on the different anatomical forms of the pathology and its management.

A study of clinical profile, etiology, therapeutic outcomes of patients with cerebral sinus venous thrombosis in men

Cerebral sinus venous thrombosis (CSVT) is very rare in men compared to women. There are many causes but they are very rare in men, and it is an uncommon cause of cerebral infarction. Patients usually present with Headache, Focal deficits such as Monoparesis, Hemiparesis, Paraparesis and Hemisensory disturbances, seizures, impairment of level of consciousness. Now it is recognized as a non-septic disorder with various clinical presentations with a favorable outcome, and low mortality rate below. CT scan, MRI and Magnetic Resonance Venography (MRV) are the best diagnostic methods for diagnosis and low molecular weight heparin is the first-line treatment. Results of this study, clinical profile, etiology, therapeutic outcomes of patients with cerebral sinus venous thrombosis in men are discussed.

Clinical categorisation and etiology of seizures in children admitted at a tertiary care centre in North Karnataka

Background: Seizure is a common problem evaluated in pediatric emergency departments. Seizure disorders are among the most frequent neurologic problems that occur in childhood. Around 4 to 10% of children experience at least one episode of seizure in the first 16 years of their life. Objectives: To study clinical and etiological profile of children presenting with seizures. Material and Methods: A total of 126 consecutive children aged 1 month to 18 years presenting with seizures defined as per international league against epilepsy classification, participated in this study. A detailed history was taken, and clinical examination was done, along with the investigation for the aetiology of seizures with routine and specific tests, computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) and electroencephalography (EEG) as and when needed. Results: In our present study, we recorded the highest incidence of seizures in the age group of 1year to 5 years. The incidence of seizures in our study was more in males, accounting for 73 cases (57.4%) while females were 53 cases (42.06%). Generalized seizures were the commonest, among them GTCS accounting for 88 cases (69.84). The identified major etiologic factors were febrile convulsions followed by CNS infections. Conclusion: The incidence of convulsions is highest in the age group of 1 month to 5 years and in males. The commonest type of seizure is generalized tonic-clonic (40.6%).The most common cause of convulsion is febrile seizures. Milestones were achieved normally in majority of cases.

Comparative and correlative study of computerized tomographic scan findings and intra-operative findings in patients with inflammatory sinonasal diseases

Background: Inflammatory sinonasal diseases (ISD) refer to a group of disorders characterized by inflammation of the mucosa of the PNS. Acute ISD are defined as sudden in onset and duration less than 3 weeks. Recurrent acute infections are defined as four or more attacks per year lasting greater than 7-10 days. Chronic is defined as duration of symptoms more than 12 weeks. Materials and methods: The present prospective study was conducted in the department of ENT JSS Medical College and Hospital. The study was conducted from a period of November 2012 to June 2014. The study included a total of 50 patients with clinically proven inflammatory sinonasal diseases not responding to medical line of treatment. A complete detail about their signs and symptoms was also recorded in a tabulated form. Data was expressed as percentage of the total information and analysis was done using SPSS software. Results: The present study enrolled 50 subjects, out of these; there were 21 females and 29 males. 56% were diagnosed as with chronic sinusitis, 30% with ethmoid polyposis and 14% with antrochonal polyp in this study. The specificity of CT was found to be best for posterior ethmoid, hiatus semilunaris, sphenoethmoid recess, uncinate process, frontal recess, inferior turbinate. The values were 97%, 89%, 95%, 93.5%, 89.5% and 88.5% respectively. CT was relatively less sensitive for anterior ethmoid, infundibulum, bulla ethmoidalisad maxillary sinus. The values were 86%, 85%, 71%, 66%. Conclusion: CT is effective in demonstrating predisposing cause of Inflammatory Sino nasal diseases (e.g. Anatomical variants) and provides guidance for therapeutic endoscopic instrumentation. CT with its excellent capability for displaying bone and soft tissue is the current diagnostic modality of choice for evaluation of osteomeatal complex. CT scan has to be done, to know sino nasal anatomy and anatomical variations and to plan for FESS.CT scan provides findings which helps in management and acts as Road Map to the surgeons if FESS is indicated.

Double Compound Intussusception桝 Clinico-radiological Correlation

Intussusception is the invagination of a proximal segment of intestine into a distal segment leading to intestinal obstruction. The rarest form of intussusception is the Compound Intussusception. In adults, the typical signs and symptoms may be present in only a small subset of patients. Hence, the diagnosis may be missed clinically. Computerised Tomographic (CT) Scan can prove to be a useful adjunct for the diagnosis. In patients with Compound Intussusception, the Triple Circle Sign may be seen on CT scan, which gives a useful clue to the diagnosis. This clinico-radiological correlation can help in early diagnosis and intervention and lead to decreased morbidity in patients

Fístula traqueoesofágica como complicación de la intubación endotraqueal prolongada / Tracheoesophageal fistula as a complication of prolonged endotracheal intubation

RESUMEN Introducción: La fístula traqueoesofágica consecutiva a intubación endotraqueal prolongada es una lesión grave con elevada morbimortalidad. El alto índice de sospecha, diagnóstico precoz, resolución de las complicaciones y un tratamiento quirúrgico definitivo son los pilares fundamentales en los cuales descansa su manejo correcto. Objetivo: Describir el comportamiento y manejo de la fístula traqueoesofágica en pacientes con intubación endotraqueal prolongada. Presentación del caso: Paciente de 34 años de edad que sufrió trauma craneoencefálico grave con necesidad de intubación endotraqueal prolongada. Su evolución fue favorable, con recuperación neurológica, pero presentaba tos incontrolable después de la deglución, aumento de las secreciones respiratorias y pérdida de 30 Kg de peso no resuelta, lo que motivó se le realizara tomografía computarizada multicorte dual sincronizada con el electrocardiograma, la que permitió de forma rápida y no invasiva, llegar al diagnóstico de la fístula traqueoesofágica. Conclusiones: La intubación endotraqueal prolongada constituye la causa principal de la aparición de la fístula traqueoesofágica. El mecanismo de producción fundamental fue la isquemia provocada por la compresión de las paredes posterior de la tráquea y anterior del esófago entre el manguito insuflado del tubo endotraqueal y la sonda nasogástrica. La tomografía computarizada multicorte dual sincronizada con el electrocardiograma permite realizar el diagnóstico de esta complicación.

ABSTRACT Introduction: Tracheoesophageal fistula following prolonged endotracheal intubation is a serious lesion with high morbidity and mortality. The high index of suspicion, early diagnosis, resolution of complications and definitive surgical treatment are the fundamental pillars on which its correct management rests. Objective: Describe the behavior and management of tracheoesophageal fistula in patients with prolonged endotracheal intubation. Case Presentation: A 34-year-old patient who suffered severe head trauma with the need of prolonged endotracheal intubation. His evolution was favorable, with neurological recovery, but he presented uncontrollable cough after swallowing, increased respiratory secretions and unsolved loss of 30 Kg of weight, which motivated to perform to him a dual multi-cut computed tomography synchronized with the electrocardiogram, which allowed quickly and non-invasively, to reach the diagnosis of tracheoesophageal fistula. Conclusions: Prolonged endotracheal intubation is the main cause of the appearance of tracheoesophageal fistula. The fundamental production mechanism was ischemia caused by compression of the posterior walls of the trachea and anterior walls of the esophagus between the inflated cuff of the endotracheal tube and the nasogastric tube. The dual multi-cut computed tomography synchronized with the electrocardiogram allows the diagnosis of this complication.

Application of stereology in liver volume measurements using computed tomography scan / Aplicación de la estereología en mediciones de volumen hepático mediante tomografía computarizada

SUMMARY: The application of stereology in hepatobiliary conditions is essential in liver volume estimation. Computerized topographic scan with contrast is a reliable method in liver scanning for precise boundaries demarcation. Liver volumetry varies in relation to different factors. Reports showed a correlation of liver volume with sex and body mass index. Steady relation between age and ethnicity is not established. This study aimed to design a protocol for liver volume measurement and apply it in the estimation of volume among the Sudanese population use stereology. Recruitment of the study population was obtained in the royal scan clinic in Khartoum by making an announcement for participation in the study. Patients with a history of hepatobiliary diseases were excluded. CT abdomen with contrast was obtained in DICOM format and transferred to computer-based software for image analysis. A protocol was designed and validated and then applied in volume estimation using software MRIcro for image display, ImageJ for volume estimation, and Onis 2.6 as image viewer. 300 apparently healthy volunteers were recruited. The protocol reliability result was 0.805. Absolute mean liver volume was 3261.32 ± 1365.313 cm3. High liver volume among females was detected than among males. A positive correlation was detected between volume and body mass index (p-value 0.001) regardless of sex. Relation with age showed a rough steady rise till the age of 50 years then it started to decline steadily. The relationship was detected in liver volume with sex and body mass index. More studies are needed to investigate the relationship between ethnicity and age groups.

RESUMEN: La aplicación de la estereología en condiciones hepatobiliares es fundamental en la estimación del volumen hepático. El escaneo topográfico computarizado con contraste es un método confiable en el escaneo del hígado para la demarcación precisa de sus límites. La volumetría hepática varía en función de diferentes factores. Los informes mostraron una correlación del volumen del hígado con el sexo y el índice de masa corporal. No se establece una relación estable entre la edad y la etnia. Este estudio tuvo como objetivo diseñar un protocolo para la medición del volumen hepático de la población sudanesa usando la estereología. El reclutamiento de la población de estudio fue realizado en la clínica de exploración real en Jartum mediante un anuncio de participación. Se excluyeron los pacientes con antecedentes de enfermedades hepatobiliares. Se obtuvo TC de abdomen con contraste en formato DICOM y se transfirió a un software informático para el análisis de imágenes. Se diseñó y validó un protocolo y luego se aplicó en la estimación de volumen utilizando el software MRIcro para la visualización de imágenes, ImageJ para la estimación de volumen y Onis 2.6 como visor de imágenes. Se reclutaron 300 voluntarios sanos. El resultado de la fiabilidad del protocolo fue 0,805. El volumen hepático medio absoluto fue 3261,32 ± 1365,313 cm3. Se detectó un volumen más elevado de hígado en las mujeres que en los hombres. Se detectó una correlación positiva entre el volumen y el índice de masa corporal (valor de p 0,001) independientemente del sexo. La relación con la edad mostró un aumento continuo y brusco hasta los 50 años, luego comenzó a disminuir de manera constante. Se detectó la relación del volumen hepático con el sexo y el índice de masa corporal. Se necesitan más estudios para investigar la relación entre la etnia y los grupos etarios.

Role of early dynamic PET/CT scan imaging with 18F-PSMA-1007 in staging and restaging prostate cancer in a tertiary private hospital

Introduction@#18F-PSMA-1007 is a novel prostate-specific membrane antigen (PSMA)-based radiopharmaceutical for imaging prostate cancer. The recommended imaging time is 60 minutes post-injection of the radiotracer. However, during this time there is a physiologic accumulation of the radiotracer in the urinary bladder which sometimes may obscure lesions adjacent to it. @*Objective@#This study aims to determine if early dynamic imaging in addition to the recommended 60-minute postinjection static imaging can improve the detection of PSMA-avid lesions in the staging and restaging of prostate cancer. @*Methods@#This is a retrospective cross-sectional study of the detection rate of early dynamic and static imaging using 18F-PSMA-1007 PET/CT scan in patients with prostate cancer (PCa) who were referred for initial staging or restaging. The McNemar test was used to compare the detection rate between the two imaging. Spearman correlation was used to determine the correlation of Gleason score (GS), PSA, and SUVmax values.@*Results@#18F-PSMA-1007 PET/CT scans of 53 patients with prostate cancer, were referred for either staging (22/53) or restaging (31/53), all of whom had undergone both early dynamic and static imaging. Among the 53 patients, 5 had 2 lesions each, for a total of 58 lesions were included in the analysis. There were 48/58 lesions detected on both early dynamic and static imaging, 2/58 lesions were only detected in the early imaging, 1/58 lesions was only detected in the static imaging, and 7/58 were not detected on both imaging. McNemar the test was not statistically significant (p = 1.000) in the detection rate of the two methods. There is a positive correlation between serum PSA levels and SUVmax measurements for all the patients. Only the correlation between the GS and SUVmax in the static imaging of the staging group was statistically significant. @*Conclusion@#Early dynamic imaging may be an adjunctive procedure in detecting PSMA-avid lesions, particularly in the basal segment of the prostate gland near the urinary bladder. However, it is not recommended as a standard component of the comprehensive protocol for imaging using 18F-PSMA-1007 PET/CT in patients with PCa.

Application of three-dimensional image reconstruction technology based on 3D-slicer software in urology / 国际外科学杂志

Objective:To investigate the application value of three-dimensional image reconstruction technology based on 3D-slicer software in urology.Methods:The data of 36 patients with urinary tract diseases admitted to Beijing Friendship Hospital, Capital Medical University from May 2019 to December 2021 were retrospectively analyzed, including 20 males and 16 females; the median age was 53.50(41.75, 66.25) years. There were 10 relative kidney transplant donors, 12 cases with renal tumors, 6 cases with hydronephrosis and 8 patients with urinary calculi. The CT urography data of 36 cases were reconstructed into three-dimensional image models based on 3D-slicer software, and the morphology of the target tissue was measured.Results:In the urinary system model of 10 relative kidney transplant donors constructed in this study, the type of donor renal artery was single artery in 7 cases and accessory renal artery in 3 cases; In the three-dimensional model of 12 tumor kidneys, 4 tumors were located at the upper part of the kidney (2 near ventral and 2 near dorsal), 5 tumors were located at the middle part of the kidney (2 near ventral and 3 near dorsal), and 3 tumors were located at the lower part of the kidney near ventral. The average maximum diameter of the tumors was (27.3 ± 9.63) mm, and the tumor volume was (15.89 ± 5.93) cm 2. The study also successfully constructed a three-dimensional image model of the urinary system in 6 patients with hydronephrosis and 8 patients with urinary calculi (without hydronephrosis). Three-dimensional model image reconstructed by 3D-slicer software clearly showed the spatial structure of renal parenchyma, blood vessels, renal pelvis, calyces and ureter. The diameter, position and direction of ureters and blood vessels can be observed clearly based on the three-dimensional reconstruction model, and clinicians could also evaluate the location, shape, size and adjacent relationship with surrounding tissues of renal cysts, tumors, stones or other masses. Conclusion:3D-slicer software platform can assist clinicians to reconstruct the three-dimensional model of urinary system, which is worthy of further clinical application.